Public Hospitals Bill, 1933—Second Stage (resumed).

Wednesday, 3 May 1933

Dáil Éireann Debate
Vol. 47 No. 4

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

Mr. T. Kelly: Information on Thomas Kelly  Zoom on Thomas Kelly  I was about to speak on this measure on Friday last, when I was told that progress had to be reported. That put out of my mind what I intended to say. This being Wednesday, I am not able to remember what I was thinking about last Friday; I never think about the same thing every day in the week. There is no evidence to show that at any period before the introduction of the Sweepstakes any man, woman or child who required hospital treatment was refused it. That being the case, I read with some astonishment the report of a dinner held at the College of Surgeons on Saturday night. The President of the College, proposing the toast of prosperity to Ireland, expressed the firm belief that the days of the voluntary hospitals were over. I went through other newspapers to see if there was an expression of regret by any of those assembled at the dinner because the days of the voluntary support of hospitals were over, and I could find none. I submit, with all respect to the learned gentleman concerned, that the majority of the hospitals, certainly in Dublin if not throughout the whole of Ireland, were founded on the voluntary principle and sustained by it through many generations, even in very difficult times and under very hard circumstances. I should have thought that there would be some expression of regret on the part of men so closely identified with hospitals all their lives, but there was none.

The reason I am speaking against this Bill is because, in my opinion, the Government should not have made these sweepstakes permanent. I know that certain difficulties presented themselves because of legislation previously enacted by the Cumann na nGaedheal Government. Nevertheless, I do submit that the principle of sweepstakes, certainly permanent sweepstakes, is not a principle that should have been supported by our Government here. I am not opposed to sweepstakes at all. But I do not [469] like that they should become a portion of our national life and national policy in the future. It is perfectly open to every man, rich or poor, to back horses and to take part in any form of sport he wishes. I am not against that. I believe the poor man has a right to back horses and to go to races as much as the rich man. Absolutely as much right. But what I do object to is the permanency of this thing, which will give a certain amount of imprimatur to sport. What I mean by “sport” is money-making sport. I am getting fairly well on in years but I think I will live to see money-making sport a big business in this country, a business which is going to bring out every effort of men's minds, efforts that should be directed to far higher and greater things.

It is astonishing to find the progress that this money-making sport business has made in recent years. I remember the time when it was just an incident in a man's life, and no more, to go to the races now and again and that sort of thing. In a special race such as the Derby or that class of race in England, he backed a horse. But it was no more than that. Gradually in recent years it has risen to be a very big thing indeed. Why, you see in the newspapers every day that more than half of their contents is given over to sport.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  That is only true of the Irish Press.

Mr. Kelly:  Well, I very seldom read any other class of Press. Of course I am not as well acquainted with the foreign Press as Deputy Fitzgerald-Kenney.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  I am talking of the home Press.

Mr. Kelly:  Even half of the newspaper is given over to sport. It is there in front of us. From the early Spring to the late Autumn there are races every day in the week and from the late Autumn to the early Spring there is football, so that the whole year round there is nothing but sport Having regard to what one hears about people wanting a lot of money and all this thing about sport putting money in one's pockets, it is no wonder that [470] the temptation is spreading to all classes of people. Now we have the Government here giving a permanence to sweepstakes. I wish—but I do not think my mind is subtle enough for it—to differentiate between the man who backs horses and the man who gambles. I have seen in the dictionary the meaning of the word “gamble” is to play for money. I believe that in gambling and in the extra forms of gambling there is still a remnant who play for sport. I am speaking of the sport that has got into men's minds every day of the year, the desire and the wish to have cheap money and to take part in the various forms of sport.

I could give hundreds of examples of it. I will just give a couple. Last Friday when I left this House to open my shop at 2 o'clock in the day, a well-dressed elderly woman came and said to me: “Could you tell me the name of Steve Donoghue's mount in to-day's race?” She was no more a sportswoman that I am a woman. I gave her the name of Steve Donoghue's mount in the day's race and I asked her would I put paper and cord around it so that she would not lose it on the way home. She grew very indignant and left my shop very angry at the idea of being received in such a discourteous manner. If any of you here want Steve Donoghue's mount, or Canty's mount, or Beary's mount, or Gordon Richards' mount or any other mount will you consult me by appointment, and I will give them to you. My fame has spread through my connection with the Turf, for you may believe it that for the last three years or less I have been the recipient of various communications enclosing to me letters for the Sweepstake people, saying they saw my name in some newspaper or some directory, and asking me would I be good enough to have this delivered to the Sweepstakes' office as they were afraid of sending direct through the post.

One man, especially, from Canada, and his name is Kelly, sends me two letters previous to each Sweep. In each of the letters there is always enclosed a birthday card wishing me a happy birthday and there is also a very small [471] coin to defray the postage. The coin is of no use to me. I could not buy a stamp for it in the Post Office because if I presented that coin in the Post Office the assistant would look at me very suspiciously. It would be absurd to bring the coin to Cook's and my conscience will not allow me to give it in charity. The only thing I can do with it is to give it to the new political association which the people over there are forming.

There is another correspondent of the same name of Kelly from South Africa who sends me enclosures for Sweepstakes. He, I think, described himself in one of his letters as “agent,”“trader” or “commercial traveller” Evidently he was inducing the natives in that portion of the world to buy Sweepstake tickets, because he told me in his second letter that I would not believe the interest the people there were taking in Dublin now. That took a good deal of worry off me because I was always anxious that the natives of South Africa would think well of Dublin. His communications have ceased. Probably he sold the tickets to the natives and these chaps seeing that they were not getting quick returns or that they were getting no results from their investments in the Sweepstakes have ceased to give their money to Kelly the traveller, the trader or the agent, who probably had to shift his quarters elsewhere. These things are very funny in their way, but it only goes to show how far this wish for easy money engendered by this class of business and this class of sport has gone.

The very last letter I got, a few months previous to the last sweep, was in this form:—“Dear Sir,—I send you enclosed and if I pick a horse would you be good enough to say that you sold me the ticket in Dublin, because if the people out here know that I picked a horse there will be a lot of people watching me and I will not be able to get a prize. If I back a horse I will reward you in very good style.” If his reward is in keeping with what he used to send me by post there is certainly no fear of my celebrating, and I am certain I would go home [472] sober. He concludes the letter in this way:—“Hoping that I will pick a horse, Yours faithfully.” I do not know whether he picked a horse or not. I hope that those who vote for this Bill will “pick” a horse until the horse is bare. I could mention many of them who do not go in for sport but who are really evidently out for easy money by money-making sport.

That is the reason that I oppose this Bill. I shall not vote for it. That does not matter one way or another but it matters a great deal to me and the class I represent because, amongst the working classes, this desire for easy money is growing apace. I am sorry for it because it will bring in its train greed, selfishness and envy. These are very serious matters, especially for those charged with any responsible office regarding government in this country. The voluntary hospitals have, up to this, done remarkably well. The memory of those who founded and sustained them should not now be overclouded by big money. That is what has happened. Otherwise, there would be some reference at this dinner of the College of Surgeons on Saturday evening to those who helped the hospitals, as I said before, for generations. I hope sincerely that the future of the hospitals will be as good and as beneficial, especially to the suffering poor, as has been their past history. If the old order is now changing and yielding place to the new, I hope the new order will be as beneficial to suffering humanity in connection with hospital work as the old order was. I cannot help thinking—it was not so long ago since I read of it—of the efforts of a valiant woman, scarcely a hundred years ago, who, with tremendous faith, with a subscription of £50 and with a promise of £5 a year and four patients, established a hospital in this city which has become not only a credit to the country but, I might say, a credit to Europe—that is St. Vincent's Hospital. When I think of what that valiant woman did with such slender support, I hope the new order there, at any rate, will be as beneficial as her work was. I mention her achievement in this assembly with great pride and [473] satisfaction and, with all my heart, bear tribute to her memory.

Dr. Davitt: Information on Robert E. Davitt  Zoom on Robert E. Davitt  As a member of the staff of one of Dublin's voluntary hospitals, I feel I must say something in connection with this Bill. It would be absurd, at the outset, to hold that there was nothing good in the Bill. For instance, I think that the section referring to the probability of provision being made for future research is a very good section. Clinical research, as distinguished from laboratory research, is a type of work to which sufficient attention has not been paid in this country. If it is the intention of the Government to help on clinical research under this Bill and not lose sight of that aspect in the more technical laboratory side, I should be thoroughly in favour of the Bill so far as it affects that particular point. I gathered from the statement of the Parliamentary Secretary the other day that the policy of the Government is to aid the cities to become big centres for medical teaching and for medical advance. Many of the country Deputies will probably contend that that is not fair to the county and district hospitals. Owing mainly to the moneys already distributed from the sweepstakes, the county and district hospitals have had more funds at their disposal, and I do not think that as much good has accrued from that as one might have expected. I am not a surgeon—I am a physician—but many surgeons have told me that decentralisation, so far as it has gone, has adversely affected the treatment of surgical cases in the county and district hospitals, owing to the fact that in many instances it is carried out by non-specialists. As everybody knows, it is very hard to be perfect in any job when you have a lot of other jobs to do at the same time. The time of a surgeon who is attached to a county or district hospital may be taken up in various ways—apart from surgery—which keep him from becoming efficient in that particular branch of medicine. As a result of that, treatment which is not sufficiently expert is applied in certain cases— especially surgical cases—to patients, with the result that they have to come up to Dublin later to get that treatment [474] corrected. If it is the tendency of this Bill to centralise specialised teaching and specialised treatment in the cities, I think it is a very good tendency.

What I do not like about the Bill is the retrospective portion of it. Deputy Fitzgerald-Kenney, on the last day on which the Bill was discussed, pointed out that when the previous sweepstakes were before the public, money was asked for under almost a guarantee that a certain percentage would be applied to the relief of certain hospitals. That money has now been collected, and the Government intend, judging by this Bill, to use it for other purposes. If the purposes, in their opinion, are good purposes, that does not take away from the fact that they are breaking contract with the public. This affects the hospital managing committees. They have entered into commitments. That has been pointed out already, but it is no harm to emphasise it. Contracts have been made with builders and others on the assumption that the hospitals in question would have a certain amount of money at their disposal. They were entitled to expect that they would get these moneys from the distribution of the funds now held up. They have no guarantee that they will get any portion of these moneys, and naturally they cannot be blamed for being extremely restless, in view of what may occur to the commitments and contracts into which they have entered.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  I do not want to interrupt the Deputy, or to put him off the trend of his speech, but he is developing a line of argument against the Bill that is really not applicable in the circumstances. It is admitted that many of the participating hospitals have embarked upon schemes of construction and equipment, on the assumption that certain moneys will be made available to them, as a result of the sweeps that have already taken place. I think it only right to say that it is the intention of the Government, and the Minister for Local Government, to advise the Minister for Justice to release certain moneys that have already accrued in respect of two sweepstakes, the Grand [475] National and the Derby of 1932. As far as I understand, the committees of the associated hospitals will be quite satisfied with the release of these moneys, and it is hoped to reach agreement with them for any scheme of extensions they carry out as a result of the disbursement of these moneys, and that they will, as far as possible, fit in ultimately to the co-ordinated plan we hope to put into operation.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  May I ask the Parliamentary Secretary if there is anything of that kind in the Bill? There is no such pledge in the Bill and, as far as I understand what the Parliamentary Secretary has said, that applies to two sweeps only. It does not apply to the breach of faith with the public in the third sweep.

