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Seanad Éireann díospóireacht -
Thursday, 22 Jul 1954

Vol. 44 No. 1

Health Bill, 1954—Second Stage.

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

I would like to explain to the Seanad the reasons why this legislation has been found necessary and the purposes which it is hoped to achieve under the legislation itself. Members of the Seanad will have been provided with a White Paper dealing with the purposes of the Bill. I think if I briefly explain the existing legislation and what is sought to be achieved by the Health Act, 1953, and, in addition, what will be achieved by the present Health Bill, it might assist Senators.

At the moment in this country, provision is made in relation to health services under two different codes and for two different classes of persons. First of all, under the Public Assistance Act, 1939, provision is made for the sick poor, those who are unable to provide for themselves, those who, by reason of incapacity or lack of means, are unable to pay for medical care, surgical care, hospital treatment, or for the different services that their ailment, illness or condition might require. That class is provided for by the Public Assistance Act, 1939. Of course, the services provided for them are provided without charge, and they are as good as the country can provide at the moment. In addition, under our existing legislation—and when I say existing legislation I do not include the Health Act of 1953 which, in the context in which I am speaking, is not yet in operation—insured workers who are in benefit under the Social Welfare Act, 1952, are entitled to free hospital, specialist and other services envisaged in the Health Act, 1953. They are entitled to these services free not by reason of the fact that they cannot pay for them but by reason of the fact that, under the Social Welfare Act, they have a contract for the provision of these services and get them freely. These, broadly speaking, are the two classes of persons who, at the moment —subject to certain details which are not relevant just now—are entitled to free medical services—and both of these classes are entitled to these services in priority to anyone else. They are entitled to them in priority in every local authority hospital and also, in fact, in most of the voluntary hospitals.

Broadly speaking, that is the present position so far as our legislation is concerned. The Health Act of 1953 proposes to reorganise the health services of the country, to remove the existing code and to add new classes to the classes of persons at present receiving free treatment. Under the Health Act of 1953, provision is made to repeal the Public Assistance Act of 1939, to take from the Department of Social Welfare all insured workers and put them under the care of the Department of Health and, in addition, to add certain other classes as being equally entitled to free hospital and specialist services. These additional classes are to be found in Section 15 of the Health Act, 1953. The effect of that section is to provide that, from the date of the operation of the Health Act, 1953 instead of there being two classes of persons entitled to free hospital and specialist services there shall be five, and the five classes are as follows: (1) the sick poor; those, I have already defined to Senators; (2) insured workers; (3) all persons whose income is less than £600 a year; (4) all farmers whose valuation is less than £50 a year, and (5) all persons on whom payment for these services might mean an undue hardship. These five classes, under the Health Act of 1953, form a new pool or group of persons in respect of whom free hospital, specialist, medical and other services must be provided.

There are certain things which I would ask Senators to note with regard to the scheme under the Health Act, 1953. The first is that, in relation to these five groups or classes of persons, a statutory obligation is imposed by the Act itself on each local authority —or health authority, as it is called under the Health Act—to provide for all of these persons full hospital, specialist, medical and other services. The second thing I would ask Senators to note is that all of these persons are given equal rights to the services contained in the Health Act. No preference is given for the sick poor. No preference is given for the insured worker. No preference is given for any single person covered by Section 15 of the Health Act of 1953. Accordingly, in order that the services may exist in fact, and not merely on paper, it is necessary to ensure that full accommodation to cater for all these classes shall be available when the Act itself becomes law. If that assurance is not realised, certain undesirable results may follow.

If there is a statutory obligation on each health authority to provide equally, with short accommodation, for added classes, then someone will suffer. I am not concerned here and I am sure Senators are not concerned to investigate who is likely to suffer but it is not a good thing in our legislation to build up false hopes in the minds of people—hopes which we may know cannot be realised. If there is a shortage of accommodation, then either the sick poor, the insured workers, persons on an income of less than £600 a year, farmers up to £50 valuation who may or may not be badly off, or other persons for whom payment might mean an undue hardship will suffer because they would not get what the Health Act entitles them to get, namely, a bed in a hospital, the services of a specialist, free medical care and free maternity services for their wives during motherhood. That is, broadly speaking, the change proposed by the Health Act 1953, and the aims which it sets out to achieve.

When I became Minister responsible for the administration of this Act I was concerned to see that the Act would not merely gather dust on the files of this Oireachtas but that it should be examined as a practical proposition to see whether in fact the services which it assured the people of this country could be provided for them, and, if those services could not be provided in the immediate future, that they certainly should be provided within the foreseeable future. I accordingly examined what arrangements had been made to bring this Act into operation and what accommodation was in fact available to provide for the added classes and groups of persons referred to in the sections of the Act which I have mentioned. I think Senators will realise that in order to provide any health services it is necessary to have available not merely hospital accommodation but also the professional services of doctors, dentists, chemists, opticians, nurses and a variety of other bodies whose services are necessary to implement any scheme of health service.

I accordingly examined first of all what agreements or arrangements had been made with interested professional bodies, and I found that no agreement at all had been made with any professional body. Secondly, I examined what accommodation was available in our hospital system to provide the beds necessary for the care and treatment of all the persons who were assured of such treatment under the Health Act, 1953. I found this extraordinary position to obtain, that prior to the enactment of the Health Act, 1953, every county hospital in the country was providing service to an extent in excess of its proper capacity. Putting it in another way, the average bed occupancy in every county hospital in the country was more than 100 per cent. That meant that county hospitals, which were built in accordance with medical and architectural advice in the past and designed to accommodate a certain number of beds and a certain number of patients were, in fact, being forced to accommodate additional beds and additional patients. That was the position in relation to all county hospitals. In addition, all our voluntary hospitals in this city and elsewhere throughout the country were also providing services to the very limit of their capacity.

Accordingly, I came to the conclusion, as a non-medical man and as a layman charged with responsibility for the administration of health services, that the necessary accommodation was not available, and that even in relation to the classes now being provided for our hospital accommodation was not adequate. Accordingly, I felt that if, in face of that lack of accommodation, added classes and a large number of additional persons were given equal statutory rights in a time of shortage, very undesirable results would follow. I felt that, first of all, a premium would be put on the exercise of influence in every part of the country, that wirepulling would take the place of medical urgency in securing necessary accommodation for persons in need; and in these circumstances I thought it advisable to take steps to ensure that in relation to these health services we would apply them step by step strictly in accordance with arrangements that had been made and accommodation that might then be available.

I then examined the Health Act of 1953 to see whether under the Act I would have power by regulation to provide these services for different people in accordance with the facilities available for them. Might I just refer Senators to a provision in the Act, Section 22 of the Health Act, 1953, which is the section authorising the Minister for Health to make regulations dealing with the services to be provided for the people. Section 22 of that Act, I am advised, means this— that the Minister for Health in making these health regulations can do one of two things; he can either provide on paper everything for everybody, or he can provide nothing for anybody. Accordingly I found that under Section 22 I had to make regulations entitling all of the five classes that I have mentioned to equal rights in relation to health services and institutional and specialist treatment, or in any particular county I could refrain from making any regulations, thereby disentitling those who are now entitled to these services from any such services.

I was further advised that under the section I could not deal with any particular group of persons or any particular class, and that Section 22 impelled me to put the entire Act, so far as the services were concerned, into operation in relation to all these classes.

Accordingly, having examined the position in relation to agreements and arrangements and in relation to the accommodation that might be available and in relation to my powers under the Health Act, I came to the conclusion that it was necessary to ask the Government for authority to bring a legislative proposal before this Parliament. Naturally I can assure Senators, as I assured the Dáil, the decision which the Government came to was not taken hastily or without very grave consideration. In this country in relation to our health services we have had a turbulent history. There has been acrimony, controversy and disputing about health legislation over the past decade. It is not a desirable thing that every few months or every few years new health legislation should be introduced. It means a lack of continuity and a discordance in policy with regard to what is one of the very grave needs of the people. In addition, in relation to this Government I suppose political wisdom might have dictated a policy of sitting down and twiddling thumbs and doing nothing; but that kind of lack of action would not be a responsible course to follow. For those reasons, the Government felt coerced into asking the Dáil to intervene to ensure that, on the operation of the Health Act 1953, those people to whom this State owes a duty—either in accordance with the canons of charity or in accordance with contract—would not suffer. Accordingly, this Bill became necessary.

There is one matter I should mention before I deal with the proposals in the Bill—that of the steps taken by my predecessor in relation to the Health Act. I am not going to discuss matters of policy or anything of that kind, but I would just like to draw the attention of Senators to the fact that when I became Minister for Health unless a Bill of this kind were introduced and passed by the Parliament the Health Act with all its regulations would have come into operation in ten days' time. This position was brought about by the action of the previous Minister, first of all, on March 31st, in making a commencement Order bringing the Act into operation on August 1st. It is not possible for a Minister, when he makes a commencement Order, to get second thoughts the day after and to make another Order in place of the original one. Once an Order has been made bringing an Act into operation, the Minister is functus officio. The Act itself speaks from that time on and by reason of a day being named in the commencement Order the Act comes into operation on that day.

My predecessor made such a commencement Order on the 31st March, as I have said, naming August 1st as the date of operation. In addition, on the following day he appointed the National Health Council. That council was convened. The council had presented to them on last Holy Thursday, 15th April, seven sets of draft regulations upon which their recommendations and views were sought—but they were given a time limit in which to give those recommendations and views to the Minister. The National Health Council considered some of those regulations in the time available to them. It was not possible for them to consider them all. While they were still considering some of them, my predecessor, on the 15th May, made all the regulations law.

Those regulations dealt with a variety of health services. There were seven sets in all. They dealt with the provision of milk for mothers—no question arises with regard to that. They dealt with the provision of treatment for the mentally afflicted—again no question arises there. They dealt with general medical services—no question arises with regard to that. They dealt with various institutional services, and again no question arises. But on two of these sets of regulations—dealing with hospital and specialist services and with nursing and maternity services— serious questions arose as to accommodation and arrangements with other bodies. Nevertheless, my predecessor made those regulations law on the 15th May.

As a result of the general election held three days later, I became Minister for Health on the 2nd June. Accordingly, I was faced with the situation that the Act was coming into operation, that the regulations had been made and that, in regard to the chaos which I felt would result on August 1st no saving power existed except such action as Dáil Éireann and Seanad Éireann might take. Accordingly, this Bill was introduced.

I wish to say again, before I refer to the Bill, that the views which I have expressed as to the necessity for the Bill are not merely my own views. I have not come here to the Seanad in order to make a case. The views which I have expressed are views which have been expressed many times by many people in recent months. It is not possible for me to correlate all the different expressions of opinion that are available with regard to the practicability of providing the services under the Health Act on August 1st. I would refer Senators to the view expressed by the National Health Council as a result of its meeting on the 22nd June. The National Health Council is the advisory body on health matters, created by the Health Acts of 1947 and 1953. Their function is to advise the Minister on all matters relating to the health and welfare of the people. They may tender their advice without being asked to tender it, or they may give their advice in relation to a particular matter submitted to them by the Minister for Health.

This National Health Council was appointed by my predecessor. In its appointment, in the naming of its members, in its constitution or in relation to its powers I had nothing whatsoever to do. When I went to the Department the council was in existence; I knew it merely to be the national body established by the Act to advise me on matters relating to the health of our people.

Accordingly, under the Health Act, I decided in relation to my problem to ask the National Health Council what advice it wished to give me. I met the National Health Council for the first time, and the only time I met that body, on 25th June. I think I mentioned the 22nd June a few minutes ago; the date was 25th June. I addressed that body for two or three minutes—no longer—and explained the problem as I saw it and the difficulties I foresaw in bringing the Act into operation as an entire measure on 1st August. I then left the meeting and subsequently the National Health Council sent me, as a result of that meeting, the following advice:—

"The National Health Council, being particularly concerned for the legal rights of the poorer sections of the community, and also being aware of the uncertain position regarding the insured workers who already enjoy most of the services envisaged by the Health Act, 1953, urge the Minister to take whatever steps are necessary to postpone the repeal of the Public Assistance Act and the operation of Part III, inclusive of Section 23, of the recent Health Act until such time as may be essential to ensure that the proposed extension of the health services be initiated with a reasonable prospect of success."

I think that resolution, coming from a body constituted in the manner I have mentioned, should convince all Senators that the fears I held were well grounded. Naturally, I took the resolution tendered to me by the health council into consideration; I decided, however, not to accept their recommendation to postpone the repeal of the Public Assistance Act or the operation of Part III of the Health Act of 1953. I decided not to accept the advice to postpone the operation of the Health Act for a lot of reasons.

I do not like the Health Act, 1953. I have never liked it. I do not think it was a good way of setting about the provision of better services for our people: I do not make any secret of that. Nevertheless, as a contribution towards ending dispute about health legislation, I was prepared and am prepared to accept what has been done and I am concerned to make what has been done work and operate throughout the country. I sought for some solution which would enable me not to postpone the operation of the Health Act but to apply it in such a way that it would work for the benefit of the people as a whole and for that reason I felt impelled not to go so far as the National Health Council had urged. I came to the conclusion that the best approach to the problem of preventing the hardship and the chaos which would result from a premature attempt to provide services for which the necessary facilities were not available was to take power to regulate these services step by step and to bring in the hospital and specialist services and the maternity and infant services on such a step-by-step basis.

I then had to consider a factual amendment of Section 22 of the Act. That section is the section which governs the making of regulations and which makes no provision for a step-by-step approach to the problem. I considered that the best course was to amend that section to make it possible to provide for the bringing in of a service for a particular group within the wider groups set out in Section 15 in such a way as to apply the services under the Health Act in a rational manner.

The amendment I consider necessary is the legislative proposal now before the House. In relation to the Bill itself, Section 1 and 3 deal with insured persons who are already eligible for services from the Department of Social Welfare by virtue of their insurance and these sections are designed to relieve insured workers from a charge being imposed upon them by the Health Act, 1953; that is a charge of 6/- per day in relation to hospital treatment. Might I interpolate here that, as I have already explained to the Seanad, all insured persons at the moment by reason of their contract and insurance are entitled to hospital services without charge whatsoever. Under the Health Act, 1953, power was given to each health authority, if it so desired, to impose on insured workers a charge of 6/- per day or £2 2s. per week in respect of hospital and other services. Sections 1 and 3 of the present Bill are designed to remove for the time being that power from local authorities and to continue the existing rights of insured workers to free hospital and other services.

I have mentioned that I propose to move step by step after the 1st August with the addition of further groups to the groups for whom the services will be provided on that date. As soon as health authorities have had an opportunity of adjusting themselves to the change over on the 1st August, I propose to discuss with them the additional classes for whom they could provide services and, when I have satisfied myself that the facilities are available, to bring in new groups progressively within the limits laid down in the Act. Even if all the services provided for in the Act were in operation, I still feel that more must be done before we will have achieved what is the aim of everyone in the State who has given the problem serious consideration, that is, first-class health services within the reach of all. Therefore, concurrently with the extension of services under the Health Act, I propose to review the entire position. As a result of that review, I hope that, using existing services as a basis, it will be possible to produce a system which will end for our generation the controversy which, unfortunately, has for so long surrounded health legislation and health services.

Accordingly, I ask the Seanad to deal with this Bill as a sincere effort to make workable a piece of legislation with which I and a great number in this House and in the Dáil do not agree, an effort that is being made as a contribution to ending all dissension, disputes and controversy with regard to health services. But I do not ask the Seanad to accept this Health Bill or the parent Health Act of 1953 as being in any way a final measure in the provision of proper health legislation here. I think it will be possible, with this Health Act of 1953, in accordance with our own traditions, to work out far better services which will provide far better benefits for our people. It is my intention to work out such services.

It is unusual that, at the first meeting of Seanad Éireann, we should have such an important Bill brought before us as this. It is unfortunate from many points of view. We have many new members here who, I am sure, are not very familiar with the very long discussion that has taken place on this matter of public health over a long period and who have not made available to them the debates in the other House on this particular Bill. That being as it is, it might be no harm to remind the House that the Health Act of 1953, which the present Bill before the House now proposes to amend or place in abeyance, was passed through this House last October. One of the sections of that Act was brought into operation by a regulation made by the then Minister in January, 1954.

Having had the Bill passed as an Act of Parliament, the then Minister took immediate steps to do what the new Minister proposes to do, that is, to arrange conferences throughout the country with local authorities. Regional conferences took place, many of which the Minister attended; where he himself did not attend they were attended by officers of his Department. At these conferences the local representatives put forward their point of view. The Act and all it entails was explained to the representatives of the councils at these meetings. We all know the greatest fears our local authorities had in connection with the operation of this Act were not those the Minister has placed before us to-day but were in relation to the cost.

It was suggested by the Parties who opposed the enactment of the Bill from the start that if it became an Act or was put into operation by the health authorities throughout the country the cost would be an intolerable burden on the ratepayers. When these matters were explained at the local conferences it was found that the majority of the representatives there were prepared to do their best, as far as the facilities at their command would enable them, to give full effect to the Act.

A step further was taken by all these local authorities. Every health authority in the country made provision in their estimates last March to find the moneys necessary to give effect to the Health Act. Not alone did the local authorities do this, but the Department of Health in the Book of Estimates presented to the Dáil through the Minister made provision for it as did the Budget of this year. A considerable sum of money was made available so that full effect could be given to the Act as it was passed in October.

I do not wish, at this stage, to go over the many controversies which Health Bills have aroused in the country but to say that when the Health Bill of 1953 was being piloted through the House by the then Minister for Health, Deputy Dr. Ryan, it was opposed vigorously by the largest Opposition Party. It was supported by the Labour Party but not wholeheartedly because the then Labour Party felt that it did not go far enough and their opposition to it at that time was that the provisions of the Bill were not sufficient to enable them to give it the support they would like to give.

When the Bill was enacted certain steps were taken to give effect to it. As the Minister has already pointed out, an Order was made last March providing that particular sections of the Act would come into operation on the 1st August. In the period between the making of the Order and the 1st August a general election was held. A new Government was elected and it was only natural to expect that that Government, composed in the main of the Parties who opposed so vigorously the passage of the Bill, would, as far as possible, prevent its implementation. The Minister of that Government comes before this House to-day and states, through this House to the country, that he does not agree with the Act, that he does not accept it; nevertheless he is prepared to put it into operation, step by step. I would say that is a dishonest approach. If a Minister does not agree with the particular legislation that he has there to operate then he should not introduce a Bill of this kind. He should put before us a new Bill that he himself would stand over and be prepared to put into operation rather than say: "I am taking this but I do not like it. Apart from my intention to put it into operation step by step, I do not propose ever to give effect to it because I do not believe in it."

