Health Bill, 1952—Second Stage (Resumed).

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

When the Seanad adjourned last night, I had almost come to the end of the remarks which I proposed to make on the Second Reading of this Bill but there are a few matters to which I feel I must revert. Senators will recollect that in the course of my speech I referred to the fact that when this Bill was first circulated, there appeared in a newspaper known as the Standard an editorial stating that there were no objections or that there could be no objections to this Bill on ethical grounds.

I was pressed by Senator Baxter to quote the editorial. I do not suggest for a moment that Senator Baxter was not within his rights in pressing me for the quotation. Of course, I think it must be accepted that it is an editorial which could scarcely have been written without the knowledge of Senator Baxter, in view of the position he holds on that paper. However, I have been fortunate enough to find the quotation and so I am in a position, therefore, to refresh the Senator's memory. It appears, Sir, in the Standard of February 13th, 1953, page 6, and is the second paragraph of the editorial:—

"At this point we think it important to draw a distinction between measures which are objectionable from the ethical point of view as undermining family or personal responsibility and those which reveal an unwelcome advance towards State control of medicine. On the first head, the present proposals are not objectionable. The Bill sets out to help the individual to carry the heavy burden of sickness by providing institutional and specialist treatment at a cost which he can contemplate without the prospect of excessive sacrifice."

So much for that. My recollection, I am happy to say, was correct, but it does give rise to an important reflection. Senator Baxter, in his theological capacity, had pronounced on this Bill in its original form. As the House knows, this Bill was subsequently amended as a result of certain representations made to the Minister. Last night, Senator Baxter pronounced that this Bill was unethical and was contrary to Catholic social teaching. Is the only inference that can be drawn from that that Senator Baxter considers that the amendments, which the Minister made at the behest of certain authorities, have had the effect of making a Bill unethical which was previously ethical? If there is any other inference which can be drawn from Senator Baxter's curious change of ground, I have no doubt other speakers will enlighten me as to what it is.

I think that before I pass from that I might be permitted to refer to a quotation from Christus Rex, the issue of July, 1952. As most Senators will know this is a periodical edited by Canon McKevitt, Professor of Sociology in Maynooth College. The issue contains an article on the British Welfare State by F.P. Walsh. I think it has a certain appositeness in this debate. This is the quotation:—

"True there are Catholics who equate socialism even in its British form with Communism and express amazement that any Catholic can join the Labour Party."

That is the British Labour Party. He then goes on to refer to propaganda which was circulated against the Catholic Labour Party candidates and he remarks:—

"Such propaganda takes no account of the British Hierarchy and deserves to be dismissed with the contempt due for those Catholic laymen who wish to be more Catholic than the Bishops."

Cap fit, cap wear. Again, Sir, if I may go back very briefly to last night's debate, I had occasion last night to mention a document which had been circulated by an organisation known as the Knights of St. Columbanus, amongst its members. Now I want to make it clear in all fairness and justice that I do not deny that organisation the right to circulate anything it likes amongst its members, literate or illiterate. My point in raising this matter at all was to point out to the Minister the danger of a plethora in Departments of State of persons who are members of a secret mutual benefit society. Link that danger with the fact that there are ex-Ministers and potential future Ministers who have declared their membership of this organisation and the danger to which I have referred, linking these two circumstances together, must be apparent to everybody.

It is true, of course, that the Knights of St. Columbanus is a Fine Gael organisation. Fine Gael has always had a curious addiction to secret societies. In its early days as Cumann na nGaedheal they were supported by the Freemasons and the Ancient Order of Hibernians. Nowadays they are supported in very great measure by the Knights of St. Columbanus. It is curious that that Party should always rely on organisations of that kind but, considering its record, it is perhaps explicable.

Have the Freemasons changed their allegiance?

Have they not a right to?

Why did he attack the representative for Westmeath and Longford in the last election if that be so?

The whole record of Fine Gael can be judged in the light of its performance on this particular Bill. I do not want to go into too much detail—I doubt very much whether I would be within the rules of order in doing so—into the treachery which has marked the history of the mother and child scheme introduced by Deputy Dr. Noel Browne pursuant to the provisions of the 1947 Health Act. That is public property now. Everybody knows what went on: The Minister being given money; the Minister being told to propagandise the scheme; the rank and file of the Party not knowing of the conspiracy at the top; Coalition groups struggling for the electoral credit to be gleaned from the "Browne scheme."

I recollect reading in the newspapers a report of a meeting attended by Senator O'Higgins and a member from another Coalition Party; the member of the other Coalition Party referred to the scheme as Deputy Dr. Noel Browne's achievement and Senator O'Higgins intervened and said: "Not at all; it is the achievement of the whole inter-Party Government." Then they ran away with their tails between their legs and abandoned their own colleagues in that. It used to be said in the Coalition days by a prominent member of the Labour Party: Allow Fine Gael to dispense the patronage and let us get on with the work.

Who said that?

I said a certain prominent member of the Labour Party and I will not further satisfy the Senator's curiosity. What were their achievements in the inter-Party Government? Those who thought they could get on with the work found they were, to use a colloquial expression, being led up the garden path. Social Welfare Bills were hung up to dry. The mother and child scheme was dealt with with a treachery which was more than Punic.

In those three and a half years when there were progressive elements in the Cabinet what social legislation was brought in? What health legislation was enacted? None. Before that, from 1932 onwards, what was their record? It was a record of opposition to every single measure of social advancement proposed by the Fianna Fáil Government. Every single measure without exception was opposed by them on one ground or another. I believe that in 1948 there was a genuine intention on the part of the more progressive or less reactionary components of the inter-Party Government to bring forward some new social legislation. But in the three and a half years not one single measure was introduced. If I am wrong in that, I can be corrected. I trust I will be corrected if I am wrong. I want to know whether from 1932 onwards they ever did anything as a Party except oppose in one guise or another, on one pretext or another, every piece of social legislation. I make those statements for the purpose of warning people not to be deceived, not to be beguiled by them. They pretend to be disinterested. They pretend not to have a policy. They pretend they will fall in with "A" or "B". They pretend they will be more progressive than the most Left progressive provided they get office. It is wrong to underwrite them. It is wrong to treat them as fools. They are not fools. They are very clever, wily politicians. Some of them are part of the furniture of this House and equally functional. I trust I am not going outside the limits of the debate, but health is the touchstone of the attitude and social policy of any political Party.

I referred last night to the remarks made by one of the most intelligent of the Fine Gael Senators, Senator P.F. O'Reilly, when I intervened on the Appropriation Bill to praise the Minister for Finance for having made the money available to the Minister for Health in order to carry out the proposals set out in the White Paper. Senator O'Reilly's reply was, holding up the White Paper: "Yes, here it is. It seems very good indeed, but I doubt very much if he will ever put it into operation." I am paraphrasing the Senator's remarks.

Then the Bill was circulated and Deputy Dr. O'Higgins said that what was wrong with the Bill was that it did not go far enough. Again, they were to the left of the Minister. The Bill did not go far enough. They were going to scrabble for whatever electoral advantage would be gleaned from the Bill and on the Second Reading in the Dáil they sat quietly, like perfect old gentlemen, and there was no division challenged. Then when they heard that help was coming from a certain quarter——

What quarter?

I said a certain quarter. It is not part of my function in this House to educate Senator Baxter. I could not undertake the task.

I think Senator Hartnett should be allowed to make his speech.

I think the House is entitled to know what the quarter was.

I will quote some more Standard editorials if the Senator is not careful.

I challenge the Senator to answer.

The Senator challenged me last night and I was able to remember the issue of his paper because it was the same issue which carried a very scurrilous and scandalous letter attacking two members of Dáil Éireann, a letter for which the Standard had to print two apologies and pay damages and costs; and there is the humbugging moralist.

That is not an answer.

Now challenge him again.

I challenged him to answer and he has not answered yet. Perhaps Senator Quirke will answer for him.

Senator Hartnett on the Bill.

On the Committee Stage all the Fine Gael voices again spoke out. Deputy J.A. Costello said: "Let it not be thought we are opposing this Bill because of the cost; it does not matter what it costs, the health of the people cannot be measured in terms of money; we are opposing it because it is a thoroughly bad Bill; it is an absolutely rotten Bill, and we will oppose it lock, stock and barrel, root and branch."

The Senator might now leave the history of the Bill.

I have practically concluded.

He has not said anything about the Bill yet.

Not a bit.

This is Horse Show week.

Deputy Esmonde said that what was really troubling him was the cost of the Bill, that the cost of it was going to be enormous. Deputy Mulcahy, in his customary lucid fashion, spoke about the Viking invasion and such like for six weeks. The Minister had to sit, listen and observe this performance of patent and obvious buffoonery on the part of those men, all for the purpose of delaying medical benefits to people who, in the opinion of every reasonably minded person in the country, are very badly in need of those benefits. They were blocked and obstructed by those people. Yesterday, I put it to the Minister that I could not blame him if he thought, with regard to this whole performance, that he was dwelling in Wonderland.

In yesterday morning's newspapers, Dr. Falvey, of the Irish Medical Association, took his stand on Catholic social principles which are unshakable and unbreakable. Then we had three of the most distinguished medical men in Dublin, all members of the Irish Medical Association. I am sorry we did not have Senator Professor Cunningham, but, perhaps, he had some other more important duties, but we had Senator Professor Barniville, Senator Professor Fearon and Senator Professor Jessop. As I have said already, I feel that it would, perhaps, be unreasonable to ask for an explanation of those principles to which Dr. Falvey refers from the last two mentioned Senators, but I thought that Senator Professor Barniville would have told us what he thought of Dr. Falvey's letter. Senator Professor Barniville omitted to do so. Then we had all the arguments that appeared in the document which emanated from the Irish Medical Association, which I quoted yesterday, but none of these arguments were used by these distinguished medical men. There was criticism of the Bill in a tentative way suggesting that the Minister might consider this approach or that; if these men were to exert their influence in the councils of the Irish Medical Association that there might not be the deadlock which has occurred because of the obstinate and undemocratic attitude of the Irish Medical Association; for this, of course, you cannot blame them when you consider that they found themselves seated in the Minister's seat in the Custom House in 1951, and then, after the change of Government, they had to go out and negotiate in the ordinary way, like any trade union, for better working conditions and better pay, all of which I wish them. But they have got to negotiate with the people's representatives and with the Minister in the ordinary way. It would be grossly undemocratic if any section should be accorded the right to go into a Department of State and fix things up for themselves in a way that the Irish Medical Association were invited to do by the then Taoiseach and Minister for Health, Deputy Costello.

Now, I think there are people even in the younger ranks of Fine Gael who must realise that we are living in a changing world and that our attitude to social legislation must change, no matter how conservative may have been the mould in which we were cast. I put points to Senator Baxter yesterday. I appealed to him to drop his pharisaical attitude, his pose that he was not like the rest of men, that he did not take a drink, that he did not smoke a cigarette——

I did not say any of these things.

——and that as a result people who are provident like him should not be asked to pay because other people are improvident. I put it to him as the House will recollect that children should not be punished because their parents may have been addicted to drink or may have been addicted to gambling, and that if they are in need of the best possible medical attention they must get it—not the second best but the very best which the nation can afford without any distinction whatever, irrespective of the social status or wealth of their parents. I appeal to them to recognise that principle as the overriding Christian principle. I appeal to them to stop dressing up their own stinginess and meanness as if they were Christian virtues. I appeal to them especially to stop trying to prostitute religion in order to get electoral support for their own Party, than which there can be no greater crime in the eyes of anybody with any true regard for religion. Nobody can have failed to observe during the past two years their attempt to set themselves up as the Party of all virtue, the Catholic Party and their suggestion that all those opposed to them are bad men, evil men, communistic-minded men and men who want to destroy the family unit, men who want to tear apart the fabric of Christian society. We have heard all that humbug and hypocrisy and all for the sake of gaining perhaps a Parliamentary Secretaryship. All that is a sin crying to heaven for vengeance. They are responsible for the rising tide of bigotry and intolerance which we see in this country at the moment. I trust that I will be regarded as being in order when I register my individual protest against the vicious and envenomed attack made on a respected member of this House on the ground of his religious faith by a minor theologian in Galway.

What has that got to do with the Health Bill?

It does not arise on this Bill.

I am glad at any rate that I have had an opportunity of registering that protest in this House. I feel sure that the Minister must feel relieved that the arduous task which he has had to face in introducing this relatively small advancement on the present admittedly unsatisfactory condition of our medical services is at last coming to an end or at least that the end is almost within sight. He deserves the thanks of every progressive minded person in this country no matter to what Party he may belong and whether he belongs to any Party or not. He deserves due thanks for his courage; for his resolution and for his refusal to be panicked; for his self-confidence in the rightness of his own attitude in refusing to allow the hypocrites and the humbugs to throw him off the path of improving the health services in this country.

The Bill is not as good a Bill as I would have liked and I am sure it is not as good a Bill as the Minister would have liked to introduce, but it is the best Bill the Minister could introduce in the circumstances. When the name of Fine Gael with its history of attempted dictatorships by portly old men——

Did you not try to join its central branch and they would not have you?

That is a contemptible lie. I regard that as a slander. If the Senator will repeat that outside the House I will give him an opportunity of testing it with the same result, I trust, as happened last February.

Will you bring the action for slander if he says it?

Yes, of course. To accuse anyone of my outlook of trying to join Fine Gael is a gross slander.

You would lose such an action.

Come back to the Bill.

Are you threatening to pack the jury? It is unfortunate that I am always interrupted. It is not my fault. I do my best not to interrupt other Senators unless the provocation be very great indeed. I have referred to the history of Fine Gael, its Blueshirt adventures, its attempts at dictatorship, its persistent opposition to social advance, its love and affection for the vested interest. When the name of Fine Gael is rotting in the memories of the Irish people, the Minister will be remembered for the work to which he has put his hand in this Bill; he will be remembered with gratitude by all progressive and decent people in this country.

Is he not a lovely character?

Thank you, Senator.

I shall not add very much to this debate because the real points against this Bill have already been made by Senator Professor Hayes. He made a very sensible and reasoned case. I would just like to stress one or two points. For instance, I think the worst feature of this whole Bill is the unhappy atmosphere in which it was prepared, presented and argued. Even this last speech we have had has shown the very unhappy atmosphere in which this Bill is being conducted through the Houses. One thing that interests and intrigues me is the rather notable fact that we are told in the expanatory memorandum that was issued with this Bill that after the publication of the White Paper, the views of the several bodies particularly interested in the development of health services were sought on the proposals and their suggestions for modifications have been taken into consideration in the drafting of the Bill. The vocational body most interested—I do not mean from a self-interest point of view-but interested from the point of view of doing the job properly is, undoubtedly, the Irish Medical Association, no matter how much it has been slandered. Members on the Government side have been at pains to point out how good the doctors have been in this country, what a good job of work they have always done. Why is it now suddenly discovered that they are a lot of self-interested people, anxious to protect their vested interests? Why is it on this particular Bill and on this particular occasion that that has been found out? We know what happened to them. There was a letter in the Irish Times from the secretary stating that they were kicked out of the Custom House by the Minister.

In any State there must be continuity in ministerial offices and if one Minister invites a vocational body to come along and help to do a job of work, even though the Minister changes, he has some responsibility to the office. One matter in which the conduct of this whole business has offended is this vioation of due regard for the vocational bodies concerned. The I.M.A. were not only justified in having themselves heard, but were asked to be heard.

Another very interested body which a lot of people seem to be afraid to talk openly about, a body which is disinterestedly interested, is the Church. We have certain moral authorities here and we set ourselves up to be a Christian and Catholic country and the Church has come out, day in and day out, on the subject of the Health Bill for years past. I have reams of material here, reports of Bishops' pastorals over the last few years showing how the general tendency of this legislation offends against Catholic moral philosophy on the grounds that the State is trying to do things which the individual and individual groups are better able to do for themselves, not only better able, but morally bound to do for themselves. What do we find then? We have the Irish Medical Association overlooked. We have the moral authorities overlooked.

A most interesting phenomenon is that the people who seem to be very pleased with this Bill are so-called progressives. Apparently, a progressive is somebody who is always linked up with the word "Left". One would think social progress was never heard of until modern socialism arrived. The fact is that there has been real social progress from the time of Christ and the leaders in social progress have always been the leaders of the Christian Faith, and the Christian Faith and the Christian leaders are as strong as they ever were.

It is always assumed that if you are not a socialist you are against social progress, which, of course, is ridiculous. The most interesting phenomenon is that the people who are charmed with this Bill and anxious to shout everyone else down as being reactionaries are all socialists. There are very few of them here in Ireland, but they are so noisy and so loud-voiced that they have assumed and attained a position in our society altogether out of proportion to their number and their strength and their position in our community.

Therefore, although there is this statement to the effect that the advice of the interested Parties was sought, I feel that there has been a failure to observe the idea of vocational consultation in this legislation.

This country has something to offer that many other countries have not got, the Christian philosophy of life. Our clergy are never tired of telling us that we should set up a social system and a political system that is based on Christian philosophy of the right and dignity of the individual which naturally carries with it responsibility and that the State is only there to aid and assist the individual to live according to that philosophy, whereas the philosophy that we hear from these Socialist people is that of the all-powerful State that will help the poor man and will help everybody. We know from experience that the State is the most exacting of all masters. I should not say masters. It is the most exacting of parents—that is the word that is being used. The State exacts for what it gives not only in cash but in liberty and oppression of all kinds which we see all over the world. If we cannot take a lesson from what has been happening all around us and at this stage establish a society of our own, without copying other people who have not the same philosophy as we have, it will be a tragedy that we ever had self-government.

As I have said, Senator Hayes has made a very excellent speech on the objections to this Bill. I merely wanted to stress that one facet of the objections to the Bill. I should like to enumerate what I think are the three main objections to this Bill. They have already been pointed out.

