Seanad Éireann - Volume 24 - 15 May, 1940
Public Hospitals (Amendment) (No. 2) Bill, 1940—Second Stage.
Question proposed: “That the Bill be now read a Second Time.”
Minister for Local Government and Public Health (Mr. Ruttledge) Patrick J. Ruttledge
Minister for Local Government and Public Health (Mr. Ruttledge): The main object of the Bill is to provide for the establishment and maintenance of hospitals bureaus for the purpose of facilitating admission to hospitals of persons who require hospital treatment. The necessity for a hospital bureau in Dublin is admitted on all sides. Elsewhere, the need is not so apparent and it may be assumed that it is only in Dublin that the provisions of the Bill will be operative.
In Dublin, the public voluntary hospitals provide general and special treatment for all classes. These institutions have done admirable work in the past and the intention is to interfere as little as possible with them in the admirable work they are still carrying on. A considerable proportion of the patients in these hospitals for years past have received free treatment. It is evident, however, that there are many persons who are in urgent need of treatment in hospitals who cannot secure admission under present circumstances, and in such cases it is hoped the hospital bureau will be an advantage to all concerned. It is proposed to confer power on the Hospitals Commission to establish and maintain a hospital bureau, but in the carrying on of the bureau they will have the assistance of an advisory committee. A bureau cannot be established in relation to any hospital which has not received a grant from the Hospitals Trust Fund after the passing of the Bill, unless the governing body of the hospital consents to be included.
The advisory committee will consist of one representative appointed by each of the hospitals included in a bureau scheme. The Hospitals Commission, after consultation with the advisory committee, and with the  approval of the Minister, will make regulations governing the manner in which the bureau is to be carried on, and defining duties as regards the admission of patients, and the furnishing of information to the bureau as to the accommodation available in hospitals for the treatment of persons.
Provision is made in Section 4 for the investigation of complaints in relation to any refusal to admit to a hospital a person for whom the bureau had made arrangements, or in relation to any unreasonable delay in treatment of any person admitted through the bureau. The complaints will be made to the Hospitals Commission who will investigate them in consultation with the advisory committee. Only when a complaint is specially referred to the Minister by the Hospitals Commission, is the Minister required to take action. In any such cases, and I expect they will be very few, the procedure in subsections (2), (3) and (4) of Section 4 of the Bill will be followed. The powers conferred by Section 4 are regarded as essential in the public interest and they will, it is believed, moreover, prove to be a protection for the voluntary hospitals.
Generally speaking, the management of a bureau will be under the control of the Hospitals Commission. The powers given to the advisory committee in relation to the framing of regulations and the investigation of complaints will safeguard the interests of the hospitals. It is not intended to interfere with the ordinary rights of the hospitals to control their internal management.
There is one other important point in the Bill, namely, that dealt with in Section 7, which extends the exercise of powers of inspection of hospitals. The Public Hospitals Act 1933, in Section 14 (6), gave certain powers in this respect to the Hospitals Commission. Since that Act was passed, there has been a considerable increase in the applications received from voluntary hospitals, particularly in respect of deficits in their annual accounts. These impose a large volume of work on the Hospitals Commission in relation  to the examination of accounts. Definite obligations are also imposed on the Minister to secure that grants are properly applied. It is considered necessary that both the commission and the Minister and authorised officers should have the powers indicated in Section 7 of the Bill. The proposed powers do not confer any power to interfere with medical treatment in hospitals, or any interference with staff, or confer any control over the general administration of the hospital.
Section 5 of the Bill proposes to amend Section 12 of the Public Hospitals Act, 1933, in relation to the proportion of the proceeds from the sale of tickets to be assigned to meet the expenses of promoting the sweepstake. Future sweepstakes are not likely to receive support outside the country to the same extent as in the past. In such conditions it would be difficult to determine which proportion of the proceeds should be payable to the promoter. It has therefore been decided to remove the limit of 7 per cent. in the Act of 1933, and to rely on the maximum percentage of 30 per centum of the proceeds of the sale of tickets in a sweepstake which can be made applicable to meet expenses generally, other than tickets, commissions, prizes, or other remuneration given in relation to the sale of tickets. There will be power to fix a lesser percentage if the Minister for Justice so decides. There is also an amendment of the Act passed last year providing for a reserve fund. That fund was created for the purpose of meeting an emergency, and it is not considered that it will be necessary.
