MEDICAL CHARITIES (IRELAND) BILL. (Hansard, 25 June 1851)

§ LORD NAAS
said, he wished to say a few words on the principle involved in this Bill, which appeared to him to be entirely novel. It was the first time, he believed, that any proposition had been brought forward for levying, through the medium of the poor-law machinery, taxes for other purposes than those of the relief of the poor. He did not mean to say that this objection pervaded the whole of the Bill, but it went through a great part of it. If this principle were established, the people of Ireland might afterwards be called upon to allow the machinery of the poor-law to be used for lunatic asylums, gaols, and other purposes, which were now supported by different means. He thought the mode of levying taxation as carried into operation under the poor-law sufficiently objectionable as it was, and only excusable under the circumstances in which the country was placed. He trusted, therefore, that the Committee would consider the matter well before they took a step of this kind. With regard to the details of the measure, he thought that the House was entitled to expect from his right hon. Friend the Secretary for Ireland a statement respecting the practical effect which he anticipated from the operation of this Bill. He admitted that the present mode of administering medical relief was not what it ought to be; but still admission did not involve a necessary acquiescence in the propriety of the change proposed. He should like to hear from his right hon. Friend an estimate of the number of dispensaries, hospitals, and medical officers which would be required if the measure became law. He should like also to know, though he did not expect an exact account, what amount of additional taxation would be wanted to be raised to carry out the measure.

§ SIR WILLIAM SOMERVILLE
said, that considering this Bill had passed through the House in the last Session of Parliament, and had been read a second time in the course of the present, he was rather surprised to find his noble Friend asking for explanations with respect to the change of system in collecting funds for medical relief—a question on which he thought the House had been entirely agreed. His reason for proposing the 1241 change was, that nothing could he more unsatisfactory than the present system of levying rates for medical charities in Ireland, and there was no way of rectifying the evils which had arisen without having recourse to the poor-law system of rating. Had he been aware that this question would have been raised, he could have shown numerous instances in which, with a wealthy neighbourhood, there was a plethora of dispensaries, while in poorer districts, where they were much more needed, there was a plentiful lack of them. It was absolutely necessary, therefore, that the mode of raising funds for the administration of medical relief should be changed, and he did not think that any more equitable plan could be adopted than a system in accordance with the poor-law system of rating. The alteration which he proposed to make was not altogether new, as, with regard to fever hospitals and dispensaries, in order to justify grand juries to apportion a particular amount of rate for their support, it was necessary that an equivalent sum should be made up by private or public subscription. The portion of rate intended now to be taken from the landed proprietor was heretofore represented by the subscription which he paid. The returns of subscriptions and amounts of taxation voted for the support of these establishments, showed that in 1845 they came to 170,000; in 1846, 121,000l.; in 1847, 122,000l.; and in 1848, 113,000l. In the year 1845, the number of dispensaries was 754; in 1846, 670; in 1847, 670; in 1848, 655. His opinion was, that if these dispensaries were properly distributed over the country, that a lesser number would be amply sufficient. He believed 465 well-distributed and well-managed dispensaries would be sufficient for the wants of the population. Taking, then, an average of 95l. for each dispensary, that would give 44,175l. as the amount which would be probably required for the support of the dispensaries of Ireland, thus effecting a considerable saving, as the present expense amounted to between 60,000l. and 70,000l. Now, as regarded the infirmaries and fever hospitals, their number was considerable. In 1845, they amounted to 108; in 1846, to 137; in 1847, to 130; in 1848, to 107; and he believed that, by adopting the system of district hospitals, a very large number of them would be done away with. From the calculations he had made he believed that, if the districts were properly marked out 1242 and defined, seventy-four district general hospitals, each with sixty-eight beds, would be sufficient for the treatment of all diseases. If he remembered right, the average number of beds now was fifty; and although under the plan which he proposed, the number of hospitals would be considerably smaller than at present, for they now exceeded a hundred in number, there would be altogether a larger number of beds. The increase would be 1,013 beds, which would be supported at the public expense. The expense of the hospitals and infirmaries was calculated at 53,655l., so that the total expenditure under this measure would be about 97,830l. Another point to be considered was, the enormous expense of the temporary fever hospitals in the different counties in Ireland, in consequence of the very defective state of the law when any sudden calamity occurred. He found from a return that the cost of supporting these temporary establishments under the Fever Act, was, in the year 1848, no less than 81,448l. A considerable saving also, he thought, might be effected in the present item for vaccination. He had now endeavoured, as far as he could, to comply with the request of the noble Lord (Lord Naas). The calculations he had given were made from data which perhaps could not be strictly relied on; but it was the best data that he could select, and at all events it was sufficiently accurate to dispel any notion that the plan proposed by this Bill would be more expensive than the old system. He believed the plan would be infinitely fairer to the ratepayers, and far more beneficial to the poor in Ireland, to whom the relief was administered.

