Against the Tide

by Noël Browne

  Throughout the 1948 election, and especially after Seán MacEntee’s revealing and unrefuted attack on MacBride, there was a feeling among some of us that we were working with people with whom we had little in common. Those of us who were non-army accepted the proposed coalition with Fine Gael because we had entered public life in hopes that we would see the end of the damaging and meaningless political alignments of the civil war. The proposed coalition would end the monopoly of office of Fianna Fáil. Since there was no precedent from which we could gain experience or warning of the possible insoluble contradictions in a coalition, we welcomed the innovation, with its possibility of breakthrough to conventional European-style left-right politics.

  As it later transpired, the ex-IRA group, led by Seán MacBride particularly on the issue of the primacy of the Catholic Church over parliament, had no serious policy differences with Fine Gael. As Mr de Valera was to show later, neither had he nor his party.

  I was powerfully motivated by my hope that we might make progress on general health needs in our hospitals, and especially to curb tuberculosis. In a discussion before the formation of the Cabinet about possible ideological conflicts with Fine Gael, as I even then envisaged them, Seán MacBride and I made a pact designed, in effect, to achieve limited objectives. This was certainly my understanding of it. MacBride went on to summarise it succinctly: ‘When your health service objectives are fulfilled, tuberculosis controlled, your hospital buildings that high, Noël, we will go to the country, and ask for an increased mandate.’

  With a mixture of innocence and naïveté I accepted this assurance. A little thought, and more of the scepticism which I later developed about such promises, would have shown me that whatever about Seán MacBride’s good faith and the sincerity with which it was offered, such an assurance would cut no ice with his ex-IRA comrades. Had he indeed gone back to tell them that since I had now achieved our main objectives in the Department of Health, he intended to call an election for a larger mandate, his comrades would have been astounded.

  In the negotiations leading to the formation of the coalition, an interesting piece of black propaganda appeared in de Valera’s Irish Press. The paper issued a list of probable ministerial candidates for office were a Labour-Fine Gael coalition to be formed. The black propaganda element was the inclusion in the list of young Jim Larkin as Minister for Education. Larkin, many years previously, had returned to Dublin following a spell at universities and colleges in Moscow, and had stood for election as a member of the Communist Party. He backed his election campaign by putting out lurid anti-Catholic propaganda and called for the virtual suppression of the power of the church as the influential institution it then was in Irish public life. Not surprisingly he was defeated. Having become a respected member of the Labour Party, Larkin was elected to a Dublin constituency in the 1948 election. What the writer of the Irish Press article well knew was that the proposal of Larkin as Minister for Education would almost certainly scupper any possibility of the formation of a coalition government. A Communist in the Department of Education, even today, is unthinkable. That fine liberal politician, Owen Sheehy Skeffington, had been expelled from the Labour Party merely for being a liberal.

  To give some idea about the attitudes to Communism at that time, even in Labour circles, I recall asking Jim Everett, leader of the National Labour Party, how it was that the very experienced, widely acknowledged and talented Larkin had not been nominated by William Norton or elected by the party for a Cabinet post, even the most innocuous. Everett’s reply was brief and instructive. There was no possibility of Larkin being brought into Cabinet because of his Communist background: ‘If Larkin politically ever shows the whites of his eyes, we’ll blow the top of his head off.’

  With a mixture of bewilderment, unbelief, and delight at my new access to power and authority from a subordinate medical post in an obscure small country sanatorium, I took over the Department of Health determined to revolutionise the quality of the health service. In a small way we were to show just how much could be gained through the existing state bureaucracy, in spite of its inherent inefficiency and defects.

  Easily the most important immediate need was the elimination of tuberculosis. We had promised to do this, if given power by the people. The response to my call for help from the much maligned ‘intransigent’ civil servant bureaucrats began my own re-education about the true potential of our civil service. There was no need for a Commission of Inquiry into what needed to be done. Tuberculosis control had been a special study of mine since I had qualified as a doctor.

  The Department of Health was transformed into a battle headquarters. Since I had considered the need for an efficient tuberculosis service for many years a clear plan of action was quickly outlined. The first essential was the limitation of the disease by the isolation of existing known possible sources of infection. The nearly pandemic nature of the disease stemmed from the failure to establish a disease control organisation in which diagnosis, followed by isolation of the index case, was the most immediate need. Denmark, a small country, had already shown what could be done simply by efficient diagnostic isolation and treatment facilities. They had succeeded in containing the disease as a first step towards its control, long before the introduction of the miracle anti-tuberculosis drugs.

