Thursday, 5 November 1959
Dáil Éireann Debate
Mr. Dockrell: Last night, I was making the point that the Minister for Health ought to be jealous of the democratic rights and interests of the citizens of this country. We have a new State and we are anxious that the people should participate, as far as is possible, in voluntary efforts of all kinds. I am perfectly aware, as is this House, that we live in an age when charitable organisations can no longer keep our health services operating. That day is long past but the day has not passed when people can give their time, interest, and attention to voluntary work in connection with the sick, and that has been done by members of these various boards. I shall deal with the Dublin Fever Hospital Board, in particular, in a moment or two.
I want to refer to the other six boards to be abolished in the Dublin area. I refer principally to the Dublin area but what I say about Dublin applies equally to other parts of the country where boards will be abolished under this Bill. We have a number of members of the corporation on these boards, Grangegorman and Portrane, and the county council and Dún Laoghaire Corporation have members on the Rathdown Board of Assistance and the Balrothery Board. Many years ago, it was felt in the corporation that the work in connection with these hospitals was so great that the average councillor found it very difficult to give adequate time to it. They are vast, enormous hospitals and, therefore, a system was evolved whereby the council could appoint members who were not city councillors to these boards. We on this side of the House think that was a very wise thing and a very important thing because it gave a large number of outsiders—when I say outsiders, I mean those outside the political life of the country—a great interest in corporation matters, and they devoted their time voluntarily.
As I read this Bill, it seems to me that that situation has gone. The Dublin health authority shall now consist of nine members appointed by the county council, 15 by Dublin Corporation and three by Dún Laoghaire Corporation. It would appear, therefore,  that those outside members will become redundant. I should like the Minister to clear up that point. Of course, it will be clarified on Committee Stage, but I understand that the membership of the health authority will consist entirely of councillors and members of the various public bodies.
For two reasons, I do not believe that is entirely a good thing. One is that the work thrown on the members of that health authority will be overwhelming. I do not know how they will visit the various hospitals and give the same attention to them as members of the various other boards gave in the past. No councillor would have time to do anything but discharge his duties on the health authority. That is one reason why I think it a mistake. The other is that under this Bill we apparently envisage the wiping away of membership of these boards for the ordinary citizen. I go further and say that even if I have misread that in the Bill, I still do not think that those 27 members can adequately carry out these duties.
I referred yesterday to the lack of detail concerning the saving of money in connection with this Bill. The Minister talked vaguely of administrative savings. I hope I am not cynical about administrative savings but during my lifetime I have seen very few if any such savings—it is usually quite the reverse. I believe that a great deal of the work formerly done by voluntary people will have to be carried out by civil servants appointed for the purpose. Where up to now these various boards were able to deal voluntarily with matters affecting the welfare of the patients and of the staff, we now may have to have somebody such as a liaison officer to deal with these matters.
I am very dubious about savings to the public purse. We have had no details of any proposed savings. The Minister has assured us that there will be no interference with people engaged in the service at present, so it certainly does not look as if even a speedy saving is envisaged in that respect.
 More specifically, I should like to mention the question of the Dublin Fever Board. Originally, as is well known, that was the old Cork Street Hospital founded 150 years ago by charitably-minded persons. Many changes ensued and eventually the hospital and its trustees became the Dublin Fever Board. The Minister is apparently going to wipe away that board with a stroke of the pen. It is in a very different position from that of the other boards which it is proposed to abolish under this Bill. I do not really believe in the abolition of any of the others but there is not the same insult to the others. The others are composed mainly of members of county councils or other local authorities, and it is not the first time they have had their faces slapped and their feelings injured by the Minister for Local Government; they are well accustomed to that. It is a very different matter in the case of a hospital built up by a group of people, which functioned very satisfactorily and which a few years ago repelled a piratical attack. It failed, first of all, and was submerged and then under a different Government it was reconstituted. At that time, everybody felt that an injustice had been done to that hospital. Now it appears that, far from learning from the mistakes of the past, the Minister is prepared to go forward and repeat them.
I believe the board of that hospital did not have any notice that they were to be abolished until almost a matter of days beforehand. I think that was unfair and discourteous—I am sure the discourtesy was not intended. I would ask the Minister not to do what he proposes in the case of the Dublin Fever Hospital. I think we would lose something that is very dear to us in Dublin and in our Irish life if we wiped away representation on a board which originally began as a private charitable institution. It is a precedent which I do not think any of us would like to see established.
The whole tenor of my remarks is that if these proposed changes take place something very precious will pass out of our lives—voluntary service by quite ordinary people who worked very hard. I have had a great  deal of experience of the work of those people, and frankly I have never been able to do anything like it. Their names are not known; they do not want to be known; they are quite unrewarded and unrecorded. Their real work has been the smoothing away of difficulties in these institutions, making patients happier, helping them in their convalescence. Some of them do the work by bringing books to the patients; some watch the kitchen; some watch the food and the welfare of the patients generally. They do a tremendous amount of work entirely unpaid and it contributes enormously to the quicker recovery and the happiness of the patients.
I would ask the Minister very earnestly to alter his intentions in connection with the Dublin Fever Hospital. In connection with other parts of the Bill I would ask him to widen the area of democratic representation and bring in outsiders. I do not want to see—and I am sure none of us do— a situation in which unless one is a member of the Dáil or Seanad or of a local authority, one can do practically nothing to help one's fellowmen. This Bill is a step in a direction that is certainly authoritarian and possibly totalitarian, something that none of us wishes to see.
Mr. Wycherley: The Minister has impressed me with the case he put forward for the amalgamation of services in Dublin. Certainly, he has a thorough knowledge of the area and realises the importance of amalgamating these services in Dublin, now run by seven boards. He knows the streets of Dublin and the people of Dublin; he knows the great disadvantages under which people laboured in the past. The difference between the city of Dublin and the county of Dublin is very little, indeed. It could be regarded for administrative purposes as one unit as it is a very small, compact area. For administrative purposes, I feel that amalgamation is the solution of the difficulties which exist there. I shall not quarrel with the Minister in that regard as he is more conversant with the problems confronting the people of Dublin than I am, but there is no comparison between the problems in Dublin and the problems confronting  the people of Cork whom I have the honour to represent.
The area from Castletownberehaven to Kilbeheny bridge is greater than the distance from the borders of Limerick to Dublin. That will give the Minister and the House an idea of the serious position the people of that vast area will be in, if that area is to be controlled by 16 members as compared with the present system under which the county is divided into three parts for administrative purposes.
We have in West Cork the Western Committee controlling the affairs of the West Cork Board of Health; we have the North Cork Board which controls the affairs of North Cork; and we have in South Cork the South Cork Board. In addition, we have the joint boards set up for the sanatoria and the mental hospital. These boards have worked reasonably well and if there is to be any economy whatsoever in the administration of the services in County Cork, the only amalgamation I can see by which any economy will be effected is the amalgamation of the sanatoria board and the mental hospital board. If I am prepared to agree on those lines, it is because we have in Cork city the mental hospital and the sanatoria board catering for the needs of the people of the city and the county of Cork.
For that reason, it is only fair and just that the membership of that board should be representative of the city and county. They have joint interests because their friends and relatives from the city and county are housed in those hospitals. If a saving can be effected, it can be effected there, but I fail to see how better service can be given to the people of West Cork and North Cork by amalgamating all the services in one small authority.
We have in West Cork at the present time a new hospital erected in Bantry under the control of the Western committee. In addition, we have a hospital in Skibbereen, Clonakilty, Dunmanway, Schull, Castletownbere. We have also the county home in Clonakilty—all under the control of the West Cork board. The problems  confronting the people of all those areas and in those hospitals are well known to the local representatives. The people have the opportunity of conferring with these local representatives and if they want assistance, they have their local representatives convenient to them with whom to consult and discuss their problems.
Under the new health authority, as proposed in this Bill, the same facilities will not be available to the people. It is proposed to have 16 representatives from the whole county, at least one from each electoral area. How that one person is to be elected I do not know but I understand that this board is to be elected after each county council election. I think it is a degrading system to resort to bargaining after the election is over to get on this very important board which has the running of all the affairs of the county in that respect.
This bargaining after every election —jockeying for power, so to speak—is one thing with which I could not agree. It would be far better, if there is to be one county health authority, that it should be elected by the votes of the people in a democratic fashion rather than by the system, outlined in this Bill, after the election is over when the various Parties come together bargaining for places on this authority.
If we are to preserve democracy in this country, it should be done now. Give the people the opportunity of electing to this authority the people they want, instead of giving it to the political Parties when the election is over and putting them into an office to which, perhaps, they are not entitled. It is only right and proper that the people should have the final say in this matter.
I know that if bargaining had been resorted to in the past in Cork, some Parties would not have come out so well after the elections but bargaining was never resorted to. In county Cork, we have four Parties—the Fianna Fáil Party, the Fine Gael Party, the Farmers Party and the Labour Party. In addition, we have  some Independents. Up to the present time, all those Parties got fair representation because of the fair approach of each Party. They got their representation on every committee in proportion to their strength because there was no bargaining and because no Party, and particularly the Farmers Party, would stoop so low as to bargain. I am glad to be able to say from my place here in Dáil Éireann that justice was given to every Party in Cork when the elections were over. Under this Bill that will not be done and cannot be done and Parties will be completely deprived of any representation on the new board.
I claim to represent the Farmers Party in my area and I would not bargain after the next election to try to get on this authority. It would be degrading; it would be unfair and unjust that I should do so, having been elected by the people. I can see that many public men will be deprived of the rights given to them by the people at the election.
I cannot see where the economies will come in. The Minister said yesterday that the main reason for this Bill is to co-ordinate health services and to improve the services and to make them more readily available to the members of the public, and that a further purpose was to achieve substantial economies in administration. I maintain that this Bill fails in both respects. The service which can be expected if this Bill is passed is far worse than the service which people now enjoy. What interest could a representative on the proposed new health authority have in hospitalisation in West Cork, if he resides in Cork city or North Cork or, vice versa, what interest would the elected representatives from West Cork have in the business of the city and of North Cork?