The Minister in asking the House to accept this Bill suggested that he was acting on the advice of the National Health Council. The National Health Council had a meeting on the 25th June of this year. The meeting was convened at the request of the Minister. The Minister had a discussion with the chairman of the National Health Council and I wish to quote now from a minute of that particular meeting: "The chairman apologised for having to call the meeting so urgently——"

On a point of order. What the Senator is doing has been the subject of protest already in the other House. Under the Health Act of 1953 the proceedings and meetings of the National Health Council are private meetings. I do not think it is desirable that private meetings should be later referred to in public discussion.

I take it the Senator will accept that.

The extracts I am reading here are taken from a document that is on the Table of the House in the Dáil Library.

"The Minister had outlined certain circumstances affecting the operation of the Health Act and these circumstances in his opinion called for an early meeting of the council."

He went on to say:—

"The Labour Party which had supported the Bill had lately agreed, but very reluctantly, that its commencement date must be deferred——"

I do not like, on my first day, to interrupt the Senator, but am I to understand from him that he is quoting from a document which has been laid on the Table of the House and is correctly quoting from it?

May I ask the Chair if it is in order for a Minister to raise a point of order in this House? I understood that was the function of Senator Hayes.

Surely it is no peculiar function of Senator Hayes to raise points of order. The Minister, I understand, has, under the Constitution, the right of audience, and the right of audience would appear to me to include everything.

I still contend that it is not the function of the Minister to raise a point of order.

I should like to support Senator O'Reilly on that. The Minister is not a member of the House, and I do not think he has the right to raise points of order. I should like to have a ruling from the Chair on that.

Before a ruling is given on that, some consideration should be given to the point raised.

A ruling on that matter might be valuable for the future guidance of the House.

But not just at the moment. Senator Hawkins.

The document which I have been quoting from has, as I have said, been laid on the Table of the House since it is in the Library. It was there that I took these extracts from it. If, by any chance, I have not taken them correctly, then, with the permission of the Chair, I can get the document in the Library. The chairman apologised for having called the meeting so urgently and explained that:—

"the Minister had outlined certain circumstances affecting the operation of the Health Act and these circumstances, in his opinion, called for an early meeting of the council."

The chairman was apologising for having called them so early, and then he went on to say that:—

"the Labour Party which had supported the Bill had lately agreed, but very reluctantly, that its commencement date must be deferred to safeguard the interests of the lower income group and insured persons."

That is the advice which the Minister puts before us and is now acting on. The reason given by the Minister this evening for this Bill was that it was in the interests of the lower income group and of insured workers, and pointed out that, if the regulations made by Deputy Dr. Ryan came into effect on the 1st August, they would have five categories of people entitled to benefits under the Health Act. First, there would be that section of our people referred to as the sick poor who were entitled to benefit under the Public Assistance Act of 1939; there were the insured workers, the small trader and the small farmer and the small businessman, the artisan and other working-class people. Then there were the persons whose incomes are under £600 a year, and the farmer with a valuation of under £50. In addition, there were the persons on whom payment for these services might mean an undue hardship. Provision was made that the health authority of a district could come to the assistance of such persons.

The Minister has put forward as an argument for the passing of this Bill that if the regulations made were given effect to, as had been proposed, on the 1st August, there would be such a great rush of people seeking assistance under the Health Act that chaos would be created. Was the Minister serious in making a statement of that kind? Did the Minister mean to suggest that, if certain sections of the Health Act of 1953 were brought into operation on a particular date, more people were going to get sick, that more people were going to seek hospital accommodation or that more children would be born on a particular date from now onwards than had been so over a period of years? The Minister must know as well as I do, that that is not so.

During the last 20 years great advances have been made here as regards the provision of hospital accommodation. I do not wish to detain the House by detailing all that has been done over that period. I would advise members of the House, however, who have not yet made up their minds as to how they are going to vote on this Bill, to read the Dáil report for the 14th July. There they will find tabulated a long list of the hospitals, sanatoria, etc., which have been provided in this country over the last 20 years as well as the extra bed accommodation that has been made available. That is the position, even though it has been suggested by the Minister and by those who opposed the 1953 Health Bill, that practically nothing had been done during those years.

The Minister has suggested that if this Bill is not passed by the House we would have a situation like this arising: that, because we are taking in the small farmer, the tradesmen and those others who are not insured workers or who would not be entitled to hospital or special medical treatment under the Public Assistance Act, we are going to give a priority, as it were, to other classes of persons. I think that if the Minister seriously reconsiders his statement he will see that it is a serious reproach to the members of the medical profession and to those who are in charge of our public health institutions. I am of opinion that what the Minister has suggested is not going to happen. At the present time, it is not a question of whether you have or have not money. The question is that the most urgent and most necessitous cases are being dealt with first.

When the 1953 Bill was going through this House we supported it because of our knowledge of the fact that sections of our people were suffering from severe handicaps. It is true, of course, that large sections of our people were entitled under the Public Assistance Act to medical treatment free of charge. But the fact is that the regulations governing treatment were so strictly interpreted in many counties that small farmers, tradesmen of various kinds and others seeking medical attention either in the county hospitals or elsewhere afterwards found themselves faced with bills for £20, £30, £40 or £50. I am sure there is not a Senator who has not had the experience of people coming to him and pointing out how difficult it would be for them to meet these demands. People who availed of this medical treatment afterwards found the payment of these hospital bills a very serious matter for them. It was because we were anxious to help those people, and believed that prevention is better than cure, that we supported the 1953 Bill. I believe that, if the 1953 Health Act had been allowed to come into operation, after a few weeks we would have a position in which the present hospital accommodation would be found to be adequate. There would not be any overcrowding but instead we would have beds to spare. The question one has to ask is merely this: what is happening to the people who are sick to-day? Is there any person in this country deprived of hospital accommodation, whether rich or poor or in any other category who is ill and requires hospital treatment? Surely there will be no more people seeking hospital accommodation by the passing of this Bill. The Minister almost cries for those people—the sick poor and the insured workers. We are conferring no new benefits on those people because they have these benefits already except that the Minister is taking power under this Bill to take from the insured workers one benefit and to confer another as it were, at the expense of the ratepayers.

Under the 1953 Act, it was provided, as the Minister pointed out, that medical services would be made available to insured workers. It was also provided that where warranted, in the opinion of the local authority, a charge of 6/- a day could be made, but the Minister glided over the fact that provision was made in the 1953 Act to give benefits, not alone to the insured worker himself, but also to his wife. Under this Bill we are now taking away from the insured worker the benefits he would have come into on the 1st August, and we are passing the payment of the 6/- —in other words a sum of £44,000—on to the ratepayers of the country to pay for the services we are now going to give to the insured workers. That is really what the Minister is doing in connection with this Bill.

The Minister stated that he proposed to hold conferences with local authorities throughout the country. As I have already pointed out, these conferences were held by the former Minister for Health, and from these conferences there must be in the Department of Health all the data and all the particulars that would be necessary in order that the present Minister and his officials might now estimate the number of beds required in each public health authority area before he thinks he would be justified in putting into operation the full public Health Act, 1953. If that information is not there, it should not take very long to have it made available.

We are asked now to give our support to this Bill, and the Minister undertakes, as it were, despite his dislike of the 1953 Act, and despite what he has said here this evening and what he has said elsewhere, and despite the opposition of his Party to it, that he is going to give it effect, step by step. We would like to have some idea when he is going to take the first step and when it might be feasible to reach the last step. Surely, as I have already pointed out, the officials of his Department must already have acquired sufficient data to have this information readily made available.

The Minister, right through his speech, both here and in the other House, stated that the full effect cannot be given to the Health Act, 1953, until we have facilities available, which is more or less saying that until such time as we have reached the stage that we have erected sufficient hospital accommodation and provided, not sufficient beds to meet day to day requirements, but we must have vacant beds before we can come to the time when we can give effect to the Act. If we are to relate that to other activities, if the Department of Education approached their problems in the same way as the Minister approaches his in relation to public health; if we were to have no provision made for education until such time as we would have sufficient schools built and until they were all new schools equipped in the most modern way, we could have no teachers and no provision to cater for the children that are there until the time came when we were able to do it in a very up-to-date manner, as seems to be the Minister's idea in connection with the provision of hospitalisation.

When the Act was going through the final reading in this House we had, as a member of the House, Professor Cunningham who took a very keen interest in that particular measure at that time. On the final stage of the Act, Professor Cunningham, with his knowledge of the matters under consideration, said:—

"This Health Bill has been designed for the purpose of extending and improving the medical services in this country. That in itself is, of course, a very laudable object and one that we hope will, in some way, be achieved eventually and one for which we have been hoping for a very long time. A great number of people have been hoping for better medical services. They are really necessary. The people who have been asking for better medical services over a long period of time are of course the medical profession themselves.... I should like to mention again that if you introduce legislation especially in regard to health which affects everybody it should be comprehensive and apply to everybody. In the same way health legislation should not be specifically designed for one section of the people to the exclusion of another section."

What we are doing here this evening is just exactly the opposite of what Senator Cunningham on the final stages of the Health Act disagreed with. He did make serious efforts to have it amended in his way, but those were his words when the Bill was passing through this House. We are passing legislation here to-day and one section of our people is excluded. We are providing for the persons who are under the Public Assistance Act and nobody has any great objection to that. It has been there for quite a number of years and has worked very well, but we are making such provision, and placing an additional charge on the ratepayers of this country to cater for a section, and that section is the insured workers. That I have no doubt was the bait thrown out to the Labour Party to get their support for this particular Bill but we are giving to that section—and they are a very small section in relation to the number of our people who are in need of assistance—something at the expense of others. We can put it this way: you have an insured worker whose income can be anything up to £600. The fact that other members of his family are contributing to the home will not be taken into consideration and he is entitled to all the benefits that this Bill provides free. Side by side with him, we have the small farmer, and when he seeks medical aid the home assistance officer is sent out and investigates to find out how many eggs the hens laid in the last week. It is a very close examination of his means and income and his contribution to the charges placed on him by the public health authority will be based on the report of that public assistance officer. Now, we are placing on tradesmen, small shopkeepers and other people of that type the burden of meeting hospital bills and we are excluding them from benefits, and, as Senator Cunningham said, when he was a member of this House, it is a bad thing to do. We are doing it without a statement from the Minister or any hope held out that in the near future or in the distant future or at any particular date we can hope to bring those people in and give them the same benefits that we are now giving to insured workers and persons coming under the Public Assistance Act.

The Minister made a reference to the fact that in order to bring the Act into operation, the accommodation would need to be available, as well as doctors and nurses to operate it, and made a slighting reference when he said that nothing had been done in any of these directions. I have already pointed out what has been done in the way of providing hospital accommodation. In connection with the provision of the necessary staff to carry out the provisions of the Act, the Medical Association have vigorously opposed the Act— we have seen statements in our daily papers to that effect—but, when the 1953 Bill was passed and became an Act of Parliament, each and every one of us hoped that there would be a new approach, that these people would recognise the fact that this Parliament is supreme and that no group or section outside can hold up or dictate what the National Parliament thinks is the right thing to do, that they would meet the then Minister in a more free atmosphere and be prepared to implement, improving so far as it is possible to do so, the provisions of the Act.

That did not take place, and it did not take place, to my mind, for one reason, that these people felt that the whole matter of public health has become a live political issue and that, if there was a change of Government, we would have the position which we have to-day in which the Act is to be put in abeyance. There are outside this country many of our young people who have qualified in the medical profession and who were looking eagerly forward to the putting into force of the Act, who were looking forward to the day when they could come back here and when their services would be made available in the building up of a real worthy public health service. We have our dispensary doctors; we have our county institutions, and we have our county surgeons. All these people were prepared to give effect to the Act, so far as it lay within their power, and it is a pity the Minister took the action he has taken, because, apart from the withholding of the benefits which would come into operation on 1st August, the introduction of a measure of this kind is an encouragement to other groups, when some matter affecting their personal interests comes forward, to use exactly the same methods as have been used by the groups which have brought about the position we have to-day.

Finally, I should like to hear from the Minister when the review which he has suggested will take place, and whether we will have before the Bill finally passes any indication as to when the first step in the implementation of the Act will be taken. He might also give us some information as to how many beds are necessary in each local authority area and what new approach is going to be made to the Medical Association in order to get them to work this Act. These are very important questions. We on this side do not accept the reasons put forward by the Minister for his failure to implement the Act on 1st August. I believe, as I believed when the Bill was being passed last October, that it could be implemented, that, with a proper approach and with wholehearted cooperation by all concerned, it could be done, but we are now in the position that we are asked to nullify and to put in abeyance the Act which was passed last October.

Although this is a very important Bill, the facts in relation to it are very simple. Listening to Senator Hawkins, I found it very hard to see where in his speech he dealt with the facts of the situation and with the reasons for the Bill, as given by the Minister. There is no good in rambling about who was for the 1953 Act and who was against it, or about the reasons for that Act and against it. The Minister, when he went into office recently, found the 1953 Act there for him to operate it and he gave an assurance to the House—and we ought to accept it —that in good faith he intended to carry out the Act, that he accepted the verdict of the Oireachtas in passing the 1953 Health Bill. I think he made it perfectly clear that the point we are concerned with in passing this Bill to-day is whether it is practicable to carry out that Act and give to all these different categories the medical services which the Bill promises and gives them the right to have. It is merely a question of that and not a question of whether one class of people are more deserving than another. It is a question of what can be given.

The Minister has pointed out—and in doing so has shown that he has gone into the matter very carefully—that the accommodation in this country at the moment simply will not allow people outside the existing categories he mentioned, poor persons and insured people, to receive these health benefits. We all agree with Senator Hawkins that great advances have been made in the provision of hospitals and hospital accommodation, but the Minister has pointed out that, even with all these, they are over 100 per cent. occupied by the existing categories. It is just a practical proposition: can the Health Act be carried out or not? It is not a question of whether it should be carried out, whether it would be nice to carry it out or an idealistic thing to carry it out. The practical proposition before the Minister is: if we do not pass this Bill before 1st August, what will be the state of affairs with all these new categories who will have to get free service presenting themselves for the service? It is as simple as that.

I have been in this House for some few years and I never heard a better presented case than that which we heard from the Minister to-day. Any reasonable person should agree that this Bill is necessary. The Minister made it perfectly clear and plain, and anybody who can go off on sidetracks and argue matters which are really irrelevant to the Bill must either not be listening or not want to understand the reasons for the Bill. The thing is so simple that there is really nothing to be said about it. We have merely to make up our minds as to whether the Minister is right when he tells us that we are not in a position to implement the 1953 Health Act because of the limitations of facilities and personnel available. I suggest that the Minister has made a case which shows that the Bill is perfectly reasonable, and the only course to take in the situation. To use the Minister's own words, an Act should be practical in fact as well as on paper, and he has shown that it is only on paper at present. He has told us that he is determined to work as much of it as possible and he has also said that he will put into operation all the other parts, as and when it is possible to put them into operation.

The Health Bill of 1954, so far as I am concerned, and so far as many other people on this side are concerned, poses only one really important question: When the Bill becomes an Act, will the power it gives the Minister be used to postpone or to abandon the Health Act of 1953? That is the big question which we on this side of the House are worried about and the manner in which the Minister is presenting his case and his refusal to give any definite or reasonable dates or times in regard to postponement has naturally created fear in everybody's mind.

It is a perfectly reasonable thing that, subsequent to a change of Government, a new Minister should take more time to implement existing legislation than the Minister who was responsible for piloting that legislation through the Oireachtas but it is, I submit, quite unreasonable that the Minister should ask us to give him a blank cheque in regard to the future of the Health Act, 1953. Let us not forget that the Health Act, 1953, was passed with one of the largest majorities which any major piece of legislation has enjoyed in the Oireachtas for many years. I personally believe that even to-day, despite the fact that there has been a change of Government, if the Health Act, 1953, were put to a free vote in the Dáil it would still command a substantial majority.

We have had now ten years of controversy in regard to health services. We have had Health Bills of 1945, 1947 and 1953. Let us not forget that the Minister's Party were opposed to every one of these Health Bills and now, after ten years of controversy, the only contribution we have from the Minister's Party is a Bill designed to postpone, we hope, but more likely abandon, the Health Act, 1953, which is in itself a compromise of a much better Act of 1947.

The Minister has pleaded with us to avoid controversy, bitterness, acrimony and dispute. We all want to do that. Therefore, I personally will not go into any of the other political issues involved in this; I shall not make any of the smart quips that can be made, but I would like to do one thing which Senator McGuire has suggested that members on this side of the House have not done, that is, confine myself to the Bill and to the case made by the Minister for the Bill.

The Minister in his speech here to-day gave much the same case for the Bill as he gave when speaking to the Dáil. He commenced by giving us his views in regard to the operation of the health services in this country at present. He dealt in considerable detail with the Public Assistance Act, 1939. In the Dáil—Vol. 146, No. 11, 7th July, col. 1,322—he dealt with the position in Dublin City, and he said:—

"At the moment, there is in Dublin City, as a local authority hospital, only St. Kevin's, and in fact for years the voluntary hospitals in this city have filled the same need as local authority hospitals fill elsewhere."

Further on, in the same column, he went on to say:—

"In Dublin, 1/- in the £ each year in rates is levied to raise a certain sum of money—I have not the exact figure—of something of the order of £120,000. The hospitals——"

meaning the voluntary hospitals——

"——undertake to provide the necessary services for every person who is poor and who is sick on the understanding that, at the end of the year, the sum raised by 1/- in the £ in the rates is divided according to a certain plan among the voluntary hospitals in this city. In that way the necessary provision is made for the public assistance classes in Dublin City."

That, I am afraid, is not a correct interpretation of the position in regard to public assistance services in Dublin City. The Minister omits to say that the Dublin Corporation is not responsible for public assistance services in Dublin City. The Dublin Board of Assistance is responsible for public assistance and for the operation of the services under the Public Assistance Act, 1939, and the position is that as far as public assistance cases are concerned—and by public assistance cases we mean those who avail of the dispensary services in the city—these patients are accommodated, in the vast majority, not by the Dublin voluntary hospitals, but by St. Kevin's Hospital. Under the Public Assistance Act, 1939, the only hospital which has a statutory obligation to admit a public assistance patient is St. Kevin's Hospital. By this I do not mean to state that there are not public assistance patients in considerable numbers in the voluntary hospitals, but what I do state is, taking the case which the Minister has made, it is quite inaccurate to say that the Dublin voluntary hospitals are so overflowing with public assistance patients and social welfare patients that there is no accommodation for any further type of patients in these hospitals.