The first objection to the Bill is the failure to work in harmony with the vocational bodies concerned. Secondly, that there has been a blind eye turned to the words and advice of the moral authorities, no matter how much other people try to obscure that fact. Thirdly, there has been no real estimate given of what this Bill will cost. Senator Professor Fearon pointed out that in England we had something to go on. They started off with a scheme which was supposed to cost a certain amount. In operation it cost four times the amount of the original estimate in the first or second year.

He thought that in this country, although we are talking about £2,000,000, it will eventually end up in something that might very easily cost in the region of £25,000,000. We are doing these things; they may sound progressive; but you have to look before you leap. I suggest that, even on the cost basis, we have not looked before we leaped.

I do not intend to speak at length on this measure before the House, neither do I intend to fish in deep waters. I will leave that to the people whom I consider to be better qualified to do that job. I propose to make my contribution as an ordinary rural ratepayer. To start with, I can agree with those people who find fault with the dispensary set-up in this country, but it is one of the evil heritages of the past which we have done our best to improve as time went on. Rome was not built in a day, and we could not make these things perfect overnight. With regard to the attack made on this Bill about paying for people who are well able to pay for themselves, it is very hard to decide that. Valuation has always been accepted more or less as a guide. In all Acts of Parliament it seems to have been accepted, anyway, as the best way to draw a dividing line. I know it is not always accurate, but at the same time it is something which has been generally recognised.

There is a very redeeming feature about this Bill. I think it will coordinate all the piecemeal efforts made to wipe out the evils of the past and bring us into step with the services the people are entitled to receive in modern times. That also requires examination and cannot be done at once. Mistakes are bound to be made. We have been told that it is by mistakes that we learn. Nevertheless, we should bear that in mind.

If a patient goes to a dispensary for treatment and the dispensary doctor decides that he must send that patient further, the patient goes into the county hospital, which is the centre in all county health districts. If the authorities in that hospital decide that they are not able to deal with the case, that it is a case which they must send for specialist attention, that also could be done. But time may elapse which may involve the life of the patient. That applies to the patient who is entitled to free treatment. But the patient who hitherto was not entitled to free treatment, such as a small landholder of 30/-, £2 or 50/- valuation, is not supposed to walk in with his chest out, so to speak, to a dispensary on the ordinary dispensary day. He must be prepared to pay something because he is regarded as one of the people who, under the law which existed up to this, is not entitled to free treatment. Let us assume that he has a £1 note or a 10/- note in his pocket. The doctor examines him and decides that it is necessary for him to go, say, to a provincial hospital. The doctor has done his duty. The first thing that poor patient has to look into is, what it will cost him in this provincial hospital, and can he face it. If he considers he can, well and good; he is free to travel to it that day or the next day, whichever suits him. If he is not, he has to go home and lie down and make the best of it. That is a thing which has to be taken very serious notice of.

Then there is the person who can afford, on the advice of his local doctor, to go to a provincial hospital. He may be told there that they do not think they can deal with the case and that it would be advisable for him to go, say, to the central hospital. There are many cases in which such patients bad to decide that they were not in a financial position to do that. They had a rough idea of what it would cost and they had not got the money and did not know where to look for it. That has to be taken into account. Let us place ourselves in the position of these people.

I should like to see this Health Bill cost as little as possible, just like anybody else. I am as conservative in regard to my finances as anybody else. But I think that when this Bill is brought into operation, if it gets the support and co-operation of everybody —the officials who have to work it and the local authorities charged with its administration—the piecemeal efforts made in the past and which cost money will be wiped out and the money provided will be used, so to speak, to the best advantage.

Reference was also made to the red ticket. It has been described as a badge of slavery and several other things. I have never looked upon it in that light. I regarded it as a grand thing that a citizen of this country who had not sufficient of the good things of this world to face a medical officer could get a red ticket and, armed with that, could go to the doctor and demand all the services to which he was entitled. I look upon it from that aspect and not from the aspect that it was a badge of slavery and I think it should be looked upon in that way by everybody.

Exception was also taken to vested interests. I am not going to decide between them. The point is that when we build up services under this Bill specialist treatment will be available for everybody deemed to be entitled to it. The position will not be that only the man whose bank account is a good one can always have the best services. We have reached the position to a great extent anyway in which the State will step in where the citizen feels that he is not able to meet the financial cost of being treated for whatever he may be suffering from. As far as the dispensary doctors are concerned, I take off my hat to them because they never refuse to attend anybody or relieve suffering humanity any time they get the opportunity. I am afraid, however, that there are vested interests in that profession, just as in all others. But the day is fast approaching when men with high qualifications will be placed in the various hospitals throughout the country and the field of exploitation, so to speak, will be limited. I may be wrong in my summing up, but I am strongly convinced of it.

I am convinced of one thing—that the necessity for the Bill exists and that none of these services can be brought into operation without costing money. I think that if this Bill is received in the spirit it deserves, good service can be rendered without reaching a stage at which the finances will be beyond the capacity of the people to pay.

As the Minister is present, I would like to take this opportunity of putting a question to which he will probably have a chance of replying later. Section 52 says that one, two or more dispensary officers may be appointed in a dispensary area. Now, down in the rural areas anyhow, if you were to pass one it would be really superfluous. As a matter of fact some people consider that some of the dispensary areas are too small and that they might reasonably be enlarged and that a greater area should be handed over to the charge of each dispensary doctor.

While what I am discussing now may be a small bit irregular I hope that I will be allowed to make this comment. When these dispensary districts were struck out long ago they followed, I think, the old baronies, the electoral divisions, etc., and great anomalies exist. I know cases myself where if you are at the left-hand side of the road it is Dr. So-and-so and if you are on the right-hand it is Dr. Somebody Else. I also know that in my own parish within less than a mile of my doctor—if I may use the expression at the moment—people have to go five miles for the dispensary doctor, that is, people who are entitled to dispensary treatment. People should be able to go to the nearest doctor if it suits them. That is an anomaly that ought to be removed.

My suggestion would be that when the Minister for Health gets an opportunity of reviewing the situation with regard to the lay-out of dispensary districts you should just take a circle around each centre in such a way that nobody will be required to travel to a dispensary doctor at an unreasonable distance from him. I know that there is nothing in the Bill dealing with it, but, perhaps, later on the Minister in his own good time may look into it and take the trouble of seeing if I am completely correct in what I say. It is unreasonable that people should go five miles to a doctor when another doctor paid by the same authority is within a mile of them. We should have the thing changed, forget about the E.D.s and the old baronies and just draw a circle around a certain pivot and let that be Doctor B's area and another be Doctor's D's area.

In conclusion, I congratulate the Minister for having brought in the Bill and I congratulate him on the great patience he has displayed all through the prolonged debate in the other House and the debate here, and I hope that everybody will unite, despite their objections to it, to give it a fair chance when it becomes law. If the Bill is found unworkable, bad for the people, bad for the patients, bad for everybody, then the same authority can repeal it that brought it into existence.

I agree that it requires a great deal of courage and nerve for any ordinary rural Senator to get up in an assembly of this kind where we have so many professors dealing with national statistics and international statistics and learned lawyers appealing to our sentiments here. I did not have the pleasure of listening to Senator Hartnett yesterday evening but I was listening to him for a very short time to-day and I say that it requires a great deal of courage to get up and express one's views on this Bill or any other Bill. In my time, evidently, my people were not in a position or there were not sufficient scholarships to avail of to get such orators as we have found around us to-day.

I do want to say right off that the Labour Party view on this Bill has already been expressed by the leader of the Labour Party and by Labour Deputies in the other House. They supported the Bill, and I am supporting the Bill not with any sense of enthusiasm but just because it gives a few extra loaves, if you like, to our hungry people and for that reason we are grateful for small mercies. For the few moments that I was listening to him Senator Hartnett made the most poisonous statement I have ever heard in this or any other House, and I do not know if it was even relevant to this Bill at all. However, he referred to the inter-Party Government and he asked what were their achievements. Our Party were associated with the inter-Party Government. We had three Ministers there and I will tell him some of our achievements so far as our Ministers are concerned.

Will they relate to public health?

I think that they are as relevant as Senator Hartnett was. Senator Hartnett asked a question and I think he is entitled to an answer. They removed the Standstill Orders, they increased old age pensions, they passed the Local Authorities (Works) Act—one of the best measures ever passed through this Parliament—they initiated the greatest housing drive on record, they cut down the cost of living, and they gave fulltime employment to our people, particularly in rural Ireland. The only man who was unemployed during that period was the British hangman.

He was never a friend of ours.

You can keep your interruptions in your pocket as far as I am concerned. I am just going to deal with the position as I find it here. As I have told you, there is nothing comprehensive about the Bill, nothing sensational about it. It is just an extension of our existing social services and it is going to be a rather expensive one. The only function which the county council will have—and I am a member of the county council in my area—is that we will be asked to strike a minimum rate of 2/- in the £. I do not know what way it will affect other counties, but I know how it affects my own county.

Two shillings in the £ will mean approximately £26,000 a year, and if the Government are going to give pound for pound an additional £52,000 in a year for health. If Wicklow County Council had an extra £52,000 to spend on our existing social services, they could provide greater benefits for our people as far as I see it and the highlights of this Bill are just mere eye-wash, at least for some years. We talk about maternity benefits, maternity treatment, hospital treatment and one thing and another. There is no hospital accommodation in this country—very little. In my own county we have a district hospital at Baltinglass and for 20 years we were clamouring for some extensions. They are being carried out at the moment. It caters for South and West Wicklow and I know the difficulty there will be to get any patient in there. The total maternity accommodation in it will be something like ten or 12 beds, and I may even be exaggerating as far as maternity accommodation is concerned. Now the Minister yesterday scored when he suggested that we were thinking that there would be more people applying for hospital treatment, and later he suggested that there was sufficient maternity accommodation in the country to deal with everything that is going to happen under this Bill. He held that a lot of people will take advantage of this Bill if they can get hospital accommodation. There is no doubt about it a lot of people are cut out of hospitals and going under the surgical knife because they cannot afford to do it. The same thing must apply in cases of maternity because there is very little accommodation in the average small farmer's home or the workingman's home to deal with cases of that kind and they definitely will take advantage of whatever facilities are provided under this Bill.

There is no hospital accommodation, as I told you, in the district. We have a glorified mansion in Wicklow town for a county hospital. I was on a committee some years ago that selected and purchased a site for a new hospital there, and there is no progress being made in connection with it and I see no hope for a number of years. Therefore, I say that except for whatever little extension there is in this Bill, whatever facilities are to be afforded to extend the present health services, there is no hope of the highlights of this Bill ever being availed of. That is my opinion. I am supporting the Bill for the reason that it is just an improvement on our existing social services.

If a mere ignorant layman dare to speak about this highly complex Bill, I should like to throw a little oil on the troubled waters of this debate in the hope that nobody will come along subsequently and put a match to the oil. I do not know whether the Minister is a student of Berkeley's Querist or not, but when he had that famous interview in the Custom House with the doctors, when he took office recently, he might perhaps have quoted to them from that source.

"Query—whether interest be not apt to bias judgment and whether traders only are to be consulted about trade or bankers about money."

The Minister might have added: "Whether doctors only are to be consulted about public health or whether it is the point of view of the general interest and not necessarily the point of view of every particular doctor that is important." I am quite well aware that doctors have a very special function in relation to public health and that no scheme can be a success which does not enlist the enthusiastic and friendly co-operation of the medical profession. At the same time, I think we should be unrealistic if we did not face certain facts with regard to the present financial position of doctors under the present system or absence of system.

There is no getting away from the fact that the ordinary doctor has a vested financial interest in the occurrence of disease and illness especially amongst the wealthier classes of the community who can afford to pay his fees. The Chinese are said to have a point of view with regard to medical services. They believe in paying their doctor when they are well and they stop paying him when, for any reason, they are ill—partly on the grounds that the doctor has fallen down on the job of keeping them well. I hope I am right in thinking that one of the objects of this Bill is to give the medical profession a vested interest in keeping people well and in removing those physical defects and ailments that occur especially in the younger members of the community, the removal of which would make all the difference to their subsequent health and general economic efficiency. If the Bill has that effect, it is bound to improve the general financial position of all doctors who co-operate in working it and reconcile the present conflict of interests that must occur as between the private financial interest of the general practitioner and the interest of his patients and of the community. There is that conflict of interest under the present system, a conflict between the financial interest of the doctor who profits by the illness of his patients and his humanitarian and public-spirited interest which makes him anxious to do the best he can for his patients and to keep them in permanent health. To the credit of the medical profession, I should like to say that, in practically every case, their humanitarian instincts and their instinct of public service triumph over their financial interest in the illness of their patients, and it is altogether desirable that there should be such a reorganisation of medical services as would remove that conflict from the minds of practising doctors who share in the operation of the scheme.

In our present society—which, if it is not capitalist, is nevertheless dominated by capitalist thinking—doctors have traditionally been outstanding for the practice of a kind of practical socialism and for operating a kind of redistribution of national income in favour of the poorer sections of the community against the more well-to-do. In fact, they preceded the Minister and his colleagues by many generations in the operation of that kind of redistributive taxation. They have traditionally made their wealthier patients pay for services rendered to their poorer patients and they have rendered them free, gratis and for nothing to those of their patients who could not afford to pay for such services.

In many respects, the medical profession, even as it is at present organised, has many of the attractive qualities of the Dick Turpins of society in the sense that if they relieve the wealthier classes of their surplus income they are apt to share the proceeds with the poorer classes by rendering free services to those who cannot afford to pay for them at all. Therefore, even as things are at present, we have the principle of free medicine rendered by the ordinary medical general practitioner and especially by the more prominent of them who occupy a very high place in our larger cities and who serve on the staffs of our public hospitals. Much free medicine is practised by leading Dublin doctors in all our Dublin hospitals. Forty years ago, I myself was a beneficiary of that precise fact when I was a student. I sat for five minutes in a chair presided over by the late Sir Robert Woods who removed an obstruction, I think due to an overgrown septum, from the nasal cavity. That had the most salutary effect on my general health in the subsequent years of my life. If it was not improper or demoralising for me, as a student, to benefit by the practice of free medicine, I do not see how I can logically oppose the extension of free medicine to every deserving class in the community, and especially to the young.

I think that one of the most desirable features of this Bill is the fact that its emphasis is on preserving the health of the young and of the mothers of the next generation. In that respect, I think that the Bill not only meets a real social need but that it is within the limits of our economic and physical capacity. I think there is a definite contrast between the scope of this Bill and the scope of the British National Health Scheme in the sense that the British scheme aims at undiscriminating free medicine for every one of the members of the community, old and young alike. There is no limit to the amount of resources that can be spent on keeping "crocky" old people with expensive ailments indefinitely alive and no future reward can come to the community from success in adding a year or two to the lives of very old people. If, however, we concentrate our resources, limited as they are, on preserving the health of the young and on removing those physical defects from the young which often require only slight attention but which make all the difference to the subsequent health of the person concerned, we shall be doing something which is within our economic capacity and which, in a comparatively short time, will pay a rich economic dividend to the nation in the sense of improved economic efficiency resulting from the better health of people during their working lives.

I am aware of the abuses that have crept into the national health service as it operates in the United Kingdom. I think they arise largely from the fact that they are so undiscriminating. I am told that in Belfast, for example, it is the custom for old women and others who have nothing else to do, to frequent the consulting rooms of the doctor—to the great obstruction of the younger busier people who have real illnesses to be attended to.

They bring their knitting and their gossip and spend an agreeable time in the doctor's waiting room waiting for the bottle of cod liver oil which eventually is said to go as often as not to the greyhounds. So much so is this the situation that one old lady who had missed her companion a few times in the doctor's consulting rooms said to her when she next saw her: "Where were you lately? I did not see you at the doctor's. Was there anything wrong with you?" In other words, they go to the doctors to pass the time and amuse themselves with local gossip and in doing so prevent people who really need medical services from getting them.

It has been said we cannot afford the considerable expense which this Bill will impose on the community, but if it really has the effect of raising the standard of health and efficiency of the whole population during its working age it is bound to pay a large dividend in permanently increased economic efficiency which we should set off against whatever may be, within reason, the financial cost of operating the Bill. I think the medical profession as a whole have a vested interest in the passage of this Bill from a purely financial point of view because it is bound to result in the existing or a greater number of doctors practising in Ireland obtaining in the aggregate a larger income from a more certain source than in the aggregate they now obtain.

The doctors are no fools and if they know it has that aspect, and if nevertheless the Irish Medical Association oppose the Bill, then I think the matter should be looked into very closely because it would seem on the face of it that the Irish Medical Association must be opposing the Bill for reasons of public interest or because they attach great importance to that much talked of doctor-patient relationship and their opposition may be one which should be sympathetically investigated by the Minister and if possible the causes of it removed.

I am also aware of the possibility that the spokesmen of the Irish Medical Association are not fully representative of the rank and file of the medical profession in Ireland owing to the mere physical difficulty of the more scattered members of the profession being able to become articulate or to make their views felt in the choice of persons who run the affairs of the association. That I do not know, but on the face of it it looks as if the Irish Medical Association may have genuine public grounds for objecting to some aspect of the Bill, and, if so, I hope the Minister will look into their point of view with the utmost sympathy.

One of the reasons why the voluntary insurance scheme will just not work in our present social circumstances is the fact that the marriage rate in Ireland is one of the lowest in Europe but the fertility rate, the average number of children per married woman, is the highest in any European country. Consequently, the people who most need the services of a mother and child health scheme are likely to be the people least able to afford to pay for these services themselves, and, as they are doing the necessary work of raising the next generation, it is in the interests of the whole community that they should have that aspect of their burden lightened and that the State should go out of its way to provide the necessary medical advice and treatment for illnesses, especially of the young, for the whole class of mothers and children in our community.

