Private Deputies' Business. - Public Charitable Hospitals (Temporary Provisions) Bill, 1929—Report Stage.
Thursday, 10 April 1930
Dáil Éireann Debate
Sir James Craig: After the Second Reading of this Bill it was sent to a Special Committee. There it underwent considerable amendment. It was then sent to the draftsman and the draftsman found the Bill was badly drafted and the amendments were not in legal phraseology. Accordingly he was faced with a difficult situation and it was thought advisable that the easiest way out of the difficult position was to redraft the Bill in the form of amendments to be moved in place of the existing sections of the Bill. It will therefore be necessary, if the amendments are carried, to delete each section. There must be a motion to delete the section because the amendments that are proposed here are to take the place of the existing sections with the exception of Sections 7 and 8, which, I  think, it will be necessary in the end to move the retention of. Sections 7 and 8 are the only sections that will not disappear if the amendments, as they appear on the paper, are carried. Amendment 1 is in the nature of an explanatory or definitive section. It defines the various phrases in the Bill. I beg to move amendment 1:—
the expression “the Minister” means the Minister for Justice; the word “sweepstake” means a drawing or distribution of prizes by lot or chance whether with or without reference to the result of a future uncertain event; the word “hospital” means and includes any hospital, sanatorium, or other institution which affords medical or surgical treatment; the expression “governing body” means the council, board, committee or other body having the control and management of the hospital in relation to which the expression is used.
(d) reserves, on a monthly average, twenty-five per cent. of its accommodation for indoor patients for the use of patients who do not pay for treatment in such hospital or who pay or on whose behalf is paid not more than ten shillings per week for such treatment; and
(e) is not subject to any provision, whether contained in a  statute, charter, regulation or otherwise, debarring persons from election or appointment to positions or any particular position (other than chaplain) on its staff on account of religious belief.
Mr. Flinn: May I be permitted on this amendment to congratulate Deputy Craig and the draftsman on the extremely ingenious way in which they got out of a difficulty which I would have thought was insuperable?
Professor O'Sullivan: Amendment 1 consists of two parts. There is a portion of the amendment to which I have a certain amount of objection. I refer to part 2, paragraph (e). I am not at all sure as to what would be the practical effect of this amendment. I am rather slow to adopt the principle and I suggest the Dáil ought to be slow to adopt the principle that a hospital founded on a purely religious basis and run on purely religious lines should be deprived of any help under this Bill. I think that principle is wrong no matter what are the practical effects this amendment means to achieve. I suggest that that particular portion be deleted.
Sir James Craig: As far as I am concerned I have no strong feeling in the matter. I accepted the amendment on the Committee Stage, but it has been pointed out to me since then that it is rather an objectionable amendment. If the Dáil is willing to delete it I am quite agreeable.
Minister for Justice (Mr. Fitzgerald-Kenney): I would like to get some little help on other portions of this section from Deputy Sir James Craig or Deputy O'Dowd, or from any other medical Deputy who can  tell me about the practical working of the hospitals and how the scheme laid down in this section could be actually brought into operation. For instance, take Section 1 (2) (c) —that the hospital affords treatment to members of the public without discrimination, and in particular without discrimination on the ground of religion.
Mr. Fitzgerald-Kenney: As a practical matter I would like to know how paragraph (d) of sub-section (2) of Section 1 could be worked out. That reserves a certain number of beds for patients who do not pay for treatment in a hospital or on whose behalf is paid not more than 10s. a week for such treatment. That is the precis of it. How could that actually be worked out? What sort of evidence could be produced that that is the rule of the hospital? How long must that have been in force? How long shall it continue in force? Could a hospital pass a rule that 25 per cent. of its beds are to be reserved for non-paying patients as defined here and that rule be brought into force on the eve of a lottery and cease the moment that lottery is over? I am asking these questions from the practical working point of view. How could this be really proved? Suppose a hospital has got a considerable number of persons who are willing to pay more than that, and that they have not the full quota of persons who are unable to pay more than 10s. a week, are they to keep their beds empty or are they to reserve as a sort of scheme these beds or say “We will cut you down for a few weeks”?
I would like before this is put into  operation to know how it can be worked or what evidence can be given to the person judging this scheme that the hospital comes within this definition. I venture to suggest to the Deputy responsible that unless there is a restriction that can be completely worked out it is a mistake to have any restriction. It seems to me that this is the nature of a restriction that it would be impossible in actual working to carry out. But if it were possible for Deputies who know how hospitals are carried on and how their books are kept to explain the matter to me, I would be glad.
Sir James Craig: I do not think the case presents any difficulty whatever, so far as the hospitals in which I am interested are concerned. They keep details of the number of beds occupied from day to day; they also keep details of the number of beds paid for by the occupants and the amount paid for each bed. Those items are added up at the end of the year and they are able to tell how many beds are occupied entirely free, how many beds for which there was a charge of 7/-, 10/-, a guinea or two guineas, and so on. If a hospital is not able to show at the end of the year that they are giving free treatment to at least 25 per cent. of their patients or patients who do not pay more than 10/- a week, I do not think that the Minister would be asked to adopt a scheme.