At present there are over 2,000 beds in St. Kevin's Hospital. The average voluntary hospital in Dublin City would probably accommodate something in the nature of 200 or 300 patients. In other words, St. Kevin's Hospital has a bed complement equal to six or seven or probably more of the Dublin voluntary hospitals put together.

Any dispensary doctor, district medical officer, who operates the public assistance services which the Minister is so concerned about will tell you what is the position in regard to the provision of hospital accommodation for his patients in Dublin City. When the district medical officer comes to send his patient into hospital, what does he say to the patient? He says to the patient: "I can get you a bed in St. Kevin's Hospital immediately but I may not be able to get you a bed in a voluntary hospital for some time." In the old days when you had to say that to a public assistance patient the reply you usually got was: "Ah, doctor, do not send me to the union" but, happily, St. Kevin's has made tremendous progress in the last ten or 15 years and has largely outlived its poor law inheritance.

That is the position we are dealing with in Dublin City, that while there are public assistance patients in the voluntary hospitals, the vast majority of public assistance patients are accommodated in St. Kevin's Hospital.

In regard to the agreement with the Dublin Corporation, the voluntary hospitals have an agreement with the Dublin Corporation in regard to the admission of patients in Dublin City, some of whom may be public assistance patients but the voluntary hospitals have similar agreements with various other local authorities throughout the country. I am dealing with this point because the Minister's case for this Bill is based on the fact that he believes that the voluntary hospitals are so overflowing with public assistance and social welfare patients that there is no further room for the accommodation of any other classes of patients.

Like any other medical person I have had, both as a doctor and a public representative, association with the working of a number of the Dublin voluntary hospitals and I would say from my experience that on the average far less than 50 per cent. of the patients in the Dublin voluntary hospitals are public assistance cases and social welfare beneficiaries. That is a statement I make with all seriousness and, if the Minister is prepared to go over the bed occupancy for the last ten or 15 years of Dublin voluntary hospitals, he will find that the figures in the statement I have made to-day are perfectly true.

That brings me to the all-important point, the point where the Minister's case for the introduction of this Bill breaks down completely. Who are the other 50 per cent. who occupy the beds in our voluntary hospitals in the city? The other 50 per cent. is composed mostly of country patients, of farmers and other persons who do not qualify under the Social Welfare Act for one reason or another, and various other persons who belong to the middle income group. The significance of that is that those persons who are occupying half the beds in our voluntary hospitals at present—farmers and other patients from the country and persons who do not qualify under the Social Welfare Act or under the Public Assistance Act —correspond fairly closely to the two or three groups for whom the Minister claims he is unable to find accommodation under the Health Act of 1953. In other words, you have five groups under the Health Act, 1953—the public assistance class, social welfare beneficiaries, farmers up to £50 valuation, persons whose income is up to £600 a year, and others who, in the opinion of the local authority, are entitled to such accommodation but do not belong to any of these groups. The case on which I am standing is that half the beds in the voluntary hospitals are already occupied by these groups of persons. In other words, I claim that, as far as institutional and specialist services are concerned, the Health Act of 1953 merely makes different and more equitable arrangements for the treatment of these groups.

I think the Minister has put forward a case which I have heard before but it is only one side of the picture and it is a very prejudiced one. I am quite prepared to say that if he examines the position in regard to the bed occupancy of the Dublin voluntary hospitals, he will find that public assistance cases and social welfare cases are in the minority. Let us be clear as to who are the beneficiaries under the Social Welfare Act at present and to what extent they occupy hospital accommodation. The Minister is very concerned about the insured worker. Who is an insured worker so far as hospital accommodation and specialist services are concerned? He is somebody who must have 156 contributions to his credit to begin with but, having 156 contributions, he can only obtain hospital treatment for himself and that for a period of six weeks only. If the Minister examines the number of insured workers in this country, if he goes into the figures and finds out how many are eligible for hospital treatment, if he tries to find out how much hospital accommodation they are entitled to, and get, under the Social Welfare Act, he will find that the benefit which social welfare beneficiaries get in the way of hospital accommodation and treatment is not very great. That is the big point. What I have done in dealing exclusively with the Minister's case is another way of saying what my colleague who preceded me, Senator Hawkins, has said.

All the opponents of health services say the same thing: "We cannot extend health services; we cannot give increased facilities because, if we did, we would not have room for the extra cases that would come along." That does not make sense; either people need treatment at the moment and they are not getting it, or if the extra facilities are provided they are going to be treated when they are not sick, which is ridiculous.

The Minister has made the same case in regard to the mother and infant services. He pleads inadequate accommodation. In his speech in the Dáil, he suggested that there should be a bed for every birth in the city. I should like to ask the Minister is there any one country in Europe, or any one city in Europe, which has a bed for every birth? But perhaps the Minister has not had time to examine how successful the domiciliary midwifery service has been under the national health scheme in England. Maternity is not a disease. I do not think it is necessary or desirable that every child should be born in a hospital. I believe that, not only in so far as maternity is concerned but in so far as many health services are concerned, we must as far as possible try to bring services to the patient rather than aim at institution-alising the patient. By that I mean, in regard to child welfare and many other schemes, it is desirable that we should try to avoid as much as we can, services which would necessitate hospital treatment for patients who could be dealt with at home, that we should endeavour to bring services to the people rather than to institutionalise cases.

There is one thing that rather amuses me in view of the case put forward by the Minister in regard to inadequate accommodation. When the Health Act of 1953 was before the Dáil, there was one part in regard to the implementation of which the Fianna Fáil Party, the Labour Party and everybody else who supported it, were in agreement that facilities were inadequate and that was the section in regard to rehabilitation. It is Part V, Section 50 of the Act. We were all agreed that it would be a long time before that section should be put into operation because the facilities were totally inadequate, but now the Minister comes before us and tells us that that is the section he is prepared to put into operation.

I did not refer to it.

You said you were prepared to put it into operation.

I did not refer to it to-day.

You referred to it in your Dáil speech.

The allowances will be paid. You do not need a hospital to pay allowances.

The Minister is worried about inadequate accommodation in regard to hospitals and institutional services but the one part, in regard to which we were all agreed that the facilities were completely inadequate, he is prepared to come along and put into operation.

Keeping again strictly to the Minister's case, his argument is based on the fact that there has not been sufficient consultation and discussion with various bodies. I completely agree that there has not been sufficient consultation. There is no doubt about that. We all realise that but the Minister is blaming the wrong person when he blames Dr. Ryan. Remember, as far as his predecessor was concerned, he was in the position that the medical profession, the I.M.A., had said they were not going to work the Act, that they were not going to have anything to do with it. How could you possibly negotiate with a person who is not prepared to have anything to do with you or with your legislation? We must be fair in our discussions if we are going to get anywhere in regard to this health legislation. There is blame on all sides and it is a difficult problem, particularly for doctors, but it is grossly unfair for the Minister to try to take advantage of his predecessor's position, a man who was unable to get negotiation and consultation because of the opposition which there was to the Act, and to blame him entirely for it. I believe that if the Minister had come here to the House and given a reasonable definite period for the postponement of these provisions in the Act, there would not have been any difficulty about this Bill.

We all know that it is going to be difficult to operate the Act but to come here and to ask us to give him power to postpone or abandon the Act, in view of the fact that the Act has very substantial support in this House is, for many reasons, a very serious thing. I think the Minister should have been able to give us some indication. Maybe Deputy Dr. Ryan was wrong to say the 1st August, 1954, but cannot the Minister give us the date, let it be 1955 or 1956? Could he not give us some definite date like that?

As I said at the outset of my speech, I fear that this is the end of the Act of 1953. In the closing words of the Minister's speech, where he predicted that we would be able to have probably much better services than there were in the Act of 1953, I clearly see that in a short time another Bill will come before the Oireachtas which will certainly not be as good as the Act of 1953.

I would like formally to congratulate the Minister on his appointment and on his first appearance before us. He comes here with his offspring, which is an adopted child. I think it will be an interesting child as it grows up. I hope it will have the best qualities of its distintinguished parents. From what has been said in the House, I think we ought to feel reassured in our minds that the child will be looked after and not let die on the door-step.

I find it hard to believe that this Health Act would be let perish quietly. I do not think any Minister would dare do a thing like that in view of the hopes of the country that are set on this Act. If the child were allowed to die on the door-step its ghost would haunt the Government.

If it might reassure some people, I think the Minister might this afternoon inform us whether he is prepared to go on with the Act in respect of which so much sweat, blood and tears was shed by many of us for the past ten years. Many arguments might be developed in favour of the action of the present Minister, but what seems to me to be the strongest argument is the one based on the decision of the National Health Council. We had a heated time about a year ago in persuading the people then concerned with the framing of the Bill to have a National Health Council. They naturally would not bind themselves to agree with all the findings of that council, but they promised that they would listen to the advice of the council. Having got the council appointed, surely we cannot turn round and blame the Minister for having acted on the recommendation of the council? The council has advised the Minister that the present is not the time fully to implement this Bill.

To me, biased as a teacher of medical students and biased in my view on health, this Health Act would really be better called an ill-health Act.

We have a fire service. The object of the fire service is to put out fires and not to warm the houses, and the object of a Health Act should be to put down ill-health and not encourage it. Personally, I would stress the prevention side, and I hope that in the working of this Act the prevention aspect will be developed far more; housing, nutrition and such like things. At the moment the interest seems to be largely on the ill-health side of the Act. It should go much further than protection against ill-health. The methods of getting rid of ill-health by medical services and their various ramifications and extensions brings me to the carefully presented remarks of my friend Senator ffrench-O'Carroll on this subject of hospital accommodation. Surely this is a question of mathematics. You have certain buildings. You can build at a certain rate. You have certain accommodation, but the X in the equation is what accommodation will be required when the Act comes into full operation.

At the present we have in our country the new poor and the new rich. I wonder if we are not going to have also the new sick under this Act. Senator ffrench-O'Carroll says that if people rushed in to receive services offered them under the Act the indications were that they should be receiving treatment at present or that there was nothing wrong with them. I believe this is unsound reasoning. Things are changing, and one thing that is changing is the use of the home remedies, the family medicine cupboard.

Many of my friends come from generations of large families. There was a long tradition of home treatment and home cures for minor diseases. With the change that has come over the family life people do not tend to treat and cure themselves in the same way as before. I am not arguing against the need for doctors, God forbid, nor am I arguing against the use of proper treatment, but I believe that for minor ailments and maladies people should not rush to avail themselves of free State medical service. That happened in Great Britain, and a ceiling has had to be put on medical expenditure, a ceiling that was a pretty big sum, £400,000,000 a year. Here, I think, the new sick will be recruited partly from the people who will avail themselves of these free treatments instead of looking after themselves and going to bed, taking ordinary simple remedies or giving up something they are doing. We have also to count on the fact that the benefits of this Christian and noble Act will be extended to the middle income class—the people whose income is under £600 a year. It is extraordinarily hard to predict how these people will behave with regard to health services. That is an X in the equation.

Senator ffrench-O'Carroll may be right in saying that there will be no great increase in the invalid population as a result of the coming into being of the Act. If that is so, I should be pleased and comforted but I would be greatly surprised. By increasing the number of things you get for nothing the more people will seek to get things for nothing. The general trend and tendency to-day is to be treated by the health service. The question I ask the Minister is whether he will tell us if he will take certain steps. If he is going to go forward with the Act, how is he going to decide the requirements of the hospitals when the Act comes into operation? Is he going to rely largely on the decisions of the local authorities? How are the local authorities going to know? Is there not the possibility that when one local authority agrees to operate this Act the next local authority will be forced to come in and will have to convince the Minister that it is entitled to come in? How far will the Minister have to guard against local authorities claiming sanction to operate the Act without being quite sure that they can do so? I feel that the Minister should give us an idea as to what his standards are of the capacity of operating the Act. One can do two things. One can go straight ahead quickly and say: "Things will work out. The overcrowding will not be so bad." Or one can go very slowly indeed. I imagine the Minister will take the intermediate course but I should like to know exactly what compass he will use in steering his ship. The other and the ominous thing—the matter that we raised here last year in these discussions—is the question of paying the piper. Have we any idea of what this scheme will cost? There is no limit to what health can cost. Out-patients' services will increase.

Senator ffrench-O'Carroll did not refer to the out patients capacity in the voluntary hospitals but I think it will be enormously taxed by some of the new sick. The departmental services —the radiography, the clinical laboratory facilities and so forth will be extremely expensive. Would it be abandoning the counsels of discretion to ask the Minister to give us an idea of what sort of ceiling he thinks he will operate, because if it will be fairly high I should like to get nutrition, and other factors which I regard as equally important, included.

However we may regard it, this is an historic occasion. Let us approach the fruition of an event which has been very near our hearts for a very long time, but for goodness sake let us proceed slowly.

I was rather surprised to hear Senator ffrench-O'Carroll state that this Bill means the postponement and the abandonment of the 1953 Health Act. I hope that, in his reply, the Minister will effectively answer that statement. The fact that Senator ffrench-O'Carroll is a doctor makes it interesting to listen to what he has to say on the subject of health. He said that there has not been sufficient consultation. I noticed that he did not deal with the important points made by the Minister this afternoon. No reasonable person could take exception to the Minister's statements. It is a question of doing the best that can be done for the people of the country. I should like to emphasise that no group, no Party and no body of persons in this country has the monopoly of sympathy for the sick and the poor. We are all interested in doing the best we can for every person and to try to convey the idea that some body or some group of persons has not as sympathetic an approach to the question of the health of our people as another is not a proper attitude to a Bill of this nature.

I was struck by the difference between the reasoned speech of the Minister and that made by Senator ffrench O'Carroll. The Minister mentioned five classes of persons who were to have equal rights, under Section 15 of the Health Act of 1953, from the 1st August next. I do not think it is fair to put the sick poor, the insured persons and those people who are really in need of treatment and on whom there would be undue hardship if they had to pay for it, in the same category as farmers with a valuation up to £50 or as persons in an income group up to £600, unless we are able to give the services we want to give in this Act. The Minister said that the services of doctors and specialists should be available, and then he went on to say that there was no agreement or arrangement with other bodies. I can assure the Minister and everybody else that, so far as the Labour Party is concerned, we will not see this Health Act postponed indefinitely or abandoned.

Hear, hear!

In my view, we are entitled to be told what big difficulty there is in getting agreement between the doctors and the Minister. Is it a question of financial consideration? Is it a question of any ethical matters? The Minister said that the services of doctors and specialists were not available and that there was no arrangement with other bodies: I take it these are the doctors and the specialists. A number of people who become ill do not want to go to hospital if they have any decent accommodation at home. Is it not possible to have some knowledge of the attitude of the doctors and specialists if they are asked to go to the homes of such people, when we need not have this great overcrowding of the hospitals?

The Labour Party are reluctantly agreeing to give the Minister a chance to do the things he wants to do. Senator ffrench-O'Carroll wished to convey that this Bill means the postponement or the abandonment of the 1953 Health Act. The Minister will hear something from us if that is his intention. I can assure Senator ffrench-O'Carroll that we will be with him if his doubts should prove to be well-founded.

I agree with Senator Fearon that, in approaching the question of health services, we should keep in mind the question of nutrition. In my opinion, malnutrition is responsible for quite a large amount of ill-health. We want a different approach to the question of the health of the people. For years I have been saying that lack of nourishment, bad housing and bad social conditions have very serious ill-effects on the health of our people. I avail of this opportunity to appeal to the Minister to bear in mind the economic aspects as well as the health aspects when dealing with a Bill of this nature.

As a new member of this Seanad, I should normally hesitate to speak on the very first occasion that I have the honour to be present in this House. I must ask, therefore, to be forgiven for intervening after what, in relation even to the length of time I have been a member of this House, is rather a short period. My excuse for doing so is that the Bill, however short, which we are discussing here this afternoon, deals with health services and seems to me to enshrine a principle which is so important that I should like to make some observations upon it.

I may say I was very surprised at the Government's eleventh hour decision to delay the implementation of certain provisions of the 1953 Health Act. I should like to say at the outset that I do not question the good faith of the Minister. I think he put his case to us here, as previously in the Dáil, extremely clearly and with a good deal of cogency. I do not question the good faith of the Government. I think they are as eager as any of us to see that our health services shall be made worthy of this country. Speaking in the Dáil, the Minister described some of the things which our State and our society at present tolerate, however reluctantly, as appalling. Therefore, I do not question the good faith of this Government—nor, indeed, of the previous Government—when they say they want to improve medical services as quickly as possible. The doubt arises in my mind, however, as to whether the best way to set about improving these services is now to postpone what seemed to be inevitable a few weeks ago.

This Bill asks us, in effect, to postpone indefinitely—I say "indefinitely" advisedly, because we are not given a time limit—the implementation of certain sections of the 1953 Health Act. I was glad to hear Senator Hickey speak so strongly just now on the matter from the Labour Party's point of view because it seemed to me that in the Dáil there was a certain lack of decision perhaps, or lack of coordination, in the policy as expressed on behalf of the Labour Party by Deputy Larkin, amongst others. Deputy Larkin, in column 1373 of this report of the Dáil Debate, Volume 146, said that such and such a thing "is important, because I doubt if the Labour Party or myself are prepared to commit ourselves to an indefinite postponement." The phrasing rather disturbs me—"I doubt". Deputy Larkin is, of course, a responsible Deputy of the Labour Party, but he is not quite sure whether or not either he or the Labour Party are prepared to commit themselves to what he calls an indefinite postponement.

I do not think that that is a fair interpretation.

I find that disturbing, and I think it is a point upon which Senator Hickey himself has spoken here more clearly. He has said quite definitely that he, for one, as a member of the Labour Party, does not intend to tolerate anything like an indefinite postponement.

Deputy Larkin earlier, at column 1364, said:

"As far as I and, I think, the Labour Party are concerned, our attitude is—I am speaking possibly for myself at the moment but I have no doubt the Labour Party adopt the same attitude—that even at this moment if we could be convinced that there are not good and sufficient reasons why there should be any postponement of the Act, we will vote against the present Bill..."

The reason I quote that is that again I am slightly perturbed at the view of a responsible Labour Deputy saying: "As far as I and the Labour Party are concerned our attitude is...", insisting then: "I am speaking possibly for myself at the moment but I have no doubt the Labour Party," and so on, almost as if the Labour Party had not in fact made up its mind. I am glad to note that Senator Hickey has made up his mind as to this question of an indefinite postponement.

We have the Minister's word that he does not intend an indefinite postponement. He has told us that he does not think the Act is a perfect one but he intends to implement it, and went so far as to say that he intends to see that it is fully implemented. We have his word for that, but no date. Senator Dr. ffrench-O'Carroll has already put that point, and other speakers before him—no date. I think it would be unreasonable to ask the Minister to give a precise date, but I do not think it is unreasonable to ask him to give an approximate date, or to suggest the duration of time during which he would hope to be able to take action to implement the Act, as he says he intends to do. I would put it to him, therefore, that surely he must have some idea of how long it is going to take. He has decided that it must be fully implemented and he has decided that he cannot do it immediately because of certain difficulties. I would ask if he would be able to say something in the way of giving us an idea of how long this is going to take.