The Bill, as Senators are aware, was very much amended in the Dáil and I think it left the Dáil having met, if not with enthusiastic approval, at least with general approval, because it was passed in its Final Stage without a division. As I said at the beginning, I think this bureau will supply a very much-felt want. Not only have social organisations and people who look after the poor brought these matters to the notice of my Department,  but medical practitioners have, from time to time, pointed out difficulties which they experienced in finding out where beds are available and, very often, when urgent cases arise, medical practitioners have considerable difficulty in knowing whether beds are available.
Dr. Rowlette Dr. Rowlette
Dr. Rowlette: I agree with most of the remarks the Minister has just made, and particularly the remarks he made at the close of his speech. Without any authority to speak for my colleagues in my profession, I think I am not misrepresenting them in saying that they would welcome the establishment of a bed bureau. Their difficulty is not one of principle. They recognise what the Minister has just said, that such an institution could be of great help in facilitating and hastening the admission of patients to hospital. Their hesitation is due rather to the admitted fact that the number of beds is entirely inadequate for the people requiring hospital accommodation, and until those beds are provided—as they should have been provided, were it not for the interference, not of the Government, but of successive Dála and Seanaid—there is considerable hesitation on the part of those who are familiar with the hospitals, from the point of view that such a bureau will not have the material to work on. The bureau is designed to guide people to beds, and, if there are no beds, the people cannot be guided to them.
When I refer to the matter of beds and say that the inadequacy has been due to the greed of successive Parliaments, I refer to the fact that although the institution of the sweepstakes was by and for the voluntary hospitals, much of the funds has been diverted, by Parliamentary authority, to the relief of the rates and to the relief of State funds. One Government alone is not responsible. Successive Governments have been equally vicious in regard to this accumulation of money. At first, a considerable proportion of the funds collected for hospital purposes was diverted from the voluntary hospitals to rate-supported institutions, thereby relieving the rates and  making our necessary national institutions parasitic on the charity of the gamblers of the world. Later, another Government devoted an enormous proportion of the receipts from sweepstake funds to the public Exchequer. were it not for these diversions of funds raised for the voluntary hospitals, there would have been an adequacy of beds, certainly in the City of Dublin and in the greater cities of the State. It is to that inadequacy that most of the hesitation of members of the medical profession and those concerned with hospitals is due. If the Minister is able to proceed in the near future, I trust the difficulties that face him may be got rid of.
With regard to the general view of the successful functioning of a bed bureau, I want to say, quite sincerely, that those who are interested in the hospitals must be very grateful to the Minister for the consideration he has given to the various criticisms offered to him, sometimes not in the kindest of terms, within the last couple of weeks, and I agree with him that the Bill as it reaches this House is certainly a much better Bill than it was as circulated a fortnight or three weeks ago. He has removed many of the points which, naturally, gave rise to considerable anxiety, so that the Bill—and I hope he has not said his last word in regard to certain clauses —certainly does not cause the same anxiety to those interested in hospitals as the original draft did.
A great difficulty in dealing with this Bill which faces us still, and which certainly faced the Dáil a couple of weeks ago, was that it deals with two entirely different topics. It contains certain purely legal provisions to make it possible to carry on the sweepstakes and thereby to keep them in existence and to collect some more money, not perhaps, for capital outlay, but to help to pay the running expenses of the hospitals in the months and years of stress still facing us. Such provisions were necessary if the sweepstakes were to go on and they could have been presented to the Oireachtas and have received approval in both Houses in the course of an afternoon. Instead,  they were incorporated in this Bill for what reason I do not know. No explanation has been given why those noncontroversial and urgent provisions were associated in the same Bill with highly controversial provisions. A few moments ago, we heard criticism of another measure because it dealt with entirely different subjects, but, whatever may have been cognate between those two subjects I cannot find anything cognate between the two subjects dealt with in this Bill. The result has been that the initiation of a sweepstake to be held, it is hoped, in August of this year has been delayed and the sale of tickets held up and the funds consequently diminished, all by this association of these provisions in the same measure with the establishment of a bed bureau. We who are interested in the hospital situation have had the difficulty that we had either to accept the Bill as it stood a fortnight ago or hold up the sweepstakes by spending time in criticising the Bill, or, on the other hand, possibly sacrificing what seemed to us to be the essential principle of the voluntary hospitals. The Minister, by his consideration, and his conciliatory attitude, has done away with a great many of these difficulties but still the loss has been incurred of holding up the sweepstakes unnecessarily for some weeks.