I was very much impressed by one of the many points made by Senator Fearon in the course of his remarks. He pointed out that the £50 valuation is not a true index of agricultural income. The Minister lumps together the valuation of farm buildings, farm house and land and it could happen that a person lived in a farm house, an enormous gazebo of a thing, with a valuation of perhaps £30, and owned or occupied land with a valuation of, say, £20 and is trying to make a living out of the occupation of that much land. It is most unfair to regard that person as in the same income position as the person who lives in a farm house of £10 valuation with agricultural land of £40 valuation. I suggest that, even if he fixes a lower valuation than £50, the Minister should alter the Bill so as to include only the valuation of the agricultural land and ignore entirely the valuation of the farm house and buildings.

I made a few notes last night when Senator Baxter was speaking and early on in his speech he said there was no desire on the part of the people for this measure. For about 40 years I have had association, because I am a pharmacist, with the treatment of disease and in my calling I have met principally the relatives of the sick people. I have not had very much contact with those who were sick, but the relatives, in my opinion, are a most important section of the community, and I wish Senator Baxter had some of the experience I have had in the four provinces of this country over these 40 years. I might remind him also that I was a compounder in two of the voluntary hospitals in Dublin for some years, and I have been attached to a dispensary for no less than 33 years. On that account, I have a pretty fair knowledge of what the people need, so far as treatment and medicine are concerned and particularly of the trouble that disease in the family causes to the healthy people of the family.

I can assure Senator Baxter that if there is one thing the people in this country want it is security against disease. He spoke of the £50 farmer and said he would provide his own medical attention for his family. He was a little critical of the improvident farmer and asked why should the man who was thrifty and hardworking be helping to keep the improvident farmer in health and so on. I feel he did not even think about what he was saying when announcing doctrines of that description. To give him one instance of what we do in the State— I am sure he knows it himself and oftentimes we are brought face to face with it—we have the case of the hardworking industrious man, the man who has worked hard all his life to rear a family and keep himself alive. He has perhaps saved a little money when he comes to old age pension age, but because he has saved up something for himself, he is deprived of the benefit of the Old Age Pensions Acts, whereas the person who squandered all he had all his life and perhaps never worked a day gets the full benefit of these Acts. In distress, the Government does not take into consideration what a person did or might have done; they take into consideration the condition that person is in.

Our aim should be, as the Minister announced in the beginning, to ensure that no person in this State will be deprived of the best medical attention possible because he has not got the means to provide himself with that attention.

What I am going to say now may appear rather peculiar but when people are talking about the sick they nearly always forget the relatives of the sick. The compassion is nearly always for the relatives and not for the sick person. For instance, if I attend a funeral I can talk quite casually about the person being buried, but I am very sorry, indeed, for the relatives who are left. I knew of great numbers of people who had to endure frightful torture because they could see their husbands, fathers, mothers or children dying, perhaps, slowly because they could not afford to give them the necessary medical attention and treatment. It has happened time and time again that these relatives have themselves suffered a complete breakdown and have died much more quickly than they would have died had they had the provisions of this Bill to relieve them of that anxiety and that worry.

I think Senator Baxter has no knowledge whatsoever of the people if he thinks there is no desire for this measure. If he thinks a £50 farmer does not need it I think he is very much mistaken too. When I heard him make that statement I thought he had the impression that the £50 farmer was the type of person we were told some time ago drove around in Chryslers. I can assure him that the £50 farmer at the present time is very glad to avail of the T.B. scheme, if he has occasion to do so, which is there for him and which would provide his wife and children or anybody else belonging to him with free treatment in a sanatorium. In addition, he can avail of the State assistance for the support of the dependents of the particular person who is suffering. One of the grandest things about this scheme is that it has extended the limit so far that people in that grade will have that particular service available to them from now on.

Senator Baxter said that it was morally and socially unsound for this measure to provide services which we can provide ourselves. That may be so, but many people cannot provide these services without crippling themselves. I know that if some person in a family becomes seriously ill, requires specialist treatment, needs to be kept in a nursing home or a hospital over a long period he might have to mortgage the £50 farm in order to pay the expenses of that treatment. In fact, he might have to deny the rest of the family things which they would need in order to provide that treatment. I believe it is not morally and socially unsound to provide for the services which this particular Bill provides for the people of Ireland. Using such words as humbug, fraud and hypocrisy in connection with this Bill is completely wrong. I do not know why a person like Senator Baxter should come in here and use talk of that kind to describe a measure which is to provide benefits for the great majority of the people.

There are a few things I would like to say about the dispensaries because in the course of this debate the dispensaries were mentioned quite a lot. In the first place, I think we do not pay our medical men sufficiently in this country. Further, I think that in the bigger towns too much is looked for from the doctors. To my mind it is absolutely desperate to think that a doctor might have to look after the poor people in a town with a population of from 5,000 to 10,000 day in, day out and in the night. They have to be available at all times for practically the 365 days of the year. I think that for some part of the year at least they should be allowed to work in the day or in the night. There should be a day service and a night service. I think it is completely wrong to expect doctors to do what people belonging to other professions or callings are not expected to do, work night and day the whole year round.

Further, I say they are poorly paid because sometimes if they had to hire cars to attend the patients in their dispensary districts the greater part of their salaries would go to pay for the car hire. They make hackneymen out of themselves by using their own cars and in that way they save moneys for the State which the State in my opinion should pay to them. The dispensaries themselves have improved tremendously during my time. Indeed, all medical services have improved tremendously during the past 30 years. In my opinion there is no comparison between the services which the people get now and those which they got 30 years ago. So far as I know the dispensaries are being improved everywhere. I understand that the Minister is only too anxious to see them improved even more.

I know that in dispensaries at the present time there is no drug which is not available to the dispensary doctor if he requires it. Practically any medicine that is required is available for the poor law patients. Senator Baxter was a bit critical of the county manager. My experience, strange to say, is different. I find it is much easier to deal with the county manager than with the central authority in the public health department. I know that the county managers are giving for use in their hospitals and dispensaries drugs, etc., which they might be slow to sanction here in Dublin. It is a good thing that the county managers are the authority in this measure. I am speaking now as a citizen. I rather think it is best that they and not the county council should be the central authority. That is just my own opinion. I may be wrong and Senator Baxter may be right.

While on that matter, I would suggest to the Minister that when he is appointing the council which is to advise the county manager he should put on it a member of my calling—a pharmaceutical chemist. He will not be able to advise him on anything connected with disease but in the equipment of dispensaries, the purchase of drugs and all things of that kind his advice would be very sound. Further, I believe that the inclusion of such a person on the council would effect a great saving to the country from the point of view of expenses because of the knowledge which he has gained in trade and so on. I would recommend that the Minister keep that in mind.

I am sure that the Minister is anxious that neither the doctor nor any other person who has what we might call a vested interest in the treatment of the sick should lose anything because of the introduction of this measure. I thought he said yesterday that for maternity cases the necessaries would be supplied through the public health clinics. I may be wrong in that. In my opinion if these things are supplied through the public body to those in the middle income group the members of my calling will be deprived of something which they have enjoyed for very many years. It is quite the ordinary thing for a person who is about to be confined to purchase these articles at the medical hall. It will mean a big loss to the chemists if they are now to be distributed free through the public authority. I think the Minister ought to be able to find out what the average value of such a parcel would be and to arrange for some voucher system which would enable the particular patients, that is those who are going to stay in their homes, to take that to one or other of the chemists. The voucher could be honoured afterwards by the State in the matter of cash.

I would like to refer very briefly to the three points which Senator McGuire tells us are the reasons why they are opposing this Bill. One was our failure to work in harmony with the vocational bodies concerned. Of course, the main people concerned in this Bill are the sick people and the healthy people who must worry about them. I am sure the Minister for Health, Dr. Ryan, was very anxious to co-operate with the Irish Medical Association, but if they would not co-operate with him it was his duty to see to it that the sick people, who are the main concern of the Minister, would have the best treatment possible.

The second point was that it was morally wrong and contrary to the advice given by ecclesiastical authorities. I have no knowledge that that is so. I have not seen any public pronouncement that this Bill contravenes any canon of our moral law. As far as I am concerned, I believe this Bill is one of the most Christian acts this country has performed for many years.

As far as the cost is concerned, which was another ground on which the Senator was opposing the Bill, I do not think you can spend too much on the treatment of the sick. I think the State would be very poor indeed when we must allow people to suffer either sickness or death or infirmity because we cannot afford to remedy it. Personally if I had to choose—and I would not like to have to choose—between giving the old age pension to the old people or providing money to give us better health services, I would undoubtedly choose to drop the old age pension and provide ourselves with health services. There is nothing more important to any human being, in my opinion, than his or her health or the health of their families. There is nothing which causes greater suffering among our people than illness in the family. I feel the Minister is to be congratulated on bringing in a measure of this kind which is a step towards seeing to it that while our people are sick they know they need not fear that they will not have the very best attention because they cannot afford to pay for it.

When one rises to speak on the second day of a discussion particularly on a Bill of this type, that has been so adequately debated by doctors, professors and people who are much more technically qualified to speak on matters of this kind, I suppose it is true to say that it gives one furiously to think. However, one of the learned professors who spoke on this Bill yesterday said that the views of the non-technical mind are sometimes of importance on such matters as this and as the Bill is a matter of live controversy in the country, I believe that most people in public life ought to express their opinions for what they are worth and to have them recorded.

I would try to take a line somewhat different from that which was covered by previous speakers. I am going to speak against State control in medicine as a general policy. I believe that State control is in itself bad because it leads inevitably to taking a great number of the rights of the individual. I was surprised when I read in the White Paper that it was estimated that almost one-third of our people would be required to be helped under the terms of this new Bill. That, to my mind, is an indictment of our economic system if it is necessary that one-third of our people would be helped for all time under this service.

I hope that in many respects this is only a temporary measure and that with the growth of our economic resources most of our people will be in a position to provide for their own health services. It is better that people would try to carry their own burden. I suggest to the Minister that at some time or other he might see his way to secure remissions in income-tax so that people could carry their own responsibilities rather than to let them have the benefit of State services.

History, and particularly recent history, has pointed to many of the evils of allowing the State to have control. I may be influenced by a book which I read some five or six years ago by a Viennese professor, Dr. A. Hayek. The title of the book was The Road to Serfdom. This professor lectured for many years in Germany, in the Germany which at that time had the most advanced social welfare services of any country in the whole world. He later came to the University of London, and it was during his time there that he wrote this book. He wrote it with the purpose of pointing out that the conditions in England under Aneurin Bevan, Jenny Lee and Harold Laski were the sort of conditions that led to the tyranny or were some of the causes which led to the tyranny that afterwards developed in Germany. They sapped the resourcefulness of the people, their thrift and self-reliance.

I think it was Lord Acton who said that freedom is lost little by little. It is by little things we lose our freedom. There is not a big battle fought so that we lose our freedom generally. Freedom is something precious and it must be worked for every day of the week. I believe it resembles virtue in that it is acquired by patient efforts. Certainly the type of society that later developed in Germany did not look at man in the Christian concept, man created to the image of God. I do not deny that the Germans are a very fine people. They are great believers in health, hygiene and many of those virtues.

I was in their country twice and they have many things that we all admire, but they did make that mistake. It is a pity that the lessons of history are not well watched and well studied. If the Church in this and other countries has been anxious from time to time about the development of State services, I think it is because they have seen what has happened in other countries. It was not for the purpose of interfering with this Government, or past or future Governments, that they made known their anxiety.

This is not confined to Catholics alone. In Germany and in Holland the Catholic Church has led the van, but the Protestant Churches were always with them, fighting for the freedom and independence of the ordinary man. I am not suggesting for a moment that our present Minister for Health, who has his feet well grounded on the soil of Ireland, is going to follow in that course, but when we make laws they are made for the next Minister for Health and the tenth Minister for Health after him, and powers will be given by regulations which will allow Ministers and officials to perform acts which none of us ever envisaged. That is the danger. Many of us know that a man who is charged with the responsibility of office will be able to do many things that his office may not empower him to do—because the ordinary citizen may not have the opportunity of objecting in a way vigorous enough to restrain that official from doing what he wants to do. The official is there, the representative of law established, and the ordinary citizen will take it in many cases that the representative of law established is doing what is right and the humble citizen will not have the machinery at his hand to object to that process, that notice, that order, or whatever it may be. These are some of the fears I have when I say that freedom is something which will have to be guarded by all of us.

Listening some years ago to a speech on the B.B.C. by a lay leader of the Protestant Churches in Holland, I heard him speak against the extremes that were experienced in Nazi Germany and in Holland when taken over by the Nazis—in many of the medical decrees which they issued, particularly against Jews and people who suffered from mental ailments. He said they protested violently and that the Catholics protested more violently and without any compromise whatsoever.

I will now touch on a particular section of the scheme. I believe that, even at this hour, we must have the co-operation of the doctors. The doctors may have been wrong in their approach, they may not have considered the responsibility of the State as fully as it ought to be considered. If there is a difference in a household —and this State is something like a marriage—the Minister and the Department and the medical side will have to work in a happy marriage if the people for whom this service is being set up are to get the best results from it. The Minister has everything to gain by a better service and a better working arrangement with the doctors.

One leading doctor said here yesterday that doctors maybe are not good politicians, may be they are not tactful enough, maybe they have not sufficient finesse in dealing with these matters. Sometimes I believe they are impatient men who want to get on with the job. I heard recently of a doctor in England who was questioned by one of the boards as to why he did not allow some appliance or other to which a certain patient was entitled under the United Kingdom State Medical Service. He said he had not time to read all the regulations that were promulgated by the Department of Health and he was more interested in reading in his spare time things which appertained to medicine rather than regulations. The chairman of that committee agreed with him and said that he was better employed in keeping himself an efficient, an up-to-date and an up-to-the-minute doctor than he was in reading reams of regulations issued by officials who may be out of touch with the requirements of the patients.

The Minister said—and I in large measure agree with him—that no one should be deprived of the best medical assistance owing to lack of means. It would be a pity that people would be deprived of the best medical service by taxation. There is a very thin line drawn at £600. I can envisage a man with a large family and other responsibilities at £600, and on the other hand people under that figure who maybe want to know what holiday they will go on to spend their surplus cash. A single person under £600 will be entitled to benefit from this State scheme, while a married person will not receive the full benefits that a person under £600 will get. I think the Minister might in some way be able to see that those who have to carry the burden might have it lightened for them. Medicine is an experimental science and, as has been mentioned already, many of the modern techniques, including the technique of diagnosis, are very expensive. For a family man that can be rather crippling. In the case of many of the family men over the £600 mark, if they have a long illness, or if a member or members of the family have a long illness—sometimes these things come together—it may have a crippling effect on the family.

During this recess the Minister will have time to consider many of the suggestions that were made to him. I would ask him to see if in some way he can cover the case of those with large families over that minimum who may well be more burdened than many people under that minimum who have little or no responsibility except to themselves.

I am generally in favour of payment for medicine by a remission of tax. That has been done in the United States of America and I believe it has been done reasonably successfully. There will be a temptation, I suppose, for the doctor to say: "You are going to get this tax free, so I will charge you a bit more." However, I think there would be a free choice, and if a patient felt he was being leaned on unduly he could go to another doctor. Freedom of choice is one of the greatest things that a man can have. I am glad to see that freedom of choice is being given as far as possible under the scheme which the present Minister has placed before us.

The question has been raised of the county manager. By and large, he is a good official. These men have done much during the last ten or 15 years, with the help of the county councils and the voluntary committees which have assisted them up and down the country. I think we have a reasonably good hospital and health service at the moment. I ought to correct some statement that was made here yesterday that the county councils are all-powerful in this respect. They provide the money, but if the manager says that he requires an official it then becomes mandatory on the county council to provide the money for that official. That means, in fact, that if the manager wants something the county council has to provide it for him. The general impression is that the county council can say: "We are going to vote only so much money and we are going to indicate where we are making a saving," and the manager has to effect that saving. That is not so. I recently went so far as to get counsel's opinion on that very point. I think it as well that we would know that a manager can state if he wants an official and on the manager's certificate the council will have to provide and pay for that official.

Senator O'Donovan made a rather interesting point. He said—I think on Section 35 of the Bill—that he wanted to refer to it briefly, but I know that food which he said is expected to come under regulations, is being carried in the public transport system of this country in buses, in guards' vans and passenger trains and in all sorts of vehicles, so that it would be very difficult to license and to see that the officials will be able to get standards that will be up to certain licensing regulations in that respect. I think Senator O'Donovan has done a service in pointing out the difficulty of licensing these vehicles because, as we all know, he has a particular function in this matter and has precise knowledge which will be of value to the Minister and the Department of Health.

Finally, I come to the cost. It is sort of vulgar—I think that is the proper word—and certainly it is in bad taste to mention anything in connection with cost when health is the topic under discussion. But every service that the State gives must be related to cost. Senator Hawkins said that health is wealth. He was right in saying that. Health is wealth provided the people who have the health, work for the wealth. Then we will have all the wealth we want and we will be able to pay for the health of the rest of the people. But you will not get the wealth from the health alone, and if people are prepared to work hard enough, we can have all the health services we like, and—I believe—provided by the people themselves, without the State paying for them. That is the kernel of the whole problem.

Let me say in conclusion we have a long way to go when it is still necessary to provide services for one-third of our people. We want to give the families health, and a great deal of encouragement to make them work harder so that something very much below one-third of the people will require the services that are being supplied by the State.

I feel slow to intrude in this debate but it is a very important measure. While I have a great horror of State control in any direction, I think it is unfortunately true at the moment that with conditions being as they are some such scheme is inevitable. We must realise, as one Senator said, that it is necessary to provide something to meet the changing conditions of the present day.

The main provision of the Bill—a lot has been said about it in various ways —is that it brings in a new class of people for whom medical benefits will be provided free or almost free of charge—the class of people represented by the farmer with a valuation of under £50 and the salaried people whose pay is under £600 a year. The Bill proposes to provide medical benefits for those classes on the grounds that they are unable to provide such services themselves. We can easily understand how that has become absolutely necessary in recent years. It was not so 18 or 20 years ago. In previous times the local medical practitioner was able to provide for the poor people and the workers. The better off people who were able to pay, he treated as best he could, but there were very many diseases for which the medical profession could hold out no hope.