We have again, as I say, the Minister's word that he and the Government are in favour of full implementation, and I accept his word on that. I am sure he is telling the truth, but when is it going to be fully implemented? Is it going to be in three months, in six months, in a year? Would such a long delay as that be really necessary? His own Department officials told Deputy Dr. Ryan that they thought the Act could not be implemented before July 1st, and Deputy Dr. Ryan decided to allow a reasonable margin that would take the date to August 1st. The Minister's Department officials must have had some notion in their mind. I am sure that they are competent judges and judge pretty accurately as to how soon a thing is possible or not. They must have had some precise figures, some ideas and facts, in their minds when they said July 1st. Consequently, I do not think it would be unreasonable for us here in the Seanad to ask the Minister to give us at least an approximate idea, in consultation, of course, with his Department and his officials, as to how long it is going to take to implement these most important sections of the Act.

As I say, all of us here, I think, will take the Minister's word and his good faith for granted, but I cannot help remembering an example during the last Coalition Government. It was said quite early on, almost immediately after the coming into office of that last Coalition Government, that the Government itself and the Minister for Justice were very strongly in favour of a Legal Adoption Act, but although three years went by, in spite of their being strongly in favour of it, in fact no Legal Adoption Act was produced by that Coalition Government. Therefore, I may be forgiven, perhaps, for expressing this element of doubt while not questioning the good faith of the Minister in the matter. I would put the question to him, therefore, arising out of what I have just said, what further delay would he consider reasonable in relation to the implementation of these particular sections of the Act?

The Minister in putting his case before both Houses has put forward virtually the same grounds. The grounds on which he requested more time I would, perhaps, summarise, and say something about each of them. The first is limited bed accommodation at the moment. The second is incomplete arrangements with voluntary hospital doctors on the question of fees and further matters. The third is a point which he did not make in this House but which he made twice in the Dáil. I quote him from column 1345. He said that "something may have to be done to meet any reasonable ethical objections which may exist." I would like to make some comment on these in the order in which I have quoted them.

First of all is the question of bed accommodation. The Minister has told us that he is genuinely convinced that there will be chaos if we go ahead and implement the Act now. I am inclined to agree with other speakers, Senator Dr. ffrench O'Carroll notably, that there will not be brought about this chaos by the implementation on August 1st of this Act. I do not believe that the pattern of application for hospital accommodation and so on will change so abruptly as to produce chaos. I believe that with goodwill— and I think there is goodwill aplenty in the voluntary hospitals among the boards, the staffs, and nurses and so on—the difficulties will be got over. Deputy McQuillan, speaking in the Dáil about the possibility of implementing the Act in so far as Roscommon is concerned, said that he did not believe that everything would be perfect in the first few months but the difficulties could be surmounted. I believe that what he said in relation to Roscommon is true for Dublin and for the rest of the country. I would say this, that we will not really realise the exact size and nature of the problem until we try. There has been a lot of fencing about how many beds will be necessary and what treatment and so on but, in fact, the size and nature of the problem will not be realised until we try. Therefore, I am in favour of the empiric approach. There will be errors. There were errors in the British scheme, which is functioning now and functioning well. The only way to do it in my opinion is by trial and error. I do not believe the errors will be big, and I believe the trial will be fruitful. With all respect to the Minister, no amount of further regional conferences will replace practical experience. The Minister, talking in the Dáil, made the following statement, as reported at column 1332 of Volume 146:—

"The Dublin Board of Assistance said it had not been possible to make complete and detailed arrangements for the operation of any one of the services because they did not know what they would be required to operate."

I suggest that in no part of the country will you get complete and detailed arrangements before the Act is implemented. No amount of guessing would enable you to have complete and detailed arrangements made.

There is a fear expressed both by the Minister and by the National Health Council that the rights and the priorities of the sick poor will be endangered for one or two reasons. I do not believe that that is so. I do not believe there will be all that rush by the slightly less poor, shall we call them, for beds in our county hospitals and so on. Those who do rush to the public wards, those who choose so to do—the near poor, the white-collared worker, the under-privileged, poorly paid worker, small farmers and others —will do so because at present on what they are earning they cannot afford to put aside what private hospitalisation and medical treatment costs. Those are the people who will avail of these services—and those are the people who will be quite genuinely deprived of something they had a right to hope for on August 1st. It is said that such people find a way of getting treatment at present. I do not think that is so; I think it is a false statement and a fallacy. I think the truth is that they do not find a way until it is too late. They put off getting a doctor, they put off going into hospital or nursing home, they put off undergoing an operation, because private medicine for that category of person is too dear.

Of course, if they have the somewhat dubious good fortune to have tuberculosis, then—thanks to the drive and initiative of another young Minister for Health, Dr. Noël Browne—their treatment and their priority will depend not on their wealth or their poverty but quite simply on their need—in other words, on the gravity of their illness. That kind of priority appeals to me more than the priority which says that the very poor must be served first or that those who can pay must be served first. The best priority to establish, if there were to be a shortage, would be the priority established by the doctors themselves for their patients on the basis of the greatest medical need. We all know there are some patients who do not immediately have to go into hospital and there are others who do. I suggest that the doctors are men of goodwill and commonsense and that it would be their practice inevitably to establish the priority on that basis. It would be a far better type of priority than that based on poverty alone or, for that matter, on capacity to pay.

The second point on which the Minister based his case, if I understood him correctly, was that arrangements with voluntary hospitals and with the doctors, doctors' organisations and individual doctors, and all kinds of questions including fees, had not yet been completed. I realise that the question of the doctors' fees is both an important one and a difficult one; but it is even more difficult to tackle in vacuo, to think of a theoretical, accurate and just, equitable fee for a doctor in a theoretical case. It is quite obvious to all of us here, I am sure, that to work well the scheme must pay the doctors well. They are doing important and responsible jobs, and they have had their training, which is expensive. For example, if we want a better educational system—which I hope some day we will have—we must decide to pay the teachers better. Therefore, I am with the doctors in asking that they be remunerated adequately in relation to the highly skilful and highly important work they do. They must be paid well—but how much? Who is to decide? Is it the Minister, the Dáil or the Seanad, or the local authorities? How is the decision to be made? The former Minister, Deputy Dr. Ryan, sent out proposals, draft regulations, to the voluntary hospitals in which there was a tentative basis for discussion and in which it seemed to most of us who know something about hospitals that the amount he was offering for distribution—I think it was 10 per cent. on the £5 12s. 6d. which was to be collected on behalf of those patients paid for by the local authority and which was to be put in the central pool—was quite inadequate, grossly inadequate. It was inadequate as a percentage and even more inadequate by the fact that the basic £5 12s. 6d. could not in any circumstances be expected to pay the full cost of hospitalisation.

Recognising, then, that that tentative offer will have to be increased, the question still remains as to how much a doctor is worth. If we ask the doctors themselves they will be inclined, out of modesty, to set their worth at too low a figure. I do not think it would be fair to ask them to assess their own merits. I think that, as a community, we have to decide that for them. How much is an engineer worth; how much is a teacher, an architect or a doctor worth? Again, the empirical approach is the one that seems to me to offer the most hope. You must make a decision. The original decision will almost certainly have to be adjusted, but you cannot adjust anything until you have taken the first step. Therefore, I see again the possibility, once we implement this Act, of arranging an adjustment after seeing how it works out. That is how it happened in Britain and the arrangements and adjustments have not proved unsatisfactory to the vast majority of doctors in Britain to-day, including many Irish doctors.

All kinds of factors enter into consideration when you try to assess the salary or fees that ought to be paid to anybody, any skilled or unskilled worker. There is the question of competition, the market position, the cost of training and so on. I suggest that all these things would work themselves out in practice and, I personally hope, not to the detriment of the doctors— for whom I have the highest respect and to whom I may say I owe a very considerable personal debt in relation to health. Therefore, I regard this as something which will work itself out by trial and error. No one to-day wants to exploit the doctors by underpaying them and they themselves, I am sure, have no desire to become a new aristocracy as a result of their being overpaid. Adjustment and arrangement—and, if necessary, as I am almost certain it will be necessary, readjustment—the empirical approach, trying it out, should be the course adopted.

I would suggest that as a second best, at the very least, on these points one and two—bed accommodation and arrangements with the hospitals and doctors on questions of fees and so on —that the suggestion made in the Dáil by Deputy McQuillan be very carefully considered again by the Minister. I have the Deputy's own words here, as reported at column 1401:

I want to say to the Minister that the health authority in Roscommon is prepared to operate this on the date that has been laid down. We are not for a moment suggesting that it is going to work perfectly in the first month or two months. Nothing works perfectly in the beginning, but our local authority is prepared to bring the provisions of this Act into force.

I would suggest very strongly to the Minister that he reconsider his decision —he has the power already, as he told the Dáil—to wait until the Act can be implemented for the whole country before implementing it in those places where the local authority is prepared to go ahead. I would deplore the attitude which suggests that the Act cannot be fully implemented anywhere until it can be fully implemented everywhere. Quite on the contrary, I would say that that is a wrong approach. If we implement it now where it is possible to do so at once, we will have pilot counties and pilot towns as a guidance for the future.

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

At the adjournment I was making the point in relation to the first two of the three main points in the Minister's case for more time—that is, the question of arrangement with the voluntary hospitals and the question of bed accommodation—that it would be valuable to adopt the suggestion put forward by Deputy McQuillan in the Dáil to try out the scheme, and I put this as a second-best solution, in those places where the local authorities are already prepared to implement it; it would provide very valuable experience to implement the scheme in places where one could see on a small scale whether the objections that the Minister foresees and the difficulties he anticipates are of the size and nature he fears.

I am aware that the Minister's answer in the Dáil to that particular suggestion was that he did not like a scheme that suffered from a lack of uniformity in the treatment of the sick and the provision of health services as between county and county. I do not think that is a very valid objection in this transition period. Already there is a lack of uniformity to some extent in relation to the medical treatment available in different parts of the country as between Dublin, for instance, and other parts of the country. Quite apart from that, it seems to me that this very lack of uniformity might be most instructive and informative in showing the Minister precisely what errors not to make in the implementation of a large-scale scheme and in showing the devices and methods which might be adopted more widely. Such pilot counties and towns and cities could serve a very useful purpose in relation to the health services and, because of that, I suggest to the Minister that he should reconsider his view.

Where local authorities are ready and willing to implement the particular sections of the Health Act now, there is no merit in delaying. The Minister has stated in the Dáil that he has in fact power to implement those sections in any part of the country. The Minister also suggested in the Dáil, if I understand him aright, that the prime responsibility devolves upon him and he did not want the local authority, as it were, to take the blame, or want, himself, to shelter behind a local authority taking on more than it could cope with. Again, it seems to me that local autonomy, at any rate for a time, would be valuable and could be, I believe, instructive.

I come now to the third point in the Minister's case—a point he did not in fact make here but which he made twice in the other House. He said that "something may have to be done to meet any reasonable ethical objections which may exist," and he mentioned this possibility again in column 1342, Volume 146 of the Official Debates of 7th July, 1954:—

"It may be that, later on, some of the ethical objections to the Health Act may have to be dealt with by me. To what extent, I do not know."

I am afraid I find that statement in the Dáil disturbing and puzzling. Perhaps I am wrong in thinking that it is disturbing, but it is certainly puzzling. My sense of puzzlement is not diminished when I discover that the Minister has made no mention of this to this House, because here too the Minister is asking for very wide powers, asking, as one of the previous speakers said, for a blank cheque. He is asking for a blank cheque not merely in relation to the other matters, but also, as he says: "It may be that, later on, some of the ethical objections to the Health Act may have to be dealt with by me"—by the Minister. "To what extent," he says, "I do not know".

This, of course, may have some very clear explanation and it is in order to ask for such an explanation that I mention it here. I would like to ask him, quite simply, what does he mean by there being a possibility later on of his having, himself, to meet certain ethical objections? He was asked that in the Dáil, but he did not vouchsafe an explanation. He did not mention it here at all, but it seems to me to be of importance. What has he in mind? Does he mean objections on the grounds of Catholic social teaching? If so, what sort of objections does he still anticipate? I think we have a right to know at this juncture before giving him these powers. How would he propose to deal with any such objections if they still subsist?

I would suggest to the Minister and to the House that in this matter, if there is a real argument in it at all, there is no need for secrecy, and that he should honour the House by taking it as fully as he can into his confidence on the point. I do not myself anticipate that there could be any such objections now to the Act as it stands. This Act in its present form was passed by Fianna Fáil, the Labour Party, Clann na Poblachta, Clann na Talmhan and by many Independents. I think I am right in saying that the Fine Gael Party alone, with perhaps one or two Independents, voted against it originally. Therefore, the question naturally arises, when we hear this phrase "later ethical objections to be made," what ethical objections can remain? It cannot be the question of a means test—that was one of the objections earlier on in these discussions—because that has been dealt with. It seems to me it cannot be, in relation to the mother and child scheme, the objection that was alluded to in earlier controversies that in any State mother and child scheme there might be non-Catholic doctors advising Catholic mothers about motherhood, and so on. When we remember the present position where, with regard to maternity treatment throughout the country, Protestant, Catholic and Jewish doctors alike give service to the patients in the same hospital, I cannot believe this is the kind of "ethical" consideration that the Minister has in mind.

The final point under that heading of possible "ethical objections" might perhaps have something to do with what is often referred to as "State interference", a State medical scheme, and so on, State interference with the private life of the individual. That sort of argument has always seemed to me a most unreal one. The State is too easily, in public life in this country, turned into a kind of bogey to frighten adult children, or childish adults. The State machinery, properly understood and actively and democratically controlled, as I trust it always will be in this country, by Dáil, Seanad and local authorities, is merely the organised strength of the community placed at the service of the individual, and, in my opinion, properly so used, so far from enslaving the individual as is sometimes suggested, it protects and liberates the individual—man or woman. I cannot feel therefore that further time ought to or could fruitfully be spent on this type of "ethical objection". I do confess, however, that I am somewhat disturbed by the Minister's phrase, by his failure to amplify it, and by his hinted intention of having to deal with this himself at some later date and in some way which as yet he himself cannot state precisely.

I have spoken longer than I intended to but it is for these various reasons that I find unconvincing the Minister's case for further delay now. I do believe that the immediate implementation of the Act would produce difficulties, but the system of trial and error would enable local authorities, doctors, health authorities in general and the Minister's Department to solve these difficulties.

In concluding, I consequently urge the Minister even though he does get a majority for his Bill, to put the Act —the full implementation of which he tells us the Government favours—to put it immediately into effect, wherever local authorities have already indicated their preparedness to do so, and to put it into effect throughout the whole country at the very earliest possible moment.

This Bill relates only to three of the 72 sections of the Health Act of 1953. It proposes to defer until some date, not yet fixed, subsequent to the 1st August, the operation of Sections 15, 22 and 25 of that Act. Section 15 of the Act relates to the provision of institutional and specialist services for certain defined classes of the community.

The idea has got abroad that these services are being provided free under the Health Act, but this is entirely misleading. For many beneficiaries, Section 15 of the Health Act imposes a new charge which does not at present exist. This charge is equivalent to £2 2s. per week in the case of institutional treatment. It is not related exclusively to the income of the beneficiary; it is determined in relation to family income, which is an entirely new and objectionable feature wholly foreign to our existing legislation.

The Labour Party supported the Health Act of 1953 because, in many respects, it showed the way to improved health services. We never considered it the last word in this type of legislation, but it was the best that we could get from the then Government. We never believed it was an ideal scheme, and we never committed ourselves to the doctrine that institutional and specialist treatment, which should be a matter of national concern, should be based on the ability of the beneficiary to pay the bill.

What is proposed in the present Bill is that the operation of this part of the Act should be deferred until arrangements are made with the professions and the institutional authorities to provide the services which the Act guarantees. The Minister has made the case that hospital accommodation is not available for all who would be entitled to hospital treatment if Section 15 of the Act were to become operative on the 1st August. This assertion has not been convincingly contradicted by anyone. On the contrary, several opponents of the present Bill have admitted that accommodation will not be available, but, notwithstanding this very serious defect, they claim that the scheme should come into force and then wait and see what happens. If this view were accepted, what clearly would happen is that the poor, or those unable to make a cash contribution towards the cost of their hospital treatment, would be stranded and left by the wayside, while those who had longer purses would be given priority in the queue.

The position in regard to specialist treatment is even worse. It is idle to promise large sections of the community that they are going to get free, or almost free, specialist treatment before any arrangement has been made with the specialists to provide it. The medical profession may have been unreasonable in their attitude towards legislation of this kind, and it may be that they are still unreasonable; but they are free individuals entitled to work or to refuse to work just as a docker is entitled to work or to refuse to work as he thinks fit. Every enlightened community provides machinery by which the services of dockers can be adjusted to the needs of the community. It is unthinkable that the resources of our civilisation are inadequate to adjust the claims of the medical profession to the interests of the community. We must hope, therefore, that the interval for negotiation which the present Bill provides will be availed of by all the parties to the contract to enable the Act of 1953 to be implemented in the spirit in which it was enacted by the Oireachtas.

Our attitude towards the Health Act of 1953 has not altered. We expect that the opportunity for bringing it into force, defective though it is, will be availed of without unnecessary delay. In the light of what I have said, we are supporting this Bill. I think it would be wrong to reject it in view of the assurances that the ground has not been prepared for the bringing into operation of the sections of the 1953 Act to which I have made reference.

I am supporting this Bill for the very good reasons which have been given by the Minister as well as from my own personal knowledge of my own county of Roscommon. I have been a member of the Roscommon County Council for 11 years. I think there is no county which has done as much as Roscommon during those years in the way of providing hospitals and medical treatment for the community. I challenge contradiction on that. I represent, and I speak for, mixed groups of people in that county. These include small shopkeepers, small farmers, farm labourers and tradesmen. I can safely say that not one individual in the County Roscommon has been refused medical treatment during those years, irrespective of his or her income. I am referring now to groups outside of the groups the Minister was speaking of. Even as regards those with high valuations who, for some reason or another were in difficult circumstances, I know of no case where a person in that class has been refused medical treatment.