Dr. Davitt: Information on Robert E. Davitt  Zoom on Robert E. Davitt  As Deputy Fitzgerald-Kenney suggests, that does not affect the principle. The Government, by this Bill, are going back on the contract they made with the public. To-day the Parliamentary Secretary has been kind enough—and we appreciate his kindness—to offer a certain amount of these moneys which have accrued to the hospitals, in order, more or less, to keep them quiet.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  It is theirs by right.

Dr. Davitt: Information on Robert E. Davitt  Zoom on Robert E. Davitt  Exactly, it is theirs by right. Why was this retrospective section introduced into this Bill? When the Parliamentary Secretary found it necessary to meet a deputation from the hospitals I believe he promised that one million would be released for division amongst them. I am very glad to hear that. I was not aware of the fact until now. That being so, the introduction of this section in the Bill is a mistake.

There was a good deal of discussion on the last day regarding the admission of patients to hospitals. Deputy Dillon and Deputy O'Dowd spoke on the question, and it has also come up for discussion in the Press. There may be instances—and to-day I heard of a certain instance—occurring where, owing to stupidity, either on the part of an official, a nurse, or someone [476] connected with a hospital, a patient who should be admitted was not admitted. These mistakes will occur, because as long as man is man you will have the human element entering, and an error of the kind occurring. Nevertheless, I say that Dublin hospitals do not refuse beds to poor patients. Very often they put up extra beds for special cases. What I mean by special cases are those where the point is made by a doctor outside, or by a subscriber, or maybe by patients coming in, that urgency demands that they should be admitted, after it is made quite clear that they cannot be admitted to another hospital with celerity. I have often seen a bed put up specially, at inconvenience, and in a manner that would encroach on the proper space for patients in a hospital ward, in order to receive such a patient at short notice. That results very often in complaints being made by the patient afterwards, that the ward was overcrowded. Many poor patients do not understand that while a ward may look big it will only contain a certain number of beds, if it is to conform to public health regulations and public health considerations. There are many instances of patients who are known as “hospital birds.” I have seen a great many examples of patients who were, as it is popularly known, “swinging the lead,” by trying to get in. I know one example where a poor man was in a certain hospital and was very bad. The man beside him in the ward said to him: “How do you like this place?” My friend said: “I like it all right. I did not come here for amusement. I came here to be treated.”“Ah,” said the other patient, “this place is not nearly as good as it used to be; the catering has gone down terribly. I think I will drop over to the Meath for a fortnight.” There are many of these cases put through the Dublin hospitals. You will find men who want a rest using every possible effort to get in either through a subscriber's influence or who, through misrepresenting their symptoms at the out-patients' department, are taken in by the house-surgeon on duty, on the principle that [477] there might be something wrong. Such patients occupy beds in the wards which properly should be given to other patients. Needless to say, they are usually evacuated as soon as possible.

Deputy O'Dowd referred to the stigma attaching to the Union hospital. Knowing the poor people of Dublin I have no hesitation in agreeing with the statement, that there is a stigma attaching to the Union hospital. But the Deputy proposed a most extraordinary remedy. He suggested that a large central hospital should be provided in Dublin, in which specialised treatment would be available, which the poor could call their own. Then the Deputy said that union hospitals have always been a failure, because a certain stigma attached to them, and that patients were reluctant to go into them for treatment. The provision of a big central hospital solely for the poor would mean that anyone who went into the big hospitals would be immediately segregated from those who went to the other hospitals in Dublin. You would be merely making a huge union hospital, and the stigma, instead of departing would become greater with the size of the hospital. You would have exactly the same dislike on the part of the poor patients to such an hospital as you have at present to entering the Union hospital. I do not think that you can better the system where poor patients are treated side by side with patients who pay a certain amount, whether that amount is considered reasonable or not. Poor patients do not like to be called or to be treated as paupers. If a patient can get treatment in a hospital which is not supposed to be for the poor alone, and if the stigma of pauper is not applied— the feeling may be due to human weakness, but it is a thing which exists and which we have to recognise in the system in vogue—that might meet the case. Of course in the voluntary hospitals in Dublin poor patients are treated side by side with patients who are paying something—it may not be much.

With regard to the remarks of Deputy Kelly which, although not [478] exactly on the same line, bore at least some resemblance to those of Deputy Thrift, about raising money by gambling, I do not think that anybody pays much serious attention to that kind of argument. It is said that sweepstakes are demoralising, but I do not see what demoralising effect the investment of ten shillings in a sweepstake ticket for the benefit of the hospitals could have. There are far more demoralising things going on at the moment and little attention is paid to them. There is a great deal in the Bill that deserves commendation. No objection could be made to the provision for a thorough examination of the accounts of the hospitals, because when public money is being distributed, in such large amounts, no one can object to representatives of the public, appointed, if you like, through the Government, seeing how this money is dealt with and whether it is being used to the best advantage.

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  The Labour Party in bringing forward on this, and on a previous occasion, the treatment of the poor in the Dublin hospitals, did a great national service. In spite of the speeches we have heard about the wonderful treatment the poor get, and despite all the statements made by people connected with the hospitals in the Press, it is a well-known fact that the poor in the Dublin hospitals get callous and scandalous treatment. They are looked upon as a class apart, as a kind of pariahs. I, who have some knowledge of the subject, desire to avail of this occasion, to raise my voice in protest against their treatment, and to hope that there will be a change in that direction because of the large amount of money these hospitals are getting through legislation passed by this House.

I happen to be a member of a board of public health. We have occasion to send patients to various Dublin hospitals for different kinds of treatment. We pay—it was ridiculed in a previous debate on one of those Hospital Bills—an adequate sum for the maintenance and treatment of those patients. We have heard from them repeatedly—and all their statements [479] cannot be false—of the callous treatment they get from the staffs of the hospitals. Consequently those who first ventilated this matter, as I said in my opening statement, are doing a national service. I know, in some of those hospitals, patients after serious operations have been thrown upon a bed and left there for hours without a drink of water.

Dr. Davitt: Information on Robert E. Davitt  Zoom on Robert E. Davitt  I think a statement of that kind cannot possibly be allowed to go unchallenged. The Deputy says that it is a frequent occurrence that patients, after operations, are thrown upon a bed and left there alone for hours. I say that is a most scandalous statement and there is no sense or reason in it.

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  I said I know of cases —I did not say all cases—but I know of sufficient cases. I know of complaints sufficient in number, as Chairman of the Westmeath County Board of Health, for the last five years, to make this statement, not only here, but at the Board of Health. I know of patients who come before us, at the Board of Health, and make those charges against their treatment in the Dublin hospitals.

Dr. Davitt: Information on Robert E. Davitt  Zoom on Robert E. Davitt  Did you look at the other side, or did you take their statements without any verification?

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  I know enough about the hospitals, or a number of hospitals, to know that there is a certain amount of truth in what these poor people said.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  What Dublin hospitals does the Deputy refer to?

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  I refer to every Dublin hospital, practically, that we have dealings with.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  May we know the hospitals that the Deputy has dealings with?

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  I refer to every Dublin hospital that our poor patients have dealings with, and that is, practically, the whole lot of them.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  May we have the names of two or three? This is a very serious charge.

[480]Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  I decline to give the names.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  But this is a very serious charge.

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  It is a very serious charge, and if the Deputy likes I shall make it in public.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  What more public place may I ask is there than this Dáil?

Mr. Everett: Information on James Everett  Zoom on James Everett  The Mansion House!

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  No, there is greater publicity here.

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  This Bill is very necessary. It tightens things up and makes for good administration of the huge sums of money that have been placed at the disposal of the hospitals in this country. Deputy Davitt spoke of breaches of faith and referred to something Deputy Fitzgerald-Kenney had said, but Deputy Fitzgerald-Kenney, when he introduced the original Sweepstakes Bill, did not believe the hospitals would benefit to one-tenth of the extent that they have done.

Mr. Fitzgerald-Kenney: Information on James Fitzgerald-Kenney  Zoom on James Fitzgerald-Kenney  I did not introduce the original Bill.

Mr. Kennedy: Information on Michael Joseph Kennedy  Zoom on Michael Joseph Kennedy  It was during the tenure of office of his Party that the Bill was introduced and passed, and, as Minister for Justice, he administered the Bill, and I say that he did not believe, and no member of his Government believed, that the hospitals would get one-tenth of what they got since that Bill was passed. Even if the Sweeps ceased at the present moment the Dublin hospitals would have been well away with the huge sums that they got from previous Sweeps, and there would be no breach of faith whatever with the public.

Deputy Davitt has spoken about decentralisation and that, as a consequence of decentralisation, certain surgical operations were a failure. But I would point out, subject to correction by the Parliamentary Secretary, or some one who has a more intimate knowledge of the matter than I have, that there has been, practically, no centralisation yet in the Free State, [481] as a result of the moneys at the disposal of the local authorities. I think, with the exception of the County Mayo, my own county is the only one that has attempted to go in for hospital reconstruction as a result of the grants we got under the Sweepstakes Acts. It will take two years before our reconstruction is complete. I do not know if the Mayo hospital reconstructions are completed yet. There is one thing I would point out as a result of the new conditions that are to be: We will be enabled to accommodate a far greater number of poor patients. We will be able to provide on our own premises a house surgeon. The whole matter will not be left in the medical officer's hands. We will have a better staff, a better operating theatre and other equipment which is necessary in a modern hospital. Decentralisation would be a blessing to us and I take it it would be a blessing to every other county and would save the ratepayers hundreds of pounds. The fact in connection with the county hospitals is that we have perforce to send patients to Dublin hospitals, because we have not the accommodation for them, even for very minor operations that the surgeons attached to those county hospitals are quite capable of performing. Decentralisation, when it comes about as a result of the grants made already and those about to be made, will be a blessing in every area.