If power is taken away from the present committees and placed in the proposed health authority, it will be a bad thing for public administration; it will be a bad thing for the people. It will be a bad thing that the personnel of the offices in Clonakilty and Mallow should be transferred to a  central office in Cork City. I should much prefer the staff in Clonakilty to be retained there to run the affairs of West Cork for the people of West Cork. I have no hesitation in saying that when the people from North Cork speak on this Bill, they will express the same view with regard to their office in Mallow.
It is much more homely and convenient for us to go into the office in Clonakilty and discuss with the manager, secretary or officials there the problems of our people than it would be to go into a central office in Cork and discuss, possibly with the City Manager, the problems of the rural community. I understand that, under this Bill, there will be one county medical officer who, possibly, will be the city medical officer. The emphasis at the present time is on the city. As long as the people of the city are catered for in Cork and Dublin, the rural community can fend for themselves.
Deputy Corry's statement here last night would give the impression that South Cork was gaining something by this proposal, but when we study the population figures of Cork city, given, roughly, at 80,000, we discover that, in addition, there are 34,000 city people in the suburbs of Cork who are actually resident in the county. That takes from the argument put up last night by Deputy Corry that the people of South Cork were to be saved £180,000. That was all nonsense because that money is going to the people in the suburbs of Cork, where there is a city population of 34,000.
I should not like to go into the affairs of the South Cork Board of Public Assistance, or the South Cork area at all, for that matter, because Deputy Corry, Deputy Desmond, Deputy MacCarthy and others are more conversant with South Cork than I am. There is a joint board administering public assistance in South Cork. I would not force my view as to whether that board also should be amalgamated with the Joint Sanatoria Board and the joint Mental Hospital Board. I do not know if it would be a good thing or not, or if economies would be effected by such amalgamation.  The administration of South Cork is carried on at the present time in the city of Cork and it is a matter that could be considered. I am not in a position to say whether or not it would be to the advantage of the people of South Cork but I have no doubt as to the disadvantages this Bill has for the people of County Cork.
The Bill is designed chiefly for the benefit of the city of Dublin and the city of Cork, ignoring the rights and necessities of the people of the rural areas. I think, then, that it is a wrong thing to amalgamate such services because the rural population in County Cork is three times that of the city. The population of the county is 256,652, or 76 per cent. whereas the population of the city is 80,011, or 24 per cent. Nevertheless, under this Bill, Cork Corporation are to get 50 per cent. of the representation on this proposed new health authority.
I do not agree with that at all. I should not like to go into the merits or demerits of the proportion they should get but I can see at the outset that it is unreasonable that they should get 50 per cent. of the representation when they have only 24 per cent. of the population. Apart from that, the principle is bad of having one health authority for the people of the city and the county and, when the principle is bad, I do not think it necessary for me to discuss in detail the other features of the Bill. The valuation of the county is £1,283,870, or 79 per cent., whereas the valuation of the city is £331,288, or 21 per cent.
Mr. Wycherley: I made a slip there. The figures quoted by Deputy Moher are correct. In any case, the figures are unbalanced, and the representation which the county is to get on the proposed board is not fair representation.  Apart from that, the principle of amalgamation is bad; the system of bargaining after an election is bad. We have had sufficient experience of that here, and over and over again it has been said there should be no bargaining after an election. If there is to be a county health authority, it should be elected in a democratic fashion by the votes of the people.
We have in Cork committees for both the North Infirmary and the South Infirmary. They are both doing good in their own spheres. I would have no objection if they were amalgamated with the new health authority. That might help in administration because the North and South Infirmaries cater for people from both the city and county. There may be some benefit by amalgamating those committees, as well as the joint inter-hospital board and the joint sanatoria committee, but to go outside that and take from the people of north and south Cork rights and privileges they have enjoyed up to now would be a very bad step indeed. Having said so much on that point, I leave it to the Minister to consider the arguments I have put up.
Mr. Wycherley: I am speaking with a local knowledge. Having listened to Deputy MacCarthy last night, I am sure he will agree with many of the arguments I have put up today. He went so far as to say that the scheme would be premature until county council offices were erected in Cork. I think it is entirely premature at this stage to amalgamate all those services and take from the individually elected representatives of the people the rights they have enjoyed up to now. That is the only economy that I can see will  be effected by this Bill. All the officials are well protected. Not one of them will lose his rights, his position, his salary or his pension. The only ones to get the axe, so to speak, are the elected representatives of the people. What have they done out of the way that the rights they have enjoyed over the years should be taken from them by one stroke of the pen and their powers given over to officials in Dublin and Cork? This can truly be described as an officials' Bill, protecting the rights of the officials and giving the axe to the elected representatives of the people.
Mr. Healy: I speak as one coming from an area about to be affected by the Bill. I feel it is my duty to say publicly that I welcome it as a natural step in the development of our health services. I do not agree at all with the previous speaker that it in any way takes from public representatives their voice in the management of public affairs; but even if that were so, if the Bill meant better services for the people who need them, then I would support it, even if it did take some of their powers from public representatives. We should not spend much time on this measure discussing the functions of public representatives. It is essentially a Bill to endeavour to provide better and more efficient services for those who need them, and that should be our paramount consideration.
I deplore an attitude which has arisen here—not for the first time, unfortunately—whereby the rural Deputies set themselves up against the city representatives. One would think we had enough borders and boundaries in this country. It is deplorable, and a reflection on the people of this country as a whole, for anybody here to think that the city dwellers would try to score off those living in rural areas or vice versa. I do not subscribe to that view at all. I have fair experience of hospital boards whose composition, in some cases, was divided between representatives of country and city and, in other cases, was mainly of city people. It has never been my experience that anybody sought to gain advantage, monetary or  otherwise, over a person or local authority in another part of the county.
Last night we heard a Deputy say that he would vote for Old Nick, if his constituency gained a few pounds by it. That was said jocosely, I believe, and I do not stress it. Sometimes that attitude can be taken a little too far and it can appear that the city dwellers would not get justice, if there were a number of rural representatives on a board. It is not quite fair to say that the manager will be the city manager. The Bill does not say which and I believe it is much more likely to be the county manager. That is immaterial. I do not mind which manager it will be.
Generally speaking, there is overlapping and duplication of health services in the area I come from. I can mention straight away as an example the dental services, which in some parts of the country are operated in a very different manner from the way they are operated in the South Cork area. I am perfectly certain that if there were uniformity in the administration of those services, it would make for a better service and greater economy. It is interesting to note that the previous Minister for Health tried to bring in a similar measure. This should be regarded as a completely non-political measure which the Minister and his predecessor obviously feel will mean a better service.
I can understand a certain amount of opposition if, as Deputy Wycherley thinks, there is a feeling that something is being taken from public representatives. I do not subscribe to that view however. With 16 members of the Cork County Council and eight members of the Cork Corporation on the proposed Cork authority the people at large will have a fair voice in what happens. Representatives of the rural parts of Cork come to Cork City, not once but several times a week, on behalf of their constituents. Anything they may have to do under this Bill will not add one mile extra to their journeys as compared with heretofore.
I believe the Bill will be welcomed  generally by the people. I admit that at the moment in some parts of Cork, it is difficult to know where one should go for a specific service. Very often one is sent from one building to another. I have a deep sympathy with those who speak of the deprivation of the opportunity for purely charitable work on the part of those who give voluntary service. I hope the Minister has not that in mind. But I know, at the same time, that no matter what Governments may do, and no matter what laws are introduced, there will always be work to be done by the individual citizen who wants to do it. That has been the experience up to now. I believe it will be the experience in the future. There are sections which, no matter what Acts of Parliament are passed, cannot be helped sufficiently and, therefore, there is always work to be done for these by those who are so minded.
The Dublin Fever Hospital has been mentioned. I cannot speak for that institution, but I would certainly take strong exception to, and vehemently protest against, any suggestion of taking over the North and South Infirmaries in Cork. Of course, the position is completely different, and the problem, therefore, does not arise. Generally speaking, I think the public will welcome the Bill for one reason: the Minister proposes to give better and more efficient health services to the public. That is of paramount importance.
Mr. Dillon: I do not propose to delay the House for long, but I think we should not lose sight of certain fundamental principles relevant to this Bill. I think Deputy Healy is right when he says that the paramount consideration in the minds of all of us must be to provide improved health services for the people. But does it always follow that centralisation and bureaucratisation of services of this kind mean better service for the people? Does the personal contact between neighbours count for nothing? Does not the peculiar character of voluntary service give something that the most efficient, salaried public servant cannot be expected to provide?
 I confess that, were the Minister for Health in a position to say to us today that the proposals in this Bill will result in a very substantial relief to the rates, that would be a powerful argument, because I believe the burden of rates on property holders, urban and rural, is becoming almost unendurable. But, even then, I believe that consideration would be secondary to the prime one of providing superior health services for the people. The Minister has not told us that this proposal will result in any material relief of the rate burden. He has given us no estimate whatever of what relief is here proposed. All he has told us, in so many words, is that he proposes to centralise these services in the hope that, from that procedure, there will emerge economies and superior efficiency.
I think it is no harm that Dáil Éireann should from time to time allow its mind to be influenced by certain fundamental principles. The Minister will agree with me that there is a sound fundamental principle that, where a small body can effectively discharge a duty, it is a mistake to pass that duty to a higher and larger body. This House is representative of every constituency in the country. Yet, no one would suggest that it should make itself responsible for the health services in County Kerry. That is the reductio ad absurdum.
Past experience has suggested, certainly judging from what Cork Deputies say, that the division of Cork into various areas for the purposes of the health services has had many merits; the problems of West Cork are so remote from those of East Cork, or Cork City, that the people of Cork have, in their wisdom, notionally at least segregated the problems of the various parts of this vast county and sought to ensure thereby that the people close to the patients in the institutions have a substantial say in the administration of the institutions. I think that is a sound principle. I do not think it is coercive. I think circumstances can arise where it becomes manifest that it is necessary to effect some amalgamation. But here is a  proposal in this Bill to amalgamate everything in Dublin and in Cork, city and county, and that, I think, requires to be justified. I do not think the Minister has justified it in this House.