I know for a fact that the Roscommon County Council and the ratepayers of the county do not begrudge anything that is intended for the welfare of the sick poor or for anybody who is sick and is deserving of treatment. That has been the position and is the position at the present time. As regards this new Bill, if the Minister doubts my statements, I would ask him to come down to Roscommon to meet the county council and the ratepayers. If he does, he will find that my statements are substantially true. The former Minister, when he visited Sligo and Roscommon, found the position to be just the same. The only thing that troubled the Roscommon ratepayers and the county council— the only worry they had—was as to what would be the cost. The former Minister was unable to give a definite figure and that has never been clarified. If the Minister is coming to Roscommon, I suggest to him that he would be well advised to be able to give some estimate of the probable cost. It is one of the things which the people of Roscommon look forward to with interest. These are the reasons why I am supporting this Bill, and they are my own personal reasons.

I know of people requiring admission to the county hospital and they have been refused owing to the lack of beds. Other people have come to me and asked me to try to have their stay prolonged after they have been notified to leave the hospital, probably immediately after an operation, and while they were anxious to remain for treatment or convalescence. I have known, and I have been interested in cases where, when I intervened, some people were transferred from there to some beds that were vacant in the county home for the sake of getting medical attention. Knowing these facts, I have no hesitation at all in saying—I am speaking about Roscommon, where I know the position, and everybody should speak for himself—that the Minister's decision to postpone is very wise.

If the position were such that there was not enough accommodation or beds to cater for the present needs, what would be the position in Roscommon if the Act came into operation on the 1st August? I do not know if it applies to other counties but I know that in our county there is an increased demand by people who want to go to hospital for various reasons. There is a general tendency in that direction. People are anxious to avail of medical services and that is quite reasonable, I think, because, in the first place, they cannot have the same accommodation at home nor get the same medical attention as consistently. In many parts of the country, increasing numbers of people tend to go to hospitals. These are the reasons for which I support the Bill and because of which I say that it is a wise decision on the part of the Minister to postpone the operation of the Act for some time. In agreeing to that, I would like to say that I accept the assurance given by the Minister. As Minister for Health, he or any other Minister, is in a responsible position and he scarcely comes into the Seanad or the Dáil to say something very foolish or something that he does not mean.

I accept what the Minister said, that he intends to operate the Act, and in doing so I think it is very reasonable to give him time, and I think he is also wise in implementing it step by step. Above all, I was very charmed to hear him say it was his intention to give better medical and health services to the country than were proposed in the present Act. I hope he will be able to achieve that while taking into consideration the ability of the ratepayers of the country to meet the demands made on them.

I hesitate to intervene at all in this debate. I find it most controversial and I find it lamentable that health legislation should be dragged into such bitter controversy especially by people whom one would expect to approach this subject objectively.

I think I can be excused for intervening at all because of my personal knowledge of the excellent work done by nurses and doctors for the health and welfare of the people. Knowing that and knowing still further that much more can and should be done, I would like to show by the brief contribution I make, that some credit for the spectacular progress we have made in health legislation in recent years clearly must be given to the members of the Party to which I belong, for their forceful enlightenment and far-seeing approach to this problem, starting back in 1932. I think it must be agreed that the 1947 Bill was a landmark as far as our health legislation is concerned. Some of the Senators have said that none of these health Bills is perfect, and I do not think that any legislation that we pass in any sphere is perfect. We strive for perfection but we must be satisfied with what is possible. Unlike the last speaker, I am not so frightened about the cost although I am a member of a local authority and I must answer to the ratepayers for the money we spend. I cannot see that the Health Act is going to increase—I know it is going to increase, but not in the fantastic way that people who object to the whole scheme would like to make out—the burden the people have to bear.

Personally, I had hoped that when the 1953 Health Act had reached the Statute Book and had been generally accepted as the law of the land the many pressure-groups who had operated against it would accept it as the law of the land and would use their best brains and efforts to help the Government of the day to bring that Act into effect, and give to the people the benefits that undoubtedly would accrue from this legislation.

I do not doubt the honesty of the Minister—I would not like him to doubt my honesty or common sense for I feel myself a very common-sense person—I repeat, I do not doubt the honesty of the Minister but I hope it is only postponement because personally I feel that if the people I am in contact with, of all the different groups mentioned here to-day and more particularly the poor, the groups going to be most sadly affected by the withdrawal of those benefits, were in a position like some of the powerful professional groups, the trade union groups and others, to organise and make their weight felt in this matter, I say with all respect that there would be an outcry up and down the country. I also think that because people are not fully aware of what they have lost, that because of the political fog that has been created by the whole discussion in the other House and through the country in statements by responsible members of the Government and different people, the people are not aware—the people who are now being deprived of the benefits—of what they are losing and if they were fully aware and strong enough to organise themselves, I do not think this matter of postponement would be taken so placidly.

The abandonment of the 6/- a day charge on the insured worker for hospital treatment means, as I understand it, that his family and wife are denied these benefits of the 1953 Act to which they would be entitled. Like other members of local authorities I find, in my day-to-day contact with these people, some really very sad and hard cases and I would suggest that until this section is put into effect the Minister might like to consider—I do not suppose he would like to do it but perhaps he would be interested in— the sad cases put to us on local authorities. Others have asked for a date but I would ask with great respect and most seriously that he will endeavour in the shortest possible time to put this part of the Act into effect. I should like to ask whether, when this Bill becomes law, the State and the ratepayers will share equally the £5 12s. per week hospital bill which will have to be paid. The Minister made a statement to this effect in the other House and I should like him to tell us where the State's contribution is to come from. Is it to come from the National Health Insurance Fund? I think it is clear that this cost to the State will in fact come from that fund, and, if that is so, there will be a goodly amount left over in that fund. I think that is an important point which needs clarification.

With regard to hospital accommodation, I am fully aware of the 100 per cent. occupancy of beds, because I have the honour to be a governor of a hospital and I know the day-to-day demands for beds, but as is known, if any emergency arises, if any serious accident takes place, even when a hospital is fully occupied, further accommodation can be found. I know that it is not possible to run a health service in these conditions, in conditions in which extra beds are put in where they should not be when an emergency arises, but I do not think the matter of bed accommodation is the most serious objection. Like other speakers, I do not think that all these extra people are going to become sick and, if they are, they are not all going to get sick immediately, that, being ill, it is only because the benefits are there that they will avail themselves of them.

Between 1932 and 1954, over 60 hospitals were constructed—general, fever and mental hospitals, T.B. institutions and maternity hospitals. I understand that there are 15 more in course of construction and as many more planned, which should give an additional 6,000 beds. This is a great addition to our bed accommodation. I do agree with Senator Sheehy Skeffington that there has been a certain amount of experimentation, but if the Minister and his Government and the people supporting them feel that this Act can be implemented only when the beds, complete with hot water bottles in them for the patients—if I may be somewhat facetious—are available, I am afraid we will never see it implemented. Again I ask the Minister to give us this Act and the benefits he has promised us in as short a time as possible.

I want to thank the Minister for the very clear and lucid explanation he gave the House of his reasons for introducing this measure. It was particularly helpful to Senators like myself who were not present when the 1953 Act was going through and who did not take the trouble, as perhaps they should have done, to read through the Dáil Reports as others apparently did. This whole question appears to me to be a question of what is practicable and possible to be done. The Minister has told us, with the knowledge which should be in his possession and in the possession of his Department, that at present the available bed accommodation is occupied to the extent of 100 per cent., and possibly more. If that is so and if it is true that the two classes the Minister mentioned who are at present entitled to free medical treatment, hospital treatment and so on, amount to something like one-third of the population, it must be obvious to anybody that, if another group, estimated by many people to be another one-third, are given equal facilities, a condition of affairs will be caused which will lead to nothing but chaos and confusion.

I think it was Senator Sheehy Skeffington who suggested that he would favour the empirical method— put the Bill into operation as it stands and see what happens. I am fairly certain of what will happen and who are the people who will suffer, if that is done. If there is a rush, as there naturally would be, for all this free treatment, I know that the people who would go to the wall and suffer most would be the people now entitled, as of right, to get these benefits. That is one of the reasons why the Labour Party are supporting the Bill—because they are anxious that these people should not suffer. Senator Hawkins put forward the argument as to why there should be no difficulty about putting the Act into operation, that no more people are going to get sick and no more children going to be born than are sick and are born at present. That may be true, but there are more of the sick people going to rush to avail themselves of the services made available to the detriment of the people now entitled to them.

There is one point which the Minister made which I have not heard referred to. It is, to my mind, particularly significant. He said that the commencement Order in relation to putting these provisions into effect was made on 31st March. The irrevocable decision was taken on 31st March to put the Act into operation on August 1st. Under the Act, a health council was to be appointed to advise the Minister, but that health council was not appointed until after the irrevocable step had been taken. One would think that a Minister who was to appoint a health council to advise him, if he considered their advice to be worth anything, would appoint his health council and see what they had to say before taking the step taken on March 31st.

The suggestion was made by a Senator that some undue influence was brought to bear on the Health Council to give the advice they did give. The resolution which the Minister has read out was not, I think, the first intimation from the Health Council of their serious doubts about the advisability of bringing this Act into operation on 1st August. In any case the members of the Health Council were appointed by the former Minister. They were not all doctors. I understand the local authorities were represented and various classes of people who were entitled to representation were appointed and put in a position to advise the Minister. The decision was unanimous. If that decision came about only because of some influence that was used on them by the Minister, I would not have much respect for the personnel of the council, but I do not believe that for one minute.

A measure of this kind, a revolutionary measure as it stands, would require long and careful preparation and the utmost co-operation of the people who were to put it into operation. We know that that co-operation has not been received. Senator Dr. ffrench-O'Carroll says the fault is with the professional people and not with the former Minister. Much could be done by goodwill. As far as I know the position, there was not any great evidence of goodwill on the part of the former Minister in his relations with the medical profession and the other people concerned. We know what happened right at the commencement of his Ministry. When the first Minister for Health appointed under the former inter-Party Government resigned, the present Taoiseach took over the Ministry and he did what I believe was a sensible and proper thing to do, he invited all the various interests concerned in the implementation of an Act of this kind to come together and to give him a considered decision as to how the Health Bill should be framed. With the best goodwill in the world, those people met on several occasions and framed provisions in a general way which they considered suitable for embodiment in a health measure. The first thing that Deputy Dr. Ryan did when he came to the Ministry was to tell these people to go about their business. I do not think that was a wise thing for him to do. I do not think it was an exhibition of the goodwill which he ought to have set himself to obtain from these people. The fault may be with the doctors or with the other professional people; I am not in a position to say but that was not evidence of goodwill on the part of Deputy Dr. Ryan.

I notice that the present Minister had a consultation with the nursing profession yesterday. I saw a paragraph to that effect in to-day's paper. I believe that that was the first consultation a Minister had with the nursing profession. I am not saying where the blame lies as between these bodies but the facts are there that at the time the former Minister made his decision to put the 1953 Act into operation there was no agreement with the voluntary hospitals, there was no agreement with the doctors and specialists, there was no agreement with the nursing profession. How it could be possible, in face of that, to think that the Act could be operated passes my understanding. No course was open to the present Minister than the course he has taken.

There was some suggestion that the introduction of this Bill means an indefinite postponement of the Health Act of 1953. Why should we assume that it will be postponed indefinitely? We have the Minister's statement, a responsible statement, that he will introduce the provisions of the Health Act step by step. That is the wise way, the only possible way, to do it.

I do not want to take up time referring to some of the points that were made by previous speakers. There is just one other point I would like to mention. All through the measure there are statutory obligations on health authorities—"specialist services shall be made available", "health authorities shall make available, without charge, medical, surgical, midwifery, hospital and special services of various kinds for various people". Suppose it is the case that a health authority is not in a position to provide these services, what would be the position of a county manager or a health authority if a person who is entitled to these services claims them and demands them? I think a legal question would be involved. I am not a lawyer but it seems to me that the health authority, in such a case, would be in a very difficult position. They are not in a position to provide the services but the law says they must provide them. It might be an actionable matter. I do not know but it seems to me that if you simply say that specialist services must be provided and if the authority is not in a position to provide them they would be put in a rather difficult position.

It has been said that there would be no difficulty in providing hospitals and doctors. Hospitals are not provided by a wave of the hand. Senator Hawkins said that there was consultation with local authorities and that many local authorities provided for the financial commitments. It is not a question of finance alone. You might have £1,000,000 at your disposal but you will not put up the necessary hospitals in 24 hours. The same thing applies in regard to specialists. Specialists are not provided by advertisements in a paper such as are issued for Bord na Móna workers. There must be provision for them, too.

Having regard to all these considerations, it seems to me that the Minister had no option but to take the steps he did take to put the Act into operation according as he would have the facilities. The Minister was being pressed to give a date, not a definite date, an approximate date. How can the Minister say when or how soon these facilities can be or will be provided? There is no use in the Minister giving a date and then feeling tied to that date when he is not in a position to provide the facilities. We can only trust that the Minister will do his best to do that. I am prepared to accept his word and to trust that he will do so as soon as he is in a position to put these provisions into operation. It is the wise thing to do. It is much better than to cause chaos and confusion. Perhaps, if he were politically minded, he might have said: "Let it go." I am sure the temptation was there to say: "Let it run and then we will see." Of course, nobody with any sense of responsibility would take that action and the Minister did not, of course, take that line.

As I said, the people who are most deserving of free treatment and who are entitled to it at the present time will have a better chance of getting that without having to take their place in the queue and being crushed to the wall. I believe that this is the only way they can be treated properly and that is the main reason why I am supporting the Bill.

To my mind the Minister has made an unanswerable case for the acceptance of this measure. Suggestions and insinuations have been hurled around as to the abandonment of the 1953 Act, and so on.

I do not think anybody can suggest that, either in the Minister's statement here to-day or in the very convincing statement he made when replying to the various arguments put up against the Bill in the other House, the Minister conveyed the idea that he was about to abandon the Act. He was forthright in his remarks here to-day. He said he never liked the Act, that he does not like it now but that he is prepared to recognise it as a fait accompli and that he is endeavouring to make it a better Act than those who designed it intended it to be. One would imagine that nothing was ever heard about suffering humanity until the Health Bills of 1947 and 1953 were introduced. As a member of a local body for the past 28 years, long before either of these health Acts were talked about, I certainly never knew of an appeal in regard to a case of suffering humanity, the circumstances of which were brought before either the board of guardians or later the board of health, that fell on deaf ears. I know of no case where a patient who could pay his or her own expenses which received more expeditious treatment or was given priority to the home assistance cases received, when the facts were made known to the responsible body.

When the 1953 Act came before this House as a Bill, I gave some figures from my own county as evidence of the fact that County Mayo was not negligent in so far as consideration for the sick poor was concerned. If I instance County Mayo as a cross section of the whole country it is because I am sure there is not a member of a local body who cannot give similar instances for his own county. In the 1951-52 budget for the Mayo County Council, the figures for health charges totalled £590,000. Of course, part of that was recouped but, after getting recoupment, the rate-paying community in County Mayo had to contribute £328,000 towards financing the health services operating in that county. That sum of £328,000 is just £50,000 less than the total poor law valuation of County Mayo. This is not an insignificant gesture on the part of the administrative authority in County Mayo.

I think that Senator Hawkins said to-day that the only objection which local bodies had to the 1947 and 1953 Acts was connected with the question of cost, but our representatives at various conferences addressed by officials from the Department of Health and by the Minister himself in some cases could never get any accurate information as to what the figure of the local contribution would be. At one time it was said to be 1/6 in the £; on another occasion 2/-in the £ was mentioned, and the last figure we heard, on the occasion of the conference in Sligo, was 2/6 in the £. A levy of 1d. in the £ in County Mayo realises £1,500.

Senator Fearon in his very helpful contribution to this debate referred to the question of providing services and also the question of financing them. Mind you, it is all very well to provide services but it is another question to decide how you are going to pay for them. I am sure that the Minister in giving his undertaking to this House that he is approaching this question step by step is taking, as Senator O'Connell said, a proper course. He has already taken a few of these steps after consultation with people who will have a big responsibility in administering the provisions of the Health Act, doctors and nurses among the number. When all is said and done, the Bill before us to-day is the result, as far as I can understand, of an advice given to the Minister by a body that was set up by his predecessor. Are we to take it that the advice given by such a body, a body selected because of their inner information of the particular services on which they are asked to advise, is only to be accepted when it is in accordance with the wishes of the Minister? I do not think anybody would stand for that argument.

I think that the analogy which Senator Hawkins tried to draw between the progressiveness of the Department of Education and the lack of progress in the Department of Health was most unfortunate, for I hold that if the Department of Education in 1922 tackled the question of the restoration of the Irish language step by step, as the Minister is now tackling the question of health, more progress would have been achieved, after 30 years of native government, certainly in making Irish the spoken language of the country.

There is no use in my labouring the points that have been already made and I do not intend to do so but I should like to refer to the Minister's caution in bringing forward a Bill to ensure that the real cases for which this legislation is necessary will not be neglected as a result of accepting a measure that will add at least three more groups to the two groups already provided for—one by the Public Assistance Act of 1939. Under that Act local bodies guarantee to look after cases, qualifying for their attention, in the local institution. If they have not accommodation in the local institutions or if the local institutions are not in a position to give them the medical, hospital or specialist attention that the case needs, these bodies, as I know happened from time to time in my own county, enter into contracts with the voluntary hospitals here in Dublin to provide the necessary treatment. There are times when a patient has to wait but I know that cases sent from Mayo to the voluntary hospitals, cases for which the local authority is paying, get priority over patients who are able to pay for themselves.

I should like to compliment the Minister on his foresight in approaching this very important question in the level-headed manner in which he has approached it. He has given us a guarantee that he had already given to the other House, that he is not satisfied with the present Act, not because of the services it means to give but because of the services that it does not give. He has, however, promised to implement those services and he is at least entitled to all the co-operation that we and every other section, including every local body in the country, can give. I trust that in the steps he proposes to take, he will find time to consult local bodies before any further action is taken to implement this Act.

So much has been said on this measure already that I do not propose to keep the Seanad very long. I listened to Senator O'Connell on the question of goodwill and he tried to convey the impression that the former Minister did not look for the goodwill of the Medical Association. I think that statement is quite wrong. Of course, it is very easy to get people's goodwill if you are prepared to go along the whole road with them. It appeared to the then Minister and to other people, too, that the members of the medical profession at the time wanted to dictate the terms of the Health Bill. When I speak of the medical profession, I am not alluding to the medical practitioners down the country but to certain members of the medical profession who take the reins into their own hands and give very little to say to the ordinary practitioner down the country.