There is another matter—perhaps it is not exactly in connection with this Bill—to which, with the permission of the Chair, we might be permitted to refer. There is a section here which deals with employment in the manufacture of tickets, and the manufacture of the paper for the tickets. This whole Sweepstakes business exists because of legislation passed by the Oireachtas. The principle in employment which the Government stands for, namely, employment for the most necessitous, should obtain in connection with the giving of employment in the Sweeps. I would like to see an amendment to this Bill insisting on that. We had recently an indication in the Press that certain people interested in employment in the city were going to picket the Sweepstakes offices, [482] because of unfairness in the giving of employment. Deputy T. Kelly has referred to the growing greatness of this business. I do not see eye to eye with the Deputy on this Sweepstakes business, but I do agree with him that the power of those people is immense, and that with the growth of the Sweeps it is increasing. People outside say that they are greater even than the Government. Those people should be brought to realise that they exist and have their being because of facilities given by the passing of certain legislation in this House, and that in the employment they give they have a duty to the unemployed. It is a well-known fact—I am not going to mention the names of individuals here, any more than I would mention the names of hospitals, because I am in a privileged position—that in some cases three or four people out of the same wealthy family are in positions in the Sweepstakes offices. Those people are not mere hewers of wood or drawers of water; they are not merely girls on 30/- or 35/- a week who address envelopes. It is a well-known fact that the wives of servants of the State, of officers serving in the National Army, and of members of the Gárda Síochána, are in big positions in those offices, whilst qualified people, fit to fill those positions, go abegging through the streets of Dublin, and of every city in the Free State. The people in charge of the Sweepstakes offices should be brought to their senses by the Department of Justice and the Department of Local Government. They should be made to realise that they exist because of special facilities extended to them by the Oireachtas, that in the giving of employment they should be fair and just, and that they should not act in a high-handed fashion, or with the favouritism which has distinguished them up to the present.

There is one other point mentioned by Deputy Davitt about the Union hospitals. He quoted my colleague, Deputy O'Dowd. While what they say may be true about the Dublin Union Hospital, those Deputies who know the working of the county hospitals in the various counties will agree with me that there is no stigma attached to [483] them now. Since amalgamation took place under the First Dáil the only complaint against county hospitals is that they are crowded over their capacity, and nobody thinks there is any stigma attached to going into them. The extension of them, and the building of new ones under this Bill, will be a blessing to everybody concerned. I welcome this Bill. I would like to see it more rigid in its clauses so as to provide for more control and supervision by the Government. Deputy Fitzgerald came in with an interruption a few minutes ago, which gave us to think that those people were above the law—that they were something which existed and had no origin in a Bill like this. This Bill should be even more rigid to control the activities of those people, to remind them that they are responsible to this House for their conduct, and to ensure that the money is spent in a proper, systematic fashion that will do the greatest possible good to the greatest possible number of people.

Mr. Bennett: Information on George Cecil Bennett  Zoom on George Cecil Bennett  I am not enamoured of the Minister's Bill. It provides in the first place for, I might say, an almost excessive Ministerial control of the sweepstakes in general, a control which cannot be justified in the light of the success of previous sweepstakes. Up to this, the sweepstakes have been running rather smoothly. There has been very little expressed dissatisfaction either with the allocation to hospitals, the control of the funds, or the manner in which the people who actually carried out the sweepstakes did their business. Deputy Kennedy said a moment ago that, in his particular county, there was a hospital set up or augmented to such an extent that they were going to have new buildings, new nurses, new doctors and several other facilities, and that provision would be made for them. Provision was made for them by the very facilities that were expressed in the Act which the Minister is now amending, or in fact changing altogether in its scope. There was an examination of the needs of all the various hospitals that applied for relief, and there were [484] a number. There was a careful examination made of what they needed in the way of buildings, staff, etc., and the endowment necessary to carry on the work when the grants had ceased. All this was arranged for under the old Act. Deputy Kennedy seemed to assume that the new Bill would lead to improvement in his hospital. There is no assurance that it will. It is all in the lap of the Minister whether he sees fit to increase the benefits that accrued to the hospitals under the previous Sweepstakes Bill.

The most lamentable clause in the Bill is that which makes it retrospective in respect of the allocation of certain funds. The Minister might at least have left alone the sweepstakes that were authorised under an Act of this Dáil, which were carried out correctly, which were considered by the Hospitals Committee set up to consider sweepstakes and appointed by the hospitals concerned, which after that consideration were put into the hands of the people who carry out the sweepstakes, the Hospitals Trust Committee, and by them advertised all over the world. In these advertisements they guaranteed that by the expenditure of a certain sum, the subscriber was in fact subscribing a certain sum for certain hospitals, for the provision of prize-money and a certain sum for expenses. The purpose for which subscribers contributed their money was definitely stated. Any departure from that definite contract is, if not illegal— the Minister proposes to make it legal —certainly immoral.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  What was the specific purpose?

Mr. Bennett: Information on George Cecil Bennett  Zoom on George Cecil Bennett  The specific purpose was that a certain sum would be allocated to certain hospitals. The Minister is going to upset that now by making the Bill retrospective. He has to go hat in hand to the Hospitals Committee themselves and make half an arrangement to encroach on the fund, robbing them of proceeds which should go to two of the hospitals. There were four or five concerned. He has no more moral right to divert this money from these two than he had from the other three. There is no moral justification [485] for a departure from a specific contract made in writing, which passed before three or four separate committees and which was finally put before subscribers, telling them that their money was to be utilised for a certain purpose and that purpose only. This is a departure from any honest amending legislation. We have had retrospective clauses in many Bills but I venture to say in no Bill has there been a retrospective clause which so violently and immorally impinged on the working of a previous measure where it was well worked as this.

I notice that none of the Deputies on the opposite benches who intervened in this debate spoke in glowing terms of this measure. Deputy Dr. O'Dowd spoke for a considerable time and his only contribution to help the Minister was a series of pious hopes that the Minister would do this or that in respect of the Bill. He was not able to point out a single clause in the Bill which would help, except the Minister in his wisdom desired to give assistance to the various hospitals. There was nothing in this Bill as there was under the old Act to ensure that certain benefits were to accrue to particular hospitals. There is nothing in the Bill such as the Labour Party and other Parties fought for under the old measure. That is the provision that a certain proportion of the beds in hospitals should be reserved solely for the poor. There was a provision in the old Act that at least 25 per cent. of the beds should be reserved for the poor. Where was the necessity for eliminating that provision in this Bill? Again, we are left to the tender mercies of the Minister to see that effect is given to what was specifically stated in the measure he is now amending.

There is possibly some good in the Bill. Personally, I would want a microscope to see it, as far as it is an advance on the other Act. I am opposed to the Bill mainly and principally because of the one clause that makes it retrospective. I believe there is no justification in the mind of any Deputy who has studied the Bill for making this clause retrospective. The fact that the Minister has had himself within the last 24 hours to enter into [486] an agreement with the Hospitals Committee giving them something, in part is an admission that he himself is not a believer in the retrospective clause. I hope that at another stage the Minister will accept an amendment to wipe out the retrospective effects of the Bill and accept also some other amendments which will make the Bill harmonise more with the needs of the hospitals and with the desires of subscribers.

Mr. T.J. Murphy: Information on Timothy J Murphy  Zoom on Timothy J Murphy  I am interested in this Bill principally from the point of view of the aim I endeavoured to secure when I was associated with the introduction into this House some months ago of a certain Bill. That Bill had for its object the checking of grave abuses that existed in many of the hospitals which benefited under previous schemes or which were likely immediately to benefit. It might be no harm to mention again some of the cases we had in mind on that occasion. The cases did not concern entirely the very, very poor. Provision was available for such patients, but the abuses concerned the very considerable number of people who from time to time need hospital treatment, but who are not entitled to free medical relief. I took the case of a small farmer or his wife or children who could not pay two guineas or three guineas a week in a hospital. They could pay, perhaps, 15/- or £1 a week. I think I demonstrated to the House on that occasion that here, in the City of Dublin, which is so free from reproach as well as one could judge from the speeches made here this evening, there were hospitals that absolutely declined to accept patients, although such patients were not anxious to be treated as free patients.

In one case, a patient was anxious to pay £1 a week but when the hospital authorities saw that there was a chance of such people being sent in through the agency of the board of health, thereby netting for themselves £2 or £3 a week from the rates, they advised the patient to go back and to be sent to the hospital through the agency of the board of health. I pointed out that there was one hospital [487] in the City of Cork that absolutely declined to take a patient of that kind at all. They absolutely shut their doors to all patients except those who could pay the ordinary fees charged in the hospital. There was no place for the wife of the small farmer or for a member of that farmer's family or for himself, even though he offered, and was willing to pay, the most he could afford to pay in any hospital. That type of case could not be regarded as a case to be dealt with through the agency of the board of health and people in that position were nobody's children.

I want to pay a tribute to the manner in which the Parliamentary Secretary and the Minister met us on that occasion. The Parliamentary Secretary was sympathetic and willing to understand our needs and he promised that a full and comprehensive measure that would deal with very many more aspects of this whole question than we were capable of enshrining in the small measure that was put before the House at that time would be considered. Since that particular time, there has been no change in the policy of at least one hospital in Cork City, and, while I make reference to that hospital with regret, I want to pay a very well deserved tribute to the other hospitals in Cork City and to many hospitals outside Cork City which have benefited under the Sweeps scheme and which have very loyally carried out, and more than carried out, any obligations that were put on them to provide for certain types of patients. Within the last three or four weeks, it came to my notice that an applicant for the blind pension who had to obtain a certificate from a certain hospital, or from a certain type of specialist in a certain hospital, was unfortunate enough to travel 40 or 50 miles to Cork to have the necessary examination carried out with a view to obtaining a certificate to enable him to qualify for a blind pension. It would probably take ten or 15 minutes to attend to that particular case in the hospital, and I know two or three cases where such people were turned away from the hospital because [488] they did not take the necessary steps to have their cases sent through by the county board of health.

I think it is a scandal that poor people should be treated in that way, and I do regret not to find any definite provision for dealing with abuses of that kind in the future. I quite appreciate the Minister's desire and the Parliamentary Secretary's desire to see that the hospitals are at the disposal of all classes in the community whether they are in a position to pay or not, but I want the Parliamentary Secretary and the Minister to believe that their job in drawing the line as tightly as they can to check abuses of this kind in future, or the job of the immediate authority they establish over the hospitals, is going to be very difficult and I would like to have the position made very much clearer in this Bill than it is. I would sympathise with and support the plea made by a Deputy who has already spoken that the provision for retaining 25 per cent. of the beds in the hospitals for people who could not pay more than 10/- or 15/- a week should be again put into this Bill. I hope the Parliamentary Secretary will, at a later stage, sympathetically consider an amendment to that effect. It is very necessary. They may not be very many but, no matter how tightly this Bill is drawn, there will be certain hospitals in the country that will endeavour to evade its provisions, and, I say it advisedly, to obtain all the money they can under any scheme that will be put forward while shouldering as little of the responsibilities of that scheme as they possibly can, so that I should like to see this particular provision very tightly drawn, and not alone very tightly drawn but very closely watched afterwards.

I am not quite in agreement with the suggestion that we ought to have larger hospitals in the cities and less development in the smaller hospitals in the country districts. Reference has been made here to the stigma of pauperism that attached to certain hospitals under the control of the county boards of health. I think that, to a great extent, that disability has been got rid of. The local district hospitals and cottage [489] hospitals, as we know them now, have done a great deal, by the manner in which they are run, by the manner in which they were constructed and planned—and I confess that I was not very optimistic about this matter some years ago, but I am willing to admit that I was quite wrong—to do away with that prejudice and stigma. As a member of a county board of health, I have found that people who are in a position to pay are sensible enough to avail of the excellent facilities many of the district hospitals now afford for the treatment of cases that formerly had to be treated in big central hospitals. It is, perhaps, too late to convince the Parliamentary Secretary on this matter, but I think he might, even yet, give some little consideration as to whether it would not be a wiser policy to develop, encourage and assist in every possible way the district hospitals and cottage hospitals. They are doing excellent work, and they have been fortunate enough to get into their service, in a great many places, very able surgeons who are doing an extraordinary amount of good work. He will find, as his predecessors found, that the centralisation of hospital services is not a step that is very cordially received by a great many people in the country. I would prefer to see the policy that was enshrined in previous local government administration, of developing the smaller hospitals, continued for the present. There may have to be some extensions made in the larger areas, but I think that the unit in the matter of good, sound local government administration ought still to be the district hospital or the local cottage hospital.