The Deputy from Cork is mistaken if he believes that it is a remarkable and striking precedent that the Minister's predecessor was examining this question. That is a Minister's job. Any Minister is bound to examine questions of this kind. Deputy Healy, I assume, knows that it is the function of a Department to submit proposals to the Minister from time to time, which, in the judgment of the experts, would be a useful improvement in the service for which the Minister is responsible. It is the Minister's duty to listen attentively to his technical advisers and, if he sees fit, to bring proposals before the Government founded on that advice. Or the Minister may consider the proposals submitted to him by his advisers and then go out and consult the people who will be affected by the proposals, such as the boards mentioned in this Bill, the representatives of the patients or the beneficiaries under the health services. When all that has been done, it is then the function of the Minister to bring such proposals as he deems desirable before the Government and, if the Government approves them, to bring them to Dáil Éireann. So far as I know, no proposals along the lines outlined by the Minister here were ever brought before a Government of which I was a member.
There is this danger, and I urge the House to consider it. There is an illusory, superficial attraction in the proposition that one board can more effectively administer any group of activities than five boards. When one puts it in that form, it seems to be almost obvious, but I suggest to Deputies that on reflection it is not always true because one may very well be confusing fundamental values. Efficiency is not the only thing that counts in this troubled world and, particularly in the administration of health services, efficiency is not the only thing that counts: humanity enters in.
I very well remember years ago going into a nursing home in Denver,  Colorado, which represented the apotheosis of modernity in those days, but the patient looked to me more like a corpse on a mortuary slab than a patient in bed. I compared him mentally with the conditions of a patient in a nursing home in Dublin where there was much less tiling, much less terrazzo, and much less modern equipment, but where there was that humanity which made one want to get well, and persuaded one that one was surrounded with what the Americans call tender loving care, rather than the modern asepsis of an up-to-date American-style hospital room.
I mention that merely to indicate that there are values to which we in this country should attach importance, other than administrative efficiency. I do not think we in this House should lose our balance in either direction, and abandon efficiency in the name of comfort and tender loving care, but on the other hand, I do not believe that we should jettison lightly well-tried methods, for revolutionary new departures, unless we are entirely satisfied all the interests concerned will materially benefit.
These principles which I submit to the House are, I think, relevant to the proposal to divorce the administration of these services, very largely, from the present intimate contact with public representatives, but when we come to the proposal to abolish the Dublin Fever Hospital Board, I think, as Deputy Dockrell said, further and additional considerations arise. The Dublin Fever Hospital Board is the heir of a long tradition which recalls the institution of the ancient charity by a group of our fellow citizens which ultimately, in the course of time, developed into what is now the Dublin Fever Hospital Board. Its long history and its origins were recognised by the maintenance of participation on a voluntary basis of a number of the members of the old community which established the original charity.
I do not think it is a good thing lightly to brush aside voluntary participation in services of this kind. I endorse what Deputy Dockrell said, that one of the curses of modern society is not only that many people  look to the Government to do everything for their own benefit, but that people who felt in past generations that their good fortune in life imposed upon them an obligation of voluntary public service are being encouraged to shrug their shoulders and say: “Ah, let the Government do it.”
I urge on the House, and I urge it with some knowledge, that that kind of departure is wholly wrong. After all, every Deputy, no matter what his position, must make his contribution to our deliberations, so far as he can, from his own personal experience. My personal experience, of which there is testimony on the records of the House, is that in a matter concerning the Department of Agriculture, what could be got by voluntary work was infinitely better than anything I could get by the most carefully organised bureaucratic operation. Evidence of that is available to the House in that I succeeded in getting the Department of Finance and this House in my day, for the first time, to authorise contributions from public funds to voluntary bodies like the Irish Countrywomen's Association and analogous bodies, so that they would do voluntarily certain work, if we assisted them by providing them with funds to stimulate their organisation, and to send out organisers to explain the character of their activities and form new branches.
We did that because experience taught us that in the field of rural education, and such work as the Irish Countrywomen's Association engage in, the voluntary type of work produced results that no exertion on an official level could get from our people. The same we felt was true of Macra na Feirme and other voluntary bodies of that kind. I think it is also true that in regard to health services and bodies of that kind, voluntary service is of inestimable value and will give results that salaried service, no matter how efficient, or how conscientious, cannot be expected to provide in the same degree. I would, therefore, urge the Minister to consider the proposals of this Bill again and to have regard to the representations made against them.
I want to say this in conclusion. Nothing in our imperfect world—seeing that we are all the children of  Adam—is perfect. Sometimes in this country we are too prone savagely to criticise the minor imperfections of a good system because the system is not perfect. There is no Deputy who does not know perfectly well that in respect of some boards in this country an element of abuse may exist in regard to public representatives desiring rather to get travelling expenses than to give the service on the boards to which they belong. Let us not pretend that none of us knows that. I mention that deliberately because I think that could occupy people's minds to an excessive degree.
Given that that defect exists, set it against all the other advantages that result from local administration rather than centralised administration, from the service of neighbours by neighbours, from the intimate knowledge of local bodies rather than central authority—set it against the social value to our society of voluntary service as opposed to the impersonal administration of the State of everything—and I think whatever evil in that regard that exists shrinks to insignificant dimensions.
May I use a homely simile? I urge on the Minister that, in his desire to dispose of anything that appears to him to be dirty water, the dirty water of inefficiency here, in throwing out dirty water, he should not throw out the baby as well. There is the danger that, in our desire to remove certain imperfections, we may discover too late that we have lost a great deal more than we have gained. We are not satisfied that the Minister has made a case for a reduction in the rates on a scale which would justify this radical change. We are not satisfied—the Minister still has his turn to give us his view of the relative advantages— about the superior efficiency he hopes for against the elimination of closer public representation of the intended beneficiaries of the health services, especially in scattered areas such as exist in county Cork.
We have heard nothing from the Minister which would justify his peremptory proposal to abolish the  Dublin Fever Hospital Board, which, so far as we are aware, has faithfully and conscientiously discharged the duties put upon it. We have heard nothing from him or from any other source which persuades us that there is justification for blotting out this very valuable survival of voluntary personal effort in the service of the sick poor. We attach real importance to the preservation of such voluntary service. We attach real importance to the broad general principle that where a service can be done by a relatively small body, it is, in principle, a mistake to remove that service to a superior and larger body or a superior and more remote body—and that principle seems to be very gravely traversed by the proposals in this Bill.
I have heard it said sometimes that it is dismaying not to hear in Dáil Éireann trenchant and furious condemnation by the Opposition of every and any proposal put forward by the Government. It is no part of this Opposition's intention to approach legislative proposals brought before this House in that spirit. Our function here is faithfully to examine Government proposals; and where we think it is right to criticise them to express our ready willingness to be convinced, if the Minister is in a position to produce arguments to counter those advanced by us, and our firm resolve to vote against any proposals which we are not persuaded are in the best interests of the people and cheerfully to accept any proposals deriving from the Government or anywhere else which, in our opinion, will advance the interests of the people whom we are sent here to serve.
Mr. Casey: To my mind, the fundamental weakness in this Bill is that it is based on the erroneous assumption, which emanates from the Civil Service mind, that what is good for Dublin must be good for the rest of the country and if it is not good for the rest of the country they will have to put up with it anyway. I should like the Minister clearly to understand that any criticism he may hear from these benches on this Bill is not political criticism and is not made for  any political purpose. Indeed, the history of this whole matter adequately proves that to be so.
The first suggestions for the amalgamation of the health services for the Cork area came originally from a Fianna Fáil Administration and the Cork representatives and the people of Cork rejected feelers put out on that occasion. Similarly, during the period of office of the inter-Party Government, the then Minister for Health, Deputy T.F. O'Higgins, put similar proposals before the Cork representatives and again they were rejected. These proposals were rejected on both occasions because it was felt that they would not give better health services to the people whom we are endeavouring to help.
I would not feel competent to judge this Bill on what it envisages for Dublin, Limerick or Waterford. If the Minister states, and if he is supported by Dublin Deputies, that this is a good Bill for the amalgamation of the Dublin services, that section of the Bill will have my support and similarly with the sections dealing with Limerick and Waterford. However, I am not at all happy regarding the proposal in the Bill to amalgamate the health services in Cork city and Cork county. I am not alone in that. It is not simply a Party issue. Deputy Wycherley, a farmers representative from Cork, shares that view with me. He is a rural Deputy; I am a city Deputy. He belongs to the Farmers Party; I belong to the Labour Party. We both share the view that this Bill will not give us better services and that it will in fact confound some of the confusion that is there already.
I know that some Fianna Fáil Deputies are not at all happy about the measure. I would impress upon the Minister that, when we come to the Committee Stage, he should approach whatever amendments are put down dealing with the Cork area in a considerate fashion and regard them as attempts on behalf of people of goodwill to lessen the hardship we feel this Bill will impose on the people of Cork.
The Cork County Council have  already deliberated on the matter and by a majority have rejected the proposals. The Minister is no doubt aware of that. The Cork Corporation, which previously, under two administrations, under a Fianna Fáil administration and an inter-Party administration, rejected similar suggestions, are at the moment further considering the implications of this Bill. We have not yet reached the stage where we have given a final decision on it. To my mind, the decision will be the same as on the last two occasions.
We naturally are concerned with the serious implications as far as Cork city is concerned. The city health functions are administered by the 21 city members elected to the Cork Corporation by the citizens of Cork. It is proposed that these functions be now transferred to a new health authority made up of 16 county council members and eight members from the Cork Corporation. The quorum at any meeting of that authority will be six. I share the view, for different reasons, of Deputy Wycherley that that new authority could not administer efficiently the health services of either the city or of the county. The needs of the citizens of Cork city would best be dealt with by city representatives. I do not think a man from Bere Island or from any part of West Cork or from the extremes of North Cork, adjoining North Kerry or the South Limerick border, could efficiently administer the medical services in Cork city. Similarly, I do not think a member of Cork Corporation, be he a trade union official or a professional man, could appreciate the difficulties and peculiar circumstances surrounding the far reaches of West Cork or indeed the peculiar problems in North Cork.