  Although we were fully engaged in the anti-tuberculosis drive, we also established a badly-needed diagnostic and cancer hospital treatment service based on an entirely new, superbly equipped hospital, built on a new site on the outskirts of the city. This became known as St Luke’s Cancer Hospital. A group of provincial centres was also established. These proposals had been recommended by the Cancer Council which we had established in April 1948, some two months after taking up office. We also set out to build a new or reconstruct some seven thousand hospital beds all over Ireland. We reconstructed and re-equipped our county homes. We launched a new ‘clean food’ code, backed with a press, radio and film campaign directed to educate the public in methods of hygienic food preparation, sale and usage.

  We established new regional hospitals in Cork, Limerick, and Galway in addition to St Vincent’s Hospital, Crumlin Childrens’ Hospital, St Loman’s in Dublin, Ardkeen in Waterford, County Hospital in Manorhamilton, Kilkreene Hospital in Kilkenny, Gurranebraher Hospital in Cork, Foynes Children’s Hostel. There were St Mary’s Hospital in the Phoenix Park, the James Connolly Memorial Hospital, the St James’s Municipal Hospital in Dublin and many more. We established a new National Rehabilitation Organisation in Dublin; it is now a great multi-million pound national institution. There was a BCG inoculation service, a diphtheria vaccination scheme, a mass radiography scheme.

  Early in my association with Seán MacBride, he, Noel Hartnett and I were dining in the Bailey Restaurant. Seán was called away urgently to the telephone to hear that his wife Kit had been taken into Jervis Street Hospital, dangerously ill. Kit desperately needed a blood transfusion, yet Ireland did not have a national blood transfusion service.

  It was late on a Saturday evening. The speediest and safest way in which we could be sure of getting the needed blood was for each of us to join members of the hospital staff in scouring the streets of Dublin for a member of the defence forces. The pubs were the most obvious starting point and for obvious reasons not the most desirable. Meanwhile the staff had set about calling up the various army barracks for assistance. It was the practice for soldiers to carry a disc on which was stamped their blood group. Eventually we found a hapless soldier, who appeared to be quite sober, and Kit’s life was saved, following a transfusion and treatment.

  Now I was in a position to set up the National Blood Transfusion Organisation with the job of acquiring premises and mobilising equipment, staff and an administrative organisation throughout the whole country to provide what became one of the finest blood transfusion services in the world. Though I made valiant attempts to establish the headquarters for the blood transfusion service in the centre of Ireland, I was fascinated by the civi
l service ingenuity with which it was not found possible to find a suitable centre outside Dublin.

  Our new young department was faced with truly astonishing demands on its dedication, its ingenuity, its technical and professional skills in coping with this gargantuan step towards a worthwhile high-level health service for our people, and it performed magnificently.

  We commandeered Colaiste Mobhi, a joint army barracks-Church of Ireland Teacher Training College in the Phoenix Park. The army was transferred to alternative army accommodation down the country. That was simple to achieve, soldiers being accustomed to being ‘ordered around.’ Persuading the teachers to vacate their institution was somewhat more difficult. In the end, they accepted alternative accommodation in a former castle, once the Shanganagh Hotel, set in a considerable acreage of land on the Bray Road. Colaiste Mobhi, lavishly reconstructed, became the magnificent St Mary’s Hospital.

  With the agreement of the local authority, we acquired temporarily a new general hospital in Mallow, Co Cork, as yet unopened. We requisitioned as a TB sanatorium a mental hospital just opened as such in Castlereagh, Co Roscommon. We mobilised a number of small fever hospitals, which because of the decline in infectious fevers were no longer used, as well as a number of underused district hospitals, and reconditioned a number of workhouse ancillary hospital accommodation beds. We erected dozens of surplus army Nissen huts as extensions to existing sanatoria facilities. Anywhere and everywhere that emergency facilities could be mobilised, we sought help. In both local and state authorities, everyone worked to end a great national tragedy.

  The immediacy and spontaneity of the response, its versatility, originality, and creativity, make it hard for me to understand the adverse criticisms so frequently made about the rigidity and lack of imaginative planning of the civil service and the state bodies. Would that our politicians, industrialists and farmers had the dynamic qualities of many of our state services as shown at that time, both at local and central level. Is this not simply another example of the civil servant taking the blame for the less than competent politician, businessman and farmer?

  Contracts for reconstruction of old buildings were on the risky but speedier ‘time and material’ basis. Working all through the night builders did not on the whole abuse its possibilities for excessive profits. Trade unionists were happy to help. In answer to our advertisement for a surgeon to organise a new national thoracic surgical service, Mr Maurice Hickey strolled into my rooms in the Department of Health, a truly refreshing and exciting personality, well over six feet tall. All his energies were to be preserved for the job ahead of him; a chauffeured car was put at his disposal. We guaranteed all the help he needed, at local authority level and at central government level. He need only ask. Every facility was given to him to set up his regional operating theatre requirements all over Ireland. Only a man of his total dedication, limitless energy and personal charm could have taken on so successfully the outrageous demands made on him by us. Mr Hickey was to be on the road continuously when not in the operating theatre; his whole-hearted response to the challenge of the time epitomised the behaviour of all involved in our campaign.

