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Dáil Éireann - Volume 38 - 03 June, 1931

Public Charitable Hospitals (Amendment) Bill, 1931—Committee Stage (Resumed).

SECTION 6.

(1) In this section and in the next following section the expression “the available surplus” means the [2239] balance of the moneys received from the sale of tickets in the sweepstake in relation to which the expression is used remaining after paying or providing for the prizes distributed in such sweepstake and the expenses incurred in holding such sweepstake.

(2) The available surplus in any sweepstake held under the Principal Act shall not be less than twenty per cent. of the moneys received from the sale of tickets in such sweepstake.

(3) Where a sweepstake held under the Principal Act is so held by the governing body of one hospital only, three-fourths of the available surplus in such sweepstake shall be paid to such governing body.

(4) Where a sweepstake held under the Principal Act is so held by the governing bodies of two or more hospitals the following provisions shall have effect, that is to say:—

(a) three-fourths of the available surplus in such sweepstake shall be divided between and paid to such governing bodies in such proportions as the Minister shall direct having regard to the needs and circumstances of such hospitals respectively;

(b) the committee of reference appointed under this Act for the purposes of such sweepstake shall, when requested by the Minister so to do, report to the Minister as to the proportions in which the said three-fourths of such available surplus should be divided under this sub-section between the governing bodies concerned;

(c) the Minister shall not determine the proportions in which such three-fourths is to be divided until he has received the report of such committee of reference in relation thereto and in determining such proportions the Minister shall have regard to but shall not be bound by such report;

(d) before determining the said proportions, the Minister shall [2240] consult the Minister for Local Government and Public Health in regard thereto.

Debate resumed on the following amendment:—

In sub-section (3), line 25, to delete the words “three-fourths” and substitute the words “one-half.” (Seán T.O Ceallaigh.)

Mr. Briscoe: I do not propose to debate this particular point much longer, but possibly as the debate on this amendment progresses and as the various points at issue have had time to be digested over the week-end there may be some room for compromise as between the two distinct views held. I was wondering if the Minister and Deputy Seán T. O'Kelly would consider some way out of the deadlock by allowing some margin of discretion to the Committee of Reference. It is agreed that 50 per cent. be given to the charitable hospitals. It is desirable to give the other 50 per cent., if necessary, to the county hospitals, but as it has been suggested that this may be too much, why not compromise by giving 50 per cent. to the voluntary hospitals, 25 per cent. to the county hospitals and leave the other 25 per cent. to the discretion of the Committee of Reference? If they find the county hospitals can absorb more than 25 per cent. without any danger to themselves or the ratepayers, the Committee of Reference would have discretion. Another reason why I would like to see 25 per cent. kept from the voluntary hospitals is that it might be found possible to introduce into this country a radium institution. We have no place where radium treatment can be given, and it might be possible to establish a centre where radium treatment could be availed of by all hospitals. I am informed that the total amount of emanation of radium in the country is only valued at £5,000, and that it is held by the R.D.S. Members will know that where a person is sent for radium treatment to London, he has to undergo an expenditure of at least £20 per week. I am only suggesting this so that the country will get the best out of the money accruing to it out of the sweepstakes. It has been [2241] suggested to me that if we did start radium treatment, we might be able to benefit from the Rockefeller foundation.

Another thing I want to introduce is the advisability of giving this Committee of Reference some power over this 25 per cent. in dispute. It has been suggested that mental hospitals should get certain help from the money. Perhaps they would consider installing a state pathologist to develop research work in mental cases.

Last Friday I mentioned that Connacht was badly served in the way of hospitals. The nearest large hospital would be Limerick or Waterford. Since Friday I made inquiries and found that Connacht is badly in need of a fever hospital. I am told that typhus is rampant and that people find it hard to get nurses or doctors in view of the tremendous number of deaths of nurses and doctors in that area. People here from Connacht will know the situation. If that is the case it is one of the strongest arguments in favour of granting a full 50 per cent. to the county hospitals, because they would require tremendous expenditure to bring hospitals up to the requirements. I am only putting forward these suggestions in the hope that there will be some means found to make the best use of the money obtained from the sweepstakes.

It is all very well for the voluntary hospitals to argue that they must get a full 75 per cent. and leave it at that. I would suggest that Deputy Sir James Craig would be satisfied, as he is the moving spirit in this matter, with 50 per cent. for the voluntary hospitals and that 25 per cent. should go to the county hospitals. The Committee of Reference should have discretion for the spending of the other 25 per cent. All hospitals, including the county hospitals, would be very pleased to see the setting up of a radium centre in the Free State. I understand it is of urgent necessity. I hope the views that are held here will meet the difficulties and that we will develop something which will be of absolute benefit to the whole community and not to one place. There is a good deal to be said in favour of [2242] giving a great deal to the voluntary hospitals, but there is an equal amount to be said in favour of the other argument. Possibly if the two sides give the Committee of Reference some powers, which they would not have otherwise, we might find that benefits will come.

Mr. Bennett: Before the House decides this matter I think it would be well to realise what the proposal means. If this amendment is accepted it will not mean that the voluntary Dublin hospitals at present in the sweepstakes will receive 50 per cent. of the entire sum allotted for hospitals. On the basis of division in the Derby Sweep the Dublin hospitals received 69 per cent., and the county hospitals 31 per cent. If the amendment is carried, the voluntary hospitals in Dublin, that all the agitation is about, will receive 68 or 69 per cent. of fifty per cent., or, roughly, 34 or 35 per cent., and the county hospitals 31 per cent. or about 15 per cent. of the money available for distribution. I am as keen as any Deputy on the counties receiving their due proportion of any benefit that will accrue from the sweepstakes, but I think that we have to be just in the matter. Everyone will admit that the hospitals in the three great centres, Dublin, Cork and Limerick, serve very large areas in the country. I should say that the Dublin hospitals especially serve patients from a hundred miles area, as a large number of country patients are treated there. In like manner, the Cork hospitals serve a large area in the Southern province, while Limerick serves Limerick. Tipperary and Clare. The case of the counties is to a very large extent met by what I call the proprietary hospitals in these large centres. Assuming that the next sweep is as big as the sweep on the Derby—and I certainly think it will be—proceeding on the present distribution, the counties would have an average income of about £21,000, and probably more. To anyone looking back twelve or fifteen months that would seem impossible. A very large sum, £20,000 annually, will go for a number of years to the counties in aid of the hospitals. The sweepstakes have been such a huge and phenomenal [2243] success that we should not quarrel amongest ourselves about the division of the spoils. As one Deputy stated, it would be very unwise to do so.

As far as I can see, the needs of the county hospitals in the way of equipment and if you like in building the necessary adjuncts will be fully met from the proceeds of the Sweep dealt with in this amending Bill. Except the proposal is to come to the relief of the rates—and I think every Deputy is agreed that we should not do that—by sweepstakes, we have quite enough money to provide for all the needs of the county hospitals. Deputies should remember the position if the fifty per cent. proposed in the amendment is carried. It will mean definitely that the Dublin hospitals will not receive fifty per cent. of the proceeds but 68 per cent. or 69 per cent. of fifty per cent. which on a calculation is about 34 per cent. It has been stated in the course of the debate that as a result of the Sweepstake voluntary contributions will fall off or will not be renewed to the extent that they were given in the past. I am imbued with that fear. I think there is grave danger that subscriptions which were hitherto forthcoming for voluntary hospitals will not be forthcoming, at least to such an extent. It will be incumbent on all the great hospitals to build up such reserves as will supply the loss of income owing to the loss of these subscriptions. That is a point that should not be forgotten. The county hospitals will not be in that position. If we get the hospitals fully equipped we will be safe in future as an income will be provided for them. Until we definitely make up our minds that the State through sweepstakes should come to the aid of the hospitals I think the 25 per cent. limit proposed by the Minister would meet all the needs of county hospitals. I may make one suggestion—I do not know how it will be received—that as the voluntary hospitals in Dublin, Cork, Limerick and Waterford have already received very large sums through these sweeps, it might be possible to provide some amendment whereby those boroughs would be excluded from any [2244] further participation in the sweeps. Something like that might be put into the Bill. I do not think these places want any more than they got for the voluntary hospitals.

Something like that might be put in. I do not know how the suggestion will be received, but a little concession might be afforded by the Minister. There is only one part of the country for which a real case could be made. That is Connemara. It is not proper, I suppose, for any Deputy to say that his own province has been well treated, but I must say that my province has been well treated both by voluntary contributions and the amount at the command of the Minister to help the hospitals. Connacht is not so well situated as the other provinces. It is mostly at a great distance from any of the big centres where there are large hospitals. There may be some way by which a little help could be given to that province, perhaps in the way of setting up a big central hospital in Galway. I have not heard that suggestion made by any of our western Deputies and it is merely a suggestion of my own. I think that the twenty-five per cent. offered by the Minister should be accepted. For myself, I thought that at the beginning he was rather generous but, so far as I can prophesy, I think that the amount will meet the needs of all the hospitals in the south if the sweeps last for the next four years, as I confidently hope they will with increasing measure of success.