If we need any further proof of the foolishness of that proposal, we need only read the contribution made here last night by Deputy Corry. Deputy Corry proceeded, with his usual anticity bias to which Deputy Healy referred and deplored and which all of us deplore, to stir up some kind of ill-feeling between city and county, as if all of us do not wish the best to one another. Nevertheless, we cannot get  away from the fact that Deputy Corry —there are not many people like Deputy Corry, thank goodness—in his approach to this matter proved to me beyond yea or nay, that the health services of the city of Cork would not be in the best hands if they were in the hands of an authority made up in the ratio of two-to-one of county members as against city members. We need not develop that argument at the moment. We shall have a further opportunity to do so during the Committee Stage.
Mr. Casey: He would make a good bid for it anyway. It has been represented here that the implementation of this Bill would involve the transfer of officers of the Cork Corporation who are now administering the city services to the new authority. I am given to understand that everybody, with the exception of the Cork city manager, would be transferred to the new authority and that the city would then be left with no medical officer of its own, no health inspectors of its own, to administer the various Acts, such as those relating to housing and sanitary services and the Local Government Acts. I am not suggesting that those services would not be administered. They would, of course; they would be administered by the officials of the new authority.
Again I am suggesting that the people best qualified to administer these services are officers under the direct control of the Cork Corporation, the city health authority. I intend, in conjunction with some of my colleagues, to move amendments on the Committee Stage and I hope the situation will be such that there will be a free vote on the various proposals put forward for decision at that stage of the Bill. It is a non-political Bill and one I am quite sure that every Deputy would like to approach in a reasonable fashion with the main aim of carrying into this Bill clauses and suggestions which will give to the people of his own area the best health services possible.
 I hope the Minister will appreciate our approach to the Bill. Even if he were to say to us in relation to Cork city or county: “We think those two services should be amalgamated,” nobody would immediately oppose that; we would look at it and give it very serious consideration. We do not pretend, at least in respect of the city, that the administration of the health services is perfect. We know there are many faults in it. I am sure the same applies to the county health services, but this “big stick” Bill which endeavours to amalgamate all the services in the city and county is not the answer to our problems. I hope the amendments we shall put down on the Committee Stage will receive consideration from the Minister and that he will let a free vote of the House decide whether or not the amendments are good amendments.
Mr. Russell: Speaking for my own area, which is the only one about which I am competent to speak, the area of Limerick city and county, I welcome the Bill. It appears to be a logical development of the various Health Acts passed by this House over the years, particularly the 1947 and the 1953 Health Acts. So far as Limerick city and county are concerned, if the Bill is put into effect I believe it will lead to an avoidance of overlapping and will give a better service to the citizens in both areas.
I am not conversant with the situation in Cork, Dublin or Waterford, although I must say I have been very much impressed by the arguments put up by Cork Deputies. It is quite possible the Minister may feel that the position in Cork, which is vastly different from that in Limerick, may require further consideration. In Limerick the position is simplified to a large extent by the fact that most of the institutions which come under the jurisdiction of the county council and the city council are established in the city of Limerick. The only institutions outside the city boundary are the hospital in Croom and the county hospital in Newcastle West. All the other institutions such as the mental hospital, the city home, the sanatorium and the new regional maternity  hospital, which has not yet been opened, are situated inside the city boundary. The regional hospital is just outside the city boundary. Therefore, with regard to Limerick there is a very strong argument for bringing all these various health institutions under one joint body. I believe that the joint body will work well, with the desire on the part of both the city and the county representatives to give the best possible services to the citizens.
It should not be forgotten that the principle of joint administration is not a new one. In regard to mental treatment, the principle of joint control between city and county authorities has been in operation for a number of years. Although I have never had the good fortune to be elected to a mental hospital committee—invariably being in a minority in Limerick Corporation—I do know that the system has worked well, and, so far as I am aware, there never has been any clash of opinion between the city and county representatives regarding the treatment given to the patients from their respective areas.
Further, there is the fact that in Limerick generally, at least for some years to come, the effort will be concentrated on building up the standard of the county services to that of the city services. I do not say that with any desire to criticise the efforts made by the county council to provide an efficient and economical scheme in their area. Of necessity, the building up of services in rural areas must be slower and, for obvious reasons, much more expensive. Some indication of that may be found in the fact that in Limerick city, there are only five dispensary doctors to cater for 50,000 people while in the county, there are 27 dispensary doctors to cater for a population of 90,000. The representatives for the rural parts of County Limerick can be assured that so far as they are concerned, any additional costs which will be entailed over the immediate future years, will, in fact, be to the benefit of the county.
I want now to deal with one or two points in the Bill which the Minister may think worth consideration. The  Bill, so far as I can see, does not provide any method by which any institution or service not at present under the jurisdiction of either the city or county authority can be taken over. Possibly such a situation may never arise, but as we know, there will be certain institutions outside the control of the city council and the county council that may in time be either proffered or may, for one reason or another, become available and one of the new health authorities might have to take over their administration in one form or another. As I say, there is no opportunity for the health authority to do that. Perhaps the Minister might include a clause to provide for such a development at some future date.
Another point is in regard to the representation of the city council, of Limerick Corporation, on the voluntary hospitals boards. In Limerick city, there are two voluntary hospitals at present, St. John's and Barrington's. At the moment, under existing arrangements, Limerick Corporation appoints a certain number of its members—four, I think, in each case —to the governing body of these two hospitals. Under the new arrangement, will the corporation continue to appoint these representatives or will they be appointed by the new health authority?
I welcome the provision whereby the estimates of expenses for the new authorities will be referred to the respective rating authorities for their comments. I do not know exactly what is involved in the suggestion that they will be allowed only to comment. It does seem to me that the people who pay the piper—in this case, they pay up to 50 per cent.—should have more than just the right to comment on the expenses proffered to them by the new health authority. The Minister might consider allowing them to hold up these expenses, to disagree with them, and to refer them to him, or his Department, for consideration, if one or other rating authority, or both of them, were dissatisfied with the estimates.
In his introductory speech, the Minister referred to the total cost of  health services and the cost of health services in the four areas covered by this Bill—Dublin, Cork, Limerick and Waterford. He mentioned that a sum of £7½ million was now being spent in these areas, of which the general taxpayer provides, by way of subvention, 50 per cent. or £3¾ millions. I think we would get a clearer picture if the Minister indicated what the taxpayers in these areas provided to the Central Exchequer through taxes raised in these areas.
The Bill, in Section 17, provides for the appointment of a Chief Executive Officer only for the Dublin health authority. I should like to ask the Minister if he has considered, not a similar appointment, because I do not think such is necessary, certainly in the case of Limerick and, I presume, Waterford, because both are substantially smaller, but some appointment such as a secretary for Limerick and possibly for Waterford also?
I have a good deal of sympathy with the views expressed by Deputy Dillon and Deputy Dockrell on the work done by voluntary bodies and the members of voluntary bodies who act on various institutional boards and who have given silent, considerate and humanitarian service down through the years.
I am a little concerned about the outcome of this Bill on the rights of public representatives to plead the cause of their constituents in regard to various grievances or difficulties that they may have in the future. As the Minister is aware, at the present time, if a Deputy, a county councillor, or city councillor, is approached by a constituent who has some difficulty over a question of public assistance, or something in connection with health services under the auspices of the health section of the various local authorities, he can go to the manager and plead his constituent's case. When these new boards are set up, the county councillor and city councillor who does not happen to be a member of a health authority will, strictly speaking, have to put his case to the health authority. To my mind, that could be a very cumbersome and difficult system in practice.
 It seems to me that the Minister would need to tread very warily in this connection. I know that public representatives are regarded as a nuisance from time to time, but they do very useful work, and I think the Minister would be the first to agree with me on the need for keeping a contact and a fair balance between the genuine needs of the individual members of the community, especially the more humble members, and what has grown up over the years, a large and efficient but bureaucratic machine. I think the rights of public representatives and their opportunities to plead the cases of their constituents should not be interfered with or in any way curtailed.
I feel that even though the Minister has provided for the setting up of these committees, there is bound to be, as the Bill reads at present, some interference and some restriction on the rights of public representatives to bring small problems quickly before the city or county managers, as the case may be. I should like to ask the Minister to look into that section of the Bill again. It is possible that might be partly overcome by increasing the number of members on these health committees so that a larger number of county and city councillors would find a place on them.
I see no provision in the Bill whereby visiting committees to hospitals can be set up. Possibly that is provided for, but I have been unable to see it in the Bill. So far as I can see, these committees have been set up largely to act in an advisory capacity for certain specific purposes. Will these purposes include some of the matters to which I referred a few minutes ago? Will they be able to criticise individual cases of the giving of home assistance and, if they are to do that, what is the procedure by which they do it? Do they hold a meeting? Does a city councillor come to a meeting with a list of grievances and put them before the manager, who is bound to attend such meetings, or is there some other system whereby the local representative can deal with these grievances more quickly and more effectively?
 Like Deputy Dockrell, I always regret the passing of a voluntary body. He referred to the Dublin Fever Hospital. I have no knowledge of the set-up there, and know absolutely nothing about it, but I do recall that under the British system, which is a completely comprehensive national health system, there are regional boards—I do not remember the number; I think it is 12 or 14—and within these regional boards, there are committees of individual hospitals, and the governors of different institutions, who have a certain measure of freedom even inside the largely socialised English system. I think the Minister might consider allowing, and making provision for it in this Bill, certain institutions, for instance, the Dublin Fever Hospital which is an appropriate example, to continue to have a committee and operate within the general purposes of the Bill, possibly under the Dublin health authority.
The Bill continues, as I read it, the reserved functions of public representatives. I am not quite clear what that means. The reserved functions of a city councillor or county councillor are very limited. Those of us who act on a city corporation or county council know that, in effect, the city or county manager is the corporation or county council, and the functions reserved to local representatives, apart from striking the rate, are very limited indeed. Does this mean that these very negligible functions are the only functions which the individual members of a health authority can discharge, and that the city or county manager will be the boss in these authorities?