These are the two points I would like to mention in connection with the Bill. We shall have an opportunity of discussing them on a later occasion. Perhaps the Parliamentary Secretary in his reply would be good enough to advert to them and to throw some further light on our little difficulties. If the objects that were sought to be attained under the previous Bill can be attained in any other way than the way we indicated in that Bill, I think we will be very satisfied and very pleased, but [490] experience has taught us to be very cautious in a matter of this kind and to make sure that we leave nothing undone to check abuses that, undoubtedly, have crept into a certain number of the hospitals with regard to the treatment of people who were borderline cases and who were not, strictly speaking, poor law cases but people who could afford to pay very little. I commend these points to the attention of the Parliamentary Secretary and I trust that he may be able to give us some further information on the matter in the course of his reply.

Mr. J.I. McGuire: Information on James Ivan McGuire  Zoom on James Ivan McGuire  I rise to oppose this Bill for several reasons, all of which I do not propose to elaborate. When these Hospitals' Sweepstakes were first legalised in this country, the sole justification for their legalisation was that they were created for charitable purposes. The charitable purpose for which the sweepstakes were legalised was that of providing the hospitals with very badly-needed money. The present Bill puts the supervision of the way in which that money is going to be dealt with entirely under the control of the Minister. As we all know, money which was segregated for the purposes of the hospitals for a number of sweeps was, to a certain percentage, the exact amount of which I am not aware, raided by the present Government for the general purposes of the Exchequer. I am told that that is not so. It is whispered to me from behind. But that is my impression—that a certain percentage of moneys going to the hospitals has been taken or is going to be taken by the present Government and used for the general purposes of the Exchequer. It seems to me that one is entitled to suspect that this present Bill, in so far as it puts the control of these moneys entirely under the care of the Minister, is framed for the purpose of enabling him to keep the expenditure, so far as it is directed towards the improvement of the hospitals, as low as possible, with the object in view, of course, of attracting as much as [491] possible of the money to the Exchequer.

I had not meant to contribute to this discussion at all except for a speech which was delivered a few minutes ago by Deputy Kennedy. Deputy Kennedy made the suggestion that the Minister should see that the employees of the Hospitals' Trust— of the Sweepstake organisation—should be drawn from a certain class of the community, the unemployed class. That is typical of a number of suggestions which I have heard made here from both the Fianna Fáil Benches and the Labour Benches since I came into the Dáil. In other words, because a man is unemployed and badly in need of money, that is to be the sole criterion by which one is to go in order to decide whether or not it is he or someone else who is to get the job. Deputy Kennedy appeared to forget that the sweepstakes are a huge business proposition and that the organisers of the sweepstakes have made a colossal success of that business proposition. The suggestion of the Deputy is that when they are deciding what hands they should take into the Hospitals' Trust in order to carry on this great machine of sweepstake work, they should have regard, first and foremost, to the pecuniary position of the applicant for the job. The Deputy absolutely ignores the necessity, first of all and primarily, regarding the capabilities of the person applying for the job to perform that job. I know of a case in the City of Cork where a doctor's daughter was given a job in the sweepstakes. She was given a job in the foreign department. About a day afterwards a picket was put outside the sweepstake office in that city and an outcry was raised because a doctor's daughter was given a job. The picket, however, was removed after a very short time when the ringleaders of the agitation were asked to produce a girl who could speak four languages and write and conduct a correspondence in four languages.

It would be far better if the Government were to keep their hands out of the business side of this proposition. I do not wish now to discuss the proposition [492] that it is not part of the function of the Government to interfere in the business life of the community, but I think it is patent, and will be patent to everyone, that the great success of this sweeps organisation certainly entitles it to be left alone to go on, as it is run, on the most successful lines possible.

There is one other reason, which I should like to mention, for my opposition to this Bill. As I understand the position, it was pointed out to me a few days ago, when speaking to the governor of a hospital in this city, that arrangements had actually been entered upon and that big contracts have been entered into with firms in Ireland for the construction of buildings in connection with some of the largest hospitals in this country. These contracts have been actually completed. As has been pointed out already here in debate to-night, money was raised from the public on the understanding that that money was going to be used for hospital work and for hospital work solely. I may misunderstand the position, but if my informant is correct—the governor of this hospital to whom I have already referred— he tells me that schemes which they have had on foot are now about to collapse by reason of the provisions of this Bill. That is a very serious matter from the point of view of the hospitals of Dublin to-day, and I would certainly impress upon the Minister the necessity of looking into that difficulty and of giving it every consideration before this Bill proceeds to its final stages.

Mr. Briscoe: Information on Robert Briscoe  Zoom on Robert Briscoe  I really cannot understand the opposition to this Bill when I try to examine the various points of view put forward by those who state they are in opposition to it. The last speaker, Deputy McGuire, my colleague from the South City, has given very many reasons why he objects to the Bill. I am afraid that I must confess, after listening to him, that I believe that he, first of all, does not know what the Bill is about and, secondly, that he does not understand the situation from his own personal experience of, particularly, the city hospitals.

[493] First of all, I am in full accord with this Bill and I am in full accord with it not only from the provisions or expressions enshrined in the Bill but because it is completely in line with the point of view held by us on this side of the House when we were in opposition and when the sweepstakes were first inaugurated. Deputy McGuire does not understand, first of all, that this is not a Bill to interfere with the management of the people who are promoting the sweeps as such. As far as I can see, there is nothing in the Bill to interfere with the running of the business of the sweeps as such. The purpose of the Bill is to try to control the manner in which the money that falls to the hospitals is to be appropriated by the various hospitals and in what manner it is to be spent. I have a little experience of various hospitals in this city. I am on the governing board of a hospital and I know, from my own experience, that it would be far better if the Government were to take even a greater interest, legislatively, in the matter. Deputy McGuire does not know the difficulties that confront the governors of hospitals. In the first instance, I should like to inform the House that nobody at all anticipated that the success of this Hospitals Trust would be anything like near what it has been and what it still continues to be. No hospital ever thought that it was going to get during the whole lifetime of the sweepstakes what it got, as a matter of fact, out of a single sweepstake. When they got this money they decided to erect buildings and to make certain structural alterations and when they had got so far in this they found that they would have to invest a certain amount of the money coming in to meet the expenses which would arise from the upkeep of the additional facilities. Other things came up also. Everybody is human, from the nurse up to the doctor in charge, and everybody saw for themselves the improved conditions under which they could live and under which they could give facilities to those who came into the hospitals. I can see in the country districts every hospital thinking of the same thing and having a multiplication of facilities [494] which might not be necessary if there was proper co-ordination through some central authority. I am satisfied that if an hospital is going to get certain money the money should only be granted, as is provided for in the Bill, according to the requirements of the hospital and the surroundings of the people it will be called upon to cater for.

Deputies have made remarks about certain hospitals treating certain people in a certain manner and there has been a lot of public comment. From my experience of the many hospitals with which I am associated, as representing the Corporation on the boards, I cannot accept as an absolute fact that there is any ground for suggesting that hospitals have not done and are not doing all they possibly can for the poor. Complaints were made to me in one or two cases by members of the Corporation. On investigation, however, I found that it was not the hospital that was at fault but the person who made the complaint and that in fact the statements made were exaggerated. It is not fair for Deputies to make these bald statements without having previously investigated them to find out if there was anything in them.

Deputy McGuire laid stress on the fact that there was a suggestion made by Deputy Kennedy that the Government should see that, as far as possible, unemployed persons were given a preference for employment by the Hospitals' Trust. Perhaps the Deputy does not know that the Government have already made representations to that effect, and that the Hospitals' Trust now engage all the people they possibly can through the labour exchanges. As far as I know, that complaint arose from the fact that a lot of persons were employed there who were not in need of it, and who were doing work that could easily be done by unemployed persons. That position has been rectified to a great extent, and is continually being rectified. I know that if any Deputy were to write to the Hospitals' Trust suggesting a person for employment he would get back a printed form which goes to every applicant stating that the Trust have decided, at the request of [495] the Government, I think, to employ anybody who is not a specialist in a particular branch through the labour exchange. They are able, as a matter of fact, to-day to select their employees on merit, because they hold examinations and vacancies are now filled from the successful candidates. At one time there was some reasonable ground for the complaint made by Deputy Kennedy, but efforts have been made to remedy that as far as possible. I cannot understand Deputy McGuire saying that he objects to the Bill, and as a legal gentleman, giving as a reason that the Bill is doing something which it does not in fact intend to do, and does not seek to do; that it intends to interfere in the business side of the Hospitals' Trust.

Mr. McGuire: Information on James Ivan McGuire  Zoom on James Ivan McGuire  I did not say that. I was dealing with Deputy Kennedy's speech.

Mr. Briscoe: Information on Robert Briscoe  Zoom on Robert Briscoe  Deputy McGuire said he would not like the Government to interfere in any business or to go into business in any way. I am sorry he was not here some years ago when the Government decided to go into business and, in fact, went into business and is in business to-day in competition with taxpayers and rate-payers, inasmuch as it opened up shops in competition with these people and carried on advertising out of the taxpayers' money. I would have been glad to have his support then, and I hope I shall have his support when the occasion arises. I hope he will join with me then in putting the Government out of business when it comes to competing with taxpayers and rate-payers. Another reason was that he did not want any interference with the hospitals. They were to be given this money to spend in any way they liked. There was to be no suggestion as to whether there was a multiplication of facilities or a lack of facilities.

Mr. McGuire: Information on James Ivan McGuire  Zoom on James Ivan McGuire  The Deputy has invented all these reasons.

Mr. Briscoe: Information on Robert Briscoe  Zoom on Robert Briscoe  I must have misunderstood the Deputy's English and I think it would be very hard to suggest [496] that I would misunderstand a colleague from my own constituency. I would ask the Deputy really to state what his objections are. If he had any practical experience of hospital work, beyond calling at the hospitals on the eve of the election canvassing and getting the nurses photographed with him, if he went there when the governing body sits and decides all the day-to-day things which crop up, I would like to hear him speak. The course the Government is taking now is to regulate this huge sum of money and see that it will be spent in a way which will be of lasting and real benefit to the people for whom it was intended. As I said, the difficulty that cropped up after the passing of the original Act was that the hospitals found themselves wealthy suddenly and they were able to embark on huge schemes of structural alteration and the acquisition of surrounding premises. As a matter of fact, the suggestion was made in the Dáil by some Deputy that steps should be taken by the Government to see that for whatever additional expense was entailed in the shape of extra upkeep provision should be made out of this money. I can only speak of the city hospitals which I know of, and I can say that they have been very judicious in that respect. They realise that if for any reason the sweepstakes were to be stopped, or if they were not so successful as they have been, and if the money was to cease to come in, a position might be reached when the upkeep of the hospitals would either fall on the taxpayers or they would have to fall back on the system of voluntary subscription, which was never satisfactory from the point of view of giving the hospitals all they needed.

