HL Deb 13 August 1919 vol 36 cc834-41

My Lords, I rise to ask whether the attention of His Majesty's Government has been directed to the in:—pending closing of Lice Houses of Industry Hospitals in Dublin; if it is intended to take any action relating thereto; and to move for Papers. I desire, if possible, to draw from the Government some sympathetic view and practical assistance in connection with the serious difficulty that has arisen with regard to the management of four hospitals which are essentially State hospitals, and at the present time are supposed to be supported by a grant from Imperial resources.

It is not very easy for your Lordships to understand the exact position without being informed of the constitution of there four hospitals. This is really a serious matter which ought to be dealt with, and hope to suggest one practical way of dealing with it. In the eighteenth century theme were established, by the Irish Governments of the time, a series of hospitals to provide surgical and medical aid for the poorer classes in Dublin and in Ireland generally, and these hospitals for a time fulfilled the functions now fulfilled by Poor Law Relief Hospitals. Under the Act of Union this was one of the liabilities taken over by the Imperial Government, and a short time after the operation of the Act of Union it was found that difficulties, both from a practical and monetary point of view, arose with regard to these hospitals. Two Inquiries were held. One was an Inquiry by the House of Commons in the year 1854, and the second was as Inquiry held by a Commission, which was generally referred to as the South Commission, in 1856. The South Commission reported that these hospitals were doing such good work that they should be maintained in their then state of efficiency.

The Report of the South Commission was followed by an Act of Parliament called the Hospitals Regulation Act, 1856, and this Act constituted the hospitals in their present form. They consist of a group and are called the Richmond, a surgical hospital; the Whitworth, a medical hospital; the Hardwicke, a purely fever hospital; and the Auxiliary block, for surgical and certain emergency services. These four hospitals are constituted under the Statute with a government of a very peculiar character. The Lord Lieutenant of Ireland—of course, it is the Irish Office, but nominally it is in the name of the Lord Lieutenant—exercises complete control over the management of these hospitals. He appoints—not as governors, because it was so decided by the case which arose in Ireland, but as merely a committee of inspection and assistance (an advisory committee we call it now)—a number of governors. These governors cannot appoint officers without the sanction of the Lord Lieutenant. They cannot dismiss officers without the sanction of the Lord Lieutenant; and the hospitals are bound by the Superannuation Act of 1859, a position which. I do not think has arisen in connection with any other hospital with which I am acquainted, certainly not in Ireland.

The building themselves are not private property, but are vested in the Commissioners of Public Works in Ireland, and nothing can be done in that way to mortgage or charge these buildings, except with the approval of the Commissioners of Public Works in Ireland. I mention this to show your Lordships how completely these are semi-State institutions; but more than that, resulting from the recommendations of the South Commission, a sum of £7,600 originally and now £7,500 per annum is provided as being sufficient to keep up these hospitals. From 1856 down to the beginning of the war this grant was found sufficient—a rather tight fit perhaps but still sufficient—to keep them going. I should explain that they are so situated in the poorest part of Dublin, and so regarded as fulfilling all the functions required for giving aid to the poor, that the ordinary Poor Law Hospital at the north side of the City of Dublin was closed, and prior to the war these hospitals dealt with the ordinary Poor Law relief cases. Of course we all know that it is utterly impossible to keep any institution going on the same rate of contribution that was possible before the war, and if I give your Lordships figures you will be able to appreciate the practical difficulty that has arisen. I am informed that while prior to the war £64 12s. 11d. per patient was sufficient to keep the hospitals going, in 1919 the sum required per patient was £119 1s. 10d. That, I think, will be the experience of all those who have had to deal with ordinary hospitals which are supported by voluntary contributions.

The position in Dublin is this. There are a number of hospitals supported by voluntary contributions. Most of them at the present time are in debt. The difficulty of getting the public under present conditions to clear off debt or to keep the hospitals going in their old condition of efficiency is practically insuperable. These particular hospitals have no private subscriptions. The Statute under which they were constituted did contemplate private subscriptions and donations, and there is a provision in the Act by which a certain number of governors may be appointed by those who have given donations, but in consequence of the fact that private donations are not forthcoming to what was always regarded as a State institution, this power has never been used, and at the present time the governing body is one nominated by the Lord Lieutenant of Ireland. The hope of getting money in present circumstances from private sources is, I am afraid, an impossibility, and that is the condition of things which has arisen. These hospitals, the four of them put together, are practically the largest institution of the kind in Ireland. They have practically the largest nursing and training establishment, which is a most important public matter, and they also have got possibly one of the largest if not the largest clinic in Ireland. The closing of them accordingly will not only affect the indigent poor but seriously affect medical I science and practice in Ireland. It will also seriously affect the question of the training of nurses.

These, my Lords, are absolute bedrock facts, and at the present time the governors can do nothing. The hospitals are practically closed, and there is no chance of their being opened unless some practical solution is found. I do not know what view the Government may take of the matter and how far they consider that they have any obligations connected with them. It is not my habit to press things to an unreasonable conclusion. I think it may be fairly said that these hospitals are not practically speaking purely government institutions. It may also be said that they are not purely private institutions. Any additional income which they get comes from the patients who pay for services rendered, and accordinaly it is a case in which I can understand the Treasury saying, as they have said, "this £7,500 was fixed and we will give no more," but at the same time the words of the South Commission unquestionably proceeded, as I am informed, on the basis that these hospitals were to be kept going—not merely that they were to get a ''kind of charitable grant of £7,500 but that they were to be kept going in their then state of efficiency.