Within recent years there has been a great development in medical science and many diseases which were considered hopeless before are now found to be either curable or capable of alleviation by the medical profession. But in recent times the cost of medical treatment has increased substantially and many of the new remedies are very rare and very costly. Not alone that, but in order to provide modern treatment it is often necessary that the patient should spend long terms in hospital. I need not point out that for a farmer of under £50 valuation or a man with an income of under £600 it is a staggering blow if a member of their family has to be sent to hospital for six, eight or ten weeks and he has to pay for operations and medicines. It is something for which most people in those classes would not be able to provide themselves. The result is that, in a great many cases, unfortunately, they avoid going to the doctor as long as they possibly can, perhaps until it is too late. Many lives have undoubtedly been lost because of the high cost of medical treatment among the classes which are now provided for in this Bill. On that ground alone the Bill is justified.

We must remember, too, that while the poorer people in the dispensary class receive all kinds of medical benefit, the medical benefits provided in this Bill for the lower income group or the middle income group do not apply to ordinary practitioner treatment but to hospital and specialist treatment. That means that those people will resort to their doctor in all cases, as previously, and it is only when there is an extreme case when specialist treatment is required that the State steps in to help. I do not think that is going too far in the line of State control. In the modern condition of things it is absolutely necessary.

There are some things I would like to find out while I am speaking in connection with this Bill. First of all, in regard to dispensaries—I think the dispensary system has been a great success in this country and at the present time it has reached a very high state of development. A really poor person to-day is able to receive medical attention from his local doctor, and if it is a more serious case he is sent to hospital. I have seen the poorest of people receiving attention equal to that given to paying patients in these hospitals. If the case is more serious still, they are sent to Dublin where the best specialists in the world are at their disposal.

That, combined with the increase in sickness benefits provided as a result of the Bill passed last year has placed these people in a very good position.

There is one flaw in the dispensary system in my opinion which I should like to point out to the Minister. I must say that, taking doctors in general, they are in every way worthy of the honourable profession to which they belong, but we know that in every profession there are those who are incompetent and inefficient. It is, perhaps, only natural that in a profession which is so numerically strong as the medical profession, there are some who are not so competent as they might be. There are some people who are sufficiently well off to be able to consult a doctor from an outside district, but the majority of people, and the poor especially, cannot go to another doctor because they are too poor. They are completely in the hands of the dispensary doctor. That may be all right if the doctor is reasonably efficient but if, by any chance, an incompetent doctor obtains a dispensary appointment, what is the position? The health and the lives of all the poor people in that district are placed in his hands. We hear a lot of talk about State control, but the situation where an incompetent doctor is in charge of a district is worse than any that could arise under any form of State control. I think it is a situation for which the Minister should endeavour to find a remedy as soon as possible.

A number of speakers have praised this Bill because it affords a choice of doctor to those eligible for benefit under it. If it were possible, I would suggest that a choice of doctor should be made available to all dispensary patients. I do not know, of course, whether it would be possible.

There is, I think, a provision in one clause of the Bill under which, if a dispensary district is enlarged, two or more medical officers may be appointed to that district. I think it would be well if, when vacancies arise in districts which are dependent on one medical officer, these districts could be amalgamated with adjoining districts so that two or more medical officers would be provided, one possibly in charge of the other. That would give the advantage to very poor people, who under the present system are completely in the hands of one doctor, of having recourse to another doctor. I think too that it would be a great advantage to the medical officers concerned themselves because they could co-operate with one another. The objection may be raised that if districts are enlarged patients would have to travel greater distances or that the dispensary district would be too large in area, but the trouble entailed in travelling to the dispensary, having regard to motor transport which is now generally available, would be as nothing compared with that entailed in travelling a comparatively short distance in the days of the horse and car. With the growing improvement in telephone services it would also be much easier for poor people to contact the doctors in these districts. In that way a great improvement could be brought about in our dispensary service which as I say is one of the best in the world, even as it is to-day.

There are a few other suggestions that I should like to make. I agree with some previous speakers that a valuation of £50 in the case of a farmer does not correspond with a £600 income in the case of other people. A £50 valuation in my part of the country would represent only about 20 Irish acres and certainly the income from such a holding in normal times—although we must admit that agriculture is at the moment in a very prosperous condition—would be nothing like £600. I think that the valuation figure should be raised in the case of farmers so as to bring it more in line with the income of £600 in the case of other sections. I would suggest also that if at all possible specialist services should be provided for the recipients of benefits under this Bill at their own homes. As the Bill stands at present, it seems to me that it would be necessary for a man to go to hospital to obtain these services. I think such treatment should be available as far as possible at home.

Much has been said in regard to the control of health services by local bodies. I was a member at one time of a local body and I know the difficulties which confront such bodies in controlling public services. We seem to forget that a local body merely consists of a number of people who come together voluntarily to do public work within a period of four or five hours every fortnight or every month. These people generally have to travel long distances and two or three great talkers amongst their number monopolise three-quarters of the time. They have no time for going into the details of health services or other items of administration and it is generally left to the manager or the other officials to attend to that type of work. It is just as well, therefore, I think, that, when general policy is laid down, the details of administration would be left to those who are best able to attend to them.

Another point which I should like to bring to the Minister's notice is that people who have worked in hospitals in England tell me that a defect in the hospital services of this country is that sufficient attention is not paid to poor patients convalescing after illness. It seems strange that a person should receive the best treatment whilst he is seriously ill but that his recovery should be retarded for want of proper food. We know that a person who has suffered a serious illness requires the best of food to enable him to recover his strength. The Minister might look into that complaint to see if there is any foundation for it and to see that the best food possible is provided for these people. It has also been mentioned to me that in hospitals in England a large number of male nurses are employed whereas there are scarcely any in this country. If more male nurses were employed in our hospitals it would possibly make for greater efficiency.

In regard to the question of a voluntary insurance scheme, we should all like to see such a system evolved and I would suggest that an effort might be made to have such a system established since there would be no element of compulsion about it. These are the only suggestions I have to make on the Bill. The Bill is, I think, an absolute necessity. Even if the present Bill had been rejected, any Government succeeding the present Administration would have been obliged by the pure necessities of the case to bring in a Bill of a similar character. The longer this Bill is delayed the more lives will be lost owing to lack of services.

I want to thank the Minister very sincerely for having introduced this Bill and making specialist treatment available to a number of classes of persons to whom such treatment had not been available heretofore. We are all agreed that such treatment should be made equally available to everybody. I cannot see that there is anything immoral in providing such specialist treatment for the classes covered by the Bill, seeing that it has always been available to any of us who could afford it. If my neighbour is ill and because of lack of means is denied such services, it is, I think, a reflection on the system under which we live. Perhaps if we were all perfect Christians we should do something individually to see that a sick neighbour is looked after fully and we know, as perfect Christians, the State has now to do the work that we should be doing. I should be very nervous about taking part in anything that might be considered immoral or unethical.

I will not discuss that because I am unable to go into the realms of theology. I am not qualified to talk on such matters.

I am sincerely grateful to the Minister for bringing in this Bill. I can see nothing immoral in it. I am grateful to him, too, for introducing a new card system for the benefit of our sick. If a member of a household falls ill one should not have the added anxiety of looking for someone to give one the power to secure the services of a doctor. I think that power should rest in every individual's own hands. One's first consideration, naturally, is to get a doctor and there should be no delay in procuring his services. I am grateful to the Minister, therefore, because I consider that matter of primary importance.

It has been said that the farmers will resent being treated as a pauper class. Perhaps they will. I hope they will, but I do not think this Bill pauperises anyone. I have not noticed hitherto that the farmers have felt pauperised in accepting benefits for the ill-health of their land. Surely the ill-health of the individual is equally, if not more, important. The farmers do not feel pauperised about these things where their land is concerned. Surely it is illogical to think they will feel pauperised where the health of themselves and their relations is concerned.

I have had personal experience of a rather tragic case in West Cork. I visit a sick man there from time to time. About 15 years ago he contracted poliomyelitis. After the acute stage had passed he was brought to a Cork hospital. He appreciated, although nobody had said anything to him in the hospital, that he would be expected to pay so much per week. At the end of a week he left the hospital and he has spent the last 15 years growing steadily more crippled. I do not claim that he would have been cured had he remained in hospital, but I think it is time we took some steps to ensure that such a situation cannot arise in future, if only for the sake of easing our own consciences. We have at the moment a waiting list of 200 people in the orthopædic department in Cork. I am doing what I can to get that man treatment there, but it must be remembered that 15 years have elapsed since anything was done for him. He is a small farmer in West Cork.

I happen to know a good deal about the doctor-patient relationship, for I spent five years in a hospital. I cannot see how any damage will be done to that relationship under this Bill. Nurses, too, have the secrets of their patients. It is generally accepted that other people get to know things. Generally speaking, I do not think the patient's trust is abused.

With regard to the patient who has his or her own private doctor, if that patient is sent to hospital for treatment the private doctor has no more contact with him. The patient is put into whatever bed is available under the care of the particular doctor who controls that bed. That has gone on for a long number of years.

Reference has been made to overcrowding in hospitals, especially maternity hospitals. Experience has shown that doctors encourage women to go to hospital and possibly some of the overcrowding may be laid at their door. That is especially true in relation to private cases; the doctors encourage the women to go to nursing homes where they will have all their patients together and thereby save themselves more trouble. Women who do not want to go into a hospital or a nursing home have to put up quite a fight.

Provision is being made for rehabilitation treatment of the disabled under this Bill. This is a new departure. It is a very progressive step. It should have beneficial results and the Minister is to be congratulated on making such a provision. Recently the head of the poliomyelitis organisation visited Cork and told us of the numbers of people who have organised themselves in that group, people who could be made useful citizens through the medium of rehabilitation treatment. If they cannot be put to work they should at least be given some support and not be left as a drag on their own people. If they are given some support they will be made to feel that sense of importance to which we all think we are entitled. It is not because people are crippled that they should be thrown on one side as if they do not matter.

In directing patients to hospitals I hope the Minister will not take away the independence that the voluntary hospitals prize so greatly. I think the Minister has said that he will not do that. Even though some things may be wrong with the voluntary hospitals, one must admit that they have done extremely good work over the years. I would like the Minister to give credit to those voluntary hospitals that he believes are run economically and efficiently. On that point, why is it that hospitals in Dublin of similar capacity to those in Cork cost exactly twice as much per bed per patient per day? I have not the precise figures but the statement I have made is true and it can be verified by reference to the report of the Hospitals' Commission. Those voluntary hospitals which give good service and which are economically and efficiently run should receive special consideration when it comes to looking for capital for extensions and so forth.

I think it would be desirable, too, to provide some convalescent treatment for people leaving hospitals. I am thinking in particular of mothers returning home to young families. They have no domestic help. They are not very strong. Yet they are plunged immediately into their domestic duties and they are thereby deprived of any chance of building up their strength. I think it would be a good idea even from the economic point of view if those mothers were given a fortnight or three weeks to recuperate in a convalescent home. We are sadly lacking in such homes at the moment in Cork.

Senator Fearon raised an important point yesterday. He referred to the fact that even now there are cases of rickets in children. I must say that over the last few years I have noticed an improvement in both the condition and appearance of children generally. They are better dressed. The mothers have very smart prams. That was not the case hitherto when mothers were compelled to carry the children around in their arms. The present change is all to the good. I think the Minister should seriously consider the point made by Senator Fearon. It is vitally important that dieticians should be supplied to our hospitals, especially maternity hospitals. I do not agree that if people keep their houses clean and look after themselves they will not fall ill. Even those of us who think we set ourselves a rather high standard sometimes fall ill. It is not only the poor, the improvident or the untidy who fall ill. Illness is something that may come upon any of us. It is because the Minister is making available certain benefits for the poor and for those who are less well equipped than others that I congratulate the Minister on this Bill.

The time has come when we must direct ourselves to more and more detailed care of the aged. That is work that can best be done by voluntary associations. We have many such associations but unfortunately their efforts and their energies are often wasted for want of direction. Perhaps the Minister in his wisdom would consider getting into touch with these associations with the object of evolving some scheme for the care of the aged.

A person like myself who is not identified with the local authorities, and who has no great medical knowledge, must speak on a Bill of this kind with a certain amount of diffidence. A number of authoritative statements have been made from both sides of the House, but the ordinary man who has not got the expert knowledge which these people have must view this whole problem as very complex indeed. I must say that I was extremely impressed by the Minister's presentation of the Bill. He seemed to me to argue the case for the Bill in a very reasonable way. He even answered beforehand some of the arguments which have been raised since he sat down.

There are a few points in relation to the Bill on which I should like to question the Minister. I should like to know, first of all, whether he thinks that the estimate of the cost of it which was given by Senator Fearon is an accurate one. His estimate of the cost is £26,000,000. Everybody knows that if money is being expended internally it is not a cost but a transfer of purchasing power from one section of the people to the other—in this case in the form of medical services. Consequently, it is not a cost to the country, because, with the exception of the cost of the raw materials involved, there is nothing going out of the country. Nothing is being destroyed and nothing is being taken away. It is not an export item without a credit on the other side. If we are to assume that the estimate given by Senator Fearon is correct, then the figure seems to me to be an extraordinary one because it represents about one quarter of the total in this year's Central Fund Bill. That, of course, in itself, is not an argument against the Bill. I should like, however, to have an assurance from the Minister as to what his computation is of the cost of these medical services. Are they in fact going to cost the country £26,000,000?

I was very much impressed by the Minister's statement when he said that he was not opposed to the insurance scheme which the Irish Medical Association proposed as an alternative to this Bill. If that is the position, and if we are to take that as his final word, as a solution and as an alternative to this Bill, then I do not think that they have anything to grouse about. I do not know enough about the mechanics of the Bill or of the arguments of the Irish Medical Association to argue the question either way. Listening to the Minister's presentation of the Bill, it seems to me that if they were offered that alternative, and did not accept it, then it is their own fault.

This matter of statism has been mentioned. I am as much opposed to statism as anyone in this House. We have statism in so many forms around us to-day that it is very hard to differentiate between one person's interpretation of statism and another person's. It seems to me that, so far as this Bill is concerned, nothing new in that direction is being done. It is merely proposing an extension of schemes that are already there. As a member of the Knights of Columbanus, and I make no apology to Senator Hartnett for the fact that I am a member, may I say that I see no harm in that form of statism? I had to smile when I heard my friend, Senator Hartnett, refer to the fact that Fine Gael had taken over that organisation because I noticed when he was speaking that a great many Senators on his side of the House are members of that organisation, too.

Statism is already there. We have it entering into our lives in many ways. I should like to know from the Minister if the county manager is to be the final arbiter as regards the interpretation of this Bill and in putting it into operation. We have the local authorities. The Minister said that they were democratically elected. May I ask him if it is the local authorities, or the county manager, who will have the implementation of this Bill? I have heard Senators on this side of the House say that it is not the local authorities who will implement it but rather the county manager. The county manager is an officer of the Minister's Department. When the Minister is replying, I should like if he would clear up that point for me. Is it true that the county manager, as such and as a State servant, is going to have the sole direction and control of these local health schemes, particularly if the aim be that they are to be regarded as an extension of statism?

I should also like the Minister to tell me when replying whether any objection has been raised by the Hierarchy to this Bill. We heard to-day apostles on all sides of this House lay down theological principles. Speaking for myself, I want to be quite candid in saying that I am very loath to accept the guidance of any Party in this House on that matter. I should much prefer to hear from the Minister if the bishops have said, or have not said, so and so with regard to this Bill. I should be glad if he would let me know if any approach has been made to the Hierarchy, if there has been any condemnation of the Bill and, if there has been, what is the nature of it?

I am looking on this Bill objectively as a Catholic. I may say that I am prejudiced in favour of it particularly when I think of all the degradation and suffering that the poor have had to endure in order to get the things that they were entitled to. Because of the memory of that, I am, as I say, strongly prejudiced in favour of the Bill. I do not think as a Catholic, and, again, as a member of the Knights of Columbanus, that any Catholic in this country can say that the Minister and the Government are putting through something which in itself is essentially unCatholic. Unfortunately, the religious atmosphere is being dragged into this discussion, and I would be glad if the Minister would clarify the position. I am anxious to know whether there has been any objection made to the Bill from that point of view. In the absence of any assurance on that point, I intend to use my own discretion on the matter and say that I think the Bill is worthy of support.

With Senator McGuire I deplore the lack of the acceptance of vocational guidance, as it were, in this Bill. It is quite obvious that the Irish Medical Association must have had some good reason for opposing it. I am wondering whether there is any hope of the Minister agreeing to see the Irish Medical Association again with a view to a modification of the Bill in a fashion which would meet their wishes and which, at the same time, would give the people the benefits which he is proposing in the Bill as it is before us. Suppose, for example, the Minister for Industry and Commerce were to come here and propose some radical alteration in the whole structure of industry without first consulting the Federation of Irish Manufacturers, I would be up on my two legs to attack him. I imagine that is how medical men would feel towards the Minister for Health if he did not approach and discuss with them any changes which he contemplated.

Taking the long view of this Bill, I know that in the years to come it will help to build up a young, better and stronger people and give them the fundamental right to the fullest medical assistance that they require. Those of us who are laying down laws as theologians, expressing pious sentiments, are wrong. Taking the long view, this Bill will in time justify itself. If statism does arise and develop, this is not the end of the world and somebody, some day, will come into power and say that that must stop.

From that point of view, I dislike the Bill if it is true that the county manager, acting as a civil servant, would have some right of direction and control of the Bill. That is my chief objection to it. I would dislike it if I thought that the Minister was acting unvocationally, as it were, in connection with the Bill. In so far as the Bill will give people an extension of something which they should have had long ago, I for one will support it.