I am also not quite clear on the relationship between these four health authorities, the Minister and his Department. Are they to be allowed a reasonable measure of independence, or are their requirements in regard to capital and current outlay to be the subject of long, and possibly acrimonious wrangles with his Department? I ask that because one of the arguments which the Minister put forward on the advantage of this new  set-up is that it will provide a more efficient and economic service. It seems to me that once you introduce any Bill, and emphasise its purposes as being to make for more economy, then the Department willy-nilly will watch for every possible opportunity of introducing economies. For the life of me, I cannot see how economies can be carried out, certainly not excessive economies, while, at the same time, building up the general status of health services throughout the country.
With other Deputies, I welcome the bringing in of the mental treatment side with the general code of curative and preventive medicine. I agree completely with the Minister's view that the treatment of people suffering from mental disease, however mild, up to now has been regarded as something separate from the treatment of people suffering from tuberculosis, cancer, fever or some other form of illness, and the mere bringing of mental treatment within the general body of medical services is a step in the right direction.
It seems to me that if the members of these health authorities are to discharge their functions efficiently and conscientiously, they will have a considerable amount of work to do. Instead of meeting monthly, as provided for in the Bill, it is quite likely that these bodies will meet even weekly. Having regard to that, again I would ask the Minister to consider increasing the number of representatives on these authorities because the ordinary public representative has to find a means of existing outside his Dáil salary. A public representative who is a member of the Dáil, a member of a city or county council, and of several other bodies, would find it very difficult to carry on his normal business, profession or work, and at the same time, give the necessary attention to and attendance at the very regular meetings of these new authorities. Therefore, I ask the Minister to consider increasing representation on these authorities with a view to ensuring that there will be an adequate number of representatives in attendance at their meetings.
 In these comments, I speak specifically for the area which I know, and with which I have been in personal contact over a number of years. I think the Bill will put into effect certain improvements and, with those I have suggested, it will make for a better health service in the city and county of Limerick. The question of costs is one that should not, and, in fact, need not, concern the county area of Limerick, because, as I said at the outset, I think the expenditure for some years ahead will be largely to the benefit of the county representatives and the people living in the county areas. I feel certain that Limerick county and city representatives can work together on a joint authority for the benefit of the citizens in both areas.
Sir Anthony Esmonde: I think it is fair to say that if the previous Government had brought in a Bill like this, we would have been accused of giving way to pressure from the Left. The explanatory memorandum says that this is a Bill for the purpose of producing a more economical and efficient medical service, and to provide for the integration of the mental and general medical services.
I cannot help feeling that the system heretofore for the running of medical services and social services is a far more suitable one. These services are run by organisations on the spot and not only by organisations on the spot but by people who have administered those services over a great number of years and who have the knowledge, not only of local conditions, but of the particular services with which they are dealing. The general tendency in nearly all countries—and I regret to say here also— has been towards the establishment of central control, in the false belief that any form of control means more efficiency and economy.
It was once argued—I did not agree with it—that the introduction of the major health legislation, the parent of this measure, would make for greater efficiency and better medical services. It was even argued that it would give  a more economical service in the country as a whole. When we look back and consider the health services as they are now under a more or less unified control in every county, can any Deputy be satisfied that those in receipt of health services are getting satisfaction? I do not think so. If that is the case—and I maintain it is —what is the object of introducing a Bill such as this to extend control further over the private lives of individual citizens?
I should like to deal with the Dublin Fever Board. By this Bill, there is no question that a voluntary body which has been in existence for many years and has given good service to the public is being destroyed. It may have defects as every body has. Every body makes mistakes but the panacea for all evils is not the destruction of private bodies such as this and the placing of their work under State control. I am not clear on what is happening but I understand this board functioned for a long time, was self-supporting, and had its own funds. It has been mentioned—I may have the figure wrong—that they had some £50,000 at their disposal originally as the old Cork Fever Hospital. They were then taken over and amalgamated and their funds absorbed. A board was set up which, to some extent, maintained the original voluntary institution. I take it that the State, or the health authority which is the State, or a product of the State, will now take them over, lock, stock and barrel, and their funds as well. That is State control and nothing else.
It surprises me that the Minister for Health, who, I had always imagined, was rather inclined to regard State control with suspicion, should be the Minister to introduce this Bill. I know the previous Ministers had it put up to them by their advisers that they should introduce it and I am surprised that this Minister should fall for it and present it to the Dáil.
In effect, this Bill does away with every organisation in every county and places the health services in every county under the control of one man. The House may think what it likes but that is the case. If any Deputy  wishes to deny that, I shall ask him this question:—does he, as I do, get letters and phone calls and messages every day from people seeking medical cards? Does every Deputy not know cases of people who for years have been entitled to free services and now find themselves in the position that they cannot get those services and that they have to apply for medical cards or get Deputies to send in applications for them to the health authority, who is the county manager? If the county manager says “no,” even though the person may be in dire want, that is the end of it. I am not imputing any ulterior motives to county managers: what I am attacking is the system. The Minister was asked last week whether there was any appeal in the case of health cards against the county manager's decision. The answer he gave was “no”.
I maintain this Bill abolishes any separate health authority and amalgamates the whole system under one person. It may not be right for me to say much about Dublin, but as far as I can see from the Bill, Dublin city and county will have the health services for some 1,000,000 people centralised. The Minister will say, no doubt, that you have local representatives but you had local representatives before representing each portion of this big area. They knew intimately the requirements of their areas and knew the personal issues involved.
I want to stress that in medical matters there is a personal issue. In that respect, they are unlike anything else that may be run under State control. The personal element is being abolished in the abolition of these boards, and although representatives will be elected from different areas and will come to the meetings, they will not meet as they met hitherto to deal with particular local problems. They will bring with them the local problems all right but they will not be able to thrash them out as they did as a locally representative authority. They must come to the main body; in other words, they are decentralised. They must come and place their problems before the health authority.
As I said in the long controversy  that went on when the parent Act was being introduced, the health authority in every county is the county manager, a layman not conversant with medical affairs. He may have his advisers but, at the same time, he has the final word on everything. I do not think that makes for a satisfactory situation. This is a retrograde step in regard to social services. I do not think the Minister has justified in any way the suggestion embodied in the explanatory memorandum that there will be a reduction in expenditure. Every Deputy knows and those in every county who are members of local authorities know, that there has been a continued rise in the rates over the past few years. In fact, rates have reached a stage at which they are almost unbearable, and the answer is always given that it is the health services which are costing so much.
Deputy Dillon said here this morning that if the health services were to cost more, no one would argue against them, although people might not like paying. If they were paying for something of benefit to the community as a whole, that would be another matter but they are paying for something which is not giving better service and is costing more. I maintain that the new amalgamation system virtually wipes out everything. Creating this new centralised control everywhere does not make for better medical services and it will not make for economy.
Furthermore, I do not think there has been any direct demand upon the Minister to do this. I may be wrong; he may have had representations from these boards to be wiped out; but I am doubtful. I know he has had representations from his advisers that this is the best and most economic system and that it will produce the best social services. I just flatly disagree with that.
I should like to say a word or two on the mental services. I note that the mental committees which exist in the counties which have not this unified control are to be abolished. Mental health and the difficult problems relating thereto, are, perhaps, a more personal affair in the science of medicine  than any other section. It is a sphere in which separate committees are ideal. Many of these committees are composed not only of elected representatives but of people who are chosen because they are able to deal with these matters. The human element enters. They are able to give attention to those who are unfortunate enough to be victims of mental diseases but they are to go by the board as well. They are to be swept away.
The people who served on these mental committees gave good service. They were able to deal with all these problems. Now they are to be swept away. These committees, even if they went to hospitals as visiting committees, helped to keep the hospital authorities on the alert. They also encouraged the hospital authorities to feel that they had a local committee which was taking an interest in their affairs. It was also good for the patients to feel that they had local people who were not necessarily elected representatives on these boards to visit the hospitals. These people come from all walks of life. They are of different religious denominations. They satisfy themselves that these establishments are being properly run.
I wonder are we right in having a Bill such as this which abolishes another form of what one can only describe as a private body functioning for the good of humanity and for the sake of a distressed section of the community? I think the Minister would do well to ponder on these points.
The mental services in this country provide a problem. We are not a wealthy country. We have a lot of mentally defective children, as every country has. The religious Orders and so on who run the mental institutions are put to the pin of their collars to carry on. They face very great difficulties in that they are taking over children for whom in many cases there is no ultimate complete cure. These children are in institutions and when they grow to manhood, their discharge is not possible. Therefore, the inflow to these institutions is  continuous, while the outflow is nonexistent.
That poses a very serious problem. It poses a problem as to the way in which to deal with a situation which is rapidly getting out of control because there is a very big waiting list. Will it make for greater efficiency to have a central health authority to deal with a situation such as that which obviously must be dealt with by private enterprise and by those who have given long service to such work? What scope will the people on these mental hospital committees have when dealing directly with a centralised authority, with bureaucratic control, as compared with the existing system?
I do not see anything in this Bill to commend it. Deputies know that I did not see very much in the parent Bill to commend it, but I see nothing at all in this Bill, except that it is yet another milestone on the road to controlling the private lives of the people. We should maintain as far as we can the spirit of private enterprise in this country—the right to run our own affairs without having imposed upon us something which the Irish people do not want.
Mr. Carroll: I am confident that the Minister is desirous of improving the health services of this country. I was impressed yesterday by the contribution of Deputy O'Higgins in that he was not prepared to condemn the Bill. He said it had its good points. He spoke with great eloquence. It was a very impressive speech coming from a Deputy who is a former Minister for Health.