Another matter which raised a good deal of anxiety was that it was pretty well known that a previous scheme had been drawn up for the establishment of a bed bureau. This was agreed on after long consideration between the Minister and officers of his Department on the one hand and representatives of certain groups of hospitals on the other. Agreement had been reached and it was hoped and expected that, agreement having been reached on such a scheme after full consideration with the Minister and his advisers, it would form the model of any future plan for a bed bureau, but the scheme published two or three weeks ago and included in the original draft of this Bill was as different from the agreed scheme as a tiger is from a kitten. All the claws had come out. The Minister has since pared off some  of thtm, and I hope he will pare off a few more. Every single safeguard in the agreed scheme, for the independence of the hospitals, for their protection from interference by officials, and their independence of conduct, apart from poor patients, disappeared in the Bill. These matters have made approval of the Bill a matter of great difficulty. It is all the more credit to the Minister, and I am quite sincere in saying that, that he has been able to dissolve a great many of these fears and doubts.
I have also to make a few suggestions. I am not making any that will touch on any points of principle that the Minister has in the measure before us. In looking at the clauses as we read them, and as he has explained them to us, there are a few points which require more explanation, and there is some hope that he will consent to amendments. A technical point occurs in Section 2 which leads one to ask: “What is, at the moment, and what is to be the future constitutional position of the Hospitals Commission?” Up to the present, as far as I know, it has been a body to consider and advise on the various hospital questions and to make recommendations to the Minister as to how he should allocate the funds which, by statute, are under its control, the funds that come in from the sweepstakes. Does it become a permanent body? This is, I think the first Bill which seems to give it a permanent status. I am asking this simply to have the section clarified and not from the point of view of any criticism.
Many of us thought that if the Hospitals Commission had been permitted to advise the Minister directly, as was the intention of the Oireachtas, when that Commission was first appointed by legislation, that they should be constituted as his advisers in regard to the development of voluntary hospitals. If that had been permitted to take place, many of us thought it would have been a better method than what was actually adopted. What has followed? It is that the Commission first advises the Department and then the whole thing  begins all over again and the Department considers various schemes put up by the Commission and rejects them or accepts them and they then become advisers of the Minister. Here we have the Department put in between the Hospitals Commission, which is given a special task to perform, and the Minister. That inevitably causes delay. It is difficult to believe that the Department—the permanent advisers of the Minister—could give the same amount of study to the hospital question as members of the Hospitals Commission could, who have been devoted specially and entirely to that subject during the period of their membership. I wish the Minister would clarify the position of the Hospitals Commission in the future. Is it not unusual for any commission, which is subordinate to a Minister, to make regulations? I understood that the making of regulations with binding power was confined to Ministers, though I may be wrong in this. I am not objecting to the Hospitals Commission making these regulations, though I would prefer if it were not merely after consultation with, but on the advice of the advisory committee. An advisory committee is one thing: it has power to give advice; but I would prefer if the commission were bound to accept that advice or, otherwise, to refrain from action, that they should not have power to make regulations of their own after consultation with the advisory committee, although only with the consent of the Minister.
There is another point in this same paragraph. Section 2, sub-section (3) is not quite clear. In any previous discussions with the Minister's predecessor it was understood that the functions of the hospital bed bureau would be concerned solely with a certain number of beds to be fixed by agreement with the Minister the admission to which was to be through the agency of the bed bureau. In this section, however, and as I think in subsequent sections, it seems to be assumed that the bed bureau can function in relation to all or any beds in the hospitals which come under its purview. There was a clause in the preview  vious agreement which said that the function of the bed bureau would be ancillary to, or supplementary to, the ordinary method of admission to the hospitals; but, so far as I can judge from the scheme as it reaches us now, the bed bureau may concern itself with every single patient admitted to the hospitals which come under the purview of the Bill. I hope that the Minister will be able to give us assurance on this point; possibly he will accept an amendment to make that clear. If it is to be understood that there is any danger that the ordinary methods of admission to the voluntary hospitals, which have been in force for anything up to 200 years or more, are to be suspended or given into the control of the bureau, I think it will rouse not merely great anxiety but considerable unwillingness to have any further dealings with the sweepstakes grants.
Further down, in Section 4, which deals with the system of investigating complaints, the terminology is extremely loose and I think it would be impracticable in working. It says:
“Where the Hospitals Commission ... complain to the Minister that any person was refused admission as an intern patient...”