Mr. Kennedy: The original intention in the first Bill was to help hospitals which rendered service to the poor. When Deputy Bennett speaks of Dublin hospitals as serving a radius of 100 miles he gets away from the Bill. A Dublin hospital does serve a radius of 100 miles but it serves the patient who can pay three, four or seven guineas a week and also a fee for an operation. It does not, however, serve the poor. It serves the poor of Dublin all right, but the poor within a hundred miles radius are dealt with by the county hospitals, and if they cannot deal with such cases they are sent to Dublin and the boards of health have to pay from [2245] two to three guineas a week per case. Any of the poor who come to Dublin hospitals are paid for. Perhaps there may be special treatment, but they are paid for and they are not treated in free beds. The Bill applies to hospitals which have a certain number of free beds. Anyone conversant with the state of things in the counties knows that in the county hospitals there is overcrowding and that every week patients have to be turned away. I have spoken to the local surgeon in Mullingar, to the surgeon in the infirmary, and I know that patients week after week have to be turned away owing to lack of accommodation.

A statement was made here last Friday to the effect that £5,000 would meet the needs of the county hospitals. A maternity ward is needed in the county hospital at Mullingar, for which the estimate is £10,000. An up-to-date sewerage system is needed, and the estimate is £3,000. A sanatorium is needed, the estimate for which is £15,000. There is also needed a new operating theatre. We could find means of expending from £30,000 to £40,000 at present. We are undertaking a sewerage scheme and the building of a new operating theatre, and we have installed a modern x-ray plant. We have, however, to go slowly. We cannot undertake the building of a new maternity ward nor the building of a new wing to the hospital, because our borrowings at present for hospital needs are more than the county can afford. Taking what we need, we could absorb £20,000 or £30,000 immediately from the sweep. Consequently the statement that £5,000 would meet the needs of all the county hospitals is absurd.

Mr. Fitzgerald-Kenney: Has the Deputy any reason for thinking that under the 25 per cent. arrangement over £30,000 will not be available for his county?

Mr. Kennedy: Assuming that we will get as much from the next sweep as was got from the last one, I cannot see the hospitals getting more than £2,000 or £3,000.

Mr. Fitzgerald-Kenney: There will be well over one million available for county hospitals under the 25 per cent. arrangement.

[2246] Mr. Kennedy: Will the Minister say whether district hospitals come under the Bill?

Mr. Fitzgerald-Kenney: Yes.

Mr. Kennedy: And county infirmaries?

Mr. Fitzgerald-Kenney: Yes.

Mr. Kennedy: So far as I know, there are well over a hundred such hospitals in the country. Assuming that we get a quarter of £500,000, we would get £125,000 between them. That would mean that there would hardly be £2,000 for each institution from the next sweep.

Mr. Fitzgerald-Kenney: There are to be nine more sweeps.

Mr. Kennedy: What guarantee have we that the seventh, the eighth, or the ninth will be as successful as the previous ones? What we are interested in is to secure our due proportion out of the sweep on the Manchester November Handicap. As a person interested in county hospitals, I say that if we got fifty per cent. out of the next two sweeps we would be prepared to go back to the twenty-five per cent. arrangement. Deputy Bennett gave figures indicating that the Dublin hospitals only get sixty per cent. of the proceeds available for hospitals out of the present receipts. I have not the figures here, but I question that very much.

Mr. Fitzgerald-Kenney: It is approximately correct.

Mr. Kennedy: In the matter of hospitals I think that the policy of the Local Government Ministry has been one of decentralisation. I quite agree with that. I would like to see in every county hospital a resident surgeon, and I do not see why there should not be one. If that is the policy, there should be more money provided in the amending Bill for county hospitals. There should be money provided to bring these hospitals up to date and up to the standard of the Dublin institutions. The case of Connacht has been cited, but the same case can be cited for every county. As I have indicated, the basis of this Bill and also of the previous [2247] one was the provision of money for hospitals which are giving accommodation to the poor. The poor are primarily treated in the county hospitals. Consequently the amendment that fifty per cent. be made available for county hospitals should be accepted by the House. County Deputies especially should vote for it. I do not think it is a Party measure.

Dr. Hennessy: I would like to remind the House that when two Private Bills were introduced by Deputy O'Dowd and myself, the only questions at issue were, firstly, if a sum would be allocated to the county hospitals; and secondly, if a sum would be allocated, what would be the amount? Arising out of these two Bills, the Government undertook to make the matter the subject of a Government measure and we agreed to withdraw our Bills on the proposition that the county hospitals would get 25 per cent. A good deal has been said about the Dublin hospitals and their functions. I would remind the House that the Dublin hospitals are not only Dublin hospitals, but are national hospitals. The clinical work of these hospitals is very important if the future members of the medical profession are to get a decent education. The county hospital is a very excellent institution in its way, but we must bear in mind that it is a one-man hospital. While that man does very important work, he cannot specialise in ten or twelve different departments of treatment. I do not see how you can ever develop a county hospital on the basis on which you could develop a city hospital.

There are some hospitals specially mentioned in the Bill, such as Peamount and Cappagh. We know they undertake the treatment of tuberculosis, but they have, so far as accommodation goes, only touched the fringe of it and they do it on a national basis. They receive patients from all parts of the country. These hospitals, for their full development, would easily take between them one-quarter million of money. I think it would be a very much better national proposition to develop these two hospitals [2248] and develop them on the big basis, with which, I am sure, Deputies are familiar, in so far as their initial attempts have gone, than to establish sanatoria in the different counties throughout Ireland. It must also be borne in mind that a good deal of the sweep money under the past arrangement and under this arrangement will go to the provinces. It will go to Cork, it will go to Galway, Waterford and Limerick. I think it would be much better to try out as much provincial development as we can instead of frittering away our efforts on a county basis.

It has been said that the Dublin hospitals do not treat the poor. Latterly, of course, the Dublin hospitals were in a state of bankruptcy and they had to cut down the number of free beds. They now charge £2 2s. 0d. per week to the county boards of health for the treatment of each patient in Dublin, for very special operations, and sometimes also for special treatment. That only meets a very small fraction of the cost to the hospitals. The boards of health get it for the nominal sum of £2 per week, and I think it should not be charged against the Dublin hospitals that that is in any sense profiteering. The Minister spoke of the different sums that went to the provinces. I would ask Deputies on all sides of the House to treat this more on a national and provincial basis than on a county basis. I know it will appeal to some county Deputies to carry home as big a slice of the spoils as they can. That, however, is not for the good of the country or for the good of the poor of the country, because, as I had said, you must develop the system on big lines, and you will not develop it in that way on county lines.

Dr. Tubridy: I am very glad that this has been left to an open vote of the House. I intend to make an appeal to country Deputies to support, by their votes, the amendment of Deputy O'Kelly that 50 per cent. should be allotted to the county hospitals. Deputy Dr. Hennessy made an appeal that the question should be looked upon in a larger way, that we should consider the Dublin hospitals [2249] as the national hospitals and forget the county hospitals and our duties to our constituents in these counties. I would like to say a word as to the position of the county hospitals, especially that in my own constituency, which has developed considerably in the last few years. The hospital we have in Galway is no longer a county hospital in the ordinary sense of that term. It is a provincial hospital. We have patients coming there from Clare, Mayo and Roscommon, and it has now taken the place that the hospitals in Dublin formerly occupied, as far as these patients are concerned. Apart from the fact that we have patients from other counties, we are now in the position that practically all cases are treated in the county hospital. I remember when I started to practise in 1919 and 1920, the most serious cases had to be sent to Dublin. Nothing except acute abdominal work or urgent operations were performed in Galway at that time.

I received a list within the last few days showing the number of operations carried out there in the past year. I find that the number of major operations done in the Central Hospital was 1.100. The position now is that the Central Hospital in Galway is doing the work formerly done for the country patients by the Dublin hospitals. We have a general surgical and medical hospital, a fever hospital and a maternity hospital combined. It is the largest hospital, of course, in Connacht. It is also the clinical centre for Galway University Medical School. The point was made by Deputy Dr. Hennessy that the hospitals in Dublin are utilised for the training of the future medical practitioners of the country. The Galway hospital now does that work for the Galway Medical School. The staff includes three surgeons, two physicians, a pathologist, a gynaecologist and obstetrician, an eye and ear surgeon, and a house physician. An immense amount of money has been spent on perfecting this hospital. I have here also a list of the voluntary contributions made to the hospital for the last few years. Picking out some at random—in 1925 the amount was £1,096, in 1924 it was £808, and in 1930, £33. They utilised [2250] these contributions in installing x-ray plant, a pathological department, and other necessaries for a modern hospital.