With regard to the health services in the Dublin area—I shall not speak of any other area—I think they are on a par with anything I have seen on my many travels. However, I must wholeheartedly support this Bill in its entirety if it only means that the Minister, as he promised yesterday, will give attention to the present condition of mental hospitals. Prior to coming into this House, I had occasion to spend quite a considerable amount of time carrying out work on mental hospitals and I can say without fear of contradiction that many sections  of the buildings which house unfortunate mental patients are appalling. It would be a good thing if a Select Committee of the House were sent as a visiting committee to these institutions. Therefore, for the reason that I have mentioned, I welcome the Bill.
I am not an authority on health services but I am particularly interested in the proposal to abolish the Dublin Fever Hospital Board. I do not know whether or not I interpret Deputy Dillon correctly but I thought he inferred this morning that one was expected to oppose a Bill that was brought in by the Government, if one were in Opposition. As an Independent Deputy, that certainly means nothing to me.
Mr. Carroll: The manner in which I change from the right to the left in debates in this House is indicative of the fact that I do not hold that view. Deputy Dillon agreed that certain conditions would justify the abolition of some boards. He mentioned expense. I should like the House to know that this morning at 8.30 I attended the Dublin Fever Hospital Board as a member representing Dublin Corporation. The Board meets every Thursday morning at 8.30. Although the extraordinary members have to travel from places as far away as Dalkey and Rathfarnham, there is no question of their getting expenses. Admittedly, breakfast is available for them at 8.30, if they desire it. Apart from that, their services cost the city or the State not one penny.
This board is the successor of the group who, in 1800, when there was little or no hospitalisation in this country, succeeded in setting up the House of Recovery. I have not heard  any valid reason, based on economy, for the abolition of the Board. It must be remembered that every proposal made by the Board, which is comprised of seven extraordinary members, must be sent to the Custom House for ratification. They cannot spend money and they cannot cause any expense that cannot be justified. The history has been given so eloquently by Deputy O'Higgins that there is no need for me to labour the point. I am deeply concerned about the assertion that, in the reconstitution of the board, it was understood that these seven members would have a permanent right to elect themselves on to the board of that hospital. I was also impressed by the extract read by Deputy O'Higgins yesterday from the Dáil Debates in which the Parliamentary Secretary of the time said that we were in duty bound to honour our guarantees.
It would appear to me, therefore, that the Dublin Fever Hospital Board was included in the Bill as one of many boards. The Minister indicated yesterday that representations had been made to him to receive a deputation in regard to this matter and that he had agreed to do so. I take it that the Minister will be willing to receive the submissions made by the deputation, in addition to what has been said by Deputies, and will reconsider the proposal to abolish the board.
We have been very jealous, and our leaders have been very jealous, of the rights of communities, religious or otherwise, in this country. The Dublin Fever Hospital Board might feel, and might be justified in feeling, that they were being blotted out for some reason. I know that that would not be true but, as there has been no submission made, so far, that the abolition of this board would be justified because of the manner in which it conducts its business, and having regard to the guarantee given in this House and the very lengthy discussion in the Upper House on a former occasion, I am confident that, even at this stage, the Minister will reconsider the proposal to abolish this board.
Mr. Kyne: This Bill is of special interest to a number of areas. My  constituency covers one of those areas, embracing, as it does, both Waterford city and county. I should like to make it clear that the views I am about to express are purely personal. They are not taken after consultation, or even discussions, either with my colleagues on the Waterford Corporation or on the board of public assistance or, indeed, on the county council.
I welcome this Bill on general principles, believing, as I do, that there was need for an amalgamation of all the health services under one direct body, so that a public representative or anyone in need of the services would at least know the appropriate authority. There are various boards in Waterford city and county catering for the health services. The mental hospital joint committee has authority over mental hospitals; the board of public assistance has to do with all other types of hospitals; and, notwithstanding that, it is the Waterford County Council that has the authority in connection with infectious diseases.
This raises the question of hospital treatment for people suffering from all kinds of infectious diseases. I had an example in my own constituency recently. There was an outbreak of paratyphoid and naturally the local representatives were interested to know what caused it, what the local officers were doing to control it and to get assurances about the future. The local representatives pointed out that a similar outbreak had occurred 12 months previously but that the members of the board of public assistance, presumably interested in the health of the people, had received no report or information on it. To the surprise of the local representatives—though not to mine, I must confess—they were informed that the matter was one, not for the board of public assistance, but for the county council. Yet we had all the patients in our hospital and we had to pay for all the expenses incurred as a result of the outbreak. We suggested that a joint meeting should be held at which the medical officer, his assistant or any other interested persons could give  their views, but to our surprise we learned that the chairman of the county council had no power to call such a meeting. Surely that is an example of the frustration of public representatives in their desire to carry out their duties. If only because of that one example, I would welcome this amalgamation of services.
I would ask the Minister to give the members of the various councils, such as the Waterford City Corporation and Waterford County Council, an opportunity of studying the Dáil speeches made on this measure and of considering how the measure will affect them. I am aware that the Minister has taken steps to consult with county managers, and possibly city managers, in order to consider their views on the Committee Stage and, perhaps, amend the Bill. I am aware also that certain county and city managers desire to give the members of their local authorities an opportunity of expressing their views before any suggested amendments are sent in.
The Minister should consider postponing the Committee Stage for a period longer than the usual week or fortnight. This is an important measure and should not be rushed. Each local authority, particularly those directly affected, should have ample opportunity of considering the implications of this Bill and of knowing, if possible, its effects on the health services and the lives of the officials who administer them.
For example, I am sure that in my area of county Waterford the representation the county formerly had on the board of assistance and the mental hospital committee is being considered. The combined strength of both boards is 30, but under the Bill it will be reduced to 14, nine from the county and five from the city. That is a 50 per cent reduction in public representation. I believe public representation should be widened somewhat. I know that unwieldy boards are not desirable and that, on economy grounds, a reduction may be necessary, but the Board should be large enough to give every section on the council at least one representative.
 Under the old system of selection by the county council for the board of public assistance a section of county councillors could appoint a representative. Will that principle remain in selecting representatives for the new health authority? The different parties on local authorities are, on the whole, pretty honest about giving either Party representation or sectional representation, but it has occurred that a major political grouping on a council, for sectional or political reasons, have been fit to oust completely the representatives of the other side. I do not think anyone would consider that desirable, and the principle I have referred to should be continued in the new Bill.
Like Deputy Kenneally, I am in a very awkward position in the dispute between Waterford city and county. Both of us are aldermen of the city and also members of the county council. The dispute concerns the question of who pays and at what rating. It is suggested in the Bill that the Minister should appoint somebody to decide. I do not know if that would meet the views of everybody. I would suggest that the Minister appoint an arbitrator, that his arbitration should be carried out in the ordinary manner and that both city and county interests be permitted to put forward their views, through Counsel, if necessary. Further, unless they jointly come to a voluntary agreement, the arbitration result should be made binding on them for a period of years to see what the effect would be.
Who will administer the entire health services in the city and county? Will it be the city manager or the county manager? Who will be the senior administrative officer—the clerk of the mental hospital or the secretary of the board of public assistance? I am sure the Minister and his advisers have already made up their minds on these details, but they are the details about which questions will be asked and answers expected when the matter is being examined by the local authorities. I repeat my suggestion that the Minister defer the Committee Stage for three weeks or so to enable these  matters to be considered and, if necessary, suitable amendments tabled.
I have long felt that such a Bill was necessary. I know that the officials endeavoured to bring it about by mutual agreement between the local authorities, but did not succeed. I do not think there is as much compulsion on us as is suggested. Even if there is compulsion, sometimes that is necessary when agreement cannot be reached. From a purely personal point of view, I repeat that the Bill should be welcome.
Mr. Jones: My intervention will be brief. I listened to the Minister's statement introducing the Bill. He referred to the purpose of the Bill—to co-ordinate, improve and make more readily available treatment for persons requiring it. He also said that it should effect substantial economies. I am not at all convinced that that will be the effect of the Bill in the area which I represent. The Minister referred to the fact that in Limerick costs were the bogey. So far as I understand the position in County Limerick, the county council have still to meet to consider this whole matter. I understand Limerick Corporation have met and considered the proposals. The county council, on the other hand, have still to meet to consider a memorandum from the County Manager. Subject to correction, I think the attitude of the county council has not yet been determined so far as this Bill is concerned.
Everybody agrees that the first and most fundamental improvement is the provision of services which will give to the people in general the best possible treatment, conveniently and economically. There are six electoral areas in Limerick and how a member will be picked for each area is something upon which I cannot offer any opinion. I imagine the selection will present some difficulty. Whether such a member will be able to give the same measure of assistance as county councillors have been able to give up to this is a point for consideration.
Everybody is in agreement on the necessity for removing any suggestion of stigma from mental health services.  In Limerick there has been a unified committee acting for both the city and county in relation to the mental hospital. That committee has worked very harmoniously under the control of the city manager. Whether the proposed arrangement of ten representatives for the county and five for the city will make for better services, I am not competent to judge at this stage.
The costs of the health services are much more than people anticipated. A saving, provided that saving did not result in any deterioration in the services, would certainly be welcomed. How such a saving can be effected administratively is something I cannot understand. There is a very competent staff at the moment and that staff is adequate only for the purposes for which it is required. I cannot see how any reduction can take place in staff. The services are running efficiently at the moment with a minimum of staff. Perhaps the Minister would clear up the point when he comes to reply. At the moment we have a city medical officer and a county medical officer of health. If these two remain, perhaps the Minister would tell us who will be advising him from now on.
I have doubts as to whether a reduced membership will have the effect of providing the people of the city and county of Limerick with the same type of services as they have enjoyed up to this. I am not a member of a local authority but I know the work which county councillors do. They deal with complaints, give advice, bring matters to the notice of the county managers and take steps to have grievances rectified. That work is spread over a large number of people now. If the number is reduced, I doubt if the people will have better service than they have at the moment.
The ratepayers are concerned as to whether this proposed unification will mean a further impost on them. Perhaps the Minister would clarify the position in regard to that aspect. I join with Deputy Kyne in his appeal to the Minister to delay the Committee  Stage to enable local authorities who are considering the measure to bring to the attention of the Minister any amendments they think desirable.