“Any person” has no right unless he comes there with some authority. He may be unsuitable but, under this section, no matter how unsuitable he may be, he could lodge a complaint and the matter would have to be considered. I am sure it would never reach the Minister, if it were an unreasonable complaint, but the Hospitals Commission has to consider it and the appropriate advisory committee has to consider it. Unreasonable people who would like a week's rest sometimes arrive at a hospital and ask to be admitted. They may have no complaint requiring hospital treatment, but I can well understand such a person, if refused admission, at once putting the advisory committee, the Hospital Commission and the management of the hospital to the trouble and expense of investigating his complaint. I am not talking idly. I have had experience of a case where a citizen of  Dublin, who thought he needed a week's rest, walked into a hospital, climbed into a bed and could not be evicted unless the police were brought in and carried him bodily out into the street. He was not a suitable case for hospital treatment, but I have seen him in hospital on more than one occasion by that procedure. He was a member of the City Council, but I will give no name. The point I am urging on the Minister is that the term “any person” is far too wide. It should be “any person who requires treatment” or “any person who has received an admission order from the Hospital Bureau” or “any person who has received a recommendation for admission from any medical practitioner”. I think the term “any person” will involve these bodies in trouble and expense.
With regard to the whole section dealing with complaints, it has evidently been founded on the procedure at present used in conducting a sworn inquiry by officers of the Minister's Department. I think there is a false analogy between this case and a sworn inquiry by officers of the Minister's Department—which can only deal with institutions directly under the Minister's control as Minister, a rate supported institution, or an institution under the authority of a local body, and where the people concerned are salaried servants of the local authority. The procedure should not be the same where the work is done by voluntary workers, as is the case in the voluntary hospitals. A surgeon or physician in a voluntary hospital is not in the same position as a salaried officer of a county hospital or a district hospital under the control of a local authority and I do not think there is any reason to suppose that the procedure should be the same. I am quite ready to admit—as I am sure the Minister will say—that these complaints will be few, and that not many of those lodged will be likely to get as far as a sworn inquiry. It is not right that a person who is giving his work voluntarily and gratuitously to patients should be asked to spend some of his time—perhaps a day or two—attending a sworn inquiry.
 There is another point about the inquiry which seems to require clarification. The procedure laid down here seems to take no account of the privacy of the personal affairs of a patient. This is not a matter of personal professional privilege on the part of a medical man. It is a question of privilege for a patient to keep his private affairs to himself. Medical attendants and nurses should not be made subject to a public inquiry or be dragged into the light of such an inquiry. There are great objections to a private inquiry and there are also objections to a public inquiry.
I think the Minister should consider that matter. He could probably deal with it under the regulations and I should be quite satisfied if he did that, so as to prevent any trespassing on the privacy of a patient who seeks treatment in any one of the hospitals. Remember information of that sort may do grievous injury to the patient himself. The patient may be in employment and it may injure him grievously if the nature of the complaint becomes known by any such publicity to his employer. I have been invited by employers myself to tell them what was wrong with particular employees who happened to be under my care in a voluntary hospital, and I have always declined to do so. Sometimes my refusal has been the cause of great anger. When I ventured to ask one employer to picture himself in the place of the employee and asked him if he would be willing to allow me to disclose the nature of his complaint, he agreed that I should not do so. Yet he could not see that there was any parity between the two questions. I ask the Minister very seriously either in the Bill itself, or by regulations made under it, to take steps to prevent any publicity on such matters regarding what are at present and what should be, the private affairs of a patient. The patient very often cannot choose for himself. He must go to the hospital, and if he does so and has any cause for complaint—he would have a legitimate cause for complaint —he would have his private affairs  dragged into the light of day. I do not think that is fair.
There is only one further suggestion that I wish to make to the Minister. In Section 7 he is providing himself with machinery for getting information, to which I think he is entitled, with regard to the manner in which a hospital carries out any conditions attached to grants which it gets from funds under the Minister's control. He is being given power to employ an officer for purposes the performance of which were previously limited, if I am not mistaken, to the Hospitals Commission. I am not quarrelling with that. I think he is obliged, if he has control of certain funds, and if he attaches conditions to a grant of moneys out of such funds, to know whether such conditions are being fulfilled. It might be an advantage to him to be able to send an officer into a hospital to get such information, but I think that the powers of such an officer should be very carefully defined. Perhaps the Minister when it comes to the Committee Stage would accept an amendment dealing with that matter or would consider bringing in such an amendment himself by way of a fresh sub-section after sub-section (2) of Section 7. The sub-section might contain such words as these:—Provided that nothing in this section shall give authority to such officer to interfere with the control or management of any voluntary hospital.