This hospital of which I am speaking applied to the Hospitals Committee to be admitted amongst the voluntary hospitals which will be getting three-fourths and which up to this were getting the total amount of the money available. As far as I can hear, they have been refused admission into the scheme. To-day a sheet of paper was handed to me, signed by the Treasurer of the Associated Hospitals Committee. It contains a number of arguments as to why the money should not be devoted in any other ratio than 25 per cent. for the country hospitals, and the remainder for Dublin hospitals. The first reason they give is that the city hospitals are national institutions, that they cater for the sick poor from every county and district in the Saorstát. That is no use as far as Connacht is concerned. We in Connacht are very badly treated under this scheme. Cork, Limerick and Waterford have got their share, but the Cinderella province, Connacht, as usual, has been completely left out. The first statement, “that the hospitals we represent are national institutions which cater for the sick poor of every county in the Saorstát,” is not true as far as Connacht is concerned. The next statement is “that these national hospitals, not having the security of the rates behind them, require to be endowed, in whole or in part, owing to inevitable loss of public subscriptions.” With that also I cannot agree. Any patients who are now sent to Dublin from country districts are paid for at the rate of £2 per week, the same rate at which they are paid for in the Central Hospital at Galway or any other hospital. I cannot agree that the Dublin hospitals are doing anything for the country people for nothing. Anybody who is aware of the conditions in the hospitals here knows that if a poor person in the West of Ireland requires treatment he must be paid for by the board of health; he will not be accepted free of charge in a city hospital. The city hospitals get a big number of paying patients. I have even heard it said that they know how to charge fairly well. The third reason [2251] given is “that the moneys received and to be received from the sweepstakes will not be more than sufficient to carry out our proposals.” I believe that the hospitals in Dublin are now in a position—and they certainly will be in a better position by the time the last of the sweepstakes is over—to carry out any proposals that they may have had in mind. When this sweepstake was originated, as Deputy Sir James Craig knows, it was never thought or dreamt of by any of these hospitals that they would get as much money as they have now got. To say that the money they will receive from nine sweepstakes will not be sufficient to carry out their proposals is simply stating something that is not correct. They have more money than ever they thought they would get, and whatever proposals they originally had when they started with the sweepstakes, I am sure, have already been carried out, or they have already sufficient money on hands to carry them through. The fourth reason given against our proposal is “that the reduction of the percentage to be received by the national voluntary hospitals to fifty per cent. will not be at all adequate to provide any reasonable endowments for these hospitals, whereas the sum represented by 50 per cent. of the Hospitals Fund will be largely in excess of what the county hospitals can possibly require.” The people who presented this document evidently have very little knowledge of the country districts in Ireland.

They know absolutely nothing about conditions in the ordinary county hospitals, and they know very little of the expense that has already been incurred in Galway to make their hospital a fit and modern institution. I entirely disagree with every statement made by the Associated Hospitals Committee in this circular which was issued to me to-day. Their final statement in favour of the Dublin hospitals is: “It must be borne in mind that most of our large hospitals are teaching institutions which educate the entire medical and nursing professions of the Saorstát. No such claim can be made for county hospitals.” That is not correct. In the [2252] West of Ireland we have a medical school and university and a hospital that is doing the work that those people claim they are doing for all Ireland. It is not correct to say that they are not doing it as well as the Dublin hospitals are doing it for their own students.

Deputy Dr. Hennessy said that the county hospital is a one-man hospital. That should not be so. That is one of the reasons why we ask that fifty per cent. be allocated for the county hospitals, to enable them to cater for the sick poor and for people who are not wealthy enough to come to Dublin. It is not correct to say that one man can attend to all these people. It shows a very bad state of affairs in the different counties if that is the position. I know that in the county adjoining ours there is only one man acting as physician and surgeon to the whole county in the hospital. I do not see how that man could do eye and ear work, the work of a gynaecologist, and all the other work that has to be done in a modern hospital.

The only Deputy who spoke against this proposal so far was Deputy Sir James Craig. I must say that I disagree with every word of what Deputy Sir James Craig said. Deputy Sir James Craig's statement would lead one to believe that he is out of touch with the conditions prevailing in county hospitals and with what county hospitals have to do. The Deputy said that he would like to see the provision of a small operating theatre. Of what use would a small operating theatre be in a county where there have been 1,100 major operations in one year? Even if there were only 300 operations to be performed a small operating theatre would not be sufficient. At present we have two and they are not sufficient. £5,000 would not go a long way towards the provision of these, because £40,000 has not already done very much. How could it be expected that £5,000 would do for a country hospital what £50,000 is required for for a city hospital? It is not that the numbers of patients are not the same. Why should the people in the West of Ireland have to depend on a grant of £5,000 when other people who can [2253] afford to pay their way are not satisfied with £50,000? “A man must be trained specially in the use of the x-ray instruments.” We have an x-ray specialist, but in that connection, even with our modern equipment, in hospitals in Galway there have been three or four cases recently of superficial cancer where patients died for want of treatment. These were people who refused to come to Dublin for one reason or another. We want as up-to-date apparatus as any hospital in the city. After all there is a lot of duplication in the Dublin hospitals. You may have in one hospital, say, a certain x-ray plant which may be a very expensive one. It may be for diagnostic purposes alone or for deep therapy. You may have similar plant in other hospitals, when perhaps two would be sufficient. I believe that when this money comes into the different hospitals every one of the hospitals will equip themselves and you will have duplication. The money can be applied to the purchasing of ten, fifteen or twenty very expensive x-ray and therapeutical plants in the city, while the hospitals in the West of Ireland will be without these facilities. If it requires £10,000 or £15,000 to instal a perfectly modern x-ray plant, and, if it can be done here in four or five hospitals, I claim and I hope the country Deputies will support me, that in each county or two or three counties combined, the same plant should be installed.

So far, Deputy Sir James Craig appears to have been the only Deputy to have spoken against this amendment. I imagine from his speech that he does not understand the conditions that we have to put up with in the country, or that he does not understand the difficulty there is, at times, in sending patients to Dublin for treatment, a thing that should not, now, be necessary in the case of what is very often a very commonplace thing. It should not be necessary to send those people up to Dublin at very great expense, when the work might be equally well done in the different county hospitals. I know that Deputy Hogan has referred to the metropolitan mind, and I would like to disabuse, if I possibly could, a number of the Dublin Deputies of [2254] the idea that nothing can be done outside of Dublin. This metropolitan outlook is very well developed in the mind of Deputy Sir James Craig.

Sir James Craig: That is why he supported the Bill to benefit 34 hospitals in the Saorstát, 19 of them outside Dublin have been benefited by it.

Dr. Tubridy: How many hospitals inside Dublin benefited by it?

Sir James Craig: The difference between 34 and 19, whatever that is.

Dr. Tubridy: I do not want to argue at all with Deputy Sir James Craig on this matter. I know that a man who has been living in Dublin and in touch with Dublin could not see my point of view, and I find it difficult to see Deputy Sir James Craig's point of view in the matter too.

Mr. Jordan: You both should get medically examined.

Dr. Tubridy: I appeal to the Minister in case this money is increased from 25 per cent. to 50 per cent. to see that the different counties benefit in proportion to the amount of work they are prepared to do themselves. The Minister for Local Government will have the distribution of this grant, and in certain counties where nothing has been done, the case can now be made that they are entitled to a bigger share of the money than those counties who have, at great expense, erected hospitals, and gone to great expense in providing a staff, and in maintaining them. I think it would be very advisable for the Minister to see that each county gets its share of the grant in proportion to the amount of work already done, and the amount of money already expended in that county.

Mr. Davin: I think I could make the same sympathetic appeal on behalf of the county hospitals as has been made by any ordinary member of the House. I agree with everything that Deputy Tubridy has said, especially in so far as he is anxious to make it possible for the Minister to make better provision for county hospitals and thereby make it possible to have a larger number of major operations [2255] carried out in these hospitals and so to prevent, what I would like to prevent, the necessity for people to come here to the hospitals in the City of Dublin from distant parts of the country. I would like to save people from the necessity of such journeys unless where it was absolutely unavoidable. I served on the original Committee that was set up by the House to deal with the original Bill, with Deputies O'Kelly, O'Dowd, Moore, and other members of this House. I would not like to say how amazed everyone of us was at the success of the sweepstakes. They have succeeded in providing revenue to an extent never anticipated by the most optimistic members of that Committee. I do not think that Deputy Sir James Craig would have dreamed that a sum of £786,000 would have been realised by any sweepstake, much less that we should have received, as we have received, £2,786,000 in the last sweepstake.

I think it was the desire of all of us who served on that Committee and of every member of the House who supported the original Bill, that this thing should be looked at rather from the national point of view than from the city or local point of view. I do not like the suggestion made by Deputy Kennedy, though he has made a very moving appeal on behalf of the county hospitals. He said he would be willing to go back to the 25 per cent. allocation after the county hospitals had received a 50 per cent. share, as is suggested in this amendment, out of the next two sweeps. I would prefer to receive a certain stipulated revenue from the sweep until the necessary work was done rather than change from one sweep to another. I seriously suggest to Deputy O'Kelly to agree to this thing rather than have a division. The figure might be altered, if the Minister would agree, from three-fourths to two-thirds and thereby allow a better margin than is at present provided or than is in the present Bill for hospitals outside Dublin. I hope Deputy O'Kelly will look at that suggestion in a favourable and sympathetic light rather than risk putting it to a division [2256] and losing what he is anxious to get. It might be possible, by agreement, to get one-third rather than 25 per cent. that is now provided for. I would also like if Deputy Sir James Craig would see my point of view and adopt that suggestion. After all, Deputy Sir James Craig has been mainly responsible for this matter, for it was he who took the original responsibility in introducing the Bill.

Up to the present, as Deputy Dr. Tubridy knows, it is necessary, by reason of local circumstances, to send patients from the country to Dublin hospitals. That is because they cannot be properly treated in the county hospitals. If the county hospitals get better and more favourable treatment under this Bill, or under this amendment, I am hoping that it will be possible to prevent a large number of country patients who have been coming to the city hospitals up to the present, and a good many of whom have been paid for out of the local rates, from being forced in the future to come up to those hospitals. That is the only purpose I have in suggesting to Deputy O'Kelly that he might, provided the Minister is agreeable, leave the figure at two-thirds instead of at three-fourths, as in the Bill. If the Deputy agrees to that, the result will be that in future sweepstakes the county hospitals will benefit to this extent.