At this stage of the debate I do not propose to say a great deal. The debate has been rather controversial. There is one matter on which we should all be agreed, that is, the wonderful performance which was acted here yesterday and this afternoon by Senator Hartnett. He went out of his way to praise the Minister and Fianna Fáil for all that he and they had done. He went out of his way to attack Fine Gael, the Knights of Columbanus, the doctors generally, the Irish Medical Association and a number of other people. It is difficult, perhaps, to understand why Senator Hartnett should adopt that line. It may be, of course, that we shall see him in South Galway next week. One never knows.

The bigotry of converts is notorious. Senator Hartnett has been a convert on at least two occasions. Most of us remember when he fell out with Fianna Fáil or that Fianna Fáil fell out with him some years ago. Apparently he has settled his differences with Fianna Fáil and he has now become so bitterly opposed to one of the Parties with which he was friendly a year or two ago that bigotry dictated for him here to-day and yesterday his line of approach on this Bill. In all his hard words in the Dáil the Minister did not tub-thump anything like the way that Senator Hartnett did here.

It is regrettable that so many people should be attacked in what is undoubtedly a controversial measure. There was no reason why the Parties, bodies and persons who were attacked here should have been so attacked. Senator Hartnett was not alone in the attacks. In the unfair and unjustified attacks that were made on many people and bodies, the Minister himself was in the van. The Minister had not proceeded very far in his speech when he purported to make slighting references to the voluntary hospitals throughout the country. He instanced for us the case of the surgeon who went into one of these hospitals and said: "What is wrong with this fellow? We will operate on him tomorrow. Bring him up". He went on to suggest that that was how people were treated in voluntary hospitals.

We should make clear, as Senator Dowdall made clear, that we in the Seanad and the country generally have a very high regard for the place of the voluntary hospital in the country. It cannot be denied—and the heat of controversy should not excuse an attack on that system—that the voluntary hospital is ideal. Great service has been rendered by these hospitals. Most of us know of their work. In all fairness, it must be said that they have rendered great good to the country.

The doctors, the Medical Association and the Knights of Columbanus were attacked. I know very little about the Knights of Columbanus. Senator Hartnett seems to know a great deal about that society. It is unfair that people, bodies or organisations should be attacked for having the courage to express an opinion or opinions on matters of public importance.

Numbers of people may not like an organisation like the Knights of Columbanus or another organisation, say, the Masonic Order. Some people complain when such organisations proclaim what they wish to have done or what, in their opinion, should be done. It has been very rightly said that perhaps we should complain when they proceed to do things about which they will not tell us. It is unfair that reflections should be made on organisations that are public-spirited enough to give us their views on important public matters. It is all wrong that we here should attack such persons.

Reference has been made to the pink ticket. In fairness to doctors I should say that this ticket is the authority to enable a person to seek relief under the present free medical scheme as it might be described. If the person fails to produce a ticket the doctor may refuse to attend him. We should make clear what the practice is. Generally the doctor knows most of his patients and unhesitatingly will give free treatment without the production of that ticket. If he feels that there is doubt in the case, he tells the patient or the patient's parents to get and, later on, to produce to him a pink ticket. I do not know of any case where a doctor refused to treat a patient because the ticket was not produced. The position may be improved under the Bill in regard to tickets, but I do not think there will be any great improvement having regard to the practice that has prevailed.

I cannot support this Bill. There are many reasons why the Bill should not be supported. The real reason why I cannot support the Bill is the matter of cost, not so much because it will cost £1,000,000, £2,000,000 or £7,000,000, but because the Minister has failed to indicate to any reasonable degree what will be the cost of the services that he is now providing for in this Bill. We have reached a strange day when a Minister of State can walk into Parliament and say: "I want you to give me this Bill. It will cost a very considerable amount of money, but I cannot tell you what that amount will be. Nevertheless, I want the Bill".

If he did that, it would be altogether wrong.

I suggest that that is what the Minister has done.

If the Senator looks up the Dáil Debates he will find that at least six times I mentioned it in the Dáil.

Will you mention it for the seventh time?

I will, of course, or ten times more.

I suggest that the Minister has not a clue as to what this will cost.

Whether I mentioned what the cost would be or not, you want to say that I do not know what it will be.

I say the Minister has not a clue as to what this Bill will really cost.

It does not matter whether he gave the figures or not.

The Minister might give us his estimate, but he has not any real notion what this will cost. The Taoiseach told us that we were staggering under the weight of taxation in this country. The Minister is now about to give us a knockout blow, but he does not know what this will cost and nobody else knows. It may cost £4,000,000 or it may cost £15,000,000. Certainly the local ratepayers will find it very difficult to stand it, and we have been told by the Taoiseach that as far as the national finances are concerned it will be extremely difficult to stand up, staggering as we are at the moment.

Where has there been a demand for the facilities provided by this Bill? I find it difficult to appreciate that the position is as stated by Senator Loughman. Senator Loughman told us that if we were engaged in his business we would know of many cases of the kind for which this Bill will provide. If the cases existed to anything like the extent suggested by Senator Loughman, we should know all about them. In my opinion, there is no demand for this Bill.

In the main, this Bill is an additional piece of legislation of a social welfare nature which was brought in because it is fashionable to bring in these Bills. It is fashionable to give people something for nothing. We are subsidising everything and we do not know where we are to get the money with which to give these subsidies. We are merely following the fashion. In my view, there is no demand whatever for the provision of the services contemplated by this Bill. I think the Minister, in fairness, will agree that the local authorities have indicated to him that they do not think there is a demand for this Bill. It may be said truly that the facilities for medical treatment which exist to-day for people in poor circumstances are ample to provide for their wants. It is nonsense for people to say here that we must pay this for health and we must pay that for health. In the main, we have very good health in this country. It is ridiculous to say that, generally speaking, the health of the young people or the health of the old people is bad. It is not bad.

The Irish Medical Association have objected to this Bill very strenuously and have indicated that they will not work the Bill. I wish to make it clear that I am not concerned with the Irish Medical Association. They are entitled to their views on this matter. They may be right or they may be wrong in the views they hold. But, if they will not give the Minister their co-operation after the Bill has become law, what are we going to do then? Are we going to pass this Bill to provide all these facilities and find ourselves in the position that we cannot give effect to the Bill? I am aware, of course, that the British had great difficulty in explaining to the doctors that their system would work. Ultimately, a short time after the Bill became law, the doctors over there did work it. It may be that the doctors in this country, after this Bill becomes law, will co-operate and help to administer it. I do not know, but it would appear to me that they have not been taken in a very conciliatory way, and I suggest to the Minister that nothing should be done or stated further to antagonise the medical profession. If the Bill is to be a success, it can only be a success with the active help and aid of the medical profession.

Business suspended at 6 p.m. and resumed at 7 p.m.

Cé nach duine mise go bhfuil sain-eolas aige ar chúrsaí sláinte, ba mhaith liom, mar sin féin, roint bheag a rá ar ócáid mar seo. Is dóigh liom gur cheist í seo gur féidir le gach duine tuairim a bheith aige uirthi, fiú amháin duine nach bhfuil sain-eolas aige ar chúrsaí leighis. Mar sin, is dóigh liom gur cheart an tAire a mholadh as an misneach agus as an léargas a bhí aige nuair a chuir sé an Bille seo ar fáil do phobal na hÉireann.

Tá a lán daoine ag fáil locht ar an mBille agus is dócha go bhfuil locht le fáil uirthi ach tá sean-fhocal ann a deir nach bhfuil saí gan locht ach i ndiaidh a chéile seacfar na lochta. Deirtear go bhfuil an Bille in aghaidh múineadh na hEaglaise. Mar dúras maidir le cúrsaí leighis agus dochtúireachta níl aon tsain-eolas agam-sa ar an gceist seo ach do réir mo thuigsint ní fheicim aon rud sa Bhille seo atá i gcoinne múineadh na hEaglaise agus má tá tá go leor daoine in Éirinn chun múineadh na hEaglaise a chosaint gan mise bacaint leis—daoine atá sár-oilte agus ana-chúramach agus dá mbeadh aon rud mar sin in san mBille ní dóigh liom-sa go mbeidís mall é a insint dúinn agus dá bhrí sin ní dóigh liom gur gá bacaint leis an taobh sin den scéal.

Tá daoine eile ag fáil locht ar an mBille seo toisc go bhfuil sí ag dul i gcoinne dúchas agus nósmhaireacht na nGael. Ní fheadar an domhan an cheart é sin? Do réir mar fhoghlaimítear ó litríocht na Gaeilge bhí tithe anseo agus ansiud i nEirinn chun bia agus deoch a sholáthar do bhochtaibh na tíre agus do lucht taistil saor in aisce. Bhí brugha anseo agus ansiud agus sé an cúram a bhí orthu san ná freastal a dhéanamh ar lucht siúlta na ród. Sna mainistreacha do cuireadh ar bun fé stiúrú na hEaglaise agus fé na manaigh bhí teach aoigheadh ag baint le gach ceann acu agus san teach aoigheadh seo do réir na staire bhíodh bia agus deoch dá fhreastal ar an láidir agus ar an lag, mar dúirt Seán Ó Coileáin. Ní thaispeánann sé sin go bhfuil sé i gcoinne ár ndúchas agus i gcoinne ár nósmhaireacht freastal saor i n-aisce a thabhairt dár ndaoine. Sean-fhocal is ea é gur ceart don duine láidir cabhrú leis an duine lag. Sin sean-fhocal atá i n-ár measc. Sul a briseadh an tradisiún Gaelach bhí an rud san á dhéanamh sa Ghaeltacht. Bhíodh muintir an líon-tí ag cabhrú le chéile agus do réir Eoin MacNeíll—fear a b'eadh é go raibh sár eolas aige ar chúrsaí mar sin—go bhfanfadh an líon-tí ceann le chéile ar feadh trí glúna nó ceithre cinn agus go mbeadh ar an duine go raibh an iomarca talún aige é a roint leis an duine lag. Ní thaispeánann an méid sin go bhfuilimid ag dul in aghaidh tradisiúin, agus ár nósmhaireacht Gaelach in san mBille seo agus dá bhrí sin ní dóigh liom go bhfuil móran céille leis an argóint sin pé ar domhan é.

Is é an moladh is mó atá ag dul don Bhille ná go luíonn sé leis an dream go bhfuil an gá is géire acu leis. Fén mBille, áirítear na daoine i dtrí codanna. Sa chéad chuid, tá na daoine nach bhfuil mórán de mhaoin an tsaoil acu—agus tá freastal maith á dhéanamh orthu san cheana féin í gcúrsaí sláinte agus i gcúrsaí dochtúireachta agus mar sin de. Ar an dtaobh eile, tá daoine saibhre ann nach bhfuil cabhair ón Stát ag teastáil uathu. Is féidir leo aire thabhairt dóibh féin gan aon chabhair ó Rialtas na tíre. Ach tá dream eile sa tír— an tarna dream—agus níl siad saibhir go leor chun gach freastal dochtúireachta do dhéanamh orthu féin. Bíonn eagla orthu roimh an chostas agus chonaic mé agus tháinig mé trasna ar a leithéidí sin. In aon pharóiste amháin bhí aithne agam ar dheichniúr go raibh dian-ghá acu le dul fé chúrsaí sceana agus ní raibh an t-airgead acu agus toisc ná raibh an t-airgead acu ní raibh an misneach acu. Dúirt an Seanadóir S.T. Ruane inné go raibh cabhair le fáil do dhaoine den tsórt sanigCondae Mhuigheo. B'fhéidir go raibh ach bheadh sé an-deacair cabhair a thabhairt dóibh ón udárás aitiúil. Bhí a luacháil ró-árd agus an t-airgead ró-íseal acu. Mar dúirt. duine liom-sa: "We have the valuation but we have not got the value." Sin iad an dream daoine a dtiocfaidh an Bille seo i gcabhair orthu. Dá mbeadh an Bille seo ar fáil 30 blian ó shoin do bheadh mórán daoine, atá marbh le blianta, beo agus slantiúil inniú—agus pé oiread ama a bhí saol acu is le pian agus trioblóid a mhaireadar toisc ná raibh Bille mar seo le fáil dóibh chun seirbhísí dochtúra, leighis agus ospidéil saor in aisce mar tá siad le fáil anois agus tá moladh mór ag dul don Aire go bhfuil na seirbhísí tábhachtacha sin le fáil anois.

An chéad locht eile atá le fáil ar an mBille ná go bhfuil sé ró-chostasach. Gan amhras, tá sé costasach. Ní féidir mórán a dhéanamh anois gan airgead a chaitheamh. Ní fheicim conas is féidir na seirbhísí seo do sholáthar gan airgead ach is tábhachtach an rud í an tsláinte agus is rud í gur fiú airgead a chaitheamh más dóigh linn go ndéanfadh sé maitheas don shláinte. Tá sé seo le rá fén scéal dá mhéid í an méid airgid a chaitheamuid anois ar chúrsaí sláinte is ea is lú a bheadh an costas ar deireadh. Chímíd sna páipéirí nuachta maidir le cúrsaí eitinne go bhfuil súil go mbeadh sí díbrithe ar fad as an tír i gceann tamaill, toisc an oiread cúraim atá á thabhairt ag na dochtúirí don ghalar seo agus creidim féin é sin, ach na daoine a mhúineadh ar an mbia ceart d'ithe. Nuair a bheadh an Bille á oibriú ar feadh bliana beidh an gá leis an mBille ag dul i laghad. B'fhéidir nach bhfuil an ceart agam ach sin é mo thuairim.

An chéad rud eile, an bhfuil an costas leagtha go cothrom ar na daoine go léir? Is dóigh liom féin go bhfuil. Ar dtús tá dhá leath á ndéanamh den chostas. Beidh an leath amháin le díol ag an Rialtas agus an leath eile le díol ós na srathanna. Maidir leis an méid airgid atá le teacht ón Rialtas beidh gach fear, bean agus páiste in Éirinn ag díol an costas sin agus ón taobh seo beidh gach duine ag diol as. Mar gheall ar na srathanna, sí do réir a luacháil a thitfeadh an costas ar na daoine agus má tá aon dianas sa scéal is dóigh liom gurb iad na daoine is mó ar féidir leo an t-ualach d'iompar. Ní bheadh le díol acu as leasmuigh des na srathanna agus má thuigim an scéal i gceart ní bheidh le díol ag cuid acu sin ach punt. Pé scéal é, is dóigh liom go bhfuil roinnt chothrom déanta ar an gcostas.

Locht eile a cuirtear ar an mBille ná go bhfuil sé ag cur isteach ar ár saoirse pearsanta. Is mó slí go bhfuilimid ag cur isteach ar shaoirse phearsanta. Cuirtear leanaí ar scoil agus muna dtéann siad cuirtear an dlí ar dhaoine. Sin cur isteach ar shaoirse phearsanta na ndaoine. Is mó slí eile a bhfuilimid ag cur isteach ar shaoirse phearsanta ach in san mBille seo ní fheicim go bhfuil an cur isteach ar an tsaoirse phearsanta chomh mór san ar fad. Má thuigim-se an scéal i gceart do réir an méid a dúirt an tAire i dtosach na d'ospóireachta dúirt sé go mbeadh a rogha dochtúra ag gach duine. Dúirt sé go mbeidh a rogha ospidéil ag gach duine. Más fíor é sin agus má thuigeas i gceart é is fíor é, ní fheicim go bhfuil an oiread san cur isteach ar shaoirse phearsanta in san mBille seo ar aon chor. Ansan, ní hamháin go mbeadh a rogha ospidéil ag gach duine ach beidh a rogha seirbhís in san ospidéal. Más mian leis is féidir leis dul isteach i suanlios poiblí agus más mian leis is féidir leis dul isteach in san suanlios príobháideach nó leath-phríobháideach ach má théann beidh air beagán a dhíol sa bhreis air. Níl ansin ach cothrom na féinne agus i ndeireadh na dála ní fheicim go bhfuil mórán locht le fáil ar an mBille seo. Maidir le saoirse pearsanta ní dóigh liom gur fiú tráithnín an méid cur isteach atá á dhéanamh sa Bhille ar an tsaoirse phearsanta. Tá mórán ráite ar an mBille agus is dócha go bhfuil mórán le rá fós agus b'fhéidir go bhfuil go leor ráite agam-sa.

There is a great temptation, at this time of the evening-in pleasant August holiday weather—to shorten our sitting, by not speaking at all on this Bill. There is even greater temptation, when one is fully conscious that, on so controversial a Bill as this, whatever one says is bound to give deep offence to some people. This means that the temptation is very strong, but I feel that we must keep in mind the opinion of the great Athenian legislator Solon, who might well be called the father of democracy. His opinion was this, that every citizen should take open sides on any major matter of public controversy, and if he did not openly take sides he should be punished by law. Now that was a strong view. But I think there was good reason behind it, and on a matter of this kind every member of the Seanad if possible should openly take sides. I understand that we are not going to vote on the Bill at this stage. The only opportunity, then, of taking sides will be by speaking. I propose, then, to say a few words on the Bill. I shall try not to delay the Seanad unduly.

The Bill has aroused so many emotions, so many collisions of conflicting loyalties, so many rumours and counter-rumours, of pressures and counter-pressures, that I find it extremely hard to keep a firm grip on the essential point at issue. One's mind is confused by all these scares and counter-scares. And I have found in discussing the matter with people, very well informed people, recently that they did not really know where they were with regard to the Health Bill, it had been so much confused by the various controversies of the last few months. Now as I see it—it is only a platitude, I am afraid, but perhaps we need to face platitudes just now—our duty in this House is primarily to pass good laws and reject bad laws. So one question is in my mind, and one question only, this evening— is this Health Bill a desirable piece of legislation or not?