I should like to direct the Minister's attention to a point that I have had in my mind for a long time. I should like him to take note of the desirability of getting the hospitals to work together from the point of view of exchanging experiences. I am talking of the voluntary hospitals in the city and the desirability of having some kind of central body through which there could be an exchange not only of [497] apparatus that hospitals might have but also of the technical skill of some of the eminent and very efficient medical men that they have on their staffs. I do not know if it would be feasible now, but if we could get to the point of having more intercourse between the various hospitals professionally, as well as from the governing point of view, you would give an opportunity to the younger doctors and students of getting a far wider experience in the various branches of medicine than is available at present. At present some hospitals are renowned for their treatment in a particular medical branch and the students acquire extra knowledge by being in these hospitals.

On the other hand, other hospitals are eminent in other branches of work, and I was hoping to hear that some thought would be given in that regard. I do not suggest there should be an amalgamation of hospitals. I know that that is beyond hope at the present time. One might almost suggest that we would like to see an amalgamation of Trinity College with the National University. Conditions are as far apart in some of the hospitals. There should be some system of bringing about intercourse between medical men and the hospitals in such a manner that treatment could be, in a sense, exchanged. There are hospitals in which certain cases are dealt with and patients are changed from one hospital to another for the purpose of special treatment.

I believe this Bill makes a start in the right direction, and anybody who has any desire to see this huge amount of money applied in a way that will give a lasting and really charitable benefit to the poor will find that this Bill gives every indication of going in that direction. I cannot understand the opposition to it. I would like to know if there is any means of saving the hospitals and the medical profession from a certain class of patient who is well able to pay for medical attention but who takes advantage of the dispensary system. That type of patient is examined and gets a bottle of medicine for one shilling, just as if he were an ordinary [498] poor person, while, in fact, he can well afford medical treatment. Many hospitals have had to treat as poor people persons who are well able to afford treatment. The hospitals cannot at the moment stop this abuse. I do not know whether the Minister has power under this Bill to suggest some means of restricting that practice.

I would like to hear some real opposition offered to this Bill, if there is going to be any opposition. As it is, suggestions are suddenly brought forward here without any previous consideration. Deputy McGuire sought to base his opposition on the suggestion that the Government is interfering with the running of sweepstakes, a thing which it is not doing at all.

Mr. Good: Information on John Good  Zoom on John Good  While I disagree with my colleagues and others as to the underlying principles of sweepstakes, I cannot but agree with the underlying principles of this Bill. The sweepstakes, as we know them to-day, have achieved very different results from what the most optimistic Deputy in this House imagined when we passed the original Bill. The hospitals now find themselves in possession of very large sums. The late Government appointed Commissioners to see that those sums were wisely spent. Those Commissioners have done an amount of useful work. When they were appointed I do not know that any of them had very much experience in hospital work, but during the three years that have elapsed since they were appointed I know that more than one of them has travelled a considerable part of the Continent acquiring experience in hospital administration so that they might more efficiently discharge the duties and responsibilities attaching to the position.

We have a great opportunity of doing an amount of good in connection with our hospitals, and I am anxious that we should rise to the occasion and make our hospitals such that they will be the admiration of medical men from all parts of Europe. Knowing something of the hospital problem on the one side and of the [499] finances that are available on the other side, I am quite satisfied that there is a great opportunity to do something useful. But it does appear to me that the success of this scheme will depend almost entirely on the administrators appointed under this measure. I do not know the number the Minister intends to appoint. The Bill says they shall not be less than three. I do not know what the maximum number will be. All our experience points to having small committees. I think we will all agree that a small committee of practical men would be best fitted to discharge the many responsibilities that will fall to the committee under this piece of legislation.

One problem that has been the subject of a great deal of discussion in our city during the last six or seven years has been the question of centralisation. We have in this old city of ours some twelve to fourteen general hospitals, all discharging similar duties. The aims of these hospitals are to get all the funds they can so that each one may be a complete entity. I do not think that is a proposal that will appeal to men of experience and knowledge as a solution of a big problem of this character. I think men who have studied this problem will agree that from the point of view of training the medical men of the future and from the point of view of the patients who occupy beds in these hospitals, everything indicates a centralised scheme as being the most efficient. There is now an opportunity of achieving that ideal. In the past that ideal was widely discussed and very largely agreed upon by medical authorities, but the difficulty lay in financing such a large problem. The sweepstakes have provided funds that would enable a scheme of that character to be carried through there if the trustees should so decide. In order to get the best results which would satisfy the old desire out of this opportunity, we must get really the best men to guide us. And where the Minister is going to look for those supermen, men of very special knowledge, men of wide [500] training and wide experience I do not imagine at the moment.

Mr. Kelly:  Why not women?

Mr. Good: Information on John Good  Zoom on John Good  Good women would be better than bad men. I hope at all events when we come to look for such men that Party politics and other considerations of that character will not enter into their selection. I hope the Minister will rise above such questions and appoint men on their own abilities and their special knowledge of the particular problem with which they have to deal. I referred a moment ago to the fact that trustees had been appointed some three years ago to deal with the existing problem. I learned with regret in the last few days that these trustees, who have acquired as I said considerable experience in the discharge of their duties, have now been set aside and three other trustees appointed in their places. I have only heard that within the last few days and I do not know whether it is so or not. That is the Hospitals Committee, the men who are discharging the duties at the moment of advising on the different hospitals, men whose duties as discharged in the past have been very similar to the duties which we hope these men should discharge in the future. From my reading of the Bill I think that is so. Perhaps the Parliamentary Secretary would advise us on that point. What I am anxious to impress on the House is this: I do not know whether in connection with these appointments Party politics have entered into the problem at all but it does appear to me that our Ministers are influenced considerably by these considerations. Whether, however, the members of the Hospitals Committee, who discharged these duties during the past three years have been set aside for good reasons I do not know, but I do hope that the men who have been appointed in their places are men who know more about the problem than they did. What I want to impress upon the Minister is this, let us get three, four or five men if that number is necessary who will be capable of dealing with this problem in the way we would like to see it dealt with. As I said in the beginning of my remarks, [501] we have a great opportunity and I hope we will rise to the occasion in a good way.

Mr. Cosgrave: Information on William T. Cosgrave  Zoom on William T. Cosgrave  One would think, listening to some of the speeches delivered here, that the hospitals in the city and country were Government blessings, that they were established by the Government, that they were having the running of them and that only for the Government there would be no consideration for efficiency or for the patients or sick persons from one end of the country to the other. Now the facts are that the hospitals in bad times and under trying circumstances found themselves unable to provide the accommodation, treatment and other assistance that the suffering people of this country had been supplied with by these hospitals for a very long time. It was in this set of circumstances that a number of governors came before some members of the Executive Council then in office three or four years ago. They put to the Executive Council the absolute necessity for some special dispensation of wealth if they were going to continue or to keep their doors open. In these circumstances, although there was very strong opposition to sweepstakes and so forth, it was found that the money could not be provided from Government sources and that they ought not to be actively prevented from presenting to the Oireachtas a Bill which would enable them to raise money by sweepstakes.

When one hears now that the hospitals have got huge sums of money and that they are very wealthy, one would expect that most of their troubles would have disappeared. In the light of this measure we are still in the possession of the information that they have plenty of money. Whether that is a fact or not I am not in a position to say. I doubt it very much.

I may say that I do not like this measure for very many reasons. The principal of such reasons that I have against it is that there are 26 sections in the Bill, and out of the 26 sections there are two sections devoted towards the making of grants to these hospitals out of the funds, and another application for grants out of the Hospitals [502] Trust Fund. They are the means and they are the supplies for the hospitals. The other 24 sections refer to various provisions of one sort or another, and to various regulations, committees, the persons to be employed, precautions to be taken and so forth, but so far as the hospitals are concerned only two sections. Observe the mind behind the framing of this measure. We find that this new Hospitals Commission or Trustees, or whatever it is called, are to enter into possession of any moneys that are not yet disbursed. Then the Minister proposes to deal with distribution of these funds which were collected under special circumstances, and under the guarantee of the governors and bodies representing the various hospitals.

One would have imagined from the course of the discussion here that in the very difficult circumstances in which the hospitals found themselves in keeping open at all, that some tribute at least would have been paid to the various committees managing these hospitals; that some tribute would have been paid to the great services rendered by surgeons and medical men who freely gave a good deal of their time, and whose whole concern in their work is to have their hospitals a credit to their profession, a means of providing for the relief of suffering, the cure of disease and the other infirmities from which people suffer.

Have any of those professional men and others who contributed so much of their time, so much of their genius and so much of the gifts that God gave them, been consulted about this measure? Looking at it then one would have thought somebody sat down with a hostile notion in his mind towards the hospitals. There are in the Bill two sections about the distribution of the funds, and then so many sections qualifying, regulating and so on. The Minister may accept or reject any report made to him by the Hospitals Commission.

The Minister may, apart altogether from the report, entirely on his own initiative make grants to the hospitals. I presume he does it under some [503] direction or some recommendation from somebody other than the Hospitals Committee or Trustees that are set up under this Bill. There are two sets of Commissions—Trustees and Hospitals Commission. There is suspicion even there. Not satisfied with the bodies the Minister creates or with the bodies set up by the Minister himself, in addition to all this, it is not necessary to have in this case any professional assistance or advice as to how the distribution of the moneys is made to these hospitals. It is not a good system, it is not a wise system. It is not a system which if one were parting with his own money, or one making a will would follow. He would get some medical person or another; he would get some advice as to how the money would be spent if he were interested in the treatment of humanity.

We are told that the Dublin hospitals are much better off than ever they were, that they have more money coming in than anybody had ever anticipated. That is not quite correct. A letter appeared recently over the name of a governor or surgeon of one of these institutions, pointing out that his hospital had been at a disadvantage rather than an advantage as a result of the sweepstakes. A book was given or lent to me some time ago by a member of this House. Deputies on the opposite benches, or their friends, burned it a few years ago. An account was given in that book of the first hospital established here in the eleventh or twelfth century by a man called Robert Le Palmer, a Dane. It had accommodation for 50 beds. In the course of an inquiry held into the Dublin hospitals in 1854, the question of that particular hospital came up for consideration. It was confiscated during the time of the Reformation. A witness was asked what became of the property. The property was seized by the Crown and sold. Various people got it. He was asked what about Guy's or St. Bartholomew's, or some other hospital in England. He said that was also seized, but handed over to trustees and since maintained as a hospital. There is no double dose [504] of sin in having a hospital endowed with money. But a great mistake is made if, by reason of a huge experiment such as the sweepstake, large sums of money have come in from the charitable or speculative public for the assistance of the hospitals and the hospitals are worse off than they were because of its being held up. In the letter which I have referred to it is stated that the sum deducted from the hospital in question is about £7,000 a year. It may be £7,000 over two or three years, because it is some time since I read the letter. Let us examine the position of that hospital having regard to the deprivation of these sums of money. It is not the only hospital concerned. I have heard of another hospital which had grants from the local authority and the Government amounting to £3,500. What capitalised sum would be necessary to place that hospital in the same position as it was before its finances were interrupted by this shower of gold which, some people say, has come its way. £70,000 at 5 per cent. would be required to place that hospital in the position it was before the interruption.