Mr. O'Kelly: Has the Minister made any suggestion to the Deputy that he will agree to the suggested alterations?

Mr. Davin: No; I am making the suggestion openly to the House. I am making it to the Minister as well as to Deputy O'Kelly.

Dr. O'Higgins: I think every one on all sides of the House sympathises with the position of the hospitals, whether situated in the city of Dublin or in the country, when they find themselves in financial difficulties and hard up for finance to carry on. Hospitals are not anxious so much for the money as to be placed in a position that will enable them to do the best for their patients. I do not think, however, that the future of any hospital, either in the city or in the country is being well served by trying to make this matter [2257] an issue as between the city and the country. Hospitals and hospitalisation in all countries are viewed from a national angle as national institutions. An appeal repeated here several times to country members to vote for a certain thing on account of geographic conditions is certainly not viewing the thing in the spirit that Deputies should view it in, and more particularly medical Deputies.

In this debate, as far as I have followed it, the main distinction between the county hospitals and the city hospitals, seems to be the fact that one set of hospitals, namely, the city hospitals, are supported by voluntary contributions, freely given by the charitable public, and that the other hospitals, the county hospitals, are really semi-State institutions in so far as they are supported and assisted by the rates; also the fact that the whole position with regard to sweepstakes was brought about by the case made for the voluntary hospitals. At that time there was no case made for, or no mention or suggestion made of county hospitals in the matter. In fact, some people who most deplored the initiation of sweepstakes are most anxious to share in the sweepstakes now, when the donkey work has been done by the city hospitals. The particular case made at that time was that these were hospitals supported entirely by voluntary contributions, and on that basis the sweepstakes were initiated. Later on, a case was advanced for the county hospitals. I want to urge the point that this was a dish really prepared in order to nurse the voluntary hospitals back to convalescence, and now the county hospitals are anxious to eat out of that dish. In a broad-spirited way, the people interested in them said they would give one-quarter to the county hospitals. At the time that appeared to be agreed upon. Now there is a demand coming in for the quarter to be made one-half.

Deputy Tubridy gave us a picture of Galway county hospital and told us that there were something like 1,100 major operations per annum performed there. That is a very big number of operations, and I take it [2258] that it is a fair average for a year's work in Galway county hospital. If that is the average number of major operations per year in Galway county hospital, then that hospital should get some very special consideration. But that is not the average for the county hospitals. There is no hospital in any other county that would do 1,100 major operations in six years, and the case for the county hospitals generally should not be confused by the Deputy's presentation of the case for Galway hospital. That hospital stands out distinct and separate from any or all of the other county hospitals. It is a bigger institution and it carries a much bigger staff. The Deputy told us that it has four operating theatres and the volume of work handled, as deduced from the number of major operations, seems to be considerably more than that of any of the City of Dublin hospitals. In that way it must be taken not as a sample of the Dublin hospitals, but rather as a peculiar situation to be dealt with specially and to be set aside from the others.

The Minister for Justice pointed out that in the course of the next nine sweepstakes there should be, in the ordinary course of events, £1,000,000 available for distribution amongst the county hospitals. Deputy Kennedy appeared to disagree with that. He wanted all his share at once. I could not exactly see his point. He disagreed with the figure given by the Minister and he said that they would require £30,000 in his county. The Minister pointed out that in the ordinary course of events they would get that £30,000 and considerably more. The Deputy's attitude was that we had passed the high-water mark with regard to sweepstakes. It is extremely difficult to argue with a prophet. The only way you can argue with a prophet is to take the ordinary signs, figures and facts as they appear to everybody. I think it will be generally admitted that the indicator with regard to sweepstakes is set in an upward direction. That has been our experience so far. The reports with regard to the next sweepstakes would indicate a yet bigger sum than has been realised by any sweepstake so far. If signs and [2259] figures mean anything, in the next nine sweepstakes the figure mentioned by the Minister should be considerably exceeded. The very minute that we get a contribution for any county hospital that exceeds the amount necessary for extra medical equipment or extra scientific equipment we are on very thin ice; we have reached the point where we utilise sweepstakes in aid of rates. If Deputy Kennedy or somebody else brings along a Bill when this period of sweepstakes is over to use them openly and honestly for the relief of rates I will not say that I will not find myself in the same Division Lobby. But let us call a spade a spade. At present we are more or less shy of bringing sweepstakes to the assistance either of rates or of taxes. As long as that is the position, we should not endeavour to do it under another label, under the label of hospitals. If a certain county gets £30,000 or £40,000 out of these sweepstakes I venture to predict that there will be a considerable reduction of the rates in that particular county; in other words, that the £30,000 or £40,000 would not go towards the benefit of patients to the same extent as it would go in the voluntary hospitals.

There is another consideration. The cities of Dublin, Cork, etc., are paying rates. They are running the poor law hospitals just the same as any county. In addition to that, out of their charity they are supporting so many voluntary hospitals. The people in most of our counties, through the rates, are supporting the county hospitals, but they are not supporting any voluntary hospitals. The claim put forward by them is that they should get exactly the same out of this machine for the aid of county hospitals as those who do in fact support voluntary hospitals. I do not think that case can be genuinely upheld. We are told that there should ordinarily be £1,000,000 available for the county hospitals out of the next nine sweepstakes. If that figure is realised I think that every county hospital would be very well and very adequately put on its feet. If more money was available you probably could use it in a very beneficial manner, but we [2260] must not forget that these sweepstakes were instituted to go to the assistance of the voluntary hospitals when they were on the verge of bankruptcy, when they were nearing the point that they would have to close their doors, and that the position so far is that the voluntary hospitals have merely been pulled out of debt. There is a little bit of money left, but there is a danger of the voluntary contributions falling considerably as a result of the sweepstakes. The voluntary hospitals have to be put more or less firmly on their feet before there is any surplus to be divided generally over the country. The offer of 25 per cent. is a very good offer, and it is an offer which I believe would be welcomed in nine out of every ten counties. It has provided an opportunity that twelve months ago nobody ever thought would arise. The sum of something like £30,000 or £40,000 going to the ordinary county hospitals is equivalent to a sum certainly eight times as great going to the city hospital.

The city hospital has a multitude of departments dealing with a great variety of specialist cases. Only, at most, one-sixth of an hospital can be regarded as a general hospital. The expenses are far higher and the cost for staff and equipment is far heavier. I would like more or less to refute the suggestion that our city hospitals are not catering for country cases. Deputy Kennedy started off by telling us that the Dublin hospitals were not catering for the country or for the poor of the country, and in the next breath he proceeded to demonstrate the fact that they were dealing with the poor of the country. The question is not a financial, it is a medical question whether the poor of the country are or are not being treated in the Dublin hospitals. The Deputy, having first said that they were not so treated, proceeded then to tell us that they were so treated at the cost of £2 per week. It was not a question of figures, but a question of facts. It was a question of what class the City of Dublin hospitals were catering for, what class of patients they were treating, and what class of patients were getting into them. Deputy Sir James Craig said that they [2261] were treating the poor within 100 miles radius of Dublin.

Mr. Kennedy: They are paid for them.

Dr. O'Higgins: The suggestion made by the Deputy was that the boards of health paid £2 a week for the patients treated in the Dublin hospitals. If Deputy Kennedy knows anything about the cost in the Dublin hospitals he knows that nothing is made out of £2 a week. Every case that comes from the country is a very special case, requiring such treatment that our highly efficient county hospitals are unable to deal with them, equipped as they are with special surgical appliances. They are very difficult cases and very serious cases and very expensive cases. I have seen cases in wards in Dublin hospitals where three guineas a week would not cover the cost of injections and dressings alone.

It is up to everyone of us to stand by what we have got. The hospitals, particularly in Dublin City, are doing an immense amount of public work and doing it at a loss. Let us at least recognise that—and not suggest commercial motives to them. They have been compelled in recent years to look to boards of health for contributions towards the cost of treatment of cases sent to them, not with the view to making money but with the view to endeavouring to keep their doors open and to do greater benefit to the people of the country as a whole.

Mr. O'Hanlon: In dealing with another amendment proposed by Deputy O'Kelly, the President said that the hospitals should not be too grasping. I think that rather illustrates the situation at the moment with regard to this amendment. We must not forget that we are dealing with this question at a stage when the City of Dublin hospitals and the Cork and Limerick hospitals have already received £1,200,000 out of the sweepstakes fund. At this stage the hospitals in the country come forward and ask for a fair share of the spoils of the future. And the future is a rather doubtful thing. I think it is not unreasonable for the county hospitals in [2262] Ireland to ask for 50 per cent. of the surplus from the sweep to be distributed amongst them, for several reasons. In the first place, notwithstanding what Deputy O'Higgins has said, the ratepayers are bound to pay, and bound to maintain whatever equivalent or improvement is going to be made in the county hospitals, and they are bound to pay that out of the rates.