Senators on the other side of the House want to know why we are sceptical of the Minister's statement when he says that he means to bring in even a better measure than the 1953 one at a later date. We have every reason to be sceptical. We have every reason to doubt the statements of Ministers when they say they will do this, that and the other thing in the future. Senator Sheehy Skeffington gave an example of the non-fulfilment of ministerial promises when he mentioned the Adoption Act but we have another example to go on, one which is to my mind a much more important example, the Social Welfare Bill that we were told by a Coalition Minister he would bring in from one day to another. That was a comprehensive social welfare measure which never saw the light of day. We have every reason to be suspicious of the postponement of measures like this.

Referring to the arguments put forward by Fine Gael speakers in the Dáil and even here again to-day, I would say that the arguments put forward in connection with hospital accommodation and so on were put forward when the 1953 measure was passing through the Dáil. The members of the Labour Party in the Dáil at that time heard these arguments, listened to them and at the same time voted for the 1953 Act. The question is what has happened to make members of the Labour Party change their minds since they supported the 1953 Act and yet this question of bed accommodation did not arise with them? How does it arise to-day?

Because facts have been revealed to us.

We have no facts before us.

Senator Miss Davidson answered that point.

We have no more facts before us to-day than then.

We have more beds now.

There is more bed accommodation to-day than then.

That, unfortunately, is not so.

What happened?

The Minister, when making his introductory statement, gave the impression or at least it could be gathered from what he said, that all the people who would benefit from the provisions of the 1953 Act were still to be admitted to hospital but the fact remains that there are people in hospital this very day who would be entitled to the services which the 1953 Act provides. They, as well as the people outside, the people for whom the provisions were meant, will still have to pay exorbitant hospital fees—the very thing for which this legislation was designed the first day to relieve. It was designed to relieve poor people and people belonging to the middle classes from these exorbitant fees.

As far as the Minister and the members of the present Coalition Government are concerned, these people will have to continue to pay these exorbitant fees in hospitals up and down the country for an indefinite period. There will be no relief for them. The small farmers will have to continue to pay. The self-employed people will have to continue to pay. Fishermen and such people will have to continue to pay all because they do not belong to what would be described as organised classes in the country. If this position is allowed to continue the result will be a tendency on the part of people living in the country parts to go into the cities and towns where they can get insured and have the benefits of these services that the insured people can get at the present time.

The Minister told us that under Section 22 of the 1953 Health Act he is unable to make any regulation by which people can be admitted to the services of the section step by step. I must say that I fail to understand why, because, reading the section as I do, I think there will be found specific authority to do the very thing he says he cannot do. Here it is:—

"The Minister may make regulations applicable to every health authority, every health authority of a particular class or a particular health authority as to the manner in which and the extent to which they are to make available the services specified in Sections 14 to 21 of this Act and generally in relation to the administration of such services."

It appears to me that there is nothing in that section to prevent the Minister starting off and saying: "We will make the provisions under these sections of the Act applicable to farmers under £15 and £20 valuations." If he considers that by adopting the full provision whereby farmers up to a £25 valuation can be admitted to the provisions of the Act, there is nothing in this, to my mind, that would prevent the Minister from saying: "We will start with farmers under such-and-such a valuation and proceed by lifting the valuation ceiling as time goes on and as bed accommodation will become available." The same thing could apply to people in receipt of salaries. If he does not want to admit people in the income group under £600 per annum to the provisions of the Act, the Minister could say: "We will start off with the income group under £300 per annum" and carry on from there. As far as I can see, this Bill is merely an attempt to negative what has already been done under the 1953 Health Act. As some Senator has already remarked, it would be much more honest on the part of the Minister if he had come here and told us he was scrapping the 1953 Health Act altogether.

Dealing with my own locality, we find ourselves in very great difficulties financially. The population is from 50,000 to 60,000 and the valuation of the county is about £250,000. We are just starting a new hospital to accommodate 200 persons for a town of 24,000 residents. The cost of the new hospital is left to a Dublin man, Mr. Wallace, at something like £336,000. What the Lourdes Hospital is doing for the other town, God alone knows. At least £300,000 is finding its way there.

There is a mental hospital in Ardee. For the past ten years we have been rapping at the doors of the Department of Health for a grant. That hospital was built only 30 years ago to accommodate 340 persons. We now have to approach the Minister for Health again because the number of patients in the hospital has risen from 340 to 460. The provision of extra accommodation will involve a further expenditure of £300,000. That means that £10,000 must be found in our district.

The opening words in the speech by my neighbour, whom I am glad to welcome back to this House, were to the effect that we can only go as far as is practicable. I am sure no member of this House is unchristian enough to wish that the best services that can be given will not be given to every patient.

The Minister mentioned that we must proceed step by step in the matter of our social advancement and he instanced housing. As a practical administrator, I would suggest to any county councillor who is present that the Minister should have started at the bottom. I would willingly vote money for the purpose of providing running water in every house in rural Ireland. Many women marry at a very early age and have huge families. I believe that the mothers of Ireland, and especially those belonging to the working classes, would much prefer to remain in their own homes and be treated there. Sometimes I am asked why it is that the dispensary doctor has not a nurse at his shoulder and a mobile unit to enable him to go around and treat as many of the patients in their own homes as is humanly possible. I have in mind just now a case which took place four years ago. A mother of four children said she would not leave her home and she remained until it was almost too late. Apparently it was not in order to force her to go to the hospital. We brought the ambulance to her door and showed her how she would be conveyed. Her answer then was: "I suppose it is better than the hearse." The people who live in rural Ireland prefer to remain in their own homes. There is no reason why that cannot be done if we give a decent rise in salary to our doctors and nurses. We are giving £2,500 to the new surgeon we are appointing to the county hospital. I should like to see the dispensary doctors get something worth while too.

The Minister is right in wanting to proceed step by step. He referred to Section 15 of the Health Act which sets out five classes of persons who, from the date of its operation, would be entitled to free hospital and specialist services. I should like to see the State provide everything. In my part of the country we are only now getting electricity although we have been paying for it since the scheme started 30 years ago. Everybody else had that advantage before us even though we are an up-to-date county situated on the main line between Dublin and Belfast. With peace reigning throughout the world, I believe there is bound to be a fall in the economic situation. The Minister has a great deal to examine and a great deal of leeway to make up and, as time goes on, I believe he will find that the financial position will not warrant his being extravagant.

I have about 60 persons employed at the moment on various jobs and the difficulties that arise in regard to the payment of wages now make it plain that wages will fall in time and there is the danger that many of our rural workers will have to take the emigrant ship. Things are all right so long as there is a market for our produce but it is hardly necessary for me to point out the difficulties that lie ahead of us. In the interval, it will be the people who will suffer and, as I say, there seems to be no other opening for some of them except emigration. For these reasons, I believe the Minister is wise in hastening slowly. You will have to cut your cloth according to your measure. A chain is no stronger than its weakest link, and you cannot bring the first-class living conditions that it is everyone's desire to work up to as quickly as you would desire. You have to go the way the Minister is going. You have to go step by step. For these reasons I am glad to see him making all the efforts he can. I would suggest to him to send certain recommendations to the 26 or 27 county councils and ask for their views. We do not want it done through professional men, through managers or solicitors. We want it done by the genuine representatives of the farmers and labourers who have to live on the land.

Some people tell me that the present Government is an unnatural Government, but whether you take it to be unnatural or otherwise no other Government will be able to succeed except a Government that combines the views of farmers and labourers. If I do not agree with the 40 or 50 men working for me I know where I will be. They are not fools. It is better for the country to do things along peaceful Christian lines. For these reasons I am delighted that the Minister is taking further time for consideration. I would like him to give some leeway to councils who have done their duty to the community.

I can congratulate the Minister on being frank, anyway, in one statement in his opening speech when he said that he did not like this Bill. That is perfectly true of him. If he had accepted the 1953 Act and done his best to implement it it would have been looked upon as a surprise for everybody and the miracle of our time. The 1953 Act, to my mind, can be regarded as nothing but an orphan that lost its guardian when Deputy Dr. Ryan was removed from charge of it. When those charged with the selection of his successor set about getting a custodian or guardian they unfortunately picked upon the gentleman who not only disliked the baby but actually hated it. Be that as it may, the position is now that we are supposed to be unjust when we say that because this is being postponed at all it is going to be ad infinitum. It is possible that it can be ad infinitum because it is going to be very hard for the present Minister to implement an Act that has been disliked as much as the 1953 Act has been by him. That is only human nature. If we were in his position we would probably try to adopt the same methods. We would try to find the easy way out.

It has been stated here that if we were to implement the various sections on August 1st we would have chaos. I have seen in times past when hospitals were scarcer than they are to-day and there was a crisis in an area, a certain disease broke out, despite all the shortage of beds and everything else everybody was able to be provided for. Beds may be 100 per cent. full but there is no doubt we would be able to find places and patients who could be discharged to make room for others. I have spent a quarter of a century attached to hospitals and I have a fairly good idea of what is possible.

It is a very wrong thing to say that if there are not sufficient beds and there is a poor person seeking the one bed available, and also a man with £48 valuation or a man with £540 income, there is a danger that the bed will be given to the person with the money, with most of the world's goods. That is completely wrong. Going back all over the years, you can get it contradicted every other day. If it were to happen, it would not be the public administrator who would be at fault, but the people who would be at fault would be the people supposed to be the heaven-sent people altogether, the doctors. If you visit the county hospitals, you will find that as long as there is a county patient requiring a bed or the simplest attention nobody else, be he who he may, has a chance of getting that bed. That has worked all over the years without any legislation, the 1953 Act or any other Act, and it is just as good to-day.

Our friend from Roscommon gave us the impression that they are catering for everybody in Roscommon as if the Act were in force there in its entirety. If that is so, and if it is possible to work the Act in Roscommon, it ought to be possible in a few other counties, if not in all. We will never reach the stage where there will be uniformity. One county will always make more progress than another. That has been so in various directons all down the years. You will find one leading the van and other counties lagging behind. In hospitalisation you will find the same, but you will never be able to predict such a correct figure that you will always be sure of a bed five years in advance, or know how many will be sick and needing treatment so far ahead.

I would say this in all seriousness, that the step-by-step legislation is going to be a very dangerous business for us. If the Act is not approved of it should be torn to pieces altogether and replaced by an Act which the people in a position to bring in legislation consider should be there rather than that we should have step-by-step legislation, which has proved a very dangerous experiment in the past. I hope that the Health Act, 1953, will not meet the same national disaster as happened in the past at the hands of the Minister's Party.

The one thing that we are definitely entitled to is that there should be a time limit, a certain stage when those parts of the Act now suspended are to be put into operation. Let us see where we stand, and if the Act cannot be put into operation in all places, because some may not be ready as fast as others, then the Minister may have to take very definite steps to make some authorities implement the Act in its entirety. All these things have to be borne in mind.

I would be disposed to co-operate with the Minister if I thought he were doing right by the people by having it adjourned for a short period, but I do not think that the very small farmer and the self-employed man and the person with the low income should be forgotten. These are the main interests concerned. They have not been consulted to a considerable extent about the matter. I think we are told that no matter what figure the doctors and others charge we are in duty bound to give it to them. They are the great people. They are entitled to be paid for their services but they also have a duty. A humble doctor down the country goes around every day and does his duty and does more for the poor people and for suffering humanity than any of the great noises. It is the great noises, the vested interests, who are the people at the root of the trouble, and it would be a bad day if they won out. God forbid that they should.

The more I listen to this debate the more I am reminded of a game I used to play in my youth —round and round the gooseberry bush. I have just heard one side of the House agreeing with the Minister's statement and the other side disagreeing—that is what the whole discussion has been to-day. The Minister has brought in the Bill and said he cannot implement the Act at present, and he is asking the permission of the House to postpone certain sections. Never once during the period I heard him speak did he mention the word "abandonment." It has been suggested that the Act is being abandoned and that he is going to abandon it. All sorts of accusations have been made, in a very foolish and unproved manner. I was one of those who supported the 1953 Act. I still support it, and I believe the Minister is as anxious to implement it as anyone who has spoken here in disapproval of his action. Rome was not built in a day—Senator McGee has told us that—and we have plenty of time to put the Minister before the bar of justice if what he says to-day proves to be untrue. I would be as glad to stand up to indict him as I am glad now to support him, if what he says does not come true in the course of time.

I believe the Minister intends to implement the Act as far as possible. He has good reasons for asking for its temporary abeyance and it is unfair to say that he ever suggested abandonment. The mere inference that because he asks for time he means abandonment of the whole Act is unfair to himself and unfair to the Minister who introduced the Act. Instead of talking like that, we should simply talk about the Bill before us, in which the Minister asks that certain sections be shelved for a certain time. As regards Senator ffrench-O'Carroll and others who asked for a definite date, if at some future date any of us think the Minister has not lived up to his promise to implement the Act, we can always ask the reason why and indict him for it then. Until that happens I am prepared to believe what the Minister stated and I will support him as far as I can.

I wish to offer a small contribution to this debate, as a person who is unprejudiced, unbiased and wholly independent of any of the opinions that have been expressed already on this measure. I can feel nothing but sympathy for the Minister and for his predecessor in the task they have been set in trying to reconcile so many divergent and conflicting views, opinions and theories on the issue involved. There is no doubt in anybody's mind as to the necessity for improved and extended services. We are all satisfied that the services we are trying to plan are just as essential as the services we are already providing—incidentally, wholly at the instigation of the State—such as defence, the administration of justice, the provision of sanitation, water, transport and so on. No one would question the assertion that the provision of a well-planned and efficient medical and health service is just as essential to the progress and development of our country and the welfare of our people as any of those services I have mentioned.

It has been fairly freely suggested from more than one quarter that the I.M.A. are the niggers in the woodpile in all this controversy. I am not expressing any opinion as to whether they are or not. I am simply making this point, that I would expect the I.M.A. to be the first to recognise and admit the necessity for the improvements we are having. Furthermore, if the I.M.A. were not prepared to recognise that need and to co-operate in putting these services into full operation as quickly as possible, then the responsibility falls back on the State to see that alternative arrangements are made, and made quickly.

Having listened to this debate and having read carefully the Dáil Debates on the same measure, I am fully satisfied that the Minister has a perfect right to come to this House at present and ask for at least the opportunity to consider this very important matter in all its aspects. I think he is entitled to that respect. I was very glad to hear the Minister say, however, that he proposed to avail of the respite to undertake an even wider review of this whole problem. Frankly, I think that is very necessary. I would suggest to him that in that review he might even consider the possibility of finding a completely new approach to this whole problem. I believe some new approach will be necessary if we are to sweep away the mass of controversy and bitterness that has been created so far. He could do worse, for instance, than take a leaf out of the book of history from an older and possibly a much more experienced generation, that is, he could examine the practicability of paying the doctor —let me pause here to say that the doctor should be paid well—and paying the doctor handsomely, but only as long as he did his job in keeping the people well. The Minister might find some food for thought, if he were to examine this particular problem from some angle like that. I do not wish to detain the House, but I am grateful for the opportunity of expressing this view.

Finally, I would ask the Minister to have a look once more at the anomaly that so many of my Senator colleagues have alluded to already this evening. I refer to the anomaly it is now proposed to create under this Bill in relation to a particular class which is least able to carry any little extra burden. While this Bill will provide a monetary contribution equivalent to about two guineas per week in relation to insured workers who are in receipt of not more than £600 a year, I want to take this opportunity of reminding the Minister that there is a substantial number of people, wage earners and salary earners, who, whether they like it or not, will not be permitted to insure under the Act and if this Bill goes through in its present form they will continue to be debarred even though they are quite willing and ready to pay. I refer to the lower paid civil servant, the teacher and others in similar circumstances; these are sometimes looked upon by some people as parasites but I think we must all admit, if we are honest, that they are making a very substantial contribution to the economic development of the country and from that point of view they are entitled to at least as much consideration as any other class catered for under this Bill. I appeal to the Minister to consider that particular aspect of the matter.

I do not consider myself young enough to join Senator O'Donnell in such a juvenile game as round and round the mulberry bush. I propose to put the issues before the House as clearly as possible. This is a simple measure which proposes to postpone the operation of the Health Act, 1953. The justification the Minister has sought to give for that postponement is that in his opinion the facilities are not available. In expressing that opinion he has not produced any convincing evidence that the facilities are not available. I realise that such a statement is always difficult of proof. It is easy for us to say that the facilities are available and it is easy for the Minister to say that they are not. We have, therefore, to get back to the fundamental facts.

We know that the Minister's predecessor was informed by his official advisers that everything would be in readiness for the implementation of the 1953 Act on 1st July. The then Minister, being a prudent man, decided to allow an additional month in order to ensure that everything would be in readiness for putting the Act into operation. Is it seriously contended now, or can it be seriously contended, that the officials of the Department of Health were wrong when they advised the then Minister that the Act could be put into operation on 1st July? That is the idea the Minister has tried to put across here. It is an idea in relation to which he has failed absolutely to convince the House.

I think everybody would be prepared to concede that a new Minister taking over an entirely new Department might be entitled to a little extra time in implementing this legislation, and had the Minister come in here and said: "I feel I cannot do justice to this Act by bringing it into operation on 1st August and I ask for an additional three or an additional six months," there would have been a general feeling in the House that the Minister's request should be met. But the Minister is asking for an indefinite period; he wants a blank cheque to do anything he likes with the main provisions of the 1953 Act.

While no one would question the honesty or sincerity of the Minister in his desire to postpone the operations of the 1953 Act for an indefinite period he is, I feel, actuated in the main by the history of his Party's attitude towards that particular measure. We know that all through 1953 there was a long, fierce and bitter fight against that Act. The then Government were supported in carrying the Bill through by the Labour representatives in the Oireachtas. With that support the Bill was enacted in defiance of the most bitter opposition. Does it not appear now that in postponing the operation of the Act indefinitely the Minister is continuing the campaign so vigorously prosecuted against the Act last year?

It is also significant that while the Minister was in Dáil Éireann announcing his intention to put the Act into operation at the earliest possible date and accepting it without reservation or qualification, the chief opponents of the 1953 Act—the political medical men who control the I.M.A.—were stating definitely and unequivocally that they were still as completely opposed to the Ryan Act as they had ever been. Is it not clear, therefore, that there appears to be an attempt on the part of the Minister now to face in two directions simultaneously: to tell the Labour Party and those who supported the Ryan Act that it is his intention to put it into operation at the earliest possible date and, at the same time, to tell the leaders of the I.M.A. that the Act will never come into operation?

Two conflicting policies are sought to be put over by the Government through the Minister and that to my mind savours of something that is neither straight nor honest in the Government's dealings with the people. If the Minister had come in here and told us in clear, simple language that he was still, like the leaders of the I.M.A., violently opposed to the 1953 Act and that it was his intention to repeal that Act, then we would admire his stand as being an honest and an honourable one. This attempt, as it appears to be, to face in two diametrically opposing directions cannot commend itself to this House.