Going further through the Bill, I find that according to Section 24 (5) “no grant out of the Hospitals Trust Fund shall be made or applied for or towards the future maintenance of the grantee.” According to sub-section (6) the expression “the grantee” means “the hospital or organisation to whom a grant out of the Hospitals Trust Fund is made under this section.” The word “maintenance” means “ordinary day to day support and upkeep properly chargeable to income.” The expressions “past maintenance” and “future maintenance” mean respectively “maintenance before and maintenance after the making of the grant out of the Hospitals Trust Fund in relation to which the expression is used.” In this Bill, provision is made for the endowment of a bed. The endowment of a bed, I presume, would connote the maintenance of the bed. But if my interpretation be correct, no sum of money can be given to a hospital for future maintenance. What, then, is the position of those hospitals which have been in the privileged position [505] of getting a few thousand pounds from Government funds which have been stopped by reason of this shower of sweepstake money which has come in and which, they say, they have not received? Deputy Good has referred to the work done by the committee. The committee has done very useful work. It has, at least, established standardised accounts, so that we now know where we are. Very different accounts have got to be kept by different hospitals. It is very easy to criticise the hospitals and to say that they do not give treatment to this, that or the other person. Is there as much energy, determination and philanthropic effort used up by the persons concerned in looking for subscriptions for the hospitals as there is in criticising them? There is scarcely any more expensive institution than a hospital and hospitals cannot give help of any sort or kind unless they get funds from some source. By reason of the sweepstakes and of the conclusion people have come to that huge sums of money are available to the hospitals, public and private subscriptions have dried up. I understand that the Minister is now going to let loose the sum of money which has been dammed up. It is about time.

There is mention in the first section of the Bill of the provision of money for medical research—a very interesting subject. Perhaps the best contributors to it—I do not know whether I am right in chronological order or not—were Corrigan of Dublin, Pasteur of France, and Banting of Canada, the discoverer of insulin. There was also a well-known German whose name, I think, was Von Lichtenberg. There was also a Viennese who specialised in splints, Bohler. It is rather interesting that not a single penny of research money was spent on any of these remarkable, providential discoveries. That is very remarkable, indeed. I should like to know if the Parliamentary Secretary can give us any indication of the results achieved in respect of the sums of money that have been spent on research. These results ought to be available. There are very rich research organisations in various parts of the [506] world, not excluding the Rockefeller Institute. It would certainly interest me and, perhaps, a number of members of the medical profession if we could get some indication of the result of their labours. I hope no laymen are to go into this business of medical research. I am not expressing professional views upon it; I am simply stating historical facts. I should be glad to have professional information on the subject, if available. The Bill, as I said, has 26 sections and two of them are concerned with the hospitals. The rest are concerned with new schemes of organisation and with reorganisation. The two which make reference to the hospitals disclose as many obstacles in connection with the distribution of the money as facilities. Everybody is agreed that our hospitals ought to be well equipped. Equally important to the equipment of the hospitals is the maintenance necessary to allow them to be run. There is not much use in having a Rolls Royce car if you have not oil or petrol or a person to drive it. Similarly, if we are to look after the sick and infirm poor and alleviate suffering, we ought to see that these institutions which were running so well up to two or three years will not have their operations interrupted. I oppose the Bill.

Mr. Everett: Information on James Everett  Zoom on James Everett  I intend to support this Bill because it will give the Minister power over moneys for the hospitals before being distributed. Under Section 24 the Minister will have power to make it a condition that a certain number of free beds will be available for small farmers, small shopkeepers or tradesmen who are unable to pay the charges demanded by the Dublin hospitals. In my constituency we pay £5,000 yearly to the Dublin hospitals. One poor person who came up to a Dublin hospital and offered to pay £1 weekly was advised to go back and to get in through the board of health. During the last ten or 15 years I have never received a complaint regarding the treatment of patients in the Dublin hospitals. I will certainly pay a tribute to the hospitals, and to the surgeons connected with them, both as a member of a public body and as one who has [507] been a patient. I was a patient in two Dublin hospitals and I saw the surgeons giving their time and their skill regardless of whether they were poor or private patients. The Wicklow Board of Health sends large numbers of patients to Dublin, and it has never received any complaints. I hope the Minister will consider the position of areas in close proximity to Dublin and that he will not be led away by appeals from public bodies to have large central hospitals. While minor operations are performed in district hospitals the Minister should not consent to the building of large hospitals near centres which have as skilled staffs as there are in Europe, such as is the case in Dublin. If a patient has to undergo a big operation that patient goes to Dublin, where there are specialists to deal with special complaints, instead of to an hospital where one man is supposed to be a specialist in all diseases. For that reason I object to large hospitals being built in close proximity to Dublin.

Deputies who voted for the previous Acts did so in the belief that there were to be free beds. A hospital in my constituency received a very large sum of money, and, as a result, they are paying secretaries, and doctors, but the Board of Health have to pay for patients sent to that hospital—The Countess of Wicklow Hospital. We have to pay two guineas a week for poor people sent to Dublin hospitals by the Board of Health, notwithstanding the large sums that these hospitals received from the sweeps. I believe that under Section 24 the Minister will have power to make it a condition, before any grant is given to hospitals, that a certain number of free beds will be available, or that there will be moderate charges for people who are poor or semi-poor, such as small farmers, small shopkeepers or tradesmen. Deputy Briscoe pointed out that a certain number of people who were not poor availed of the hospital treatment given in Dublin. People in the country have not that privilege. The hospitals have to be paid two guineas weekly for [508] patients who are sent to them. Now that large sums of money are to be distributed amongst the Dublin hospitals I want to know will the poor people in the country districts get advantages similar to those that the poor people in Dublin receive. I am not going into the question of the employment given in the hospitals sweep. That is a matter for other people. As Deputy Cosgrave pointed out, no tribute has been paid to the surgeons or to the hospitals. One Deputy suggested that the Labour Party brought forward the case of a patient who had been left without a drink of water after an operation. I do not think any member of the Labour Party brought forward such a charge. As one who is a member of a hospital board, and who has been a hospital patient, I would like to pay a tribute to the surgeons, to the hospitals and to the nursing associations in Dublin. I never saw any discrimination made between a poor patient and a private patient. I hope the Labour Party will not be associated with the serious charge that was made by a board of health against the hospitals of the City of Dublin. In his reply I hope the Parliamentary Secretary will explain the working of Section 24. If I interpret it correctly the Minister will have power to make certain conditions, and to make the hospitals agree to the terms he suggests.

Mr. O'Neill: Information on Eamonn O'Neill  Zoom on Eamonn O'Neill  There is one aspect of the Bill, as outlined by the Parliamentary Secretary, which I deprecate very much, and that is where he spoke of the general tendency to centralise hospitals in big centres and to have them run on big lines. He instanced Stockholm, where it is contemplated having one hospital for something like 1,500 patients, and Copenhagen where a hospital was contemplated for the treatment of about 1,000 patients. This is another instance of the terrible trend towards centralisation in this country. I think we have proof that centralisation leads neither to efficiency nor economy.

In relation to hospital treatment we have an example of the difficulties that arose over the amalgamation of what [509] were called the old union hospitals. I thought that tendency had been changed, to some extent, and that latterly there was an inclination to develop local cottage hospitals. In this matter I hope the Department will go carefully into the question. I think the Minister will find that big hospitals are inclined to be run as big factories are run, and in a very unsympathetic fashion. They are likely to be de-humanised. With the money that is going to be at our disposal we should run our local hospitals in a very efficient way, and, at the same time, in a sympathetic and human way. I deprecate very much the tendency outlined in the Bill to look towards more centralisation. I hope that will not be carried into effect.

Mr. Moore: Information on Séamus Moore  Zoom on Séamus Moore  I would like if the Parliamentary Secretary would, in his reply, deal with the question, as to how this Bill is likely to affect voluntary contributions to the hospitals. I have heard nothing but admiration for the Bill from people connected with the management of hospitals. I heard practically nothing but admiration for the provisions of the Bill, but I heard certain criticisms regarding Section 22 (5):

It shall not be lawful for the National Hospital Trustees to solicit contributions to the Hospitals Trust Fund, but the said trustees, may, with the consent of the Minister, accept any such contribution in money which is offered to them without such solicitation....

The criticism I heard was that such a section, more or less, discourages voluntary contributions so far as Hospitals Trust Funds are concerned, that the phrase “with the consent of the Minister” seems to imply that such contributions are not welcome, and that they are not considered desirable by the Parliamentary Secretary. From that is arising the fear that voluntary contributions to the hospitals for maintenance and ordinary running expenses may suffer. There is a possibility that the Hospitals Commission, in distributing moneys at its disposal, will take into account [510] what each hospital is receiving in the way of voluntary subscriptions and that the hospital for which hard work is done by that means, or which might receive a legacy, during the year, is going to suffer in its grant from the Hospitals Commission. The effect of that possibility would be that there would be a substantial reduction in voluntary contributions to the hospitals and not merely so, but, also, that where a great amount of voluntary effort is made in the way of organising entertainments, and so on, for the benefit of the hospital there may be a falling off. I heard that point raised by people who are full of admiration for this Bill and regard its provisions as extremely sound. I would be glad if the Parliamentary Secretary would deal with that point because that is the only direction, so far as I know, in which apprehension exists.

Mr. Corish: Information on Richard Corish  Zoom on Richard Corish  I want to add a few words to what has been said by Deputy Everett and Deputy Murphy on behalf of the Labour Party in connection with country patients sent to Dublin. I suggest that the Parliamentary Secretary should make better provision, or special provision, in the Bill, for country patients. Deputy Everett said that patients sent to Dublin hospitals from the County Wicklow cost the County Board of Health £2 2s. 0d. per week, per patient. In a great many cases patients sent up by the Wexford Corporation cost 10/- or 12/- per day which is considerably more than £2 2s. 0d. a week. Wexford Corporation sending patients to Dublin hospitals finds it costs 2d. or 3d. per £ in the rates each year. No doubt with a little trickery a great number of them could be sent through the County Board of Health, but owing to the fact that certain regulations have to be observed, and that people have to make themselves paupers within the meaning of the Act, a great many people avoid going through the procedure necessary. I suggest that special provision should be made for country patients. The Hospitals' Sweeps were inaugurated on behalf of the country generally and while I [511] do not want to set Dublin people against the rest of the country I suggest country patients should get the treatment they deserve seeing that these sweeps were contributed to generally all over the country.