Professor Thrift: And it says “on a monthly average.” I would like to know how that is calculated on a year. I would like to expand what the Minister for Justice says—“reserves so many beds on a monthly average.” Does that mean when the leave to run the sweep is applied for, or that it is always done? I would like to be clear on that.
Sir James Craig: Deputy Thrift ought to know that every fortnight  there is laid before the Board of a hospital a detailed account of the number of beds occupied. You cannot set apart certain beds in any hospital and say “These are going to be kept for twenty-five per cent. of the cases.” That is not possible. That may be the wording of the section.
Mr. Fitzgerald-Kenney: Apart from the wording I would like to know how it could be practically worked out unless you knew the period of time. You would have to lay down that during three or four or five years preceding the passing of this Act one quarter of the cases were patients who were paying under 10/- a week, if that could be done. Also there is the labour of going through that and it will be very hard to check. I am not opposed to it. I know what the Deputy and what the House want is this: that there should be some provision in the Act—the spirit of the Act should show—that the hospital is, to a very considerable extent, a charitable hospital. I think that is the view of the House generally and I think it is right that that view should be expressed in the Bill. But when you come-down to set a definite figure you will, I think, find that it is very hard to prove. Before a scheme is sanctioned clear proof will have to be given to the Minister for Justice for the time being that the hospital is a charitable hospital really. He must check these things. I would suggest to the House that a vague expression would be very much better and much casier to carry out— that is if you require an expression at all.
Mr. Derrig: I think it should not be beyond the powers of the House to devise some basis by which we could decide whether a hospital is really doing charitable work or not. The Minister for Justice has criticised this Bill but he has not put up an alternative. I think that the alternative of leaving the whole question in the Minister's hands would be really preposterous. The Minister in the opening stages of this Bill was not at all in favour of it and I do not  think that a change of attitude which he has now displayed is sufficiently——
Mr. Derrig: —constructive to merit the placing of the whole power in his hands. Personally I think that Deputy Sir Jas. Craig's section preserves a working basis. Some such basis will have to be found and if that basis is not quite satisfactory the Minister should now be able to suggest to the House, before he asks for power to interpret the Bill himself, some better average. This average that has been suggested is the outcome of the work of the Committee which apparently has gone into this whole question. I feel that there ought to be a definite period in the Bill to preserve the benefits to hospitals that can show that they are definitely doing work for the poorer classes of patients.
Mr. MacEntee: It seems to me that the point that the Minister has raised could be met by a simple alteration in the wording of the paragraph. Supposing the paragraph were to read: “In which during the three years preceding a yearly average of 25 per cent. of its accommodation for indoor patients has been used for patients who have not paid for treatment in such hospitals or on whose behalf has been paid not more than 10/- a week.” I suggest that the average be taken for the year.
Mr. Fitzgerald-Kenney: I think it is a distinct improvement to say for a certain time beforehand. I do not know whether the reservation of the accommodation would be the right thing or the number of patients treated.
Professor Thrift: I think the Minister's suggestion is much more satisfactory. I submit that it would meet the case if a private hospital satisfied the Minister for Justice that it was worked as a charitable or philanthropic institution.
Mr. Fitzgerald-Kenney: I do not think so, because the hospital might not be able to produce the evidence. It might be a deserving hospital and it might be the fact that it had fifty per cent. but it might not be able to produce evidence to prove that.
Captain Redmond: That is the situation you want to arrive at. If the hospital is not able to produce evidence the Minister will not be satisfied. If the hospital is able to produce evidence, then the Minister will be satisfied.
Dr. O'Dowd: As to the suggestion of Deputy Thrift that a clause should be put in to say that it was a charitable institution, I think the wording of this far better than anything I have heard, because a hospital can be philanthropic if it reserves anything more than five per cent. of its beds. I think we want to arrive at something more definite. It was because I had that in view that I put down 25. because it could still be described as charitable if it had only one per cent.
Mr. MacEntee: That is why I suggest a wider period. If you take a year the inequalities even themselves out and certainly a hospital which does not within the year appropriate one way or the other twenty-five per cent. of its accommodation to non-paying patients could hardly be described as the type of hospital I wish to assist through this Bill. If it does not keep at least twenty-five per cent. for the very poor who can pay nothing or for those who can pay a little, then it is a profit-making concern and exists for the purpose of presenting a sound balance sheet at the end of the year.
Sir James Craig: I think the word reserved must go from what the Minister has said. Would it satisfy the Minister if the following were inserted: “That such hospital should satisfy the Minister that twenty-five per cent. of its beds on a yearly average have been occupied by patients who have not paid more than ten shillings per week for such treatment”? That has been threshed out by the Committee. The Committee felt they were not prepared to give this help to any hospital that was not giving a very large proportion of its beds to the free treatment of patients.