The Minister tried to make the case that if the Health Act were to come into operation on the 1st August the hospitals would be completely overcrowded. Might I ask from what source would this overcrowding be likely to come? Are there in the country at the moment hundreds or thousands of sick people who are willing to go into hospital or to seek specialist treatment immediately after the 1st August? There is no evidence of that. We know that people who need medical or surgical attention usually endeavour to secure it. A small percentage—and there is always that small percentage of small farmers and people of low incomes—may defer seeking medical treatment too long for economic reasons but they are only a comparatively small number. I do not believe that, if that small number were to come to seek the medical services provided under the Health Act of 1953, they would in any way overcrowd the hospital accommodation or overtax the services available. The impact of numbers would be nothing like as severe as might arise in the case of even a mild epidemic.

There is no validity whatever in the contention the Minister has put forward. The people mainly affected by the extention of the services provided under the 1953 Act are the people of small incomes who do not come under the public assistance group but whose incomes are less than £600 a year. Are we to believe that a large number of these people, who are independent self-employed people in the main, would leave their own business and seek medical aid simply because it was being given to them at a cheap rate? Are we to assume that the small farmers, who are the largest body affected by the Bill, would leave their work in the fields, leave their hay and their corn and seek medical aid simply because it was provided for them at a cheap rate? We must remember that hospital treatment is not being provided completely free but at a fee of 6/- per day, and the average small farmer might regard that as a substantial sum. At any rate, no man who does not need medical attention or hospital treatment is going to leave his work and seek aid simply because an Act comes into operation which confers cheaper service.

In the face of this case, which is clearly established, I do not think the Minister has convinced anyone that there is any substantial justification for this Bill. If he were to name a definite date upon which the Act of 1953 would come into operation then we might accept his arguments as having some validity, but when we are faced with a proposal to postpone the Act indefinitely we cannot avoid the suspicion that the intention is completely to abandon and destroy the 1953 Act. As I see it, that would constitute a grave injustice to a large number of deserving people who have now come to look forward to the operation of that Act as giving them some measure of relief.

I do not know what the experience of other Senators may be, but I know personally of people who have been ordered hospital treatment and who were looking forward to this Act coming into operation so that they would get that treatment at a cheaper rate. Those people will still avail of hospital treatment. They must; otherwise they will die, but they will suffer the hardship of having to pay perhaps a substantial fee when they were led to believe they would benefit by this Act. That is the kind of hope deferred that makes the heart sick. It is a bitter disappointment for these people. The people who will lose by the postponement of the 1953 Act are a very deserving section of the community. They are not highly organised. In the main they are small farmers and people of small incomes. They do not belong to any of the larger trade unions or to the powerful professional groups. They do not play golf or move among select society; they are human beings, working on the land or self-employed in various enterprises. These people will not cause the Minister any trouble if they are denied their rights. I am prepared to give that assurance to the Minister. If because of the denial of the rights guaranteed to them under the 1953 Act they have to die, they will die quietly and peacefully, and when they are dead they will be buried in nice clean coffins and they will not cause any worry to the Minister, at least until the Day of General Judgment.

The number of people affected is not large. They come in the group of small farmers who do not go on their knees to the local authority to claim assistance under the Public Assistance Acts. They are not the people referred to by Senator Meighan who are relieved by the generosity of the local authority. They are, in the main, a limited number of independent people who put off availing of medical attention through their independent outlook until it is too late. In most or in all cases they eventually go to the hospitals or seek medical aid, but usually because of their lack of means they defer seeking that aid until it is too late. The Minister is doing a grave injustice to this deserving section of the community.

It is no use for the Minister to tell us that the Health Act will be put into operation step by step. We know how short some of those steps can be. We know what happened three or four years ago in regard to the Social Welfare Bill which, during the first inter-Party Government, was deferred from month to month until finally the Government escaped that liability by getting out of office. The same thing is likely to happen again. The Ryan Act, under this Bill, can be postponed from week to week, month to month, year to year, until the Minister eventually escapes from the responsibilities of office. I think that this House should urge the Minister, even at this late hour, to reconsider the whole matter. If he puts into the Bill a short section stating the date on which he is prepared to bring the Health Act into operation, then I think he will be meeting the wishes of most fair-minded people in the country.

The question of priority was raised— of the poorer sections of the people being pushed aside by the other sections who would be brought in by the 1953 Act. If there was any validity in that case, and I do not think there is, it would be a very serious reflection on the medical profession. I think that every doctor, whether he be a specialist or an ordinary general practitioner, would in all cases give first priority to the person who was most seriously ill. That would be the first and main consideration with him. But if there was any validity in the point the Minister has made, then it would be quite easy to put into the Bill a proviso that priority would be given to the classes the Minister has mentioned, those in the public assistance group and insured persons. It would be very easy to amend the Health Act in such a way as to——

To restore the poor law code.

——give priority, and that priority could be given without altering the general effect of the Health Act. All the provisions would go automatically except that a certain priority would be given. That would only be necessary if the medical profession have such a low standard that they are not prepared to give priority automatically to the person who requires treatment most urgently.

I think it is no harm to refer briefly to the one point on which the Minister sought to rely very strongly, and that was the resolution passed so conveniently by the National Health Council. If that resolution was passed spontaneously without any influence or consultation on the part of the Minister, then it might be worthy of serious consideration, but when appointed bodies are called together by the head of the Department, and when it is suggested to them that they ought to make a certain recommendation and, in addition, are told that that recommendation has the approval, not only of the Minister but of the Party to which the Minister belongs and also of the other Party to the Government, the Labour Party, which had given their support to the Health Bill: when, as I say, that influence was used in order to secure a resolution which, on the face of it, appeared to have been carefully drafted in advance, it is very hard in these circumstances to place very much reliance upon a recommendation of that kind.

That is a very severe reflection to make on the Health Council—what the Senator has just said.

It is also untrue.

There are certain standards in this House.

There is evidence, which has been given in a most convincing manner, that it is quite true, and I accept it. I think that there is an opportunity still available to the Minister, in the short time at his disposal, to put this matter right by doing what I have suggested, namely, to fix a definite date on which the Health Act will come into operation. If he does that, it will help to secure unanimity in this House for all stages of the Bill. It would be a step in the right direction and one that would convince the people of the Minister's sincerity.

I will finish by saying that this matter of a date is an important one. In matrimonial matters, it is usually the gentleman who proposes and it is the lady who invariably fixes the day. The reason for that is because the date is the all-important thing. In the case of a Bill, it might be held up indefinitely unless there is a specified date on which it is to come into operation. If the Minister is hostile to a date he can hold it up indefinitely unless he is bound by statute to some fixed date. I am asking the Minister to show his sincerity in the statement he has made, that he accepts the Health Act, by including in it the proviso I have mentioned.

I had the privilege of being a member of the House when the Minister at the time brought here his Health Bill of 1953. As one of the fortunate members who escaped the recent blitz, I can say now that I have a clear recollection of what the former Minister's attitude was when he brought that measure before the Seanad. He made it perfectly clear, I think, to all those who were members of the House at the time that the Bill was one to be operated by way of Orders and regulations made by the Minister. I think there was no one who knew the difficulties better than the former Minister, Deputy Dr. Ryan. He was a Deputy for a rural constituency and was aware of the difficulties to be met with in implementing certain sections of that Bill.

When pressed by the then Opposition to name a date, he plugged his replies by way of answering that it was the kind of Bill that would be implemented from time to time by regulations and Orders made by the Minister. That Bill was introduced in the Dáil in 1953. It was later brought in here and handed back to the Minister some time in October, 1953. It then lay in cold storage until March, 1954 when it was brought out and dangled, as a political carrot, in my opinion before the people in view of the general election.

Great play has been made about the Labour Party. The Labour Party supported that Bill. I think that Deputy Hickey was right when he said that they supported it not with any great degree of enthusiasm. They supported it because it represented a slight improvement in social services and because it was giving a few more crumbs to the poorer sections of the people. For that reason, it was supported by our people as all measures to help our people even in a small way have been supported, whether introduced by the late Government or by any other Government. Senator Sheehy Skeffington took advantage of a statement made by Deputy Hickey by quoting, in my opinion, in a most unfair way a statement, taken from its context, in a speech made by Deputy Larkin in the other House. I think that anybody who has read the speech made by Deputy Larkin in the other House, as I have read it, will agree that it was a splendid contribution, and that it left no illusions as to what the attitude of the Labour Party was. I think that if Senator Sheehy Skeffington would read, in particular, the concluding portion of Deputy Larkin's speech when he told the Opposition to keep their hands off the Labour Party, that the Labour Party were fully capable of looking after themselves, he would be very well advised.

So far as the Labour Party is concerned I can assure Senators on the opposite side that we have given very full consideration to this Bill. It was considered by the full Oireachtas Labour Party and by the Executive Committee of the Labour Party and we are satisfied that the sections which this Bill covers if implemented would create severe hardship on the insured and on the poorer sections of the people. That is our position and our attitude. We are satisfied that the Minister should be given an opportunity and that he will implement this Bill without any undue delay and Senators on the opposite side can rest assured that we will see to it that that will happen.

It is regrettable I think that at this stage after 32 years of successive native Governments our hospital position is, I think, worse than before we took over. I take the position of our own county, and prior to the amalgamation we had four workhouses in Shillelagh, Rathdrum, Rathdown and Baltinglass. I am safe in assuming that these four institutions would accommodate at least from 500 to 600 people but they were wiped out as it were with one stroke of the pen and the patients were taken from three of these and put into a glorified workhouse at Rathdrum which is now called the county home. I have been on Wicklow County Council for many years and in fact I have represented the second generation of people since the passing of the Local Government Act of 1899 and I have a fair knowledge of the treatment meted out to people who are entitled to hospital treatment and those who want to be admitted to some of them. After waiting for days on end we find that someone who is not fully recovered is sent out to make room for them. That is the position as far as our county is concerned and I am sure there are several other Senators who are members of public bodies who are in the very same position. I do not know what the position would be if we were to try to throw another 500,000 people into the pool.

There is no use in anyone telling me that a person with £50 valuation or a person coming in under this Bill with an earned income of up to £600 will not get priority over some of the people living in condemned hovels in the country or provincial towns. I am satisfied hospital accommodation cannot be procured overnight. It has been said here that the accommodation will not grow up overnight and some time has to elapse before all the people coming in under this Act can be accommodated. At the same time I want to appeal to the Minister to put into operation whatever portion of it can be put into operation without inflicting any hardship on the insured people or the people entitled to free medical treatment at present. I would appeal to the Minister as a first instalment to send out some recommendation to the health authorities—or county managers to change their present attitude in sending out bills and accounts to small farmers and others who are lucky enough to get a bed in their institutions.

So far as we are concerned, we are supporting this Bill before the House because we know if the sections referred to were implemented as already stated it would mean locking out the poorer sections of the people and the insured workers.

Before Senator Stanford speaks, perhaps the House would consent to sit on after the hour, say until 11 o'clock so that the Minister can get in and would be able to conclude.

As far as I can see there is only one other speaker and if the Minister gets in before a quarter to ten I do not think there will be any objection——

——if he goes a little over the time. He will be very brief.

It is agreed then that the debate will conclude to-night on the Second Reading.

I shall confine my contribution to 70 words in telegram style as the Germans say. "Possible future ethical objections"—whatever this phrase of the Minister's means, may I urge him with all the emphasis I can command to keep in mind constantly and inflexibly that the phrase involves matters of fundamental importance for our religious minority as well as for our religious majority.

Much has been said on this measure and since I now understand it is proposed to conclude, I will try to be brief. The Minister has been praised and criticised in regard to his motives and his opening statement, but one of the things I think I feel like doing is this: I think I could praise the Minister for his excellent statement. It would surely be regarded as an excellent statement from a lawyer who could appear to make a bad case appear good. That is the prerogative of a good lawyer and certainly the Minister is to be complimented on the very able way in which he introduced his Bill. But having regard to the fact that this Bill proposes to put in abeyance—a very good word that has been used in this debate to-day—the Health Act of 1953, I am one of the people with many others who must regard very critically the motive behind this Bill in postponing the 1953 Act. We must realise that, apart from the health services that are provided under the 1947 Act, the Infectious Diseases Act, there is no other service or no obligation on a health authority to provide any service except that as outlined in the Public Assistance Act, 1939, which makes it obligatory on a health authority to provide for people who are unable to provide by their own efforts or other lawful means the medical, surgical, ophthalmic or other treatment or medicine they require for themselves or their dependents. Under the earlier Act, these services were provided as a dole rather than as a right to a certain class of people, and under the 1953 Act it was intended to cease to treat these health services as a dole given to a certain class of people and to give them to the people as a right and, in other words, to get away from the poor law.

This Bill in my opinion is going to confine for an indefinite period the health services that can be given by a health authority to that group of people who are vaguely defined in the 1939 Assistance Act. That, as far as I can see, is the real purpose behind this Bill. If the people who are responsible for this measure here had a really good, progressive social outlook, I do not think this Bill would be introduced at all. I cannot help feeling that it is an attempt on the part of the Minister—a very able attempt, because he certainly made an excellent case as a good lawyer would make an excellent case out of a bad one. It is an attempt to coalesce the two viewpoints. We all know of the heated discussions that have taken place over a number of years with regard to health services, and we realise that the Minister's colleagues opposed the 1953 Act word by word, section by section and stage by stage. Is it reasonable then to expect the Minister to do other than try to play for time? This Bill is really only an attempt to play for time, to put the Act in abeyance. Why is that being done? I suppose that what the Minister's colleagues and the Minister himself would like to do would be to completely change the measure and to reinstitute the proposals once put forward by the heads of the I.M.A. to have this glorified insurance system whereby people would pay into a voluntary insurance fund and would get nothing, if they did not pay. That is the scheme that would be nearer to the hearts of some people, but I know that it would not be near to the hearts of many people who support the Minister in this House. Therefore, this measure is really an attempt to coalesce the two viewpoints. I think it a pity that that is being done, because, once an Act like this has been passed, it should be implemented and health services and social welfare services generally should not be made shuttle-cocks in politics.

The case being made by one group, including the Minister, is that the accommodation does not exist to enable the measure to be implemented and another group of people, such as Senator Ruane, object on the ground of cost. I wonder which viewpoint is the real reason for the introduction of this measure. If it is a question of cost, all I say is that economy at the expense of the sick or the poor is the economy of a miser. I do not think people should set themselves up to decide that the relief of sickness or hardship should be carried out on the basis of pounds, shillings and pence.

I am also fairly satisfied that there would not be this chaos that has been suggested. One would think from listening to some people that, once the Act came into force, people would rush to hospital, would get sick and seek treatment in hospital for fun. I do not think that would happen. One Senator has made the case for a particular section, the insured workers, but I argue that many of the insured workers are better off than the small farmers who are being denied the services which it was intended to give them, by reason of this measure, and I know that in a county like Leitrim, where the average poor law valuation is under £10, the small farming community are being denied the relief they would get under the 1953 Act, because the fact is that, as things are, they are being asked to pay for medical and surgical treatment, which they are not able to pay for, with the result that real hardship is inflicted on them and on their families.

Since that is so, it is a pity that the Minister could not have found a better way of dealing with the 1953 Act than introducing a measure to postpone it, to put it in abeyance, or, as other speakers have said, to put it into a position in which there is no time limit set for its implementation. I wish I could accept the Minister's assurances, but, in view of what has happened, ably and well as the Minister has made his case, I am afraid I cannot accept his assurances that it is only a question of waiting until better provision is made for hospitalisation of our people.

No reference at all was made to the operation of Section 23 of the Act. That section has been in force and no chaos has been created. I agree with Senator ffrench-O'Carroll that maternity should not be regarded as a sickness, and, with better housing conditions in the country, more of the midwifery cases would be dealt with in the homes of the people under Section 23. The operation of the section would go a long way to ensure that there would not be that chaos and overcrowding suggested by the Minister in his opening statement. Since local authorities are in a position to send their patients to voluntary hospitals, and do send them, I do not think the implementation of the 1953 Act would create the chaos and confusion that has been suggested. Probably, it is because the Minister cannot reconcile his views with those of his colleagues and of the I.M.A. that we have this Bill. That, in my opinion, is the real reason for the introduction of this Bill, which really aims at playing for time.

It has been said that the difference between a psychotic and a neurotic is that the psychotic believes that two and two make five and is terribly happy about it, and that the neurotic knows that two and two make four and is worried to death about it. It seems to me that this discussion has largely resolved itself into a debate between those who believe that two and two make five and those who believe that two and two make four, but are determined that it shall make somewhat less, if they can possibly influence it. Those who have asked the Minister to name a date have a certain degree of justice on their side. I can see that people desiring to hold up the Bill might very well take advantage of that fact and force the Minister out of office by prolonging and protracting negotiations. At the same time, I myself would have felt much surer about the matter, if the Minister had had the courage of the French Premier and had named a date after which he would go out of office if the desired objective had not been attained.

I hope I will have a better service.

I still would ask him, if possible, to name a date, even if it is a fairly remote date. If that is impossible, the only course for me, as a reasonably independent person, is to name my date. I am willing to give him a chance, but I am not willing to give him an indefinite chance. I am willing to give him five months. I think after five months, that is by the 1st January, 1955, we ought to be in a position to judge whether any steps at all have been made and, certainly, if no steps at all have been made, if there is no evidence that he is in earnest, I would be prepared to vote in any vote of censure on him or to propose one. It is reasonable to ask for some time, in the circumstances.

There is one point that struck me particularly about it. It is this: even if only 50 or 60 extra people apply for aid, 50 or 60 people more than the hospitals can accommodate, then 50 or 60 people definitely have grounds of legal action against the Minister and I would not wish that fate upon my worst enemy, particularly in view of the way actions turn out, as we know. Therefore, I would support him but only support him to a certain date line of my own if he cannot give me a date line himself.

It may seem perhaps unusual that an ordinary practising doctor should be heard to support a Minister to postpone a Health Act. I propose to reserve any of the sensible things I wanted to say about this Act until the Committee Stage. I will let the Seanad into a secret, that is, that the medical profession are interested in health. I will let them into another secret: the Dublin hospitals for the last 300 years have taken everybody in, irrespective of whether they had 2d. or anything. By the way the medical profession are mentioned here one would think we were M.V.D. or such. I feel I might almost lose my temper. That is why I reserve any sensible thing I have to say until the Committee Stage. I have heard more claptrap and idiotic nonsense from people who do not know B from a bull's foot. I do not mind young people coming in pinafores, but people who should know better come in here and make statements such as that the British Act was a great success. Many intimate friends of mine have tried to make it a success in seven years, and hope to make a success of it in the next 20 years. Things like that annoy anybody who knows anything about the question before us.