I should also like to take this opportunity of suggesting to the Parliamentary Secretary that he should urge on the county boards of health the necessity there is of proceeding at a faster rate with the hospitalisation of the counties generally. In Wexford there is a lot of talk about the provision of a new fever hospital. For the last two or three years, both in the time of this Government and the previous Government, I had occasion to draw attention to the fact that Wexford town was left without a fever hospital. I think the Parliamentary Secretary will agree that a town with 12,000 inhabitants should not be left without a fever hospital. In my opinion fever is cloaked because of the fact that the nearest fever hospital is 23 miles away. I am confident that in view of the fact that parents do not like to see their children taken so far away from their homes notifiable diseases are cloaked continually since the hospital was taken from Wexford. I do not suggest that the county fever hospital should be brought back to Wexford, but I suggest that there should be a fever hospital in each of the four principal towns of the county. I ask the Parliamentary Secretary to see that the boards of health should proceed to carry out the hospitalisation of the counties. I understand the money is available and that it is only a question of agreeing upon certain plans. I suggest that sufficient time has elapsed to urge the Parliamentary Secretary to see that the boards of health should proceed more rapidly in this matter than they are doing.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  I think that taking it on the whole, the Bill has been very well received in the House. There would be considerably less discussion on the Bill if Deputies interested in it had either listened to, or read, my speech in moving the Second Reading. In that speech I dealt with most of the [512] facts dealt with in the debate here to-day. I can, of course, quite understand, and to a certain extent sympathise with, the frame of mind, and the attitude of approach, by Deputies who must oppose on Party lines any measure introduced by this Government. I can understand that position. It appears to me that Deputy Fitzgerald-Kenney has been allotted the unhappy task of attacking this measure on behalf of the Cumann na nGaedheal Party. He, evidently, had no heart in his work. He was given a very difficult task and he did the best he could to find fault with the Bill. But I think it will be generally agreed by anyone listening to him that his arguments did not carry conviction, and that, evidently, he was not himself convinced of the soundness of them. In the course of his speech he said, “When I look upon this Bill it certainly seems to me it has been designed for the purpose, and will have the effect, of sounding the death knell of voluntary hospitals in this country.” I do not think, if the Deputy read the Bill, and took into consideration the intentions of the Bill and the probable result of enacting such a measure, he would have made such an utterly nonsensical contribution as that. The Bill seeks to preserve anything that could be preserved in the voluntary system. It is generally agreed, I think, that the voluntary hospitals system has been adversely affected by conditions arising since the European War. The increased cost of maintenance, and the failure of voluntary subscriptions, at any rate in proportion to the increased cost of maintenance, has led to the consequent necessity of increasing the revenue of voluntary hospitals by increasing the charges to private patients. As an example of how that operated in five Dublin hospitals we find that the revenue from paying patients had risen from an average £2,000 a year, in the pre-war period, to £24,000 in the post-war period.

Before the sweepstakes were promoted the principle of free admission and voluntary subscription had been seriously impaired, and the future of [513] the hospitals was seriously endangered. The sweepstakes have given those voluntary hospitals a new lease of life, and the present Bill before the House is calculated to improve the machinery, to secure better co-ordination, and to provide the necessary funds to enable those voluntary hospitals to continue to do the good work that they have been doing in the past. Deputy Fitzgerald-Kenney said that the responsibility for disbursing those moneys should not be placed on the Minister entirely free from Parliamentary control. At the present time under the existing legislation—legislation for which Deputy Fitzgerald - Kenney accepted responsibility when he was Minister for Justice in a previous administration here—the ultimate and final responsibility for the disbursement to the hospitals of the moneys accruing out of the sweepstakes rests on the Minister for Justice, after consulting the Minister for Local Government. If there was nothing wrong in having the ultimate responsibility resting on the broad shoulders of Deputy Fitzgerald-Kenney, when he was a Minister, surely there can be nothing wrong in having a similar responsibility resting on the present Minister for Local Government and Public Health.

As I said at the outset, I do not think that Deputy Fitzgerald-Kenney was really sincere in a number of arguments which he advanced. He said that not a single safeguard for the sick poor has been put in. The Minister for Local Government and Public Health has a responsibility in so far as making adequate provision for the hospital treatment of the sick poor is concerned, and in Section 24, sub-section (3) of the Bill will be found the safeguards that are considered necessary to ensure that all modern hospital facilities, and the best treatment that medical science can provide, will be made available to the poor. For the benefit of the many Deputies who did not read the Bill I will quote this sub-section:—

Whenever the Minister makes under this section a grant out of the Hospitals' Trust Fund to a hospital or a nursing organisation, he shall [514] specify the purposes for which such grant is to be expended and may attach to the receipt of such grant such conditions (whether to be performed before or after such receipt) as he thinks proper for securing the due expenditure of such grant on the purposes specified by the Minister or for securing or attaining any other object.

That appears to me to be a much more valuable safeguard for the poor than the provision in the previous Sweepstakes Act. The previous Act provided that 25 per cent. of the beds would be free to the poor, but Deputies will remember that in the course of time it was found that that particular provision was unworkable. Amending Bills were introduced and passed in this House, admitting to participation in the sweeps hospitals that were not providing any percentage of their beds free to the poor. We cannot, at this stage, estimate with any degree of accuracy what percentage of beds in any particular institution, catering for a particular class of sick people, should be allocated as free beds at the disposal of the poor. When the Hospitals Commission have examined the entire question, and when they have so informed themselves as to be in a position to advise the Minister in regard to the allocations they intend to recommend to a particular institution, we hope to be in a position to know what percentage of the beds in that particular institution ought to be allocated as free beds for the treatment of the poor. I believe that that is a much sounder provision, and much more likely to bring about the desired results, than the hard and fast 25 per cent. rule that operated in the previous Acts, and that was found to be unworkable in practice.

Deputy Fitzgerald-Kenney complained that money collected on one pretence is now going to be diverted to other ends. I do not know how on earth the Deputy could find anything in the Bill which would justify such a very serious allegation as is contained in that innocent looking phrase. The money which has accrued, and the money which will accrue as a result of future sweepstakes under this Bill, will [515] be devoted to the purposes set out in this Bill, and the purposes set out in this Bill are the specific purposes— with very little variation—that were set out in the previous legislation.

Mr. Good: Information on John Good  Zoom on John Good  Will the purposes include maintenance?

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  I will deal with that later on. Every book of tickets for the sweepstake has plainly printed on it, as required by law, a statement to the effect that the sweepstake is being held in aid of the hospitals of the Irish Free State. The money is being devoted to the hospitals of the Irish Free State, and so long as the money is devoted to the hospitals of the Irish Free State there has been no breach of faith, as has been suggested, with anybody who bought a sweepstakes ticket in the past.

It has been suggested in the course of the debate that the Minister for Local Government and Public Health is going actually to confiscate the money that has accrued. There is no foundation whatever for that charge, and I think the Deputies who made it know in their hearts that there is really no foundation for it. If we waited until all the money had been disbursed, until all the voluntary hospitals had got all the money they wanted, what on earth would be the use of setting up a Hospitals Commission at that stage to advise as to how some co-ordination could be obtained amongst the existing institutions, or how far it might be necessary to provide new ones? Obviously a halt must be called somewhere, and those people who have given any serious thought to this question will agree—if they do not agree in this House they agree in private conversation outside it—that the pity is that this Hospitals Commission was not set up at the very start, instead of setting it up now. As I stated to-day, we realise that certain participating hospitals have involved themselves in financial embarrassments on the assumption that certain moneys would accrue to them on the recommendation of the Committee of Reference.

It has been indicated to the Joint Committee of the Associated Hospitals [516] by the Minister for Local Government and Public Health, before the Bill was introduced at all, that we intend, as far as possible, to make good the allocations that have been promised to them by the Committee of Reference of the Voluntary Hospitals, but on the understanding that they will co-operate with the Minister in securing some co-ordination of the hospital services in this country. While Deputies in this House have expressed considerable anxiety as to the future of the voluntary hospitals under this legislation, the extraordinary thing is that the Committee of the Voluntary Hospitals welcome the Bill and approve of the terms of the Bill. I think if the Committee themselves are satisfied that one might reasonably expect that Deputies in this House would be satisfied, especially Deputies who are not associated with hospital administration at all.

Later on Deputy Fitzgerald-Kenney asked the question: “Why should the Committee start a scheme at all under the new Bill when they know that the hospitals they represent will not gain one single penny from it?” I suppose it is not necessary to follow such childish arguments as these in detail. I would not deal with these matters in detail at all were it not that somebody outside the House who does not know Deputy Fitzgerald-Kenney as well as we know him might take his remarks seriously and they might have a serious effect here or across in England where these utterances of an ex-Minister might be quoted to the detriment of future sweepstakes. The Bill gives an assurance that the money will be devoted to certain purposes, and when a controlling body feel they are doing good and necessary work their schemes will be fairly dealt with by the body set up for that purpose.

In column 335, volume 47, we have another interesting contribution from Deputy Fitzgerald-Kenney. He says: “Looking back upon it now I think that the view I took in the administration of the Bill was the right, correct and proper view and I think I may venture to say that it was crowned with success.” He is referring to the question of whether we should mention [517] in this Bill the words “sweepstake” or “sweepstakes.” He says: “The view I took in the administration of the Bill was the right, correct and proper view.” We have not departed from the wording of the Act that got such excellent results for Deputy Fitzgerald-Kenney when he was Minister for Justice. In fact, that particular section has been copied word for word. He had many opportunities himself in the various amending Acts that passed through the House of having it in the singular or plural if he really meant what he would lead us to believe, in the course of his contribution on the Second Reading of the Bill. I suggest, at any rate to the House, that the right, proper and correct view of the clause that Deputy Fitzgerald-Kenney took when he was Minister will be taken by the Minister for Local Government and Public Health when he is interpreting the same clause. After all, Deputy Fitzgerald-Kenney is not the only one who can take a right, correct and proper view of the clause and secure the best possible results. I believe the present Minister for Local Government and Public Health will get the best possible results from it and take a right, correct and proper view of the interpretation of that clause.

On the question of endowments and prohibition of grants for future maintenance, we have had a number of Deputies expressing some anxiety on the clauses of the Bill relating to these matters. Under the 1931 Act it was provided that sweepstakes money should not be applied towards the ordinary maintenance of institutions established by local authorities, the intention being, of course, that the sweepstakes money would not be allocated to such relief of rates. Section 5 of this Bill provides that no grant shall be made for or towards future maintenance, but this does not, as will be seen by Section 4 (e) preclude the possibility of endowment. An hospital can invest its endowment in hospital buildings and equipment. It must deal with an endowment in such a way as to provide a regular income which must be applied for the express purpose indicated by the trust to [518] which the endowment is subject. It is quite possible that that section would require clarification. We must guard against future maintenance of rate-aided institutions by sweepstakes money. When we have that particular section further examined, if it is not clear that the section does not in any way interfere with the Minister's right to allocate grants for the endowment of beds in the voluntary hospitals we shall have an amendment brought in on these lines, but I am advised at the present time that with a correct, reasonable and proper interpretation of the clause, such as we shall undoubtedly get from the Minister for Local Government and Public Health, there is really nothing to be feared in relation to that particular section.