The Minister is giving nothing away in that. I am quite sure that it is not his intention that such an officer should interfere with the control or management of a hospital. I think I know the answer he gave to this point when it was put to him before in this House—that he claimed no such power but that he did not wish to put into the Bill anything which would indicate something which there was no reason to fear. I would ask him to consider that some authorities are extremely sensitive about visits of this nature. Certain hospitals are very sensitive, unduly sensitive if you like, and fear that such an officer coming in might claim some power to interfere with the control or management of the institution.  The purpose of sending him there is to get information on certain points but certain hospital authorities, as I say, are extremely sensitive on this matter and I think the Minister would not be depriving himself of any authority which he wishes to have, or any authority which he has at present, if he were to accept the suggestion which I have now made. It may be that there is no justification for such fears but nevertheless I think that the fears of these people should be considered, particularly when there is no principle involved. I would ask the Minister to consider that matter and, if he cannot deal with it in the Bill, I think he should have power to deal with it when it comes to the framing of regulations.
I have said all I wish to say by way of comment. I do want to say very seriously that a very anxious few days were spent by those interested in the control, management and working of the voluntary hospitals when the original draft of the Bill was issued. Those to whom I have spoken are very grateful to the Minister for the sympathetic consideration he has given to the various suggestions made to him both in public and in private. I shall just say one more word on the topic: that I am glad he was willing to receive representatives of the general body of the medical profession in the country and to discuss the matter with them in an entirely friendly way. He has established a precedent which I hope he will follow. He will find if he does so, that the members of the medical profession are anxious to be helpful to him in every way. He will find that while the representative body wishes to be helpful to him it is very unwilling to be spurred or irritated. That experience of one pleasant meeting will I hope encourage him not to make it a solitary example. This may be hardly relevant to the Bill but I think I can be excused for having said so much.
Mr. M. Hayes Mr. M. Hayes
Mr. M. Hayes: We transact our business in a very peculiar manner, or rather the Government brings its business to us in a very peculiar manner. This Bill we are told is urgent and it  is urgent because it combines two things. One of these things is authority to continue the sweepstakes. All of us, I am sure, are most anxious that that particular provision of the Bill should be carried into effect without delay because we are desirous that employment in the sweepstakes should be resumed as early as possible and that work should be found for as many people as possible. Combined with that provision in the Bill is another matter which is very controversial. To-day we spent until 9.30 p.m. discussing a Bill which I think its warmest advocates could not describe as urgent. That Bill, seeing that there was no urgency about it, could as well have been discussed this day week or this day fortnight. At 9.30 we were called upon to discuss a Bill which, as Senator Rowlette has pointed out, offers considerable ground for amendment. We are called upon to consider it at this late hour and we shall be asked, I understand, to pass it through all its stages to-morrow. We shall, of course, pass it through all its stages because it has been thought fit to combine this question of providing employment for persons who badly need it with the other question of getting the maximum Government control over the hospitals.
The Minister has been complimented, and I think rightly so, on the amendments which he has made in the Bill. It has to be remembered that in the form in which it came to the Dáil, taking it in conjunction with another Bill, the County Management Bill, it affords another example of the all-spreading influence of the Government and Government officials. With this question of the sweepstakes, it combined a very clear attempt to get complete control over the voluntary hospitals, even retrospectively, for the officials of the Local Government Department and the Minister himself. The fact that the Minister has agreed to such drastic changes would seem to me to indicate that there was something in the charge made when the Bill first came along that, if not the Minister, another politician was anxious to get control of the hospitals. The Bill has been altered, but there are some  objectionable features about it even yet. The aim certainly was to get control in every possible way.
A great deal of talk has been made— I have heard a good deal of it myself— about the profits which certain doctors make out of the voluntary hospitals. I happen to know, from colleagues of mine over a long period, that doctors and, particularly, the senior doctors in a big hospital make what is only a very insignificant portion of their incomes out of their attendance at the hospitals; that they merely get students' fees and give all their valuable services at these hospitals for practically nothing at all.
I hope the Minister will give careful consideration to the amendments suggested by Senator Rowlette, and particularly the amendment to Section 7, because that section does appear to be granting extra powers to the Minister or his officials. I accept, of course, what the Minister said, that there is no intention to interfere with the medical or surgical treatment of patients, but when once you start the system of inspection by a civil servant the inevitable result, not only in this country but elsewhere—it is not a particularly Irish characteristic—is that the power spreads and they interfere more and more with everything. Certainly, I think it would be very desirable that this Bill should contain a proviso similar to that mentioned by Senator Rowlette, to the effect that there is no power in the Bill to interfere with the management or with the medical or surgical treatment given in hospitals.