I have listened to approximately nine hours of debate, waiting for the final convincing argument. I have read most of the discussions in the Dáil and elsewhere, and most of the reports in the public Press—waiting for the final convincing argument. There is agreement only on one point as far as I can see. Senator Hayes made it quite clear at the beginning of his speech. We are all agreed that the health services in this country need improvement. The question is, is this Bill the right way to go about it or not? I listened to the various voices. Fine Gael and organised medical opinion say: "No, it is not the right way to go about it." The other political Parties, on the whole, say "yes". The majority of my own non-medical acquaintances say, "yes, it is the right kind of beginning," and among others there were some doctors. To say that all medical opinion is against this Bill is just false. Apart from the fact that the Minister and various others associated with the Bill are doctors there are throughout the country, I know, some doctors at least who think this is a desirable piece of legislation. Which side is right? I listened carefully because I was open to conviction until fairly late in the debate. I listened with most attention to the doctors, to what the medical profession had to say, because I try to keep in mind that this is a vocational Assembly and we should take heed of what the various vocations say; and I personally have a personal loyalty to the doctors in a sense. They are a learned profession like the lawyers, and the clerics and professors, and in this sense I have a definite personal loyalty to them.

Here I must express a profound regret. I do think it is profoundly regrettable that the medical profession on the whole has been antagonised in the course of the negotiations over this Bill. I do not know where the blame lies, but it is a regrettable fact. It is, in a sense, a failure to negotiate successfully. They have been accused of self-interest in certain quarters. Now I think that Senator Barniville answered that very satisfactorily. It is sheer cant and hypocrisy to say that most of us are not primarily moved by self-interest. Only the saints can denounce other people for acting on self-interest. Most of these doctors are, as I know them, my own colleagues in the university, honourable and public-spirited men, but at the same time, they must look after their personal interests. I feel that there must have been some incompetence in negotiations somewhere that these public-spirited men were antagonised. Their chief fear seemed to have been that they would become tied State servants eventually as a result of this measure. The Minister has assured us in this House that that will not happen. I am content to accept his assurance, but I would like to say this, I would like to pledge myself to this, that if it should happen that this Bill was made an instrument for tyrannising over the medical profession I pledge myself to do everything in my power to repudiate my support and to fight that tyranny. I do not think that the risk is great, but as Senator Burke pointed out there is a risk and I hope that the Minister will be specially careful on that account.

I repeat again that I think it is most regrettable that these public-spirited men were antagonised; yet I could not help feeling as I listened to those representatives of the doctors in the Seanad that they were not so deeply antagonised as some people tried to make out. That ultimately was my conviction, listening carefully to their speeches.

A letter from the secretary of the Irish Medical Association has been referred to several times. It said that the decision of the Irish Medical Association was based on Catholic doctrine. I would like to make it quite clear—I feel it is my duty to make it quite clear—that a large, or a fairly large, section of that association was not influenced in this matter by Catholic doctrine. These are not members of the religious majority. I would like to define my attitude, which I think is their attitude, in a matter of this kind.

We listen with the greatest respect and consideration to any pronouncements by the leaders of the religious majority in this country. We will weigh them, study them, consider their utterances with the greatest respect; but when there have been no utterances, no clear utterances, what can we do? I feel that there has been no clear direction in this matter. There has been no genuine effort to meet the statement that if this Bill is immoral in Ireland 2,000,000 people are living in immorality in England. I have heard no answer to that. So I would make it quite clear that though we are ready to consider the views of the Hierarchy with the utmost consideration we cannot do so until we hear them, and we have had no opportunity of doing that in this case. I think the matter should hardly have been raised and I think that the secretary of the Irish Medical Association was not speaking for a considerable section of his body in his recent letter.

I would like to emphasise that none of the leaders of the minority churches in this country or of sister churches across the seas have found any moral objection to this kind of Bill so far as I know. I therefore do not feel in any way bound morally to oppose this Bill on moral grounds. Here, since we are on the subject of sectarianism, in a sense, I would like to ask the Minister one specific point. He stated in his opening remarks that the choice of voluntary hospitals would be necessarily limited in certain cases and that it would be unreasonable to expect the local authorities to contract with a large number of voluntary hospitals. I would like him to give me an assurance—though in a sense it is only a formality, I think, because I know he can and will—that in these cases religious convictions will be respected and that a member of a religious body who might have religious scruples about going to this or that voluntary hospital would have his opinions respected in the matter.

An assurance on that point would be welcome to me and to some of those I represent. I should like to add my voice to Senator Dowdall's plea for generous treatment of the voluntary hospitals. There is a danger that this Bill could be misused in favour of the State hospitals. I would urge on the Minister to see that the Bill is not misused in that way.

To come to the fundamental difficulty in my mind—the doctors' objections. I think we would all agree that they were best stated in Senator Jessop's speech. I regret to say that not a single word of that speech was quoted in a leading newspaper of this city this morning. I was appalled, in the interests of the nation and public opinion, to see that the speech might never have been made, like another distinguished contribution to the debate by Senator Fearon. It strikes me that it is most regrettable that this weighty and sound contribution should have been completely ignored. That is by the way.

Senator Jessop's criticisms amounted to this—that the national health would actually suffer as a result of this Bill. If I felt that were true, I would be bound to oppose the Bill. How did he say the national health would suffer? He mentioned the probability of crowded hospitals, dissatisfied patients and dissatisfied doctors. He criticised the British scheme; and yet I felt that his criticisms of the British scheme were not wholehearted. It seems to me—I shall study his speech in detail when I have an opportunity—he did concede that the British scheme had done a great deal for the health of the people of Britain. Senator Fearon mentioned cases of rickets in this country which do not occur under the British scheme at all. It seemed to me that Senator Jessop was not wholehearted in his criticism of the British scheme.

His main point was the crowded hospitals. Here I feel Senator Hartnett gave the answer. If the hospitals are crowded it will ultimately be the doctor's fault. It will depend on them whether they send the patients to hospital or get them out of hospital, and the doctors cannot shirk that responsibility. Perhaps, that will not apply fully in cases of maternity, but on the whole, it could apply there, too. I think that great difficulty was answered by Senator Hartnett.

There was a curious conflict of opinion between Senator Hartnett and one of our other Senators on the question whether the British scheme was contributory or not. No one has referred to that yet. I think I can solve the difficulty. I have an official pamphlet from the Ministry of Health headed: "Misconceptions about the National Health Service: Section (1) is ‘That the National Health Service is chiefly financed by means of weekly contributions.' The answer is definitely ‘no'". But I think this is where the misapprehension came: "One-twentieth of the total cost is contributed from the British National Insurance". Perhaps some of our Senators have been confused by that fact and thought that it was partly contributory. It is not. A person could refuse—the pamphlet makes that quite clear—to pay his national insurance contribution and still have full benefits under the health service. It is partly a matter of accountancy and due to the fact that the health scheme in Britain does some of the work of the national insurance fund. As far as the Ministry of Health in London is concerned it is definitely non-contributory beyond yea or nay.

I think Senator Hartnett was a little unfair to Senator Jessop on two points. Senator Hartnett quoted the case of the patients who go to England for treatment. The answer is this. Those patients who go to England are probably suffering from chronic diseases, so that they can arrange for hospital treatment several months beforehand. Either that is the case, or they are going as private patients to senior consultants. I do not think Senator Jessop's argument was faulty there. In the second place it was a little unjust to Senator Jessop to say that if candidates for posts in mental hospitals refused to take an interest in the output of potatoes they necessarily were going to be incompetent administrators in general. I hope I am not misrepresenting Senator Hartnett. If I am, I trust he will interrupt me and say so. After all, a doctor may well be reluctant to be an administrator in agricultural matters and be a very competent administrator in other matters. The main question was answered. If the hospitals are going to be crowded it is for the doctors to see that they are not.

I return to the essential question. Does this Bill deserve our support as legislators or not? We all agree that it is not an ideal Bill. But I think it is a step in the right direction and that it does deserve our support. First of all, in terms of practical politics it is the only Bill that the present Government will give us. It is either this Bill or nothing as far as they are concerned. Very well, I think it is much better than nothing. Further, when I think of the 500,000 people who will definitely benefit under this Bill, many of them white collar workers, for whom I have the utmost sympathy at present, again in terms of human values I cannot turn my back on this Bill.

Thus, on the whole, I think we must agree that in terms of internal policy we need this Bill. We also need it in terms of external policy—a point which, I think, has not been emphasised. We are in competition in this matter with Great Britain and Northern Ireland. We must face that fact. Unless we compete on something like similar terms, emigration and other evils will be fostered. I feel that in terms of external policy we must take some steps in this direction. Therefore, I support this Bill and I appeal to the doctors to forget their antagonisms and support it, too.

I wish the Minister success in administering it. He has been warned of the dangers very fully, poor man. He had my sympathy during the Dáil debates. If he used one phrase or, perhaps, two that people might seize upon, which of us would have done better under the gruelling criticism that he had in the Dáil? He has been very thoroughly warned. I trust that he will learn the dangers from it and avoid them, the danger of excessive cost, the danger of bureaucracy and the danger of autocracy. He can learn from the mistakes in England; and so can our doctors. It is for them to learn from the mistakes in England too and work in with this Bill and help it. I can only trust that both the Minister and the doctors as public spirited people will make a success of this Bill.

I feel the Bill is so important that I must stand up and say that I wholeheartedly support and recommend it. The reason I do so is because honestly I believe that there are large sections of the sick poor of this country who will benefit in so far as their health is concerned and who will receive treatment that it was not possible for them to receive heretofore. I realise that the cost on the rates would be very high but knowing the Irish people as I do I feel that the number who will object to the cost will be very limited because of the class who will gain.

Like the previous speaker I feel that this Bill will not be the last Bill in this direction. When the Bill is working the Minister will be in a position to see whether it can be improved. It is not unusual for more than one Bill to be introduced in connection with a particular matter; I can refer to certain legislation in regard to which there were nine Bills. There is always room for improvement and it will be the same with this Bill. This will not be the last Bill in connection with health matters and when it is in operation efforts can be made to make it the success the Irish people wish it to be.

There is one point on which I would like to see some alteration and that is in connection with the powers of the county manager. The power in dealing with this Bill should be in the hands of the elected representatives and not in the hands of managers. A manager is only a human being and his ability is limited. County managers and city managers have their hands full at the present time without other responsibilities being placed on them. Apart from that, I am a great believer in democracy. If the people of Ireland, both the ratepayers and those who would gain by this legislation have elected representatives, they are the people who should deal with the scheme which results from this measure.

That is my only objection. Like the previous speaker I have a certain amount of sympathy for the Minister in the hard fight he had to get the Bill through. I cannot understand why there should be any stern opposition. It may not be the last word on health matters; it is the first word in the right direction and I hope it will be possible at some future time to produce a Bill which will satisfy the Irish people. I welcome the Bill and give it my wholehearted support.

Mr. P. O'Reilly

I had some doubt as to whether I would say anything on this measure or not, particularly having regard to the amount of time which has been taken up on this discussion in the Dáil and Seanad. However, having heard Senator Stanford, I feel that in quoting some eminent authority he has almost placed an obligation on every single member of this House to give an opinion on the measure. It is refreshing to hear a speech like that made by Senator Stanford. He is one member of the House who approached the Bill objectively. He gave his viewpoint without trying to secure political kudos or to make propaganda. It is a pity that we did not have more speeches in this debate on the same level and tone as that of Senator Stanford's.

One other reason why I must speak is rather as a duty to myself. Senator P.F. O'Reilly has already spoken. I have found that Senator P.F. O'Reilly is quite fond of making speeches here and getting a very good press, with the result that in many quarters down the country where he is not known, responsible people are coming along to me and saying: "What was the matter with you when you made that speech?" In self-defence I must express that point on this measure.

You can imagine his feelings if you get a press.

Mr. P. O'Reilly

To give an instance, Senator O'Reilly made a speech when everybody was having a sprint on Tulyar. He claimed he was not worth £250,000 and suggested he was worth about £150,000. The result was that a very responsible man down the country who does not know of the existence of Senator P.F. O'Reilly and of the fact that he comes from Dublin said to me: "Had you nothing better to do than to talk that nonsense? You know nothing about that. It would be better for you to stay at home and run your farm."

On a later occasion Senator P. F. O'Reilly made a speech in regard to the price of whiskey and as to whether the excise duty should be reduced or not. It would be Gilbertian to see Senator P. O'Reilly who, you understand, is a prominent member of a total abstinence society making a case for the reduction of tax on whiskey while a prominent publican on this side of the House was going around with book and pencil making sure there would be sufficient members present in the event of a division.

That part of the discussion is out of order.

Mr. P. O'Reilly

It is because of those facts that I expressed myself in those terms on this measure.

I thought you were moved by Senator Stanford's plea?

Mr. P. O'Reilly

That was one reason, but I am giving this as a further reason. Even though I speak nonsense there has been so much nonsense spoken already that I am sure what I say will not do any more damage. If the gentlemen of the Press, when they do report Senator O'Reilly, would make sure that they describe him as Senator P.F. O'Reilly from Dublin, the position would be clarified.

I think that aspect of the case has been stressed sufficiently.

Mr. P. O'Reilly

I cannot understand why this Bill has been received as it has been. Many people are prepared to agree that our existing health services need improvement. Apart from the 1947 Act, which deals with infectious diseases, the only health service we have in this country, excluding mental hospital services, is the service provided under the Public Assistance Act of 1939. I regard that definitely as public assistance. Health services should be given to people as a right not as a dole or as an assistance. It is because I see in this Bill a change from that system, which I always regarded as a legacy of the poor law system, that I regard this Bill as very desirable and a step forward.

This Bill does not, however, go as far in many respects as I would like it to go. For instance, as my colleague, Senator O'Dwyer, mentioned, there is not in this Bill provision for a choice of doctor. In so far as the lower income group is concerned I feel sure that if and when it is possible to make improvements the Minister will do so. This service, which I regard as the legacy of the Poor Law system, is the only service available. There is, of course, under the Public Assistance Act of 1939, a definite obligation placed on health authorities to provide for anyone "unable to provide by his own industry or other lawful means, the medical, surgical or dental treatment, or medicines, or medical, surgical or dental appliances, necessary for himself or any persons whom he is liable under this Act to maintain". There is a duty placed on them by the Public Assistance Act to provide such a service. It really is a question as to what categories of people that would apply to. It is not very clearly defined what classes of people health authorities are responsible for. It depends on the opinion of the local authority or the executive officer dealing with that particular branch in the service of a local authority. Under this Bill, the categories are much more clearly defined. There is the further improvement that these services are being provided for the people as a right and not as a dole or as public assistance.

We have heard a lot of criticism—in my opinion, quite dishonest criticism— of this measure here, and I have heard and read part of the debates in the Dáil. I do not think many of those who oppose this Bill really do so at heart, except in so far as they think political kudos can be gained by opposing it. Many of us who are members of local authorities, on both sides of the House, have had to make representations to county managers that hospital accounts of individual persons should be paid in full or in part by the local authority.

I have done that myself and successfully, I hope, quite often in regard to small farmers under £50 or under £20. The question can always arise whether such a man, living on Leitrim land, with a wife and five children, is liable to pay his own account or should get the county council to pay it for him. As the definition in the 1939 Act was so vague, there was a need for the clarification and classification of people under this measure.

In the case of prolonged treatment in an institution, it is impossible for people living on farms to pay, out of their own industry, the cost of institutions, medicines, doctors' fees and surgeons' fees, without placing their homesteads and their families in jeopardy. As another Senator has said, so much meanness has been dressed up with a mantle of morality that people are advocating that a person should out of his own industry and providence provide for himself. Any responsible people, farmers or labourers, will always try to do that, but there is a strict limit to the amount of provision that people of humble means or small or medium income can make. They can never cushion themselves completely against the impact of prolonged sickness of the head of the household or a member of the family.

I take the view that it is better, through the medium of central taxation or local rating, that people should contribute towards that. It is a kind of insurance and it carries a guarantee that those who pay the contributions are contributing towards their fellows who unfortunately require such treatment. I suggest that over a 25 year period—that is a short time enough when one looks back, though it is a quarter of a century when one looks forward—nearly every family in the country is unfortunate enough to get a spate of sickness and then the need arises for medical and surgical attention. Is it not better to accept the principle in the Bill and, by all our people insuring, through taxation and local rates, have a health service provided for us?

Some Senator, I think it was Senator Baxter, touched on a point, but unfortunately did not develop it, that there should be a voluntary insurance system. I understand that that has been promulgated also by the Irish Medical Association. It was a pity that Senator Baxter did not develop that point, as I would like to hear from him the line on which it was proposed such an insurance scheme would be run. I know—and I suggest that Senator Baxter knows—just how hard it would be to get the small farmers of South Leitrim or West Cavan to contribute every week, every month, every six months or every year, to a voluntary insurance scheme. I know that the majority would not pay. Furthermore, there is nothing to prevent Senator Baxter or myself or the Minister from taking out a sickness policy with any insurance company. Anyone can do that at present and does not need a blueprint from the Irish Medical Association. One can insure year after year against the impact of sickness. I am sure there are quite a number of members of this House who do such things, but I would love to hear from somebody how this insurance scheme was to be run in rural areas. I am prepared to state that you would want a terrific army of civil servants to administer it and I know it would be quite unworkable. Supposing 5, 10, 15 or 20 per cent. of the people of Leitrim or Cavan or Galway or Mayo refused—assuming a scheme like that were put into force— because of cussedness or poverty or any reason at all and refused to contribute what would be the result? Would they be regarded as a crowd of derelicts and left to die in a ditch if they should get sick simply because they had not contributed to this glorified scheme? Then, we would be adopting the view which I always thought to be as callous a view as could be taken by anyone—"I am not my neighbour's keeper." The people who would advocate that would be just saying: "I am not my neighbour's keeper."

Despite all the attempted pontifications and preaching of theology on the part of some people, I am still prepared to say that there is an obligation on the health authorities to look after all the citizens, including the derelicts —that apparently some people would like to completely ostracise.

I think there is something cynical and cruel in such an attitude. If the people who advocate it fear that there is going to be an increase in taxation, local or central, and are trying to avoid that by saying: "I am not my neighbour's keeper", there is not much charity in that outlook. If we had less vaunted theology in this House and a little more common or kitchen-garden charity in this debate, it would be a much better debate. That is why I say it was so refreshing to hear speeches like that given by Senator Stanford. There were others, of course, as well.