Mr. Good: Information on John Good  Zoom on John Good  Might I ask the Minister before he leaves the point: supposing a voluntary hospital receives a grant from a local authority, as many of the hospitals have in the past, and that that grant in aid is withdrawn and the maintenance suffers in consequence, can the trustees in such an emergency provide an equivalent grant out of their funds?

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  That is a question that I shall require to have examined by the Parliamentary draftsman.

Mr. Good: Information on John Good  Zoom on John Good  It is a point, as the Parliamentary Secretary knows, in connection with city hospitals.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  My own impression is that they can, but we shall get the matter clarified and make sure of what the position is. Deputy Tom Kelly complained that this Bill proposes to make sweepstakes permanent. To a certain extent I suppose that is so, but it is very difficult, if we agree at all that money should be raised in this way and that it is a desirable way of raising money to solve this particular difficulty in relation to our hospitals, to estimate at this stage how long it would be necessary to allow these sweepstakes to continue before all the money would have accumulated that would be necessary to solve the problem. That is the reason why no specific time limit has been put to the operation of this Bill. If anybody could forecast the result [519] of future sweeps and if we had a detailed estimate of the amount of money that would be necessary to solve the problem, we could decide, here and now, when this Bill should expire. At the present time we cannot, and what we propose to do is to try to solve our hospital problems and, when we have done that, to repeal the Bill.

Deputy Davitt expressed anxiety as to whether clinical research would be included as one of the purposes to which money could be allocated under this Bill. The money will be available for research and it does not necessarily mean that it must be earmarked and confined to laboratory research. There is no reason why money should not be applicable to clinical research as well. Deputy Kennedy made very serious and strong complaints about the treatment of the poor in some of the Dublin hospitals. He referred to callous treatment by the staffs. I do not know what steps Deputy Kennedy may have taken to check up on the accuracy of the very serious statement he made here to-day, but I would be very slow to believe that the poor would be callously treated by the staff of any hospital in Dublin, Cork, Galway, or in any other city, and I have personal knowledge of the subject and I have a long number of years' contact with these hospitals. It is all very well for a layman to come in and say that they would not give a patient a drink of water after an operation. It might be a very serious thing to give a patient a drink of water after an operation and, in all probability, the medical officer in charge directed that the patient should not get a drink of water. Similarly, patients come out of hospital and say: “We are starved with the hunger.” It may have been part of the treatment. It may have been necessary to diet them. These criticisms are ill-informed and unfair and I am sorry to have heard Deputy Kennedy give utterance to such statements.

The trouble with the voluntary hospitals at the present time, and the only real ground for complaint against them, is not in respect of the treatment [520] they have given to the people when they got them in—I do not think there could be any ground of criticism on that score—but the difficulty of getting the patients in. The medical profession and the nursing profession are to-day as true to the traditions of their professions as they were in any age, and the services of the very best surgeons and physicians in Ireland are to-day available to the poor, as they always were without question and without asking for any fee or reward, but the trouble is (1) that the voluntary hospitals have not the accommodation and (2) if they had accommodation, under existing conditions, they cannot afford to maintain the poor free of charge. That is what we are out to remedy—to get some co-ordination and to get some proper system to see (1) that beds are made available and (2) if a hospital is not a self supporting institution to give it such endowment as will enable it to continue to make these beds available to the poor.

Deputy T.J. Murphy raised the question of including a provision in the Bill by which a certain number of beds would be made available to the people who could pay 10/- a week, a certain number available to those who could pay £1 a week and a certain number of course, would be available free Deputy Murphy, I think, did not study the terms of Section 24. I think that Deputy Everett is now satisfied that it adequately meets the point he had in mind, and if Deputy Murphy examines the section, he will see that it is quite within the power of the Minister to say. in allocating the grant or in fixing the endowment, that so many beds shall be free, so many shall cost 10/-, so many £1, and so on. The Minister has ample scope there to ensure that the point that Deputy Murphy intended to cover in the Private Bill he introduced can be covered.

Mr. Everett: Information on James Everett  Zoom on James Everett  Is that the intention of the Minister under Section 24?

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  Amongst many other intentions.

Mr. Everett: Information on James Everett  Zoom on James Everett  That is one of them.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  Yes. Deputy Corish expressed anxiety as to whether any [521] of these beds would be available to people outside the City of Dublin in Dublin and to people outside the City of Cork in Cork. Of course, they will. We cannot get a high degree of specialisation in our county hospitals. It is utterly impossible to have a staff in our county hospitals to deal with all forms of highly specialised treatment. The thing is nonsensical from every point of view. We aim at having a good general surgeon in our county hospitals to do ordinary general surgical work, but nobody would be foolish enough to think that he would be a first-class physician as well, a first-class gynecologist, an expert bone surgeon, an expert abdominal surgeon, an expert brain surgeon, or an expert throat, nose and ear surgeon. The thing is foolish and impossible and we must have provision in our city hospitals for that specialised treatment to be made available to the poor regardless of where the poor happen to be situated on the map.

Mr. Corish: Information on Richard Corish  Zoom on Richard Corish  Does Section 24 enable you to do that?

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  Yes. It is a first-class section.

Mr. Corish: Information on Richard Corish  Zoom on Richard Corish  The elastic section.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  Many of the Deputies seemed to miss Section 24 altogether and it is the most important section in the Bill. Deputy McGuire is not here. I do not think it is necessary to follow his arguments. I learned during the course of the debate that Deputy McGuire was a lawyer and I was very much surprised to hear it. Being a lawyer and a man of average intelligence, which, I présume, he must be in order to become a lawyer——

Mr. Corish: Information on Richard Corish  Zoom on Richard Corish  It is not necessary at all.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  Well, that explains a good deal but, surely, anyway, if he had read the Bill, he would have understood it. It is quite obvious, of course, from his contribution that he did not read the Bill at all and I do not think that I should be expected to follow him and debate the foolish contribution that he made in view of the fact that it had nothing to do with [522] the terms of the Bill or with the terms of the Bills we are repealing, either. When he could not find anything in the Bill, from his limited knowledge of it, which he could criticise, he, quietly and methodically, drew on his imagination and put things into it which are not there. That is all right for the sake of argument, but it involves considerable waste of time.

Deputy Moore, apparently, disapproves of the section in the Bill which provides that the National Hospitals Trustees cannot solicit subscriptions. I do not see any earthly reason why the National Hospitals Trustees ought to be allowed to solicit subscriptions at all. That is not their function, but there is nothing in the Bill to prevent the governing body of any voluntary hospital soliciting subscriptions in the ordinary way and getting all they possibly can from the charitable public, but that would be the function of the governing body and not the function of the National Hospitals Trustees. I do not think any other points were raised.

Mr. Corish: Information on Richard Corish  Zoom on Richard Corish  Can the Minister give us any indication as to when the hospitalisation of County Wexford is going to be provided for?

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  Presumably, if the Wexford Board of Health has not discharged its duties to the satisfaction of the Minister——

Mr. Corish: Information on Richard Corish  Zoom on Richard Corish  Do not do the lawyer!

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  ——in the matter of providing hospital accommodation by the time that this Bill become law, I suppose we will have to put them in the hands of the Hospitals Commission.

Mr. Good: Information on John Good  Zoom on John Good  Can the Parliamentary Secretary give us any information on the question of the appointment of the members of this Commission? One would like to have some information.

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  The Deputy will understand that the Hospitals Commission cannot be appointed until the Bill becomes law. That will be a very considerable period by the time it makes its weary way through this House and through the other House and perhaps back here again.

[523]Mr. Good: Information on John Good  Zoom on John Good  I think that the complaint we have to make generally is not that legislation goes slowly but the contrary, that it goes too quickly. We anticipate that this Bill will be through in the near future and when it is through we should like to know where will the Minister get these Commissioners, what steps will he take to get [524] them and to see that they will be men of special knowledge in hospital problems?

Dr. Ward: Information on Dr. Francis Constantine Ward  Zoom on Dr. Francis Constantine Ward  The Minister will examine that in the meantime and I think he will have ample opportunity to do so in the interval.

Question put.

Aiken, Frank.
Bartley, Gerald.
Beegan, Patrick.
Boland, Gerald.
Bourke, Daniel.
Brady, Brian.
Brady, Seán.
Breathnach, Cormac.
Briscoe, Robert.
Browne, William Frazer.
Carty, Frank.
Concannon, Helena.
Corish, Richard.
Corkery, Daniel.
Corry, Martin John.
Crowley, Fred. Hugh.
Crowley, Timothy.
Curran, Richard.
Daly, Denis.
Derrig, Thomas.
De Valera, Eamon.
Doherty, Hugh.
Dowdall, Thomas P.
Everett, James.
Finlay, John.
Flynn, Stephen.
Fogarty, Andrew.
Geoghegan, James.
Gibbons, Seán.
Good, John.
Goulding, John.
Hales, Thomas.
Harris, Thomas.
Holohan, Richard.
Houlihan, Patrick.
Kehoe, Patrick.
Kelly, James Patrick.
Keyes, Michael.
Killilea, Mark.
Kilroy, Michael.
Kissane, Eamonn.
Lemass, Seán F.
Little, Patrick John.
MacDermot, Frank.
McEllistrim, Thomas.
MacEntee, Seán.
McGovern, Patrick.
Maguire, Ben.
Maguire, Conor Alexander.
Moore, Séamus.
Moylan, Seán.
Murphy, Patrick Stephen.
Murphy, Timothy Joseph.
O'Briain, Donnchadh.
O'Donovan, Timothy Joseph.
O'Grady, Seán.
O'Kelly, Seán Thomas.
O'Reilly, Matthew.
Pattison, James P.
Pearse, Margaret Mary.
Rice, Edward.
Rogers, Patrick James.
Ruttledge, Patrick Joseph.
Ryan, James.
Ryan, Martin.
Ryan, Robert.
Sheridan, Michael.
Smith, Patrick.
Traynor, Oscar.
Victory, James.
Wall, Nicholas.
Walsh, Richard.
Ward, Francis C. (Dr.).

Belton, Patrick.
Bourke, Séamus.
Brennan, Michael.
Broderick, William Joseph.
Brodrick, Seán.
Burke, Patrick.
Cosgrave, William T.
Costello, John Aloysius.
Daly, Patrick.
Dockrell, Henry Morgan.
Doyle, Peadar S.
Esmonde, Osmond Grattan.
Fitzgerald, Desmond.
Fitzgerald-Kenney, James.
Keating, John.
McDonogh, Martin.
McFadden, Michael Og.
McGilligan, Patrick.
McGuire, James Ivan.
Mulcahy, Richard.
Murphy, James Edward.
O'Connor, Batt.
O'Mahonv, The.
O'Neill, Eamonn.
O'Reilly, John Joseph.
O'Sullivan, John Marcus.
Redmond, Bridget Mary.
Reidy, James.
Roddy, Martin.
Thrift, William Edward.

[525] Question declared carried.

Committee Stage ordered for Wednesday, 10th May.


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