I agree that the Bill has been very substantially altered, but there is still in the Bill the possibility of control of the voluntary hospitals, through a commission created by the Minister himself and through the powers given under Section 7, which gives the Minister's officials power to carry out a certain type of inspection for the purpose of getting information with regard to grants accepted by the hospital. As I said at the beginning, I  should like to protest at the way in which this Bill has been introduced. This Bill is a very important Bill, particularly from the point of view of employment, and it is a mystery to me why it should not have been considered earlier to-day. Why so much time should have been spent on another Bill, about which there is no particular urgency, and then this Bill brought in so late in the evening, is something that I cannot understand.
Donnchadh O hEaluighthe Donnchadh O hEaluighthe
Donnchadh O hEaluighthe: Ba mhaith liom cupla focal a rá ar an mBille seo. I should like to say a few words in connection with Section 4 (1) which reads as folows:—
Where the Hospitals Commission, after consultation with the appropriate advisory committee, complain to the Minister that any person was refused admission as an intern patient to any hospital in relation to which a bureau has been established under this Act or that the treatment of any person admitted as an intern patient to any such hospital was unreasonably delayed, the Minister may, if in his discretion he so thinks proper, cause an inquiry to be held in relation to such complaint and may appoint a person to hold such inquiry.
Now, what I wish to say is that these inquiries into complaints should be dealt with very carefully. There are many people who are prone to make complaints where, possibly, a cause for complaint does not exist. I shall give an instance of it now which happened to myself last Friday. I was going down a certain back street in the City of Dublin and met some person in front of a shop who stopped me—I think my voice was recognised—and told me that there was a sick person there and asked me to go in and see that person. At all events, I was called in and found the patient in bed. Naturally, I said that I was not a doctor and did not see why I should be called in to see the patient, but, at any rate, on the request being repeated, I went in and saw the patient in the back  parlour of a small shop in a back street. The complaint that was made to me by the patient—well, it was not so much a complaint as a request—was to do something on her behalf with regard to getting into hospital. She said she had applied for admission to one of our hospitals, that one of our clergymen in the city had written to the hospital on her behalf to get her in as a patient, and that she had been told that there was no vacancy. I said that that was quite possible and that it is sometimes very hard to get a patient into a hospital because the beds are all occupied. However, I promised that I would make inquiries. On the following day, Saturday, I went to the hospital and made inquiries. I saw the nun in charge there and she told me that she had got a letter from the priest to whom I have referred, that she had not a bed vacant and rang up the clergyman to inform him of that fact. I told the nun that this patient was bad, or rather that I thought she was bad, and explained my experience, and the nun told me that she would be able to send out a patient the next day, Sunday, and would then be able to make room for the patient with whom I was concerned. I went to the hospital again on the next day, Monday, and the patient was then in the hospital, another patient having been sent out on the Sunday, thus making room for her.
Now, the point I am making here is that very often complaints are glibly made, possibly without very much foundation. In this case, there was actually no complaint to be made against the hospital, because there was not a spare bed vacant, and when I pointed out to the nun that it was rather awkward that there should be no accommodation for patients when they were ill and required treatment, she replied:
“Our position is that we have not got enough accommodation; get your Minister to afford us the means of providing more accommodation and we will be able to take care of the patients.”
 I hold that there should be reasonable precautions taken to see that complaints are well-founded before any inquiry should be called. A number of our hospitals are in charge of the nuns, and my experience—and I have had some experience of these hospitals, as I am sure other Senators have had —is that the greatest care and attention is given to the patients in our hospitals. I have never seen any reason for complaint, and I do not think that any of us who have had experience of our hospitals ever saw any reason for complaint in the treatment we got ourselves or in the treatment we saw being given to other patients. As I say, certain people are rather prone to make complaints, and before any inquiry would be embarked upon which, possibly, would entail bringing the nuns before that inquiry, it should be ascertained that there are reasonably good grounds for the complaint. That is the point I wish to make.
Mr. Ruttledge Mr. Ruttledge
Mr. Ruttledge: I understood Senators Rowlette and M. Hayes to complain that two Bills had been linked up together in this Bill. The position in that regard is this: The matter of the bed bureau was introduced before the other matter arose— that is the matter of amending the legislation with regard to the sweepstakes. It was only a small amendment and there was some negotiation and some delay about what amendment there should be. Since it was a very small amendment, I thought we might as well incorporate it in this Bill. It was, perhaps, inevitable that this Bill should lead to controversy, although I did not think it could lead to very much controversy. The need for some bed bureau system has been emphasised time after time in the reports of the Hospitals Commission. I do not know if Senators have had it brought to their notice as much as Deputies have, but it has been brought to my notice, both inside the Department and outside it, that there is a definite necessity for a bed bureau system in the city, and that has come mainly from medical practitioners, apart from poor people  who find difficulty in getting beds at particular times.