This is a state of affairs which, coupled with the fact that the control is in his Excellency's hands, places the onus upon Government of trying to help in a situation which is intolerable and which in the coming winter will lead to great misery, loss and suffering to the poor in Dublin. Perhaps a business Inquiry representing the Treasury, the medical profession, the governors, and perhaps some of the business glen of Dublin might come to some conclusion. The doctors say, as I am informed, that suddenly to shut down one of these hospitals is practically impossible. If you shut down the Fever Hospital there will be no sufficient accommodation for fever patients in Dublin, because the only other hospital is an institution kept up by voluntary contributions. If we shut down the emergency block serious cases will have to be sent all across the City in cars ambulances, with great suffering to the patients. The doctors say it is practically impossible. Surely it is a question which might be inquired into rapidly and carefully. Some solution might be found before the winter. I understand that for all practical purposes the four hospitals are closed now, and that is something which ought not to be allowed.


My Lords, I should like to support this Motion of the noble and learned Lord, Lord Shandon. I think that he has made out a very clear case by establishing that these are State hospitals, and that there is some responsibility attaching to the State with regard to them. There is another point that I should like to emphasise, and that is that the Lord Lieutenant has complete control and appoints the governors, who in turn appoint the officials without referring to the Lord Lieutenant. Surely the noble and learned Lord has made out a very strong case for these hospitals and has demonstrated that they might reasonably look to the State for some help. The poor of Dublin—and they are very poor many of them—will suffer immensely from this. There is another most important point which the noble and learned Lord made. If the fever hospital is shut, which is very likely to be the case, and if we get an outbreak of any infectious fever in Dublin, the one other place that they might be sent to might be crowded out, and where are the sufferers to go? The cost of patients before the war was £64, and now the cost is £119. Surely if the State has taken control of these hospitals there is some responsibility on the State to provide more money in order to allow them to carry on their work. There are many hospitals in Dublin, but to shut up four is a very serious thing indeed, and I hope that the Government will show that at all events they appreciate the situation. I am not myself in favour of a Commission or a Committee. For my own part, I should much rather see the grant increased, then perhaps with the help of the public and private subscriptions which might be given under these hard circumstances we should be able to manage to keep the four hospitals going. They are very much needed in Dublin.


My Lords, the noble and learned Lord below the gangway said that this was essentially a State hospital. It is quite true that this hospital was established under Statute in 1856, or rather that its direction was controlled by Statute passed in 1856, but it is not a State hospital in the sense that it renders any special service to the State. It does not. It assumes no special responsibility, for instance, towards looking after Government servants—Post Office employees, Police, or whatever they may be—and it can only be said to be a State hospital in the sense that for the last half century it has relied upon State funds. This hospital differs in no degree from any other hospital in Ireland or in Britain, except that it has had this good fortune for many years of having a special grant. It is an old established hospital, and I believe it received grants under the old Irish Parliament, but since the year 1856 it has only received a sum of £7,600 from the Parliamentary votes. Its position, therefore, is unique. Apart from one or two smaller hospitals in Dublin I believe no other hospital in this country gets a grant from the State except in return for specific services rendered. Lord Shandon says that some practical solution is wanted. Lord Mayo explains more clearly what that practical solution is—namely, that the State should meet this deficit. I do not know whether my information is correct or whether Lord Shandon's is, but I have accounts before me, and it would certainly appear that the State subsidy of £7,600 is not the only source of income available to this charitable institution.


It is the only one except the private patients.


It has other receipts.


Other receipts from patients who are treated as private patients. I mentioned them.


I beg the noble and learned Lord's pardon; I did not take that point from him. During the last two or three years the hospital has had a very considerable income from the War Office apart from the money voted by Parliament. Last year it was £7,000; the year before, £6,300; in addition to that it has had an income, as I gathered from the noble and learned Lord, from the fees of patients who can afford to pay.


They are not very large, but there are some.


They are upwards of £3,000 a year. I am afraid that I cannot hold out hopes to the noble and learned Lord that the Treasury will see its way to recommend Parliament to pay a larger sum than this annual grant. After all, it must be remembered that this hospital starts with very great advantages. It receives in fact the income from what would be an endowment of £150,000 or more, and the Treasury, I have to inform your Lordships, though prepared to continue the Parliamentary grant as it has done for the last half century, subject to the assent of Parliament, can undertake no further responsibility in respect of this hospital. If that item of £3,000 comes from fees of patients it shows that the Dublin public as a whole, apart from its contribution through Imperial taxes, is making no effort whatever to support this hospital. I think that everybody will share the regret of Lord Shandon that this institution is unable either through increasing its fees, through enlisting the good offices of subscribers, or perhaps through getting some help from the Corporation of the City of Dublin, to add to its income, and I would share his regret, and your Lordships would likewise do so, if the hospital were to close. But I do not think it is wise to press the Treasury to increase this grant. To do so might, of course, involve reconsideration of this and the analogous grants which exist in Dublin, and would clearly involve equivalent demands from a hundred and one other hospitals both here and in Ireland which are in necessitous circumstances. Under these conditions I think that steps must be taken to rehabilitate the financial position of this hospital apart from those which might come from Government Funds.


I do not formally move my Motion for Papers. I merely put it down in order that I might explain the circumstances. I would point out taat it is not a question of these hospitals being closed in the future; they are closed in the present. I did not know that they were all closed at the time of putting clown the Motion on the Paper. In regard to private resources and fees from private patients, one cannot very well get them if there is no staff and no hospital, and the hospital is closed so far as ordinary hospital work is concerned. That being the case, it is scarcely a place which can derive much assistance from private patients, competing I suppose with ordinary private hospitals. That is the position of affairs, and I regret very much that the Government do not see their way at least to endeavour by some process of inquiry or getting people to meet together to put these hospitals in the position they previously occupied.