There is no suggestion in this Bill, and it has not been suggested by any Deputy who has spoken, that any sum which is going to be allocated to the county hospitals can by any stretch be given in relief of rates. Deputy O'Higgins seems to be under the impression that there is some underhand method by which whatever is given to the county hospitals can be brought to aid in the relief of rates. It is clearly laid down no such thing can happen. There is another reason why the 25 per cent. should be increased to 50 per cent. If you look at amendment 15 you will find that it is a completely new Section 7. Under the condition of the Bill as it stands, it means that whatever amount is going to the county hospitals is going to the existing institutions. Under this new section, which we will have to deal with later, I think both should be read together; it gives the Minister very much wider power. Section 7, as it stands in the Bill, deals with the existing hospitals which may put in a claim for a portion of this money. I do not think I am out of order in reading the new Section 7. It says: “Can be applied by him in such manner as he shall think fit in or towards the provision, improvement, or equipment of institutions for the prevention, treatment, or cure of physical or mental diseases or injuries of human beings.”

That enlarges the scope very considerably. It brings in the mental hospitals, and those would absorb far more money than it is possible to allocate to them; but having regard to this section which may be passed at a later stage, if it is passed it would mean that even the half share suggested would not be sufficient to deal with the requirements of the county hospitals in the future in the matter of equipment. [2263] It certainly would be quite necessary to give 50 per cent. in order to provide any new institution which may be suggested.

We must also bear in mind that if there are such things as new buildings —such as sanatoria and new hospitals for other purposes—they must be maintained by the ratepayers.

I think an unanswerable case has been made out for the change of giving at least half the proceeds to the county hospitals. I do not appeal to country or city Deputies in asking them to vote on this matter. This is, as Deputy O'Higgins said, not a city or a county question, it is a national question, and it should be treated as a national question; and, after all, this question of hospital treatment should be regarded as national and not thought of as if the whole thing was concentrated in Dublin. We should try to understand the amount of work done in the county hospitals already established. I can speak of the amount and of the variety of the work done in my own county. I would like to correct a few of the statements in Deputy O'Higgins's speech. Deputy Tubridy referred to the number of major operations in Galway, and gave the figure as something like 1,100. Deputy O'Higgins said if there were 1,100 major operations in Galway it was not a case to be dealt with under the County Hospitals Scheme but that it should get special treatment. In other words, that it should come in with the Dublin hospitals. Deputy O'Higgins said that in six years there would not be 1,100 operations in any other county institution.

Mr. Fitzgerald-Kenney: Major operations?

Mr. O'Hanlon: That there would not be 1,100 major operations in any county outside Galway. I happen to have the figures for the county hospital in Cavan for the twelve months ending 1st May, 1931, and they show that 690 major operations were performed in that county hospital.

For the same period there were [2264] 3,000 extern cases treated, 20 per cent. of these minor operations, such as tonsils, adenoids and other things, bringing it up to 600 more. Furthermore, the ratepayers of Cavan provided a new wing with something like 35 or 40 extra beds and now the number of major operations is going to increase greatly, as evidenced by the last month. Last month in Cavan Hospital 100 major operations were performed by what Deputy Dr. Hennessy called this one-man show. That is what I call good national work done in an institution pretty well equipped by the ratepayers but which requires greater assistance. Possibly there may be some jealousy in Dublin, but when the ratepayers of the counties have assisted so far out of the rates to provide equipment to enable such work to be done I think the county hospitals should get at least 50 per cent. of the available surplus out of the sweeps.

I might say, in passing, that one of the best acts by the Local Government Department since this Government came into office has been in insisting upon proper hospital accommodation for the counties. Greater relief to the poor and greater saving to the ratepayers have been effected through properly equipped county hospitals than by any other means. I would appeal to members of the House without distinction to give the county hospitals a fair crack of the whip. they are entitled to fifty per cent. of the future proceeds. Let them remember that the one and a quarter million that has already been given to the hospitals was as much a surprise to the Dublin hospitals as it was to everybody else. They never expected to get it, and having got it I think it is not an unreasonable demand to ask one half the proceeds in the future when they have already one and a quarter million in their possession.

Mr. Fitzgerald-Kenney: Some time ago in the course of the debate Deputy Davin made a suggestion that the figure of thirty-three and one-third per cent, should be substituted for fifty per cent. as an agreed figure. I think [2265] it is very unfortunate that this debate has developed precisely in the way it has developed and in a way in which there has been a certain amount of attack, counter-attack and defence. I take the view that both voluntary hospitals and county hospitals do good work and it is recognised, and I think it is a pity that there should be any attacks. To end that I would suggest that if Deputy O'Kelly would withdraw his present amendment, at the next stage I would introduce an amendment substituting thirty-three and one-third per cent. for twenty-five per cent. I think that would be to the advantage of all parties, because, as I say, if it is taken as a compromise it will assuage any differences that might arise.

Mr. O'Kelly: The position I am in is that I did say to my colleague, Deputy Ruttledge, after listening to the debate that I would personally be prepared to accept thirty-three and one-third per cent. Some other of my colleagues who were with me hearing this said that they would not accept that and they wanted the full fifty per cent. That is the position I am in. If I agreed to withdraw the amendment they would not accept that. They were behind this amendment just the same as I was. Personally I said I would be prepared to accept the Minister's suggestion and the suggestion of Deputy Davin. I wonder would it be possible to strike a farmers' bargain and split the difference?

Mr. Fitzgerald-Kenney: I think that would be rather impossible. I take a very conservative figure which would be that each county hospital would get at least £40,000. That would be, I think, on a conservative basis. It would probably get on twenty-five per cent. very much more. I think £40,000 would be ample. Some counties will receive considerably more, some less, because some have already benefited to a large extent. I think that would be ample for each one of the counties. If you increase that to one-third instead of one-fourth you will have added to that sum very largely, and the counties should have every possible need satisfied and more than satisfied.

[2266] Mr. O'Kelly: From what I have heard, I am inclined to think that if the fifty per cent. amendment goes to a division it will be carried. That is, from what I have heard from all sides of the House. I think, from the Minister's point of view, it would be wise to get the agreement of the House. I suggest 37½ per cent. to the county hospitals, and 62½ would probably meet the others. I do know that some of them say that if I withdraw they will insist on a division on the fifty per cent. basis.

Mr. Fitzgerald-Kenney: Now that a definite agreement is within reach, Deputies might moderate their demand under the persuasive influence of Deputy O'Kelly.

Dr. Ryan: If anything less than fifty per cent. is suggested there will be a division.

Mr. MacEntee: The Minister has deliberately prejudiced the whole consideration of this affair. He is talking in terms of one million pounds and £40,000. He said every county would get £40,000. Twenty-six counties with £40,000 is £1,040,000. There is no such thing in the offing. Is the Minister not aware that the running of these sweepstakes has created a problem of the enforcement of law in other countries?

An Leas-Cheann Comhairle: Let us keep to this debate.

Mr. MacEntee: The Minister's whole attitude is that sweepstakes are to be allowed.

Mr. Fitzgerald-Kenney: If they are not the voluntary hospitals are burst.

Mr. MacEntee: The voluntary hospitals are not burst.

An Leas-Cheann Comhairle: We are considering whether the amendment should be withdrawn.

Sir J. Craig: It was suggested that I was against the county hospitals getting a fair share of the money. I considered that twenty-five per cent. was a fair share, and I was supporting that proposal. According to my reading of the amount that we are to get from the sweepstakes, there will be almost [2267] £7,000 out of each sweep. If that is multiplied by nine, one gets at least £60,000.

I do not think anybody can get away from the fact that there is going to be £50,000 or £60,000 on the twenty five per cent. basis for each county. You might say how do I know. What I was going to say is that I am in favour of following the Minister in suggesting that a compromise must be made. If that is not accepted then I am going back to the original proposition. Let us decide the matter on the fifty per cent. basis. I would suggest to Deputy O'Kelly that it is wiser to accept the thirty-three and one-third per cent.

Dr. Ryan: Deputy Sir James Craig has made a point. Does Deputy Sir James Craig realise what the amount would be to the voluntary hospitals? It will mean that they will get six and a quarter millions. Are the voluntary hospitals to be in a position to spend six and a quarter million pounds while the county hospitals are spending £60,000? I think it is a ridiculous thing to ask us to compromise on this because the counties are not getting at all what they are entitled to.

Ten or twelve years ago when the President as Minister for Local Government started this question of amalgamation our whole argument was that we would get people in the counties such good county hospitals and homes that it would be in their interests to agree to the amalgamation scheme, that it was ridiculous to have four district hospitals and that they should have one county hospital. They were to obtain a surgeon who would be capable of doing all operations and it would not be necessary to come up to Dublin for an operation. The President sent us out like apostles all over the country to try and get the amalgamation scheme through. We are told now that those county hospitals are a one-man show, that the county hospitals only should have an x-ray and that it would be unnecessary in any other portion of the county to have an x-ray. Every argument is put up to try and give [2268] the impression that proper treatment cannot be given in the counties so that a person who had anything seriously wrong with him must go to Dublin to be treated.

Sir James Craig: I did not convey that impression. I deny that I did so at any time. I have the greatest admiration for the work done in the county hospitals and I have the greatest desire to see that the county hospitals and infirmaries are properly provided for. I will not allow the suggestion to go forth that I suggested that they are not able to do as good work in the counties as in the cities.