Another complaint that is made is, I think, that this goes away altogether from the previous scheme. It is true, as I said in the Dáil, that my predecessor, after some negotiation did agree to some scheme with regard to a bed bureau, but that scheme visualised the time when 600 beds would be added to the hospitals in Dublin. Such a scheme could not be operated at the present time with the number of beds that are available. Mention has also been made of free beds. If you had plenty of room available, very little difficulty would arise, and it would be very easy for the Commission or the bed bureau, rather, to say the number of beds that might be set aside in any particular hospital for a particular class of patients. That scheme that was then agreed on was to come into operation when the 600 beds were made available by addition to the hospitals. So that the present position is entirely on a different basis. I know that sufficient beds are not available. We are all aware of that, although a certain number of beds have been made available. There has been an increase of over 1,000 beds since the Hospitals Commission were put into operation.
Dr. Rowlette Dr. Rowlette
Dr. Rowlette: It was before the Hospitals Commission came into being.
Mr. Ruttledge Mr. Ruttledge
Mr. Ruttledge: I suppose part of it was but a good deal was since.
Dr. Rowlette Dr. Rowlette
Dr. Rowlette: Nearly all the beds quoted by the Minister in the Dáil had been made available before the Hospitals Commission came into office.
Mr. Ruttledge Mr. Ruttledge
Mr. Ruttledge: A certain number of them, in any case. The position we find now is this, that whatever accommodation we have available, we want to have a bureau in such a position that it will get the information that a bed might be available in one hospital and not be available in another so as to avoid the position that a poor patient or a patient in urgent need of treatment would have to be taken from one hospital to the other  when there would be no bed available in that hospital. The bureau is to deal with that position. While amendments have been made in the Bill and while it may be liable to an interpretation by some people of being very wide, except we take away from it the clauses that make it retrospective, there is no substantial change in the Bill as it stands at present except to tighten down the various sections, in other words, to avoid the implications that some Senators or Deputies might think could be read into them. Except to tighten the Bill in that way and to remove the retrospective clauses, no substantial change has been made in the Bill.
Senator Hayes referred to the attempt to try to get control of the hospitals. This Bill was started by me and I must say it was after an attempt to try to get various agreements reached with regard to one particular hospital at any rate. Several attempts were made to try to secure an agreement with that hospital. It was a hospital that just came up in the ordinary way. I do not say that it might not have arisen in other hospitals as well. Several attempts were made to try to get agreement with them and it was only when they failed that we tried to get something else and tried to work it with the bureau system. There is no desire to get any control over the internal management of the hospital. In regard to that last suggestion made by Senator Rowlette, I have considered it and I think it would be a dangerous provision to insert. The only powers the Minister has in Section 7, apart from the powers of dealing with complaints and so on, on the very rare occasion that complaints would be referred to him, are those that are set out in Section 14, sub-section (6) of the 1933 Act. Those are the only powers he has in the matter when he goes in to inquire in regard to grants to which he has attached conditions, how these conditions are being fulfilled. Suppose you put in “provided that nothing in this shall relate to some particular sort of management” it might very easily be held that if an officer of the  Department went up and asked for the accounts, the matron or whoever was in charge might claim that you were debarred from that, because that was interference with the management. I think it should be sufficient assurance to any Senators to have the position clear in the Bill that the Minister has no more powers than the Hospitals Commission had under Section 14, sub-section (6) of the 1933 Act, except the power he has taken there to deal with complaints on the very rare occasions they are referred to him.
Senator Dr. Rowlette also referred to this question of any person going in. The regulations will be made and those regulations will likely set out that no person shall be admitted through the bureau except on the certificate of a medical practitioner.
Dr. Rowlette Dr. Rowlette
Dr. Rowlette: Through the bureau?
Mr. Ruttledge Mr. Ruttledge
Mr. Ruttledge: Through the bureau. These complaints will all refer to complaints coming through the bureau.
Dr. Rowlette Dr. Rowlette
Dr. Rowlette: That will be covered?