Mr. O'Sullivan: I agree with other Cork Deputies that it is impossible to see how any improvement can be effected and that, in fact, a worsening of the position will occur if the Minister persists in his proposal to amalgamate the committees. These committees at the moment represent a wide range of territory and a great number of people. We have had no indication from the Minister, beyond a broad reference to streamlining administration, that there will be any reduction in cost or any notable economies. As Deputy Healy, and subsequently Deputy Dillon, said, the paramount consideration is the health and welfare of the people. We are not satisfied that the provisions of this Bill, if enacted, will secure that improvement in our health services that some people would seem to expect.
Some Deputies played on the point that previous Ministers examined these proposals. That is true. They were examined but not proceeded with, because the Minister in question hearkened to the advice he received from those whom he consulted on the local authorities. Consequently, he did not implement the recommendations he received to do the very thing the Minister is persisting in——
Mr. O'Sullivan: No, I am not. I am saying it is the function surely of any Minister to examine all proposals submitted to him, and to give due consideration to the opinions of those who are interested. In fact, we all know, of course, as the Minister knows, that he has behind him a number of Deputies who are very critical of this Bill, and who are expressing their displeasure with it quite vociferously. The Minister says a Minister funked it, but that Minister did not steamroll his opinion over the members of the public bodies he consulted. It would appear that the Minister is quite capable of rejecting the informed opinions of Deputies of his own Party who are  sitting on committees. He should not glory in the fact that he is so strong that he can command influence in his own Party to get the men sitting behind him to go into the lobby and vote for something they have opposed and criticised so strongly and for so long. It is no matter of credit or pride for the Minister to make the disparaging remark he has made about his predecessor——
Mr. O'Sullivan: ——who examined the proposals of those who were vitally interested and concerned and who hearkened to their opinions and did not persist with the proposals which the Minister deems fit to introduce and push through this House notwithstanding the criticism of those from whom it was sought and the criticism of members of his own Party.
In the past a number of health authorities have catered for services in Cork county over an extensive area which it is now proposed to bring within the ambit of this smaller committee. I agree with Deputy MacCarthy and others that these committees performed outstanding services. The members of these boards and committees provided an excellent link between the beneficiaries and the actual running of the services. In this day and age, with so many demands on the time of public men, it would be absolutely impossible—no matter how the Minister may meet the appeal of Deputy Russell to increase the membership of these boards—for members to do justice adequately to their duties, considering that, as members of public authorities, they will have so many other commitments and that to-day these varied duties are diffused amongst a number of committees. There are men on those committees who are prepared to give as much of their time as they can afford in order to specialise in some aspect of health. We are now expected to delegate to this group duties that will demand a frequency of meetings and a duration of meetings which will make it impossible for any member of a local  authority to give that measure of time and attention which will be demanded.
I am not a member of a local authority but I have a great admiration for those who are members and for the work they perform and will continue to perform. I am a governor of a voluntary hospital and there are members of local authorities on that committee. We have also on that committee people similar to those the Minister seeks to wipe out in Dublin who are not members of any local body or members of the Oireachtas. These men and women are doing stimulating work in the South Cork Infirmary. I am sure members of local authorities in Cork will not take it amiss if I say that our meetings are well advanced when the members of the Cork County Council can find the time to attend. They have to leave the county council meetings before they terminate in order to give their attention to the South Cork Infirmary. They have to decide which is the most important in their eyes and they have to sacrifice one side to give attention to the other.
That is a small example of the difficulties which will arise if the Minister persists in his proposals to group the existing bodies which are dealing effectively with the problems they have to meet. Superimposed on them will be that select group and difficulties may arise in getting decisions.
I wonder will the right type of representative—the representative with a worthwhile business of his own, the man who is in intimate contact with the people and has proved himself a man of business acumen—assist on committees such as this? Can he afford to go on such a committee? Or is it a fact that we will have only men with nothing else to do, because if sufficient time is to be devoted to these duties, their time will be absorbed in giving attention to those and many other matters.
These are the reasons why we, on this side of the House, think the Minister would have been much wiser to have taken the advice which I am sure many of the people sitting behind him have given, and to have listened to  those who down through the years have given their time and their talents to this work. Recently, we heard quite a lot about territorial considerations in relation to electoral reform and so forth. Here is a proposal to amalgamate what is, relatively, a huge chunk of territory in Cork county, the effect of which will be, I have no doubt, to remove that intimate personal contact which exists at the moment between persons who live in remote parts of north west Cork, or south Cork, some 70 or 80 miles from what will be the new centre, the new hub, of the committee in Cork city.
Is it conceivable that, in the extreme south eastern corner of Cork, near Youghal, the representatives will have any understanding of the conditions that exist in the Beara peninsula? Is it conceivable that there will be any understanding in Rathluirc of the problems in Crosshaven or Ballydehob? That is why we think the Bill is a retrograde step and one to which the House should not agree.
Minister for Health (Mr. MacEntee): As I listened to this debate, I began to wonder whether Ireland contained Cork or Cork contained Ireland, because the fact seems to have been forgotten by those who have spoken, particularly from the Fine Gael benches, that, after all, the people of Dublin, the citizens of Dublin county and city, the citizens of Limerick county and city, and the citizens of Waterford county and city, are all very interested in this Bill. They are interested in it to this extent, that their representatives, so far as I have been able to establish contact with them, have accepted the principle of the Bill.
I heard Deputy Dockrell speak last night about totalitarianism. The only totalitarian member of the three local authorities in Dublin City and County that I know of is Deputy Dockrell. The Corporation of the City of Dublin, the Council of the county of Dublin, the Corporation of the Borough of Dún Laoghaire, have all approved this principle of unification. The only  person who has opposed it is the Deputy who got up in this House last night and spoke of totalitarianism and authoritarianism.
The elected representatives of the people of Dublin City and County want this Bill. They have virtually agreed between themselves as to the manner in which the expenses will be apportioned. I do not anticipate that there will be any difficulty in that regard so far as Dublin is concerned. They want it because they know it will benefit the 700,000 people for whom one or other of the boards, which are constituted either directly by the votes of the citizens in the shape of the corporations and the council or indirectly in the shape of the boards of assistance which derive from the local authorities, cater. They want it because they can see no way out of the chaos and confusion which exists in many parts of this united territory, one might say, by reason of the existing set-up there.
I heard the Leader of the Opposition say that we should be very careful, where we can utilise a subordinate authority, which can pay close attention to the administrative details, to entrust the administration of appropriate services to such an authority. As a theoretical principle, that is pretty sound. I try to apply it wherever I can in relation to practical affairs. Most of this discussion, however, has ranged around the point as to whether or not this or that member of a local authority will have access to the manager, in other words, how their importance in the eyes of their constituents would be affected by this Bill.
Mr. MacEntee: We heard a great deal of praise, and I do not want to detract from the praise, given to those who sit on these local boards and these different authorities. Most of them sought to be placed there and therefore they are doing the work they wanted to do. That does not mean that in any way I am unmindful of the sacrifices they voluntarily make in order to serve the public. However, do not forget that when they go on these boards, when  they seek to be elected to these boards and to be appointed to them, and as Deputy Wycherely suggested, in some cases at any rate, seek with great vehemence and enthusiasm to be appointed to them, they are appointed to them because they want to serve the people.
In the course of my opening remarks —I think the Leader of the Opposition was not present to listen to them; I am not saying that by way of criticism; he just happened to be absent—I mentioned some of the things that can happen in the City of Dublin. I told the House about them. I have the records on my desk. I told the House of a lady who lives in Churchtown, quite close to Dundrum, who wanted to have her children vaccinated against poliomyelitis. She got a notice, issued by the courtesy, I think, of the Dublin County Council, that children were to be vaccinated at a certain time. She thought the vaccination would be carried out at Churchtown. When she went there she found she was quite wrong and that, because of the existing set-up, she had to go from Churchtown to Crumlin, across the City, with her three children, and she had to make the journey three times.
I referred to the unfortunate gentleman who happened to be taken ill in Dún Laoghaire and was rushed to a voluntary hospital in Dún Laoghaire. He was a resident of Dublin City and, because of that, had to pay the hospital expenses. If he had been taken to a Dublin City hospital, he would have been treated there either at a nominal charge or free of charge. He was entitled to be treated free of charge or at least at a nominal charge under Section 15 but, because they had not time to get him to a city hospital, he was presented with a bill, as a section 25 case, in respect of his treatment and the operation in this voluntary hospital in Dún Laoghaire. All the Corporation could do was to give him the limited subvention provided for under Section 25.
I have told the House about 3,500 people, living in Crumlin who, although they live in a Crumlin district, surrounded by neighbours in  the same district, in the same type of houses, in the same economic circumstances, if they happen to require medical treatment, have to go right down to the Meath Hospital, although there is a place right beside them where, if we had a unified authority, they could go for treatment.
I told the House of the Kimmage Road where the city boundary runs through it. The people on one side have to go to be treated by the health officers of the county council, or have to go to the health institution of the county council, while the others living on the other side of the road can go into the city. That is my concern. I do not want to detract in any way from the praise which has been lavished by Deputies, in some cases on each other and in some cases on colleagues who are members of the same boards with them, on those who serve on these boards. However, I must remember that the boards were established for the service of the public and to deal with cases such as those I have instanced.
I will not say the problem is acute in Cork but it certainly is a very acute problem in Dublin City. The consequence of that is that every body, every public authority, interested in these services in Dublin City—with one exception to which I shall refer later —have agreed that there should be one unified health authority in Dublin City and that it should have its own chief executive officer. That is the main provision in the Bill. In the case of Waterford and Limerick the same thing has happened. Let me say that there are reservations in regard to Limerick but it is merely in regard, not to the principle of having the one authority, but to the manner in which the costs of that authority will be apportioned.
The same is true of Waterford. There is the same desire on the part, mind you, of the members of these boards to have the one authority and to get rid of all the anomalies and all the inconveniences which arise from the fact that you have two authorities administering districts which overlap in some instances providing services  for the whole area and in others providing only for a portion.