Somebody questioned whether the public wanted this measure or not. I feel that the public do want an improvement of the existing health services because of the burden that exists on people of the middle income group and on farmers of £10, £20, or £30 valuation. But if anyone wants a test, I asked that question of somebody since —Senator O'Reilly, I think it was— posed that question. I got an answer and I do not regard it as a good answer. Somebody said to me since: "Well, one of the answers that can be advanced as a result of the mother and child scheme promulgated by Doctor Browne, is that a lot of controversy took place and despite all the machinations of Fianna Fáil and Fine Gael, Dr. Browne and a rather unknown man down the country, Dr. ffrench-O'Carroll, got elected here in the City of Dublin." That, a man said to me, is a real illustration of the balance of public opinion in the matter. I do not regard that as a good reason for the Bill but that is one reply that could be given to Senator O'Reilly.

I am afraid I have been speaking too long and I am sure we are all anxious to conclude this debate. Senator Stanford said he was well aware that some doctors were in favour of the Bill. I am sure he lives in or around Dublin. I do not. I am inclined to suggest that there are many doctors who are in favour of the Bill. I am inclined to suggest that many of the local practitioners who are omnibus men—and not specialists—and who have to deal with everything from cut fingers to heartaches, are in favour of the measure because any doctor who is a doctor by profession and not in the profession as a means of living, is prepared to agree that the present system—the dispensary system—is not a good system. The present scheme is an improvement on that system with the red ticket and all it stands for and that is why the men who really have to work down the country and, I am sure, in the city too, —many of them—are in favour of this Bill, while Senator Stanford suggests that only some of them are.

Before I sit down, I would like to say that Senator O'Reilly said it was regrettable that so many people should be attacked. I agree myself with the pious prayer of Senator O'Reilly, and I echo it. It is regrettable that so many people should be attacked but the question is, who did the attacking? If Senator O'Reilly were here yesterday he would know who did the attacking. While some people attacked this measure purely on economic grounds of the cost, others tried in an insidious way to suggest that there was something immoral, something ethically wrong in this Bill. The people who did that were not prepared to tell us exactly where the Bill was wrong, what was unChristian about it, or what was immoral. It is easy enough for the people under the mantle of the privilege of Parliament to mouth phrases like that and leave it so. All I say is if those people had a little more charity they should not try under the mantle of protection to destroy the reputation of the people who supported the Bill because there is a definite slander in my opinion involved in any man suggesting that the measure was immoral or unethical and it was because of the amount of damage politically that could be done to people supporting the Bill that those suggestions were made. If the people who made the suggestions had a little more charity, which I think is the cardinal principle of Christianity, they would not make those suggestions. It is rather obnoxious to me to be talked at rather than talked to, talked down to by people who pretend to be saints and scholars whatever about being good judges of whiskey as if they had some right to be guardians around this place and keep other people right. I hope in other measures we will not have a recurrence of that form and tone in debate. Strangely enough it was only recently it developed here. I hope it will stop. It is funny that while some members across attacked the Bill on the high level of ethics and morals others were interested only in the cost. Apparently, despite the preaching at the Minister and the people who were supporting this Bill, many of the colleagues of those preachers did not accept the theology at all, because those others followed to suggest that the only objection was the objection of cost.

People cannot have it both ways. You may interest some people by appealing to their selfishness and their pocket, or you may try to enlist the sympathy of some other group by saying that a fundamental principle is being attacked, but I do not think you can use the two arguments at the one time. To those people who suggest that the Bill should be resisted because of its cost I would say—and I shall conclude on this note—that economy at the expense of the sick or at the expense of the poor is the economy of the miser. Personally, I would not adopt that as a philosophy.

The case for this Bill has been made, such as it is, at length in the other House and has been made, such as it is, in this House. The case against the Bill has also been made in the other House and is being made again in this House, so I do not presume to introduce anything new to this debate. I can only give my opinion, such as it is, also. My opinion is that of one who lives in a moderately small town in the west of Ireland, who discusses various topics, including this Bill, with various people—my neighbours and friends and casual acquaintances—occasionally. That opinion, as I say, is an opinion that is freely offered and passed about in a small town. It is the opinion also of one who in the course of his daily employment comes across and mixes with very many people who can only be described as intelligent, because of the type work they perform—airport workers.

An airport is no place for "duds". The people who work in the airport are intelligent people and have a fairly high standard of education. In the various discussions I have had with these different people, I have never heard anybody say anything about this Bill except that they, personally, did not want it. I have never heard anybody say they wanted it except politicians, those professing a brand of politics opposed to that of myself or perhaps not so opposed. I have certainly never heard the ordinary man in the street say he wanted this Bill. My opinion is that the average man in the street does not want this Bill. He does not need it and he objects to paying for it.

I was listening to Senator Ashe, and if I interpret him aright, I think he said that he could see nothing wrong with this Bill from the point of view of morality. Perhaps I misinterpret the Senator and if I do I am sorry, but he said that there were enough people to defend the Church's view without our bothering about it—that is without the members of this House bothering about it. I am afraid I cannot agree with Senator Ashe that we, as members of this House, should not bother about the Bill or about the Church's view. The Church is well able to make its own case.

Hear, hear!

But the fact that it is so well able to make its own case renders it all the more necessary that we should pay attention to that case. I am not one of those people who say that it is the Church's business, and only their business, to make a certain case and that I should pay no attention to that case once it is made. If the Church is well able to make its case, I must, and so must every Senator, pay some attention to that case. Certainly, I do not think that I can subscribe—and I doubt very much that the people whom Senator Ashe is alleged to represent here could subscribe—to the opinions which Senator Ashe has expressed here to-night, and we, and presumably he means himself, should not bother about the Church's view.

He did not say that.

Perhaps I misinterpreted him and if I have, I regret it. However, that is my interpretation of Senator Ashe's opinion. Senator Ashe stated that the Church and Church spokesmen are well able to express an opinion on this Bill. The Church has expressed an opinion many times on it. A Church spokesman has expressed an opinion no later than last week. I quote from the Independent of Monday, August 3rd, last Monday. Speaking at the Social Study Summer School in Galway at which I was present, Rev. Dr. Felim Ó Briain, who is a man, I presume, that no Senator will say is talking through his hat or is talking cant——

He is talking through his hat. What else is he doing except talking cant?

That does not come very well from Senator Yeats.

We know exactly what Senator Yeats may think of Dr. Felim Ó Briain and people like him but it would be far better for the Senator to keep his mouth shut.

Not necessarily.

Perhaps if the Senator went asleep again, it might be as well. However, the Rev. Dr. Felim Ó Briain as reported in Monday's Independent said:—

"Just now our Parliament has passed a Health Bill which has been whittled down in response to appeals by our Bishops, but the fact that our politicians could draw up a health scheme which called for condemnation by the Hierarchy on the grounds of morality shows the very great need that exists for education in the fundamentals of Catholic social and moral teaching."

I do not know what the Senator from Limerick knows about Catholic social or moral teaching but, whatever he does know, I presume the gentleman who said that Dr. Felim Ó Briain was talking through his hat knows less. Dr. Felim Ó Briain said also on that occasion:—

"The instruction issued by the bishops regarding the Health Bill was written for the people, but the politicians got a hold of it and the people never saw it. The Health Bill, now passed, by no means conforms to Catholic morality and our politicians by ignoring many fundamental Catholic social principles had prepared and supported a thoroughly immoral piece of social legislation."

I do not know what Senators generally think of that statement. I must say that I am prepared to accept that viewpoint as the correct viewpoint.

Does the Senator accept Dr. Phelim Ó Briain's remarks on Senator MacMullen?

Senator MacMullen is, I am sure, quite well able to defend himself and I am equally sure he does not require Senator Yeats to defend him. Our Constitution specifically lays down that the State must have special regard to the religious views of the vast majority of the people. I think I am correct in saying that. Surely, if that is the case, the State then must have special regard to the views of those to whom the vast majority of the people look up when they express certain views as Catholic priests and sociologists. I certainly think the State must have special regard to their views. I have that regard myself and I reject completely the viewpoint of anyone who says that these people are talking through their hats and talking nonsense because the latter do not understand the viewpoint, first of all and, even if they do understand it, they will certainly not agree with it for political reasons.

Everybody is entitled to his own conception.

That is so. I have had experience as an ordinary man, as an insured person and as a member of a trade union of our national health services before I entered this House. I needed medical treatment some few months before I came in here. All the treatment I required was provided under the national health. Some few years ago I was given special treatment in a hospital. I had anaesthetics, X-rays and a private room under national health. When I entered the hospital I thought I would have to pay for treatment but the matron pointed out to me that I was entitled to free treatment. I was not aware of that at the time. I was provided with every type of treatment I needed and I was given every facility. After leaving hospital I made inquiries in an effort to find out if I were entitled to more. I tried to find out something to which I was not entitled. I still do not know anything to which I am not entitled under national health.

This Bill concerns various categories of our people. It concerns the organised medical profession which, generally speaking, is opposed to the Bill. That cannot be denied. Admittedly, a few individual doctors are not opposed to this measure. It concerns patients. Generally speaking, the people, as a whole, do not want this Bill. The would-be patients have not been consulted in any way in connection with the Bill.

This Bill concerns the Church. We have had the Church's views on the Bill. The Church is opposed to it. It concerns the general body of the people who will have to pay for it. It concerns the ratepayers. It concerns the representatives of the ratepayers organised in their county councils. They have asked the Minister specifically how much this Bill will cost and all the Minister has given is a very vague estimate. The local representatives of the people are opposed to it.

This Bill concerns the Government, for it is the Government that has introduced the Bill. I believe the Government wants this Bill because it is expedient. This Bill is the payment to the pressure group for their votes. I do not think I would be too harsh, or that I would be saying anything that the majority of the people would not be prepared to say, when I say that this Bill is payment to an unscrupulous pressure group for its support.

The Labour Party supported the Bill.

I am not referring to the Labour Party. We all know why the Senator thinks that. He does not have to pay twice for his seat. He paid in advance.

What is this reference to the question of payment?

I withdraw that. I believe that if the present dispensary system is improved, if better dispensary buildings are provided, if nurses are available for duty at these dispensaries that would solve in large measure the problem that confronts the Government. It would not solve the problem completely but it would go a long way towards providing the people with the services they want and the services they need. The present dispensary buildings could be rebuilt and remodelled. Permanent nurses could be appointed to duty in these buildings in order to provide the medical services and health services the people need and for which they are prepared to pay. That would provide, too, work for the unemployed, a problem about which the Government professes itself to be anxious at the moment. It would help in many ways to solve interrelated problems.

I am completely opposed to this measure. There was one statement to which I would like to refer, one out of many of the very foolish and incoherent statements made by the previous speaker. He said something to the effect that there was a little too much religion and not enough Christianity spoken in relation to this Bill. If I am misinterpreting the Senator, I am subject to correction. I may have misinterpreted Senator Ashe earlier but there, again, I spoke subject to correction. All I have to say in reply to that statement is that I heard that statement outside this gate last week. This morning in Galway I heard a refugee from Budapest say that he heard that statement in Budapest 15 years ago.

I would have preferred to wind up this debate after some other speaker. It is hard to have patience with a man who says he can get free treatment under the national health—hospitalisation, specialist, treatment and everything else—but he does not want to allow that to be given to anybody else because he does not want this Bill.

He does not see any necessity for it. He does not see why the small farmer, who is not insured, should get free treatment. He does not see why the shopkeeper, the taxi driver, the carpenter working in the country, the man working for himself, should get free hospital and specialist treatment as long as the Senator himself can get everything that he wants under the national health insurance. That was the gist of his speech. It was a bad speech, because to any person who heard it, it shows the sort of claptrap that is trotted out in this House.

Would you like me to get in again and make a speech before you finish?

That might be worse. But Senator McHugh said that I had to do this—that a pressure group made me do it. The Senator may not know anything about recent Irish history. In 1947, when I was Minister for Health, I put an Act through. The Government issued a White Paper saying what their intentions were with regard to the health services. Then there was an election and the Coalition Government came into power. We came back again in 1951. The White Paper was again issued with hardly a change in it. Now, we come along with our Bill and we are accused by Senator MacHugh of giving in to pressure groups. I am quite sure that if we had not issued our White Paper and had not brought in this Bill, Senator McHugh would probably be drawing attention to that and asking why did we run away from it.

The fact is that we have been consistent in our health proposals in 1947, 1951 and 1952. We did not change any of the policies we outlined in 1947. When we brought in this Bill we were told many things in this House, as we were in the other House, that have no foundation in fact—that we had to yield to pressure groups.

I think I know what Senator McHugh means. He probably means that we had to buy the support of certain Independent Deputies in the Dáil. I am very glad to have the support of those Deputies in the Dáil because, to my mind at any rate, a Deputy who was a Minister in the last Government has been consistent in advocating good health services, and to that extent he agrees with me.

When I was making my Second Reading speech here at the beginning of this debate I spoke for over an hour. Some Senators said to me afterwards that I had avoided speaking on some certain thing or other. I thought, indeed, that I had spoken too long, and I, therefore, probably omitted to speak on certain aspects of the Bill. It will hardly be possible for me, even now, to refer to every point that was made in this debate. If I omit anything it is not that I am trying to evade it, and if I am asked afterwards about it I shall certainly try to deal with it as far as I can.

The Opposition from certain quarters to this Bill is very determined and persistent. I have suffered from one great disability and that is, that I have never got from any quarter what are the specific objections to the Bill. All that we get are vague objections: that it is immoral, that it is State control and that the county manager does everything—all sorts of vague things of that kind. But nobody has ever taken the Bill in his hand and read out a single clause or line of it and said: "I do not agree with that." It is the easiest thing in the world to use vague generalities. You can object to anything, and, when speaking like that, Senators, I am sorry to say, are almost as bad as the Deputies. They are not too particular whether they are basing their arguments on fact or not.

I can only take some of the points that were made and deal with them. Both in the Dáil and in the Seanad there was a great deal of talk about the county manager. This Bill has done nothing about the county manager. It is the law which gives the county manager certain powers and puts upon him certain duties. The same law gives the local authorities certain powers and duties too. This Bill has been brought in.

The county manager has his functions and the county councils have their functions, but this Bill does not say what these are. That is stated in the County Management Act. In the Dáil, the Leader of the Fine Gael Party there spent four days on the county manager. Here we had some references to him also. I tried to point out several times in the Dáil that this Bill does not deal with the County Management Act. There is a Bill which will be coming before the Dáil to deal with that, and as far as I am concerned, as a member of the Government, that Bill will give all the powers possible back to the county councils.

This Party was not the author of the County Management Act. It was the Fine Gael Party which started out on that policy when it brought in a city manager in the City of Dublin. The Fianna Fáil Party, it is true, followed that on when they came into power. I do not know why Fine Gael has now taken on the rôle of being anti-county manager, or why it should take on that rôle under this Bill. In any case, this is not the Bill to deal with that. A Bill is coming out and I can promise one thing definitely, and that is that it will certainly give more powers back to the local authorities than the Coalition proposed to give in the Bill which they circulated when they were in power. As far as I am concerned, as I have said, as a member of the Government, I will be altogether in favour of that.

Senator Hayes said that there was very little money being devoted to the voluntary hospitals. That is a matter which I have dealt with over and over again. The worst of it is that, no matter how often I state the facts, the members of the Fine Gael Party will still say what they want to say and will not take any notice of what the facts are as I give them. I have stated over and over again that, when the present programme is completed, as it will be in four or five years' time, that is the present programme of hospitalisation— I do not think Senator Hayes likes that word, so perhaps I had better say the present programme of hospital building——

I am not blaming the Minister for the use of that word.

As I was saying, when that programme is completed two-thirds of all the money from the very beginning up to that time, that is up to 1957, will have been given to the voluntary hospitals.

I have stated that on a good many occasions. Yet, speakers get up and say that the local authority hospitals have got most of the money and the voluntary hospitals have got very little. That is not true. That is all I can say again.

Senator Professor Hayes also spoke about teaching and research. I am afraid there is a little bit of confusion in that. There are two clauses in this Bill. I did not refer to these when I was opening this debate but perhaps it is better to do it now. There is one clause which gives the local authority power to provide post-graduate courses in a local authority hospital. The law was defective there. There were clinical courses given in some of our local authority hospitals and it is doubtful if the local authority had any legal power to permit these to be given. For instance, take the county hospital in Galway. We had to make that right. That is made right in this particular clause. We went further and we are giving authority to the local authority to provide post-graduate courses for their own medical officers. That was considered necessary. The need was felt in the past on many occasions where some new technique or new process was introduced, like B.C.G. vaccination, or something like that and it was necessary to give doctors a very short course of what should be done. That power is being given to the local authorities now.

The other clause deals with the teaching colleges. That is a matter— I will not say of controversy—but that has been under discussion between some of the teaching schools and the Department of Health for many years. Perhaps Senators know what the position is. I am sure some of them know it. Take Galway. It is the best example because it is the simplest example to take. If a gynæcologist— that is the best example to take—is being appointed to Galway hospital then, in fact, University College Galway, has no choice but to adopt that man because there is not room in Galway for two gynæcologists and, therefore no second man of repute or standing would come to teach in the University College because he would feel that he could not make a living in Galway. They had to adopt the man taken by the hospital. The man was appointed to the hospital by the Local Appointments Commissioners. University College Galway felt that it was rather beneath their dignity to accept a man in that way.

I had to take the standpoint that the hospital could not legally take the man appointed by the University College because the hospital had to take a man appointed by the Local Appointments Commission. I went further and said that I was not prepared to recommend that the law should be changed so that the hospital authorities would have to follow the University College because the hospital authorities might feel that they were not getting the man that suited them best if they were to take the man appointed by the University College. A compromise was reached, and the compromise was that where a teaching body claims to have an interest in a local authority hospital the Minister can make an Order compelling the local authority to provide facilities for clinical teaching and then it follows on: If an appointment is being made in which appointment the University College would have an interest, then the Minister can again make an Order providing for special machinery for the appointment. The special machinery is, that the Local Appointments Commission in appointing a selection board would have half that board representatives appointed by the University College and a neutral chairman appointed by the Minister. That is the compromise that has been reached and I hope it works satisfactorily.