Dr. Ryan: I may have mistaken what Deputy Sir James Craig said, and I withdraw. At any rate the Deputy said that there was no necessity for more than one x-ray apparatus in each county, that it required an expert to look after it, and that otherwise it would be useless. I do not believe that that is a fact. I think in certain cases of fracture, even students in the Dublin hospitals are able to diagnose without any particular training. Even for cases of that sort in the counties the x-ray would be necessary. I want every Deputy to realise that if the case Deputy Sir James Craig made is correct, that sweeps are going to be successful, that every county will be getting £60,000 under the next nine sweeps the other three-quarters, amounting to five millions, goes to the voluntary hospitals that have already got one and a quarter millions. Surely a county can make provision to spend more than £60,000. What are the voluntary hospitals going to spend 6¼ millions on?

A proposition was made a few years ago, to the voluntary hospitals, whereby they could benefit to the extent of £1,000,000 if they did certain things. People in medical circles in Dublin could hardly believe that it would be possible to get £1,000,000 for the hospitals. We thought at that time that all our difficulties were solved if we could get £1,000,000, and that we would never again be in trouble about raising subscriptions. Now, according to the Minister's calculations, [2269] the voluntary hospitals are going to get 6¼ millions, and we are told that they are not prepared to give away half of it to the county hospitals. We were told by Deputy O'Higgins, that the voluntary hospitals were very generous when they agreed to give 25 per cent. Who asked these hospitals to be generous? What have they to do with it? The Deputy talked of these hospitals doing the donkey work, and of the ratepayers' hospital now wanting to come in and reap the benefit. What did the Dublin hospitals do to get the money?

Sir James Craig: They started the sweeps.

Dr. Ryan: How could they have started the sweeps?

Mr. Gorey: It was the promoters all the time.

Dr. Ryan: We were told that people are sent to the city from the country and that they have to pay only £2 a week, which is only a nominal charge, according to Deputy Hennessy. Deputy O'Higgins said that the amount went nowhere towards supporting a patient when everything was taken into account. Contrast the position of the county hospitals with that of the city hospitals. In the city hospital, you have free medical treatment, free nursing treatment practically, while in the county hospitals medical and nursing services are paid for out of the rates. As far as the cost of food and maintenance goes it is about the same in each place. Deputy O'Higgins told us that Dublin had this disadvantage, that the voluntary hospitals have to be maintained by subscriptions, and that the Union had also to be supported out of the rates. Is Dublin keeping the Dublin hospitals? It is not. People all over the country subscribe to the Dublin hospitals, and I am quite sure that they are subscribing more than their due proportion for the services they receive from these hospitals.

We are asked to look at this in a national way. That is exactly how we are looking at it. We want to see the hospitals all over the country [2270] brought to a state of perfection. If you go into some of the county hospitals you will see that they were built in the style of architecture suitable to a prison. They have still small prison windows, with practically no light in the wards, and are unfit for the work. Better buildings are wanted. Look at the beds, the clothes, and the furniture in the wards. They are not at all what they should be in hospitals. Then look at the position in regard to instruments and operating theatres.

I remember on one occasion, when I was acting as locum tenens for two days in a hospital just before the amalgamation scheme, a case came in which necessitated craniotomy, and there was no possibility of getting instruments to deal with it. The case had to be kept while a telephone message was sent to Dublin to send on instruments. I believe it is the case in many county hospitals that instruments required to do certain very urgent operations are not available. I think we could very well spend at least 50 per cent. of this money on the equipment of county hospitals. If we got the 50 per cent. it would mean, according to the figures supplied by Deputy Sir James Craig and by other Deputies who are in favour of the Dublin hospitals that there would be something like £4,000,000 left for the voluntary hospitals. If they are not satisfied with £4,000,000, and if they can make a good case, when the next nine sweeps are over, the Dáil would then be in a position to get up more sweeps for them.

Captain Redmond: I have not heard the whole of the debate or whether any statistics were brought forward to show the proportion of hospitals in Dublin and in the rest of the country, but by listening to the speeches I would like to call the attention of the House to the fact that Dublin is the metropolis.

If the hospitals in Dublin were merely to cater for the residents of Dublin there would not, in my humble opinion, be any necessity for a quarter of the hospitals that already exist here. Undoubtedly these hospitals are great national institutions, catering for and [2271] serving people from all parts of the country. As Deputy Dr. Ryan has quite rightly said, they are supported also from sources other than the City of Dublin. That, to my mind, shows that in no sense can they properly be described as Dublin hospitals. That being so, I think that the compromise that has been proposed is a very just one. In fact, I think it errs on the side of generosity towards those hospitals that happen to be outside Dublin. These great institutions in Dublin render services to citizens of the State in all quarters of the State, and, Dublin being the capital city of the State, it is only right and fitting that the great bulk of the money raised should go to these hospitals, which, in my view, are in no sense of the word accurately described as Dublin hospitals.

Mr. M. O'Reilly: The question as it strikes me seems to be this: The intention is, I suppose, to convey medical science to the poorest people of the country in the best and easiest possible way. I take it that heretofore medical science was not at the service of the poorest of the population. Undoubtedly, through voluntary efforts in Dublin, the very poor in this city were to a large extent looked after; but what about the country districts? Amalgamation was proposed and carried out, and it had some very good results. When it was carried out I think that most of the county hospitals found that through the shortage of money they were not able to become as efficient as they expected. I do not think that there should be any great difference of opinion over a question like this, because, undoubtedly, the intention of every Deputy here is to make medical service available, convenient, and suitable to the very poor of the country. I think that the only way in which that could be done is by giving the county hospitals an opportunity of becoming up-to-date. We know that people in the country very often refuse, even at this stage of the world's history, to leave their homes to go to hospital. When they do leave them they usually go to a county hospital.

[2272] Mr. Fitzgerald-Kenney: Is not the Meath County Hospital one of the voluntary hospitals?

Mr. O'Reilly: The infirmary is.

Mr. MacEntee: The Minister apparently does not know the difference between a county hospital and a county infirmary.

Mr. O'Reilly: The Meath county hospital is not a voluntary institution. I think that the attitude of these people to whom I refer should appeal to Deputies, because there is a good deal of sentiment in it. These people do not go to Dublin hospitals as their relatives could not find the money to bring them to Dublin or to visit them there. Another reason why the amendment should be adopted is that we have efficient medical men who are condemned, as Deputy Dr. Ryan said, to practise their profession under unfavourable conditions. They have not got the requisite training and practice, with the result that they must pass the majority of their patients on to Dublin hospitals. I do not think that any question should arise as to what should be done with the money. A good many of these county buildings are unsuitable for their purpose. The accommodation is by no means perfect. We have a good county hospital in Meath, and, although I know nothing about medical science, I occasionally visit it, and as an ordinary layman I notice things to which I could take some exception. When I asked for an explanation I was told that there was not sufficient money to give facilities for segregation and other necessary accommodation. I do not think that we would be over-generous in giving the full 50 per cent. to the county hospitals. It is not a matter of raising any question as between Dublin and county hospitals. It is to give an opportunity to county hospitals to treat the poor and give medical practitioners an opportunity of developing their abilities. I do not think that there should be any difference of opinion upon the matter.

Mr. de Valera: I have great difficulty in making up my own mind on this matter. I have been listening to the debate, and the information which I [2273] wanted most I have not got, namely, what are the needs of the Dublin hospitals and what are the needs of the county hospitals expressed, somehow or other, in figures? I was not here when the original Act was passed, but I think I am right in saying that the sum of money now available from the sweepstakes is altogether beyond that expected when this scheme was promoted in the first instance. I take it that those who promoted the scheme had in mind certain definite needs which they wanted to satisfy. I would like to know whether these needs have, in fact, in the case of the first hospitals which participated, been satisfied. If they have, it should be remembered that other hospitals are coming in now, and I am wondering whether this large sum is going to be spent in the best possible way. I take it that the fundamental idea is to provide medical treatment for those who need it, through these hospitals, for the community as a whole. I feel that there is need for some controlling committee that will examine this question of hospital needs in general, that the services and requirements of these hospitals will be taken into account, and that it will not simply be a matter that by getting in first, or by getting a majority of votes on the committee, certain hospitals will get certain grants. I feel that although opportunities for getting money are being created by this House, we have no real knowledge as to the uses to which this money will be put—whether it will be used in the best possible way, or whether it will be spent in an extravagant manner and with unnecessary duplication.

Mr. Fitzgerald-Kenney: Possibly the Deputy is not aware that the Bill provides for a committee to look after the distribution?

Mr. de Valera: I understand there is to be a committee, and that is one of the difficulties I have about it—as to the extent to which this committee will have real power. It seems to me that the Minister was inclined, in the speech which he made on the introduction of this Bill, to leave it to the Hospitals' Committee to decide pretty [2274] largely how the money was to be spent, and the proportion, as far as I could understand, to be given to each hospital. I know there are reserved powers for this Committee not to sanction a scheme if a fair amount did not appear to be given to one particular hospital. I believe that these powers are reserved here for a special Committee which the Minister proposes to set up under the Bill. I do not think there is any provision in the Bill to give this Committee sufficiently wide powers to examine the whole question and to make certain that the money is being allocated in accordance with the needs and the services of the hospitals in general. If that were so, and if it were possible for the Committee to consider the needs of the country at large, I think it would be very much better than having a scheme like this, where we fix a certain amount in the dark and say: “We will divide it into two parts and give a certain amount to hospitals in the city and a certain amount to hospitals in the country.” We think that the question should not be settled in that haphazard way in the dark. The Committee would be in a position to examine the needs of the different hospitals and to allocate the money in accordance with these needs, whether the hospitals were in town or country. If I had anything to do with the farming of the Bill, that is the way I would like to see the system arranged. Taking the arguments put up by the Minister, and by Deputy Sir James Craig against Deputy O'Kelly, it seems to me that Deputy Dr. Ryan's point against Deputy Sir James Craig cannot be put aside, namely, that if under the terms of this Bill £63,000 is allowed to each of the county hospitals, and if such a sum would be available for the Dublin hospitals together with the sum already given them——

Sir James Craig: The Deputy should not speak of Dublin hospitals alone in this connection. There are 43 voluntary hospitals all over the country from Donegal to Waterford.