§ MR. G. A. HAMILTON
considered the statement of the right hon. Secretary for Ireland was very satisfactory. Remembering how landed property in Ireland was already burdened, he thought the Committee had a right to know what the views of the Government were. If a rate not exceeding twopence farthing or twopence halfpenny in the pound would suffice for all the purposes of this Bill, he thought the measure would be very advantageous to that country. He had an Amendment to move in the first clause, to substitute the word "or" for the word "and." His object was to give the power of selecting "a physician or surgeon," instead of "a physician and surgeon" for these charities.

§ SIR WILLIAM SOMERVILLE
said, 1243 he would not object to that alteration.

§ MR. GRATTAN
said, that much of the sickness in Ireland had been caused by the neglect of their duties to the poor on the part of the absentee gentry; and he objected to this Bill because it would reduce the present amount of medical relief from 118,000l. to 97,830l.; which latter sum would be further encroached upon in order to pay the salaries and other expenses of the proposed new machinery. He considered that to be the worst of all economy which sought to effect a saving by cutting down the amount of relief and medicine given to the poor when suffering from sickness. The Government had already exposed themselves to some obloquy by reducing the grants to the hospitals and other charitable establishments in Dublin, and he recommended the Irish landlords to reflect before they permitted their property to be taxed by an irresponsible body of men.

§ MR. O'FLAHERTY
supported the measure, and thought the arguments of the hon. Gentleman (Mr. Grattan), respecting the negligence of the gentry and otherwise, only proved the necessity for this Bill. He was not quite disposed to consent to the Amendment proposed, as he thought that plenty of men possessing the double qualification of physicians and surgeons might be found, and it was most desirable that gentlemen of the highest qualifications should be obtained for these appointments.

§ COLONEL DUNNE
said, if this Bill was adopted, the sum of 23,646l., the total amount of donations made by the Governors of Irish hospitals, would all be lost, as well as 26,000l. derived from other subscriptions. The result would be that the burden would be taken from the richer classes, and placed on the shoulders of the poorer. The subscriptions to infirmaries alone amounted to 117,618l.; those to the dispensaries were 74,000l.; and the fever hospitals, under the poor-law, cost for the temporary hospitals about 50,000l., and for the permanent ones 31,724l. He was convinced that there could not be less expended on medical charities in Ireland than 180,000l. The right hon. Gentleman the Secretary for Ireland said the proposed plan would only cost about half that sum; but he was satisfied that it would require a rate of between 3d. and 4d. in the pound, which was infinitely higher than the calculations of the right 1244 hon. Gentleman. This Bill proposed a system of centralisation in which he could have no confidence, after past experience of the management of the fever hospitals under the poor-law. Local administration was the only effective check upon mismanagement; and he should, therefore, support all the Amendments to be pre-posed going in that direction. He thought the counties ought to have the power of exempting some of the infirmaries from the operation of this Bill, if they desired it.

SIR ROBERT FERGUSON
moved an Amendment to omit the words which confer on the Commissioners any power over hospitals, except that of inspection. His object was to restrict the operation of the Bill to dispensaries. He did not deny that the present hospital accommodation in Ireland was inadequate and defective; but he believed that the Committee was not at present in a condition to legislate on this branch of the question.

§ MR. REYNOLDS
warned the Committee against the adoption of this Amendment, and hoped that the right hon. Baronet the Secretary for Ireland would not consent to it, as hospitals and infirmaries ought, equally with dispensaries, to be placed under the inspection and supervision of the medical board. He thought great sacrifice of human life had arisen from the mismanagement of the hospitals, whether connected with the workhouse or otherwise; and there ought to be some protection given by the Bill to the sick poor against the cupidity of the local governing; bodies in certain districts. Economy of human life wont before economy of money; and he was glad to find that principle recognised by this Bill.

§ SIR WILLIAM SOMERVILLE
opposed the Amendment on the ground that the infirmaries and hospitals required supervision as much as the dispensaries. He felt bound to controvert the assertion that the burden under this Bill would fall heaviest upon the poorer classes. With regard to the infirmaries in particular, there could be no great loss from the sacrifice of subscriptions, because the total amount of the subscriptions to the dispensaries in Ireland in 1849 was only 1,300l.; the amount raised by the grand jury as- 1245 sessments for the dispensaries being 26,000l., all of which sum was exclusively levied from the occupying classes. Therefore the richer classes would not be relieved of their burden, at the expense of the poorer ratepayers, through the operation of this Bill. Again, the county infirmaries at present were so situated that, beyond a certain radius, they were utterly useless.