Sir James Craig: Would you be satisfied then “that the hospital can satisfy the Minister that twenty-five per cent. of its beds on a yearly average have been occupied by patients who have not paid more than ten shillings per week for such treatment?”
Mr. Fitzgerald-Kenney: I accept it, though I am still no more enamoured of the Bill than I was to  begin with, not, as I said on the Second Reading, that I object to this Bill so much, but because I thought it was to be the thin end of the wedge. I would like to point out if this is a limited Bill the more difficult you make it the less effect it will have. If you put up a scheme that you are going to run sweepstakes on the Derby and if you have the preliminaries so hedged around with difficulties and necessities of proof it is manifest that before the scheme can be ratified you will rather defeat the objects of the Bill.
Sir James Craig: I am quite willing to leave it vague. It was Deputy O'Dowd who proposed this. I quite agree with him that it would not be a right thing to let hospitals who were charging for the treatment of patients, only leaving five per cent. of the beds free to poor people, to come in under the scheme. I am quite willing to leave it as vague as possible.
Mr. Fitzgerald-Kenney: The delay and the difficulties. For instance, the books will have to be produced and gone through and all that before there is any proof. Suppose you start sweepstakes, suppose a scheme is put in to-day and it becomes my duty to see that since Christmas at least twenty-five per cent. of the beds had been occupied by non-paying patients as defined here. That would be a very long and tedious  business and it would be awkward for the hospitals not to have these books while they were being investigated in my Department. I am looking at this in a practical manner. When a scheme is presented you look at it and see does it come under that definition, because if it does not you are not entitled to pass the scheme.
Mr. MacEntee: Possibly, but the implication contained in the statement of the Minister was that if this was going to be insisted on the sweepstakes for this year's Derby could not be launched in time. If it is to be a later race he will have more time.
Sir James Craig: I would move in substitution for (d) the clause that I have already read, “that such hospital can satisfy the Minister that 25 per cent. of its beds in the yearly average have been occupied by patients who have not paid more than 10/- per week for such treatment.”
Mr. MacEntee: I suggest that you make it that during the preceding twelve months twenty-five per cent. of the beds have been used on the average for the accommodation of patients who have not paid more than ten shillings per week. You suggest there that there has been a definite division of the beds for paying and non-paying patients. My point of view would be that you provide for non-paying patients at least twenty-five per cent. of the accommodation.
An Leas-Cheann Comhairle: My difficulty in the matter is this, that I cannot accept an amendment of substance on the Report Stage. I think if there is a substantial difference of opinion about (d) that the only course open to the House would be to re-commit it. As far as the Chair is concerned it cannot accept an amendment of substance on the Report Stage.
Mr. O'Kelly: I saw difficulties of this kind arising when the Committee was in existence. I realised that the Committee, having worked fairly hard on the Bill, would like to have another opportunity of going over it before it was presented to the  House. I was told that the Standing Orders of the Committee did not permit of it. We were told by the Chairman of the Committee, Deputy Doyle, that to make sure that everything would be water-tight he had arranged that the Bill would be submitted to the Minister for Justice, who had kindly promised that he would, so far as the phraseology was concerned, make it water-tight, with the assistance of the Government draughtsman. If that be so the blame is on the Minister for Justice. Certainly, questions of phraseology and difficulties have arisen that could best be settled in Committee, and unless the matter is very urgent I think the best course to adopt is to re-commit it.
Mr. Fitzgerald-Kenney: I do not think there is any difficulty about the phraseology. I think the phraseology here is perfect. After all, the draughtsman simply puts the idea into words. He does not supply ideas. If practical difficulties arise, that is not for the draughtsman. The draughtsman's work is only to translate into appropriate language the ideas that have been supplied to him. This could not be better worded. The practical difficulty it gives rise to is the thing which causes me trouble. Deputies are much more keen on this Bill than I am, and I think it is rather a pity to put impediments on the working of the Bill. That is all I got up to point out.
An Leas-Cheann Comhairle: I suggest that the Committee has sent back to the House what is practically a new Bill. I think it will be found as we go along that it is almost impossible for the House to deal with this in a satisfactory manner. It seems to me that the only thing open to the House is to have the Bill re-committed.
Mr. Fitzgerald-Kenney: I went through this very carefully and there are other objections. There is a clause dealing with the distribution of the money which I think in certain circumstances would be unworkable. It becomes unworkable  if the sweep becomes a failure. I think it could hardly stand as it is and possibly it would be wiser to re-commit the Bill.
Mr. Flinn: Before we do send it back to the Committee if there are any other objections in the mind of the Minister that he really wants to face in Committee, would it be a bad idea if he indicated his mind now?
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