Mr. Ruttledge Mr. Ruttledge
Mr. Ruttledge: That will be covered by regulation. I think the Senator need not worry about what may have happened after some lord mayor's ball. It will not happen again. In regard to all those complaints, even where this question of privilege is raised—I think there is a privilege generally permitted in the courts here except where there is some peculiar exception. Remember, after all, that when a complaint is made, the Hospitals Commission have to consult with the advisory committee, which is composed of representatives of all the hospitals and it is only when the Hospitals Commission, after consultation with the advisory committee, take it on themselves that they are not satisfied with the way that complaint has been dealt with; when they are not satisfied that there was a proper remedy found for it, they would refer to the Minister for inquiry. The Minister's officer will, in all cases, be a medical inspector or a medical  man, and I think the medical profession would be very safe in the hands of a medical practitioner or medical inspector who would know the etiquette of the profession and would understand these matters that are understood amongst the medical profession, whether with regard to the treatment of a particular disease or not.
Senator Rowlette asked me about the position of the Hospitals Commission. The members of the Hospitals Commission are a temporary body. They are appointed for two years——
Mr. O'Donovan Mr. O'Donovan
Mr. O'Donovan: Why is there such a deficiency of beds? How is it beds are so scarce?
Mr. Ruttledge Mr. Ruttledge
Mr. Ruttledge: Certain progress has been made with the provision of additional beds in Dublin, but the difficulties are increasing. I hope that we will be able to carry out the programme as outlined for the voluntary hospitals, but you will have this year a deficiency of something like £160,000 for the voluntary hospitals throughout the country. That deficiency is going up owing to higher costs and so on. I think at one time it was down to £40,000 or £50,000. It has been going up every year. To provide for that deficiency at present would mean earmarking something like £5,000,000, which in present times and the uncertainty of securities, does not leave very much margin to go on with. I hope we will be able to go on with the hospitals that have been given undertakings that their proposals will be carried out, but while the deficiency is there, delays from one cause or another—there is no use going into the causes of delay in one particular instance or another—may arise that are not going to be in any way helpful. There was, I believe, what was considered to be an urgency for certain hospitals throughout the country and, to a great extent, a good many of these have been fairly well provided now, and we may be able to concentrate more on the city hospitals.
I have that matter which Senator  Rowlette mentioned, and which, I think, he mentioned to me on another occasion, in mind, that is, the allocating of free beds. If it were possible to do that, I could see some point in doing it, but the difficulty is that the bed bureau will operate for the whole country in the sense that you have a bureau in Dublin which is designed to give information to the secretary of a board of health, or a county medical officer of health, in those cases in which patients are being sent to Dublin by local authorities. These are patients who may be charged two guineas a week in the hospitals which is paid out of the rates of the county, and they are people who should be entitled to get into hospitals as well as any other poor people in certain circumstances. You may get a position in which you have a very urgent case, which could not be dealt with in the local county hospital, which would be likely to receive priority over the case of a poor person, who, perhaps, could wait by reason of the nature of the disease, or the treatment required.
This is an experiment and it will depend greatly on how it is worked out. If Senator Rowlette, or any other medical men, have any fears as to people not being able to appreciate the difficulties that may exist in a hospital, that is a matter which will have to be worked out from time to time in the regulations. These regulations can be amended and they will be laid on the Table of both Houses. I cannot see, however, how it would be possible to say that a certain number of free beds will be left, and that the hospital bureau will only apply to them  because as I have said you have two or three different types of people to deal with. You have people coming in from a county board of health, people who pay 10/- a week, while some pay a little more, and then people who are not able to pay anything. It is a matter altogether for the authorities of the hospital. It is not intended that it should apply to any portion of a private hospital, but so far as the general hospital is concerned, you will have to take the position that the hospital as a whole will be considered in relation to accommodation available.
It has been brought to my notice also by some doctors that there is another type of patient who goes into a general hospital and does not come through a county board of health or is not paid for out of the rates. I do not think there will be any difficulty in that case, but these are all matters that will have to be worked out in regulations, which will be made in consultation with the advisory committee. I think that so far as the objections which Senator Rowlette has in mind, are concerned, some means will be devised to meet them satisfactorily.
Dr. Rowlette Dr. Rowlette
Dr. Rowlette: On the point of which the Minister spoke last, he is not suggesting that no patients should be admitted, except through the agency of the bureau?
Mr. Ruttledge Mr. Ruttledge
Mr. Ruttledge: No.
Question put and agreed to.
Committee Stage ordered for to-morrow, Thursday, May 16th.
The Seanad adjourned at 10.45 p.m. until 3 o'clock on Thursday, May 16th.
Seanad Éireann 24 Public Hospitals (Amendment) (No. 2) Bill, 1940—Second Stage.