Mr. de Valera: There are 43 voluntary hospitals. Deputy Sir J. Craig's point in regard to the county hospitals having more than their needs comes [2275] back on himself. I think we should have some idea, before we allocate one percentage or another, what are the needs of these hospitals, both the county hospitals and the city hospitals, and express somehow or other, by means of figures or money, what should be given to these hospitals. I find it very difficult to decide, and the fact that we have a compromise of 33⅓ per cent. suggested instead of 25 per cent. only shows that we are simply bargaining and do not know what we are bargaining about. We do not know whether we are bargaining justly or not. Taking the matter as it has been left at this particular stage, I will be compelled to vote for the 50 per cent. for the county hospitals. I would like to see some attempt being made to have the needs of the hospitals examined and to have some manner of allocating this money to the county hospitals in accordance with their needs and the services which they render to the community, without having it done in this haphazard way, by compromising between the various percentages.

Mr. MacEntee: My position on this matter is a choice of two evils. I object on one ground to the extension of the sweeps so as to include hospitals which should be supported by public funds, because I foresee in that way that the promoters of the sweepstakes are going to elicit in support of the sweepstakes a considerable volume of public opinion which otherwise might not be at their command. On the other hand, I hear those who are associated with these projects talking in terms which seem to indicate that they anticipate that the amount of money which ultimately will come for disposal as the result of the sweepstakes will be in the neighbourhood of £8,000,000. Then I find that in the Bill and in Deputy O'Kelly's amendment there is introduced a principle which I will put this way: that under the Bill the expenditure of 25 per cent. of the money is to be subject to some regulation, some control, some attempt at coordinating the purposes upon which the money will be expended, and that the remaining 75 per cent., say £6,000,000, is to be left at the disposal [2276] of the hospitals themselves, a number of voluntary hospitals, to a certain extent responsible, I suppose, to public opinion but very largely autonomous bodies. That money will be expended by them without the amount of control or without the co-ordination which I think it requires. To my mind, the great merit in Deputy O'Kelly's amendment is that it definitely regulates to a larger extent the expenditure of that £8,000,000 than the Minister's Bill does. For that reason I am strongly in favour of the amendment, even though it is open to the objection that it will elicit the support of a body of public opinion which otherwise might not be at the command of those who are undertaking the sweeps.

In regard to the necessities of the case I am speaking, naturally, as a layman, but I have been in a considerable number of county hospitals, rate-supported institutions, in the country, and I have never yet been in one of them that fulfilled my idea or conception of what a hospital should be. I have never been in one of them that was at all comparable from the point of view of equipment and the comfort of the patients to any of the voluntary hospitals in Dublin which are to receive a proportion of the proceeds of the sweepstakes. In a great many cases these buildings are converted workhouses. The patients are housed in buildings in which the primary conception seemed to have been a place of detention rather than a place of public charity or a place where healing processes had to be undergone. They are ill-lit, they are built in a very poor way with a considerable amount of timber, narrow passages, narrow doors, no attempt at comfort or internal decoration whatsoever. If I were asked for an opinion as to the probable needs or the probable capital amount that would be required in order to provide hospitals with proper equipment and accommodation, I would put the sum at £110,000 per county at least, or £3,000,000 for the country as a whole. That only relates to the ordinary county hospitals.

I do not take into consideration the mental hospitals which, under one of [2277] the amendments to come before the House, will now be included in the Bill. There are about eight of these mental hospitals in the country, and with the one possible exception of Portrane none of them is modern. Carlow, to take one that I know, was built over 100 years ago. Mullingar Mental Hospital was built about 1854. Not one of them was laid out in accordance with modern ideas of the treatment of mental diseases. None of them can be adapted to modern ideas or to give treatment on modern lines in regard to these diseases.

Practically every one of them will have to be rebuilt from the ground up and I am certain that as far as the treatment of mental disease in this country is concerned another million or a million and a half would have to be expended by public bodies in order to provide it. That I think brings me back to the idea as to what would be a fair proportion. According to what Deputy Sir James Craig said in relation to the sharing of the money that would be made available for county hospitals, I notice that he anticipates that these sweepstakes will secure something like £8,000,000. Of this he proposes that about 6¼ millions should be spent amongst the 43 voluntary hospitals and 1½ millions amongst the 83 country hospitals. He proposes to allocate about £20,000 to each of the 25 county hospitals. That million and a half pounds would go to rebuild and re-equip the 25 county, and 58 district hospitals. There would be available for each of these, something like £20,000 to rebuild and re-equip them, and there would be 6¼ millions to be allocated amongst the 43 voluntary hospitals.

Surely the discrepancy in the figures must appeal to every Deputy in the House. If there is a case at all, so far as arithmetical examination of the matter is concerned, the case is for nothing less than an equal distribution as between the county hospitals and the voluntary hospitals. Then surely the argument is in favour of the county hospitals as against the voluntary hospitals, and instead of the county hospitals receiving only 25 per cent., I think a very good case [2278] could be made out for their receiving 75 per cent. It is on that basis that Deputy Ryan and myself feel that a fair compromise was the compromise suggested in Deputy O'Kelly's amendment. The more you examine into the matter the more every fair-minded Deputy will be satisfied that the amendment is a fair one and a just one. I believe it is not wholly just to the county hospitals, but it is not unfair to the voluntary hospitals. It is not for that reason that we are not prepared to accept the compromise of 33⅓ per cent. which has been accepted by the Minister for Justice and by those who spoke rather for the voluntary than for the county hospitals.

There has been a considerable number of matters raised here on the debate into which I do not want to go. I do find this in regard to those county hospitals, that I have never been in one that has not been fairly well filled. I am not going to say that I found every bed occupied, but I have found a considerable number of patients in every one of them. That satisfies me that the need for these hospitals exists, and if it does exist, there is to my mind a case, and a case that cannot be met or overcome, for providing them with the best equipment and the best staff that can be secured.

I feel perfectly satisfied that if the public authorities were once able to deal with the question of capital expenditure with regard to building and equipment they would not be slow in providing the necessary funds to pay an adequate staff. From my experience of them I am aware that the one thing that deters them from modernising these hospitals is the fact that they are faced with a huge capital expenditure. Such expenditure would put a huge burden on the rates for a considerable number of years. The local bodies could not face that, because they feel that after that expenditure had been undertaken they would have to make the necessary provision for a staff. They cannot see any possibility out of their present limited resources of being able to meet the [2279] capital charges upon the new expenditure and at the same time provide adequate remuneration for the staff. If the problem of capital expenditure were to be solved I feel that the adequate staff would be immediately forthcoming, and that the public bodies would make every effort to provide the necessary and adequate remuneration for them.

Mr. Flinn: Deputy MacEntee said that the voluntary hospitals were at the present moment to some extent dependent upon public opinion. I just asked one of my friends what the definition of a voluntary hospital is, but I have not been able to get that definition. I understand that a voluntary hospital is an hospital which is supported by voluntary subscriptions. As soon as a voluntary hospital no longer depends upon voluntary subscriptions it will cease to be a voluntary hospital. All that internal management, self-control and autonomy and everything that went to show that they were voluntary hospitals and depending on voluntary subscriptions given ad hoc to them by people interested in these hospitals— all that position will be imperilled.

The suggestion that the State should provide machinery by which something like £6,000,000 is going to be collected in this country and other countries and handed over to voluntary hospitals, and that those voluntary hospitals shall, after they have received that money, remain in the same position of self-control and self-dependence in which they are now, seems to me to be an impossible proposition. The more money that State machinery of this kind provides for voluntary hospitals the less claim they have to autonomy, self-control and independence and that individuality which they have had up to the present.

I have heard no case up to the moment showing why voluntary hospitals as at present defined and which will cease to come under that definition should be regarded as places to which the vast preponderance of the money which is supplied could usefully go. If that argument has been put forward I have not heard it, and if it [2280] has not been put forward I would like to hear it. We have no better reason to believe that voluntary hospitals as they have been constituted in the past will usefully use a huge amount of money as compared with other hospitals. That is my first difficulty. I warn every voluntary hospital that gets from the State a huge amount of money, and an amount of money which is going to be, on these calculations, altogether more than they have been getting from voluntary sources, as to what is going to happen under the new conditions. When they take that money they are imperilling that position and the claims they have previously made will not necessarily be recognised.

I am very much of the same opinion as Deputy de Valera. I find great difficulty in putting any argument of a definite character behind any of the figures, whether 25, 33, 37½ or 50. These seem to me to be empiric figures. I have heard no suggestion which would make any of these figures sacrosanct. My feeling is that in the absence of a definite argument showing that a huge proportion should go to the voluntary hospitals, the proportion that should go to those not now so designated should be increased. I would like to see the whole of this money—assuming that we are going to get this money— paid into a central fund and distributed not upon this empiric basis at all——

Mr. Davin: A State fund.