I am speaking as a man who knows something about the attempts being made since the turn of the century to improve the indignities of the Poor Law service, with the help of colleagues across the water even. I am trying to tell them something of how we built up our hospitals in Dublin City alone. I would like to tell them that the problem of the Dublin hospitals is one of the biggest problems in Western Europe. For ignorant people to come in here and insult my profession—well, it naturally upsets my equanimity—and I want to reserve any logical remarks I wish to make on this Bill for the Committee Stage next week.

I think that the debate we have listened to on this Bill has been a useful debate. I do not go so far as to say that it was excellent or that it was merely moderate. Parts of it were good, like the curate's egg, and parts of it were bad. I shall not waste the time of the House at this stage in discussing the bad parts of the debate. Those parts made themselves very obvious to the House. It suffices to say that when I introduced this Bill to the Seanad, in so far as I could, I endeavoured merely to state the facts as I knew them. I did not attribute motives of a political kind for the creation of a situation which confronted me when I went into office, nor did I endeavour to apportion responsibility or blame for these occurrences. The first effort made in this debate to conduct it on Party political lines, unfortunately, came from members of the Seanad. I think that attempt well justified the stricture given by Senator Mrs. Dowdall, who deplored the action of certain of her colleagues in dragging this matter of health legislation once again into the muddy paths of politics.

Again, before I deal with some of the speeches that have been made and some of the points and suggestions that have quite usefully been made, I would like to remind the Seanad and Senators who, by reason of their political association, might be or should be concerned with the implementation of the Health Act, that I do not come in here on my bended knees or as a mendicant looking for assistance. I have come in here as the responsible Minister to ask this House to recognise its responsibility to the people of this country. When Senators ask me to define a time limit and dole out time to me as charity might be doled out to a pauper, do they realise what they are doing? We are dealing with sick people, needy people, with citizens of this State and we surely do not solve their problems or deal with their difficulties in the atmosphere of a debating chamber. The thing is more serious than that. It is for that reason that I, as the responsible Minister of this Government, have come into this House to ask the House to face up to its responsibilities, which I believe to be to authorise me in their name, in the name of the people, to do what I can, as quickly as I can, to provide for the sick and needy of this country.

With regard to some of the matters that have been mentioned by Senators, Senator Hawkins, who led off the debate, in so far as he attempted to deal with the Bill, posed a number of questions. He, for instance, said, how could we have provided for education in the past if we had tailored our facilities by the schoolhouses and other arrangements that might be made? I thought that was an unfortunate example for the Senator to have used because we have had recent experience in this country of what happens when a Minister for Education endeavours to carry on without the teachers and, mind you, when that happens it is not the Minister or the teachers who suffer but the unfortunate school children who do not get the facilities that most of us would desire them to receive.

The Senator went on to refer to the I.M.A. As the Minister responsible for the health services of this country, I am not a partisan and I am not briefed on either side. I hope that my course will be to seek co-operation and to work in harmony with all interested bodies. I do not think it is fair for Senators in a protected House to throw stones at an association outside it and, by repetition, to create the impression that the I.M.A., representative as it is of one of the finest professions this country has, are nothing but some crowd of brigands going around the country attempting to kill off people as quickly as possible. That is not a fair approach and it is not a right approach and there is no one in this House or outside it who would be prepared to say that the I.M.A. was not acting quite within its rights to state its views, to reiterate its principles in regard to the very subject which was of complete interest to its members.

Senator Hawkins said—and I regret to say it is rather typical of the mentality which has coloured the approach to these discussions—in relation to the I.M.A. that he had rather hoped that the Medical Association and other such bodies would have realised that our Parliament is a sovereign body. Of course, our Parliament is a sovereign body but does the Senator mean to imply that he proposes dragooning doctors into providing service that they do not wish to provide? That power is not in the Health Act. If it were the intention to put it in, the Senator and his colleagues had an opportunity of doing that when they sponsored it. So far as I am concerned, I regard our people as being strongly opposed to any effort at compulsion or dragooning. Senator Hawkins should realise from the lessons of our history right throughout the centuries, that the Irish people may be led and led well, but they can never be driven. That applies to any body of Irishmen associated with any branch of national life. I indeed hope that I shall have the co-operation and help of the medical profession. I have the greatest hopes of that profession which has always enjoyed a very high reputation, so high in fact that students from all parts of the world have for years and years been accustomed to come here to our teaching centres to pursue their medical studies. I have no doubt that a body such as that will not renege the people of this country when essential services are required to be given to them.

Senator ffrench-O'Carroll endeavoured to approach this discussion from a reasonable point of view but, again, I fear that the Senator was too concerned with making a case and rather inclined not to be critical of the matters he was urging. He did, for example, say that here in Dublin there is a local authority hospital with 2,000 beds. Why, said the Senator, could not St. Kevin's provide for the sick and the needy people of this city? Now that is an argument and it is a good debating point, on paper. On reading these debates later, any person who was divorced from reality might say of the Senator: "There is a point he has got." I, however, am the one person who, for the time being at any rate, has got to face up to realities. There are 2,000 beds in St. Kevin's occupied by the aged, the chronic, and the unfortunate people for whom no other accommodation is available, who are there to eke out the remainder of their days. There are 500, and only 500, beds available in St. Kevin's for ordinary medical and surgical cases. Yet Senator ffrench-O'Carroll said that St. Kevin's can meet the situation in Dublin.

Assume the situation were as he suggested and that St. Kevin's were the only hospital to which the sick poor would go in the city. Does he realise that 500 beds would be expected to cater for over 250,000 people, because that is the figure—and it is a very modest figure—of the sick poor or public assistance classes in the city? Are we to regard that as a comforting thought or as an adequate provision? Of course, it would not be any such thing. The Senator went on to say that he would hazard a guess that the people receiving treatment in the voluntary hospitals at the moment, were in many cases not public assistance cases but were those who at the moment are expected to pay. That, again, is merely a way of looking at the thing. It is true that our Dublin voluntary hospitals are, as they have been for over 100 years, catering in their own way, despite county boundaries or county limits, for a vast number of people from the country. It is because persons, who are not within the prior classes of insured workers or public assistance cases, at the moment cannot get beds in many county hospitals that they are diverted into the voluntary hospitals.

There are hundreds of country people who get medical treatment and care in the voluntary hospitals in Dublin. If it were considered a satisfactory step it would be possible for me to say to any of those people: "You are from Kildare; you are from Roscommon; you are from Wicklow: you can go down to your own county hospital and try to get in there." That would not be a responsible approach, but even if it were thought desirable to divert these country cases back to the health authority areas from which they came, can the Senator envisage what is going to happen? If they come to Dublin, because they cannot get beds in their own county hospital, and are then sent back to their own county and are to have equal rights with the sick poor, they will either get into these county hospitals or stay out. If there is only one bed available for two people, one person has to lie on the floor. That is merely the case I was making, that if you try to do too much too quickly, you are going to cause suffering to the community. I fear that in such circumstances—it has not been a recent experience; it has been the experience of humanity for thousands and thousands of years—those who suffer are always the poor and the needy; it is no good saying otherwise. I do not think that that is a very useful approach.

The Senator also said, in case I forget it, that I had stated in the Dáil —I think he used this in order to suggest that I had been illogical in some way or had not been consistent—that the provisions in relation to the care of the disabled would come into operation on October 1st. I here reiterate what I stated in the Dáil as reported in volume 146, column 1345 with regard to that service, and if the Senator listens he will appreciate that I am being extremely consistent:—

"There may be some slight difficulty with regard to the provision in relation to new services, the provision of institutional facilities in some sections. For instance, the allowance scheme for disabled persons will go into operation on October 1st and payments will be made on that date. Disability payments will be made to each person entitled to them but it may be some time before the institutional facilities will be available. That is not the same problem as arises in relation to the insured workers..."

Surely that indicates that my determination is to see every possible part of the Health Act which can be worked go into operation? I am providing that these payments to disabled persons will be made available as and from October 1st, but in relation to institutional treatment—and there is no such treatment now and there are no persons with existing rights—I have got to provide the institutions and I may assure the Seanad and any Senators who have had to witness, as I have had, the appalling problem that faces the rehabilitation of persons struck down with polio or other scourges of that kind that the task of providing proper institutional facilities for them is not one that will be accomplished easily or quickly. I sincerely hope that no such person who has contracted that disease and who has suffered felt that by putting that section in our Health Act of 1953 we were providing him or her with institutional treatment on October 1st because we cannot. It may take a great deal of time before we can do it but it illustrates the difficulty that can arise when by legislation people are encouraged to think that merely the passing of an Act of Parliament gives the facility. It does not do it and it is wrong that interested politicians should merely for the sake of making speeches suggest the contrary.

In relation to those unfortunate people we will provide for their maintenance because they cannot work. We will give them treatment as quickly as we can but we can make no promises that the institutions and the necessary facilities will be available immediately. They will not.

Senator Fearon mentioned the question of preventive medicine as being more important. I do not think there would be much disagreement about that but the stage when one can sit back and say: "Now we have treated everybody afflicted and so we will adopt preventive measures" is a stage that will be very difficult to attain to.

Senator Hickey said that if there was difficulty in getting agreement with the doctors or if there was a difficulty with regard to institutions and accommodation why not provide domiciliary treatment for all the people under the Act. The position is that under the Health Act, 1953, domiciliary treatment is only available for one class and that is the public assistance classes and nobody else. Under the Act of 1953 treatment in the home in general medical services can only be given to the sick poor. Again, I hope that those who enthuse about the Health Act of 1953 will make people realise that when it goes into operation and an insured worker or a farmer of £50 valuation gets a pain in his stomach and sends for the doctor he will have to pay the doctor's fee because the Health Act of 1953 does not provide anything free for him. The only thing provided free for the different groups covered is hospital treatment and specialist services on the terms and conditions set out in the section.

Senator Sheehy Skeffington spoke and, again, I think the Senator did endeavour to deal with his subject in a very careful and helpful manner. He did say that he believed in the empirical approach—trial and error. That is a courageous kind of mentality but, mind you, it is scarcely apt when one is thinking of human life and human death. I do not know whether the Senator regarded it as a correct approach. If he were asked to build an aeroplane and sally forth into the air on a trial and error basis he might err but he would not be there again to repeat the experiment. I do not think that kind of approach in relation to these really fundamental matters is a proper approach.

I do not agree with the Senator that one cannot provide a perfect service or cannot hope to attain to the sublime but within those limits one has got to assure that at least some effort is being made and that some arrangements are available to provide the services that one promises the people. May I say again in relation to the Senator's approach that one is not dealing with something new. For instance in relation to T.B. services of some years ago when there was nothing there and where no one had vested or prior rights it was quite understandable to go ahead and give things as they became available. Merely because you have not got T.B. sanatoria to say that you will have no T.B. service would be quite unthinkable. But here you are dealing with a social problem and you are not dealing with people who already had rights to beds in sanatoria. Here you are dealing with the general health services of the nation and you are particularly concerned with up to nearly 500,000 insured workers and up to one-third of the population who already have prior rights in hospitals and prior rights to these services, therefore, one has to be careful in one's approach because if you err and if your experiment fails then those who will suffer will be the sick, the needy, or the insured workers.

The Senator also mentioned the question of ethical objections. I did not mention this matter here because, frankly, it had not occurred to me. I mentioned it twice in the Dáil. May I make the position quite clear. The Fine Gael Party of which I am a member opposed the Health Act of 1953. The Labour Party reluctantly— and emphasis on the word "reluctantly"—supported it. I think it is fair to sum up my Party's objection to the Health Act and to repeat it here. My Party is opposed to the Health Act, 1953, as being the sole means of providing health services in this country. That is what was offered to the people a year ago. That is not in my view, an intelligent approach to providing better health services.

As I told the Seanad when introducing this Bill, I do not regard this Act or the services it provides as being in any way the final step in the provision of health services for our people. There are large sections in the community who will not qualify at all under the Health Act unless they can prove they are impoverished and there are large sections in the community who look forward to the provision of some assistance by the State. They do not want the State to provide for them entirely but they want a helping hand. I hope such a helping hand will be given.

I realise that, in relation to the Health Act of 1953—and I do not want to go into its turbulent passage now— there are people who have ethical objections—I am not talking on religious grounds—to the policy enshrined in it. Some of the professional bodies feel it is wrong to have health policy dictated by lay persons such as county managers. Other interested bodies feel that the local advisory councils should have more power in relation to local health matters and local health policy. These are the kinds of objections I have in mind. I propose to examine them and if there is a reasonable objection on these lines I propose, later on, to ask the Dáil and the Seanad to deal with them. I made it quite clear in the Dáil and I repeat here now that that in no way concerns the services being provided under the Act. As far as I am concerned, they will be provided as quickly as possible. Naturally, I am not talking about objections of an ethical nature from any particular religious viewpoint. I realise that, in matters of this kind—I think it was Senator Stanford who mentioned this —all religions have their own views. Again, I certainly am not concerned with merely one view or the view of one side only. May I just end that matter by saying again to Senator Sheehy Skeffington, through the Chair, that, if such an amendment is necessary, it will be done in a democratic manner through the Dáil, which is the only way it can be done, and through this House. I hope that, if it is necessary, the reasons for it will be fully stated.

It has been suggested by different Senators—and I hope no one will be offended if I do not mention each Senator by name: I have so many notes here that it is difficult to correlate them all—that there should not be anything wrong in applying the services on different dates to different counties. Some Senators have said that that is not unusual and that, in fact, it is the position now. My objection in the matter of policy is that I believe that, in a small country of this kind, the rights enjoyed by our people should be universal. One can recognise that, in so far as services depend on human effort, the services will vary from county to county, but the rights should be the same. I do not think it would be desirable to provide something in one county—and it would be merely because that county is better off—while denying it in another county—and, again, it would be because that county could not afford what the other county could. However, that is a matter of policy and the power is there under the Act. So far as I am concerned, I am opposed to doing it.

Some Senators doubted the objection that I had mentioned with regard to accommodation. They are entitled to their views. They are lucky that they have not to put their views into practice. I have. I should just like to put this to the Seanad. We have in operation in this country—I think it is a mistake, but we have it—a county system based on English ideas. Although this is a small country, we cannot merely look at it and say: "Oh, well, 10,000 or 12,000 beds are all that are required in this small country." I have to look at each county and I have to be concerned to see that, in the different counties, hospital accommodation is available for the people. That makes for waste of effort and often waste of money. It is for that reason, in relation to general hospital policy, that we are hopeful to have more regionalisation such as has been done in relation to a number of sanatoria. At the moment, however, we are confined to the county system and the accommodation available in each county. Even in relation to that, the shortage of accommodation in each county has been eased by the fact that the voluntary hospitals have taken the overflow, are doing it at the moment and will, I hope, continue to do it.

While more people will not get sick —as Senator Hawkins seemed to make out I was suggesting—there is no doubt but that a great number of persons will go to hospital because the facilities will be there for them: they are on paper, at any rate. When services of this kind are provided, one can expect—it has always been the experience—a very marked increase in hospitalisation. At the moment, we are not capable of meeting that. I will give only one example. A few Senators have referred to the maternity provisions in the Health Act. At the moment, free maternity services are provided to women in the public assistance class in every county, in every health authority area and in every town and city. The accommodation available at the moment is just about capable of meeting the demand —but only just. In some parts of the country it is not adequate, particularly in this city. In the Dáil, I mentioned the National Maternity Hospital, Holles Street. As Senators are aware, or should be aware, judging by their obvious interest in health, the minimum period during which a woman in motherhood should be kept in bed is 10 days, and that is not very much. At this moment in Holles Street these women are being turned out in four or five days, and, in fact, cases are occurring quite regularly where unfortunate women having given birth to a baby some four days ago are turned out of their beds at three or four in the morning, not because anybody desires it but because the facts of life dictate it, because another unfortunate woman has come in in labour and she has to be put somewhere and they have to take the chance and ask a woman who has given birth to a child and had three or four days rest to leave in a car or in an ambulance. Whether Senators realise it or not, those voluntary hospitals do try to do their work, and overcrowding there is appalling because every effort is made to put in a bed into any possible corner and it is only by the liberal use of different anti-biotic drugs that serious infection is not caused.

There is a clear example of part of the problem I have to face. Is it to be suggested that it is a responsible thing, merely to keep some political reputations intact, for me to do nothing and to allow on the 1st or 2nd of August thousands more—and there will be thousands more—women to queue into Holles Street and to cause more chaos than already exists in that hospital? I do not think it is right. I do not propose to suggest that it should be contemplated at all. I merely give that as a clear example of what I have in mind, but it is for that reason that this measure is necessary. I hope that as quickly as possible we will be able to deal with maternity in Dublin. In the immediate future, other beds will be available in the city, but they are not there now, and it is no good thinking that because additional beds will be available in 12 or 18 months' time we can allow a situation such as could arise to take place.

I say finally and generally that so far as the Government is concerned, and the Parties supporting it, we have endeavoured to face up to our responsibilities in relation to this subject of health in an energetic, deliberate and courageous manner. I think that all of us realised that the introduction of a measure of this kind at this time would give to those who wanted to use it plenty of political ammunition. I hoped that good taste and honesty and sincerity might prevent that being done. Unfortunately it has not taken place, but I would like to say this of the Irish Labour Party, that their position has been consistent and courageous right through. They are more concerned, and always have been, with the facts of any situation. They are concerned, and they have so stated both here and in the Dáil, with the facts that will exist on the 1st August. It may be that Senators with extreme left-wing ideas such as Senator Cogan may be satisfied with making health professions in an Act of Parliament, but that does not do the ordinary working people of this country. They want to see what is being done. It is no use trying to buy them off by making fine speeches and passing fine Acts of Parliament. I must say that so far as the different Parties supporting the Government are concerned, I think the people will realise that what we have done has been necessary, that it has been done in the best interests of the people and with due regard to the principles and aims which we all have in front of us.

As I said in opening, I hope that it will be possible now, once I have power to deal with this problem in a logical and rational manner, to get the co-operation and the help of all interested bodies. I do not think it would be feasible—and this is not an expression of weakness—to operate a health service with Guards and other persons of that kind, or indeed, with professors. We have got to have doctors, and I hope we will get doctors, in a spirit of harmony and co-operation. So far as I am concerned—and the medical profession realise my stand—I am determined to see that the services envisaged in this Health Act will become available. I hope in addition that it will be possible to provide better services for the people generally. Those are the aims which I have set before me, and if I fail in achieving those aims then I will regard myself as a failure as Minister for Health.

Question put and agreed to.
Committee Stage ordered for Tuesday, July 27th.
The Seanad adjourned at 10.28 p.m. until 3 pm. on Tuesday, July 27th, 1954.
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