The only outstanding case is that of Cork. I concede at once that Cork is not on all fours with Dublin, the corporation of which is more compacted; nor is it on all fours, either, with Limerick or Waterford where the areas are comparatively small. In the Bill, we have provided for the establishment of local committees. There is no reason to believe that these local committees will not be able to deal with these concerns in their own local area. Deputy Casey referred to the fact that the economies which he anticipated would not be achieved in the case of Cork because, after all, we had the same three staffs, and so on. That is true. The existing staffs and the existing institutions will have to be maintained but there is the fact that we shall be able to make a more effective use of these institutions and of these staffs.
There is a considerable amount of administrative work, as I pointed out in my opening speech, which is done at the same time by three separate staffs sometimes, not always, in relation to the same individual. If one staff organisation can deal with one individual in relation to a great many things, is it not bound in the end to lead to some economy? Certainly it will eliminate a great deal of frustration for the people who are sent from Billy to Jack trying to find out who is going to give them the medical attention which they desire.
In relation to Cork, it may be that the need for further examination may arise and that we may not be able to carry through the same close-knit integration as we hope to achieve in the case of the city of Dublin because, perhaps, of the territorial difficulties. However, that is a matter which I suggest we might argue out on the Committee Stage of the Bill. There is a separate Section dealing with Cork and the problems of Cork can be considered specifically on that Section; I would hope on the Committee Stage to be able to satisfy many of those who have spoken that their fears are unfounded.
 There is no reason to think that the existing offices in Clonakilty or the existing office in Mallow will be completely closed down. They will remain there to the extent to which they will provide a real service for the public which otherwise might not be available to them. At the same time we must remember that by far the largest part of the administrative work relating to the various boards which operate the health services in Cork City and County is centred in the City of Cork. We have been hearing about the distance from Cape Clear to some other parts of Cork, but Cork City is fairly centrally situated and the distance from Cork City to many of the centres which have been referred to here is very much shorter than is the case with distances in Donegal, Galway and other places.
The difficulties arising mainly from the size of Cork county have been largely exaggerated but, as I have said, on the Committee Stage of the Bill we can consider Cork specifically and try to find a way to meet the points of view of the Deputies who represent that county. Nevertheless I do suggest we should make every attempt to secure some sort of co-ordination in the administration of the health services in the City and County of Cork, so that they will be made as conveniently accessible to the public as is possible and that the standard of the services, where it is not satisfactory, will be brought up until it is satisfactory. We must try to give all the people in the areas affected the highest possible level of services. We should be able to do that with some effectiveness when the new Dublin unified authority is set up and we should be able to do it in Limerick and in Waterford. I should like to think we would be able to do it in Cork too but we shall not be able to do it unless we adopt some principle of co-ordination.
In that regard, of course, there is provision in the Bill for the setting up of local committees. Possibly the powers and functions of these committees as I envisaged them originally may be too limited and there may be some practical reason why I should go beyond my original ideas as to the  responsibility which would be entrusted to them. They could function with some degree of autonomy—I do not want to carry this too far—with the central health authority functioning to ensure that there would be a uniform policy and a uniform standard for the whole area of the City and County of Cork. That is what I should like to see.
I do not want to make this a controversial Bill but there are one or two things I must say for my own protection. Deputy Lynch did say there was no consultation with the Waterford authorities at any time. That is not so. Not merely was there consultation with the Waterford Corporation and the Waterford County Council as late as the 17th October, 1956, but Deputy Lynch, who is a member of the Waterford Corporation, agreed to the principle of unification in relation to the City of Waterford. Deputy Kyne, speaking, I suppose, for Waterford has welcomed the Bill; Deputy Russell speaking for Limerick has also welcomed it. I know my colleague Deputy Collins and the others who represent the county would like to see unification provided that the financial aspects of the unification will be dealt with to their satisfaction. Therefore the only problem in respect of the principle of the Bill is that of Cork and as I have said, on the Committee Stage we might be able to argue that out.
My predecessor, Deputy O'Higgins when speaking last night was betrayed by a faulty recollection of what in fact had been his ideas—I do not want to put it further than that—in relation to the Dublin Fever Hospital Board. It was included in the scheme which he had before him and it is common property that he had it before him because he visited the Waterford Corporation and the various local authorities concerned in Waterford and Cork in 1956 with a view to getting the principle of unification accepted. In his particular scheme the Dublin Fever Hospital Board was included. I am saying that because there has been the suggestion made by Deputy Dockrell that in some way I am influenced by some degree of malice or vindictiviness against the Dublin Fever Hospital Board.
Mr. MacEntee: I should prefer to accept that he disclaimed any intention such as Deputy Dockrell and others seemed to imply, that I was acting in this matter from a spirit of vindictiveness. I want to say that that is not so. In regard to the Dublin Fever Hospital Board, I have undertaken to meet a deputation from that board after this debate but we must not lose sight of the fact that, in the present scheme of health services and administration, the Dublin Fever Hospital Board is something of an anomaly. Nowadays certain fevers are rightly regarded as the particular concern of the local health authority. Due to its history, of course, we have in existence the Dublin Fever Hospital Board. It administers Cherry Orchard Hospital. Cherry Orchard is a magnificent hospital but it was not built out of the trust fund of this body. It was built by funds provided by the Minister so there is no question of appropriating private property or anything like that. That should be understood.
I propose to meet the members of this board and, if I cannot persuade them to accept my point of view, we may be able to come to some amicable arrangement. Somebody suggested that the trust funds might be restored to them, thus enabling them to provide them for some other charity which perhaps would be equally desirable. I do not think that would present any  great difficulty; but perhaps that is not the point; perhaps what they are really concerned about is the tradition. I am not committing myself, but I am prepared to listen to what they have to say and to come to a decision of which, I hope, the House will be able to approve afterwards.
There were a number of other matters spoken about which are not really germane to the principle of the Bill. They are minor matters of detail. With regard to what has been the critical issue, so far as I can see, in all the discussions that have taken place over the years in the proposal for unification, I trust we have been able to find a solution.
This critical issue always has been how the expenses of the unified bodies were to be apportioned. The provisions in the Bill lay down that they are to be apportioned by agreement and, pending agreement and pending appointment of a person by the Minister to try to determine the apportionment, the local authorities will share the expenses in proportion to the costs of the existing services. If we can secure agreement, of course, I will have no function except formally to approve the agreement, provided, of course, that it does not contain any provision which I think might be contrary to ordinary common equity. I have reserved the right to the Minister for Health, whoever he may be, to give his final approval to any agreement entered into, because the Minister for Health has a very large share of the financial burden represented by these health services. I think that, in principle at any rate, his authority and responsibility should be preserved in the matter.
If however, the local authorities concerned cannot agree, it is proposed to appoint a person to determine the issue and, as you will see if you read the section relating to that matter, he is bound to take into consideration the amounts spent by the local authorities concerned over the previous five years and the other considerations which have, in fact, determined the apportionment of the expenses of joint bodies. The person  appointed is not designated as an arbitrator and I do not want to make him an arbitrator. What I want him to be is an honest broker between the parties.
There is another point in that regard and that is that, whatever agreement is reached, or whatever determination made, if it should seem to be unduly onerous or unfair to any of the contributing bodies they can ask to have that position reviewed. Therefore the position is not fixed, rigid or immutable for all time. Naturally I am hoping that it will not be necessary to review any agreement or determination and that therefore, by reason of the equitable manner in which the expenses are apportioned, the new authorities will be able to work smoothly so far as the provision of their finances is concerned.
Deputy Wycherely deprecated the manner in which it was proposed to appoint the new health authorities. In my opening speech I pointed out there must be one representative from each electoral area in the district covered by that authority. That, of course, will ensure that there is representation for every district. The others will be appointed so far as possible by agreement. That is the position which has obtained since the Public Assistance Act, 1939, was enacted and Deputy Wycherely paid tribute to the manner in which it operated in Cork, where people have felt they were fairly represented. We are just applying to the new health authorities the procedure under which the existing assistance boards have been constituted. I do not think there is any reason to fear that it will work any less satisfactorily in the future than in the past.
There are, of course, a great many matters which can arise for discussion on the Committee Stage of the Bill. Most of the objections, as I said before, related to the situation in Cork. So far as there has been any serious criticism in relation to the other three areas dealt with in the Bill they can be quite readily met upon Committee Stage. In relation to Cork we can have a fuller discussion and see if we can find some machinery whereby the considerations of the Cork people will be met, provided the principle of  unification is maintained, and that we have this unifying and coordinating authority at the top to make certain that the best possible use is made of the resources at the disposal of the health authority.
Brady, Philip A.
Browne, Noel C.
Calleary, Phelim A.
Collins, James J.
Crowley, Honor M.
Cummins, Patrick J.
de Valera, Vivion.
Egan, Kieran P.
Gogan, Richard P.
Healy, Augustine A.
Hillery, Patrick J.
Johnston, Henry M.
Kennedy, Michael J.
Kitt, Michael F.
Kyne, Thomas A.
Lemass, Noel T.
Millar, Anthony G.
Moher, John W.
Moloney, Daniel J.
Ó Briain, Donnchadh.
Russell, George E.
Ryan, Mary B.
Crotty, Patrick J.
Dillon, James M.
Dockrell, Maurice E.
Esmonde, Sir Anthony C.
Murphy, Michael P.
O'Higgins, Michael J.
O'Higgins, Thomas F.
O'Sullivan, Denis J.
Palmer, Patrick W.
General Mulcahy: I would suggest  to the Minister that the whole trend of his speech in reply indicated it would be advisable to put it off for a month, so that the consultations with the various parties he spoke about might be carried on with a reasonable amount of time for arriving at an understanding and overcoming difficulties.
General Mulcahy: I suggest to the Minister that the whole trend of his speech suggested it would be desirable there would be a month, now that the matter has been fully exposed. He would require a month to have the discussions on it.
Mr. MacEntee: The only trend in my speech was that there was only one difficulty, and that was Cork. The other areas must be considered too, and I would ask the House to order the Bill for the 24th November. If there seems to be any widespread desire that it be not taken on that day I shall try to meet the wishes of the House.
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