Mr. Flinn: At first it would have to go into some central fund which would have to be a State fund to some extent, and the regulation of that fund would undoubtedly have to be settled by the State.

Mr. Davin: State control.

Mr. Flinn: To the degree to which State control would be exercised. That is again a question. If the State, through this House, sets up any machinery for the selection of the people who will control that fund, to that extent it will be a State fund. The less interference there is by the State, in the way the State ordinarily interferes with things of this kind, the better. I would like to see the State setting [2281] up an impartial body of competent people who knew what use to make of it, and not interfering with them once they were satisfied that they had set up that competent body. We are in agreement to that extent, that it must be a State fund in so far as it is set up under the authority of the State, and the regulations for its carrying out would have to be settled in this Dáil or through some State source.

Mr. Davin: That would mean a State lottery.

Mr. Flinn: It is a State lottery now.

Mr. Davin: No, unfortunately.

Mr. Flinn: It is a State lottery. So do not let us fool ourselves. I do not believe in any camouflage about it. If we are fooling ourselves that this is not a State lottery we would fool ourselves about anything. I would like to see that money put into a central fund of that kind, under competent, scientific and medical control, and I would like to see every penny paid out of that fund on a case stated, not some empiric figure to voluntary hospitals, not some empiric figure to county hospitals, but just in the same way as a county council deals with a road scheme, a sanitation scheme, or something else. Anyone who wanted money out of that fund would have to show a case in relation to the work they were doing, the inadequacy of their equipment, and so on. A second case would be founded on the developed work which they could and ought to do if they had an adequate fund; and a third point the financial position of that concern and their difficulty in facing up to the work which they had to do in the future.

Show me such a case, and I will vote for fifty per cent. seventy per cent. or ninety per cent. unless some one is prepared to give me a case which shows that the seventy-five per cent. should go the other way. If a case is shown that the voluntary hospitals are in some peculiar way able to make better use of this money than anybody else, then I will vote entirely with them in this matter, but unless and until that case is stated, it seems to me that the general burden of evidence is in favour of a wider [2282] proportion to the hospitals which now are not called voluntary.

Mr. Davin: Deputy MacEntee has certainly made his position quite clear so far as those who were listening to his speech can put an ordinary meaning upon his words. He stated quite bluntly that his objections to the principle contained in this Bill— he previously said the same thing in reference to the original Act—were so strong that if he had his way there would be no Act of any kind and, therefore, there would be no money, either for the voluntary hospitals or the country hospitals.

Mr. MacEntee: I said nothing of the sort.

Mr. Davin: The Deputy objects to the extension of the principle contained in the Bill. He explained it in far greater detail in a speech which he made on the Second Reading of this Bill. He also said that he would not be prepared to agree to a measure of this kind whereby such large sums of money can be expended unless they were expended without being subject to the supervision that State expenditure requires. Did he mean by that that he is in favour of a State lottery, or a system of raising money under the auspices of the State, and thereby having that money allocated by the State through some particular channel? Deputy MacEntee can assure himself, if he is not already aware of it, that when I was making the suggestion of a compromise I did so without considering the position of the voluntary hospitals. I agree with Deputy de Valera that we are discussing this matter in the dark in so far as we are not aware of the needs of the voluntary hospitals, or of the county hospitals, or as to the proportionate needs of the institutions that are likely to benefit under the terms of this Bill

I am only concerned in any vote which I may be asked to give as to whether it is possible to get fifty per cent. If it is possible to get fifty per cent. I am prepared to vote for it, but if there is a possibility of losing the fifty per cent. I want to see agreement, if agreement is possible, on some lower [2283] figure. I do not want to risk the chance of getting for the country hospitals thirty-three and one-third per cent. instead of twenty-five per cent. which is provided for in the Bill. Therefore, I want to know, first of all, from the Minister what attitude he is likely to adopt on the Report Stage if Deputy O'Kelly's amendment is defeated on a division. I also want to know from the Chair the form in which it is proposed to put the amendment. Is it that the words proposed to be deleted stand?

An Leas-Cheann Comhairle: Yes.

Mr. Flinn: Would it not be better to put the figures of fifty per cent., thirty-seven and a half per cent., or thirty-three and one-third per cent.? I can see Deputy Davin's difficulty. He does not want to fall between two stools. We are not trying to score over one another or to catch anybody out at all. It is a question of finding out what the House wants done in the matter. The Chair could put an amendment that fifty be the figure, or thirty-three or twenty-five, and we would find out what the House intends.

Mr. Davin: I am not professing to be an expert on procedure. I submit, for the information of those who desire agreement, that if the amendment is put to the House in the form “that the words proposed to be deleted stand,” it will preclude the Minister on the Fourth Stage from interfering with the decision of the House.

Mr. de Valera: I think it is only a matter of procedure that the Chair puts the amendment in a particular form. In this case it would be very much better if Deputy O'Kelly's amendment were put directly. It would leave the Minister free afterwards. It would be open to him then to propose thirty-three and one-third.

Mr. Fitzgerald-Kenney: Of course Deputies understand that the suggestion of thirty-three and one-third per cent. was an effort to reach a compromise. That, I am afraid, has been rather scorned. I would urge upon the House, rather than have this matter go [2284] to a division, that it would be wiser to accept that compromise. I have a completely open mind in the matter. I came to the conclusion that twenty-five per cent. would amply meet the needs of the county hospitals. I am willing, however, to abandon that attitude and accept thirty-three and one-third per cent. There was no tendency to move in the other direction. You cannot have a compromise in which one person stands firm and expects all the “give” on one side and all the “take” on the other.

Mr. de Valera: The Minister's way of looking at it does not appeal to me. He ought to be anxious to do that which he thinks is fair, not that which is politically convenient at present.

Mr. Fitzgerald-Kenney: It is not a question of political convenience.

Mr. de Valera: The best method of getting the views of Deputies on this matter is by putting the amendment as an amendment usually is put, independently to the House. Then we can vote either for or against 50 per cent. If the amendment is lost, it will still be possible for the Minister, if he really thinks 33⅓ per cent. is fair, to introduce an amendment to that effect afterwards.

Mr. Fitzgerald-Kenney: I agree with the Deputy that it is not a question upon which you can completely make up your mind as to whether the thing is fair or is not fair, because we have not, and we cannot possibly have, sufficient data before us upon which we could decide the matter with any degree of certainty. We can only approximate. I personally think 25 per cent. is fair for the county hospitals, from such evidence as I have got—not complete evidence. I think that would be better and fairer between the two than 33⅓ per cent. But I think that in a compromise both sides must give way to a certain extent, and this is not a question in which you have any absolute certainty.

An Leas-Cheann Comhairle: Let us be clear as to what is the point.

[2285] Mr. de Valera: The point I make is that the Chair ought to put this amendment first, and put it in its own terms, and not in the negative way which we have been accustomed to for convenience, so that Deputies might come down from the Division Lobby on their own side, or some such reason as that, by putting the question in the form “that the words proposed to be deleted stand part.”

An Leas-Cheann Comhairle: There is more reason for it than that.

Mr. de Valera: As far as I can see, putting the question, “That the words proposed to be deleted stand part,” is a negative form of putting an amendment for convenience, and is not in accordance with the rules of order at all.

An Leas-Cheann Comhairle: Will the Deputy suggest what difference it makes in this case?

Mr. de Valera: If Deputy O'Kelly's amendment is put and carried, that is all right; there is a majority in favour of that particular proposal. If it is lost, then the Minister, or anybody who thinks that 33⅓ per cent. should be inserted, would be in a position to move that afterwards. This one would be disposed of, and another amendment could be brought forward.

An Leas-Cheann Comhairle: It does not make any difference in what form the amendment is put. If the question is put, “That the words proposed to be deleted stand part”—that is, “three-fourths”—and if that were carried, it would not preclude the Minister or any Deputy from moving on the Report Stage to make it 33⅓ per cent.

Mr. MacEntee: May we take that as a definite ruling from the Chair?

An Leas-Cheann Comhairle: I am giving it from the Chair.

Mr. MacEntee: That makes the matter very much easier. I should like to refer to some remarks made by Deputy Davin. I think Deputy Davin ought to go to an auralist and have his hearing tested, because I certainly did not say that I was prepared to vote for Deputy O'Kelly's amendment because certain [2286] large sums which would thereby be allocated to the county hospitals were going to be spent without supervision. One of the reasons why I shall vote for Deputy O'Kelly's amendment is because there will be supervision over a large proportion of the money that is to be provided through the sweepstakes, otherwise than there would be under the proposals made by the Minister.

Mr. Fitzgerald-Kenney: The Deputy has not read the Bill. There is complete supervision over both.

Mr. MacEntee: There is no supervision over the expenditure.

Mr. Fitzgerald-Kenney: Of course there is.

Mr. MacEntee: There is no attempt at co-ordinating the manner in which this money will be spent by the several hospitals. The Minister also said that he had an open mind with regard to the matter, and later on he said that so far as he had made an examination of it he thought that twenty-five per cent. was a fair allocation. If he has made any examination of the problem at all he cannot have an open mind— he must have come to some conclusion. If now, with an open mind in th