The point was made about the British scheme as to whether it was free or not. I think Senator Professor Stanford answered that point very clearly when he said that one-tenth came from the social security fund. That is true, I think. When the Social Security Act was passed £40,000,000 was to be devoted to the health services in order to cover the services that would be given by the medical men for social welfare purposes. If we were, for instance, in our case, to transfer from the social welfare fund money to pay the doctors for their certification for insurance and let it be paid through the Department of Health, then we would be in the same position as they are in England, roughly speaking. I do not say we would be in the same position with regard to the percentage or amount but, roughly speaking, in the same position. I think no Senator would try to argue very strongly that if that were done it would make our scheme a contributory scheme. It would to some extent but, in the North of Ireland there is no contribution whatever. It is entirely voted moneys which pay for the health scheme there.

Senator Baxter said he thought we should have a much better measure than the measure which I have put before him for the money that is being provided. That is the sort of statement that I find it very difficult to deal with. It is the sort of statement that would always come from a Fine Gael speaker. I do not think you will ever hear a clear-thinking speaker from another Party making a statement of that kind. It is a typical Fine Gael point, that we should have a better measure for this money, but they never tell you what the measure is. It is the easiest thing in the world to say that we should have a better measure and then to go on to the next point and leave the other person to think out what that measure should be.

I would like Fine Gael in this House to give me a little more help than they gave me in the other House. In the other House they refused to put down an amendment even to give me an indication of how their minds were running about a scheme. They did talk; they did oppose; they did hold up; but, they never put down an amendment and never suggested how the Bill could be improved. I would be very interested indeed if Fine Gael would give an indication of what their policy may be.

It was said here that Fine Gael had opposed all health schemes. That is true, of course. From 1945 on, they opposed every scheme that came, either opposed or sabotaged, because their own scheme, brought in when the Coalition Government were in office, was not so much opposed as sabotaged. It came to the same thing. Fine Gael got their way and the scheme disappeared. When that scheme disappeared the next Minister for Health, who was Deputy Costello, brought the Irish Medical Association into the Custom House and said: "Prepare a scheme yourselves", or words of that kind.

When I was winding up the debate in the Dáil I was reported in the newspapers as saying that I put them out. Perhaps I should not have used those words as baldly as that, but I did qualify the thing somewhat, although it was not reported in the newspapers. What I said actually was that I told them to get out and I said it is not their job but my job. Of course, I said it very politely. I thanked them for their services, and so forth. I did not want to put it as baldly as that—"Get out". What I actually did was to send them a letter saying that I thanked them for their past services, that I did not require their services in that particular capacity for the future and that I thought it was a job that should be done by the Minister himself with, of course, their advice. We can leave it at that and I can only say that the papers were a little bit hard on me in the report that they gave.

Senator Professor Fearon thought we could find out a person's means from his income-tax returns. There are two objections to that. First, there are not so many income-tax payers amongst the middle income group, in my opinion and, secondly, the Revenue Commissioners would not agree, unless we brought in a Bill in spite of them. They are very jealous of the information they get from their income-tax payers and they regard it as absolutely confidential and would not disclose that information to anybody. I suppose, on the whole, there is something to be said for that.

There were two matters mentioned by Senator Professor Jessop and referred to by other Senators, namely, the prevalance of rickets in Dublin and the prevalence of dental caries. I do not think it is a fair statement to say that rickets are prevalent in Dublin. They have almost disappeared. Last year I was out in a home that was organised by voluntary effort many years ago for the treatment of rickets. They told me the sad story for this home that they could not get any rickets patients and they had to turn to the treatment of other defects. They hardly ever get a rickets patient now. That is largely true. Rickets have almost disappeared in the City of Dublin and in this country. It would be unfair that the impression should get out that we have rickets on a large scale in Dublin.

The same applies to dental caries. There is not so much of that either. As a matter of fact I saw the report of one investigator. He is not an Irishman. He held that, at least in certain parts of the country, we are freer from dental caries, practically, than any part of the world. The person who was doing the research intended to come back again to try to discover why we were very free from it in certain parts of the country. Again I do not think it is giving a fair picture to say that we suffer a lot from that particular disease.

Senator McGuire gave certain reasons for his opposition to the Bill which were, if you like, more specific but, in a way, very general. He quoted from the White Paper saying that, having sought the views of interested organisations, we went ahead with the business of preparing a Bill. He asked: "Why did we not seek the views of the Irish Medical Association?" We did seek their views. There is no "why" about it, we did. When the White Paper was issued, I sent several copies, I think about 50, to the Irish Medical Association and said: "Whenever you are ready, gentlemen, I am prepared to talk to you." They came along eventually and they put three questions to me. They asked: "Are you prepared to drop three things?" I said, "No". They said, "That ends it; we do not talk then". That was the end of it. I will put it even to Fine Gael, do they think I should have given in to them? Should I have said: "Come back, gentlemen. I will take out these three things"? Any self-respecting Minister of any Party would say: "If that is your attitude I can get on without you". That was the end of that. They did not come back because I would not take out three things which they asked me to take out and said they would not discuss things. They maintained the same attitude a week ago when I saw them. They said they were not prepared to co-operate. Do Fine Gael Senators seriously suggest that I should have given in and said: "I will give in in order that you may discuss the Bill"? They would not discuss it. That was the end of it. They still maintain the same attitude.

I am accused of being hard on the Irish Medical Association, of saying hard things about them and about the doctors. I am not against the doctors. There are many doctors in this country who are particular friends of mine. I think the doctors are just as good as the average population in this country. They are just as good as the farmers or the lawyers or the engineers or the teachers or anybody else. I cannot find any fault with the doctors at all on that score. Many of them are friends of mine and I get on very well with many of them. I can tell you that many of them are in favour of this Bill. The people with whom I did meet with trouble are the Irish Medical Association. That is a different matter. For instance, to give you an illustration. I get on very well with certain Fine Gael people and I like them, but I detest the Fine Gael organisation. I think it is the most atrocious thing ever brought into this country and I absolutely detest it. Perhaps Fine Gael may say the same thing about our organisation. But why should I be accused of being against the doctors because I do not agree with the Irish Medical Association? Anyway, is there not something suspicious about the Irish Medical Association? You rather suspect that they are unreasonable considering that they have been up against every Minister of Health who came along. They could not get on with any of them. I do not know what anybody thinks about my two predecessors, but I think they were very reasonable men and I think I am a reasonable man. One of my predecessors was really Parliamentary Secretary to the Minister for Local Government, but he was actually acting as Minister for Health at the time or was doing the same work. But none of the three of us could ever get co-operation from the Irish Medical Association. Immediately we came into office, one after another we found that we were the enemies of the medical profession. I do not know what I am going to do about it. If any Fine Gael Senator or Deputy will come to me and honestly say: "I think you should give in to the Irish Medical Association", I might think about it, but I know what I might think about the Senator or the Deputy.

Senator McGuire referred to a letter in the Irish Times about my kicking the doctors out of the Custom House. I saw that in the Irish Press, but that does not matter. He is against this Bill for three reasons: one is, failure to work in harmony with the doctors. I have said all I want to say about that. I am prepared even now to work in harmony with the doctors. Let them come along. I said that over and over again. We will meet to talk about the matter any time they like. The second reason was, I turned the blind eye to the moral authorities. I shall leave that aside for the moment. The third was, no real estimate was made of the cost. That is a chestnut of Fine Gael. Some of the speakers said that I could only give an estimate, that I could not give the real cost. Did anybody ever give the real cost in a case like this? Even the best architects can only give an estimate as to the cost of building a house. I could not possibly know how many people may benefit in each particular category. How am I to know whether a person will get appendicitis next year or the year after? It would be impossible to give the actual cost of a scheme like this. Surely if a Minister gives an estimate it is the most that can be expected from him. I have given an estimate over and over again.

Let us now get back to the other reason, that I have turned the blind eye to the moral authorities. Many Senators on the other side have referred to that, Senator Ruane, Senator Baxter and Senator McGuire and the last Senator spoke, I think, more openly than any of them. On my own side, Senator Mrs. Dowdall said she felt that she was not qualified to talk on moral issues. I was going to say to her that if she joined Fine Gael for a few days she would lose her diffidence. They seem to be able to pontificate always on moral issues. They never stop talking about moral issues. They have been lecturing us on morality both in the Dáil and the Seanad. Why? Are they better men than we are? Perhaps they are. But, if they were much better men than we are they would not adopt that attitude; they would probably be a bit more charitable in their approach to us and probably try to bring us back to the fold in a more gentle way. Is it not quite evident that they are talking for a political reason, trying to get the people to believe that we are infidels and antiCatholic and unChristian and that the chosen few are sitting amongst Fine Gael?

The Irish Independent of August 3rd was quoted from by the last Senator. I have it here. Side by side there is a report of an address and a letter. Dr. Falvey, in his letter, stated that the Irish Medical Association's objections to the Health Bill are based on the principles of Catholic social philosophy, which are unshakable and unbreakable. Reverend Dr. Ó Briain, speaking in Galway, said that the Bill as it left the Dáil, “by no means conformed to Catholic morality and that our politicians, by ignoring many fundamental Catholic social principles, had prepared and supported a thoroughly immoral piece of social legislation”. The last Senator who spoke asked did I accept that. Well, I am prepared to give a very definite answer—no, because I cannot accept conflicting opinions from different ecclesiastics. I do not know where I am if I am going to accept whatever is said by every stray theologian who comes along. I want to say this, that I was asked by Senator Frank Hugh O'Donnell did I consult the Hierarchy. I met the Hierarchy several times. I said that in the Dáil. I met them several times, sometimes five, sometimes three, sometimes one. On one occasion I had the Tánaiste, Deputy Lemass, with me, on another occasion the Taoiseach was there and several times I met them alone, and we met the objections they made by introducing amendments in the Dáil and we heard nothing more.

It may be said that the Hierarchy did not give their approval. I do not expect them to give their approval to every Bill that goes through here. I think we would be very foolish to expect that for every Bill we put through. For instance, take the Bill that was put through by the Coalition Government when they came into power first reducing the tax on beer. It was not condemned, of course, by the Hierarchy, but would it be fair to ask the Hierarchy to approve of that Bill? I think it would not be fair and I think it would be a wrong principle and establish a wrong precedent to say that we should ask for their approval. If we get away without their disapproval we are doing fairly well and we have got away without their disapproval—that is the Hierarchy, but we have not escaped from Fine Gael; that is different. Fine Gael are not satisfied.

Now Reverend Father Ó Briain said that his objection was based on the fact that one political Party got a mandate. From whom? From the Hierarchy—one political Party.

I think that you are reading a misprint there. It should be "no political Party" as it appeared in another paper. I am just keeping the Minister right in the usual Fine Gael rôle.

Wait until I see.

It was printed in one case as "one" and in another as "no". "One political Party got a mandate" is the way it appeared in one paper, but it was printed in another paper as "no political Party".

That is all right, I will pass over that.

Fine Gael is keeping the Minister right, Sir.

The case Dr. Ó Briain is making as far as I could read, anyway, is that he is annoyed with the Hierarchy for acquiescing in the politicians suppressing what they meant to be instructions to the people. I cannot see any other meaning to take from it. Deputy McGilligan spent a day in the Dáil on it so I know the thing fairly well—that the Hierarchy wanted to issue instructions to the people but the politicians, by which was meant, presumably the Government, got a hold of it and that it was not allowed to go to the people, and we were attacked on it. This means, of course, that Father Ó Briain is dissatisfied that the bishops should let us away with it.

Thirdly, he says that when the Bill was allowed through that the bishops who are not objecting had ignored many fundamental Catholic social principles. Well now I was asked by the Senator who last spoke did I accept this from Dr. Ó Briain. I say "no", that as long as the Hierarchy do not say "no" to this Bill, I say I am satisfied and I cannot be listening to everybody who comes along, whether they are speaking in Galway or here. I think we must have one authority to issue religious principles —that is for Catholics. I am naturally not including others now. But we cannot be listening to everybody who comes along. It is all very well for the Senator who last spoke to try to score on this if he thinks it is going to make it awkward for me or for somebody like me. That is good politics, I admit, but it is not good religion. That is all very fine, but I am quite entitled to go ahead on that.

The Reverend Dr. Ó Briain purports anyway to know more than the Catholic Hierarchy here in this particular instance, and strange to say, his sermon was on the Pharisee and the Publican and I must assume that he was against the Pharisee, but the point he made would not compare with it very much. Dr. Ó Briain also, of course, does not merely condemn what was done here but he condemns many other things in the country and a lot of people who have agreed to this—trade unionists, a good number of employers and politicians in general. Then he condemned politicians in general and he did not exempt Fine Gael from it.

That is right. That is one up for Fine Gael.

In that instance, anyway, he is neutral. It reminds me that a friend of mine who delves into old manuscripts came across a letter some time ago. I can tell you the story because it was written about 1,000 years ago by a young cleric who wrote home to his superior from Monte Cassino, where there were pupils from all over the world, of course, and naturally only the best in the world attended there. This boy, who was very clever, wrote home after two years to his superior and told him: "I got first in one thing, second in another, first in another of my subjects, but my greatest triumph of all was that I left them all behind in humility."

This is a medical story. I heard it from the Secretary of the Irish Medical Association.

That shows it is true.

Yes, that is right.

Senator Hartney raised a point about the clause which says that we can appoint, one, two or more dispensary officers. I do not think the Senator need be worried about that. It is necessary in Dublin nearly always to have two doctors in a dispensary, sometimes three. It is intended to revise the dispensary areas as soon as we have time to do it and make the centres more conveniently situated for one thing, and also to try to give a more equal distribution of population between various dispensary areas. That will be done.

I was also asked is there any hope that there would be a choice of doctors for the ordinary dispensary ailments apart from maternity. I would have liked very much to bring that about, but it is going to be a very big job. I will have it examined as soon as possible and if it is found to be feasible and if it is agreed to by the Government and so on, then we will prepare to implement that, but it will take a long, long time to implement it. I see various troublesome, very troublesome jobs to be done before it could be brought into operation. All that I can say is that I am in favour of it.

The voluntary hospitals were mentioned. I have expressed my opinion about voluntary hospitals more than once. I am very much in favour of voluntary effort. I think it can be shown that since I became Minister for Health—and, indeed, I can say the same about my predecessor—voluntary organisations were recognised and some of them got grants to carry on any good work that they might have in mind from the health point of view. Certainly, I always try to encourage voluntary effort of that kind. There is no intention to interfere with the voluntary hospitals in this country. I cannot see how this Bill will injure them in any way. I think their income will be more assured under this Bill than it is at the moment, so I do not think they have anything to fear.

Senator Stanford asked about the choice of hospital. Remember, there are two points there. In the first place, the local authority makes an agreement with certain hospitals in Dublin to send certain patients to them that are not dealt with in the county hospital. Naturally, they do not make agreements with all the hospitals. They make agreements with three or four hospitals and send patients to them.

I think there need be no fear as regards religious scruples or discrimination. I think every local authority will be prepared to send a person of any particular religious persuasion to a hospital that would be in keeping with his sentiments in that regard and, therefore, there need be no fear about that matter. I would say definitely that the local authority would make agreements with only a small number of hospitals. However, if a person wants to choose his own hospital then any hospital that is on the list can be chosen. As I explained when introducing this Bill, it is very easy to get on the list but we must compile a list because we do not want a handy-woman in a private house trying to carry on certain medical practices. Therefore, we insist on having a list compiled.

Senator Mrs. Dowdall asked about the provision of convalescent treatment. I am very much alive to that matter. As soon as we can get places for convalescent treatment, that can be done. I feel, however, that hospitalisation is very much more urgent. That reminds me that many Senators have said that we have not enough hospitals to go on with our scheme. That is not altogether a fair estimate. We are not very much under-hospitalised in this country. As far as I can find out, we compare favourably enough with other countries in regard to the number of beds for the population, even for maternity purposes. However, we have a very big programme in view and much of it is, indeed, proceeding at the moment. When that programme is completed in three or four years' time, I think we will have more hospital beds per patient than most of the European countries. In fact, at the moment, we are as high as most countries so far as maternity beds are concerned and we are spending £6,000,000 a year—which is a big sum of money— on the building of hospitals. Apart altogether from that £6,000,000 a year —which is capital money—almost one-third of our income to the Exchequer is going on ordinary social and health services in this country. As some Senator has said, when comparing that position with other countries, it does not take a socialist Government to look after social schemes of this kind. That is perfectly true. I see in today's newspapers that Russia spends most of her money on defences. It is a very good illustration for us to be able to say that we spend most of our money on social services and on health.

There is one other point which, perhaps, I should mention—it is the last point which I have here—and it was made by Senator Jessop. He felt that we may have the same troubles here as they have had in England, namely, overcrowded hospitals, dissatisfied patients, dissatisfied doctors, and so forth—and that we may be worse off in the end than we are at the moment. I think we will be able to avoid that. I may be optimistic or I may be dense—I do not know which—but I cannot see how the fact that we pay for some of them instead of letting them pay for themselves will make a great difference in the number of people going into hospital. If it does make a difference, it means that the Bill was very badly needed. It means that certain people would not go into hospital because they were not able to pay. If we pay for them, and the hospitals become overcrowded, it is really a very good argument for the Bill. I do not think that the Bill is so very badly needed that we will have the hospitals crowded. We may have a few more patients; possibly we will. I do not think we need have any great fear of some of the very great troubles that developed in England under the National Health Service and I feel that we may expect to work our measure fairly smoothly and fairly successfully.

Question put and declared carried.

What is the last day for receiving amendments, if anybody wants to draft an amendment to this Bill?

The last day of September.

Committee Stage ordered for the next sitting day.