  Because major construction work had ceased during the war years and with the general inertia of Fianna Fáil in the post-war years, there was an enormous backlog of work. Departmental pigeonholes were full of promises to build hospitals and health clinics, extending as far back as the mid-twenties. Because of the low priority given to health matters by Fianna Fáil and indeed by all our native governments, few had been started by 1948. It was fortunate that while hospital building activity had stopped during the war, the planning of hospitals and clinics through the country had gone ahead. Virtually every local authority in Ireland seemed to be in need of some health facility, and to have its new hospital plan. Our first health estimate showed that 135 proposals for new hospitals, and repair to existing ones, were under review, the cost of which was estimated to be £27 million.

  During the laying of the foundation stone for Galway Merlin Park Regional Hospital, a Fianna Fáil deputy, Mark Killilea, a member of the opposition who had been generously helpful to me on a number of occasions, asked me in a guileless way: ‘What are you at? We used to make great mileage out of simply promising hospitals coming up to an election, and then forgetting about them. We would keep the hospitals until the next election. What will you do when you have built all these places?’

  Deputy Killilea was simply following a pattern set for him by his leaders on all sides in politics and in public life in Ireland. ‘We’ll drain the Shannon, restore the language and end partition’ (Eamon de Valera and Brian Lenihan): ‘We’ll provide a hundred thousand new jobs’ (Seán Lemass); ‘We’ll throw all the rocks of Connemara into the sea’ (James Dillon); ‘We’ll drown the British in eggs’ (James Dillon); ‘We’ll twist John Bull’s tail’ (Seán T. O’Kelly); ‘We’ve taken the gun out of politics’ (John Costello). Brendan Corish, when Labour leader, promised ‘Socialism in the seventies’. There is even Dr FitzGerald’s recent liberal ‘crusade’ for a pluralist Ireland, not to mention his promise of some years ago: ‘I‘ve done my sums and the cost of living should not rise by more than five, or at the most six, percent when we join the EEC.’

  All the regional sanatoria, the James Connolly in Dublin, Merlin Park in Galway, Sarsfield Court in Cork, were designed in the architectural section of the Department of Health under our imaginative, infinitely patient and talented New Zealand architect Norman White and his staff. These great buildings, still serving the public, stand today as monuments to their high standard of workmanship, design and finish. Who says that a state department cannot be creative, imaginative, and practical? Our massive hospital building programme was to lead to one of the very few occasions in which the Republic of Ireland was paid the highest of accolades. Shortly after the completion of the building programme in the late 1950s an international jury of experts voted Ireland, with Sweden, as ‘having the most advanced and finest hospital system in the world.’ This rare honour was barely referred to or commented on in the national press or radio. It must be assumed that this collective silence was an act of deliberate censorship, required because the ‘discredited’ former Minister for Health was now a forgotten man on the backbenches.

  Our total programme entailed a proposed expenditure of £30 million. We planned to replace all existing hospital beds, or otherwise upgrade the standard of accommodation in existing hospitals throughout the country. The programme amounted to a total of over 7,000 new hospital beds.

  Luckily, the finance needed to build so many new hospitals was available from the Hospital Sweep funds. Unlike the rest of my Cabinet colleagues, as Minister for Health I had absolute personal control over these funds, under the Hospital Sweeps Acts, There was none of what James Dillon, Minister for Agriculture, ruefully complained of as ‘treasury control’ over spending. I enjoyed the added advantage that all my predecessors had followed the same miserly spending on hospital building work. They spent only the income from the interest on the accumulated capital invested from successive sweeps. This amounted to a mere £100,000, but I needed millions. The £100,000 annually could not possibly build badly-needed hospitals all over Ireland. We decided to alter that policy radically, and proceeded to liquidate all the available assets in the Sweep funds invested. When we costed the various projects, it became obvious that we would still not have sufficient funds to meet our needs, so I decided further to pre-empt the income expected from the fund during the following seven-year period. This permitted us to carry on the building of all the hospitals, sanatoria, and clinics which were needed. They could be paid for as the projects matured from projected incomes of future sweepstakes. The Department of Health quickly established the seriousness of its intent to provide eight to ten thousand beds in eight to ten years, a massive building programme unequalled before or since.

  This radical departure from former spending in the Department of Health must have tested the patience of my departmenta
l secretary, Paddy Kennedy. Our early days together were turbulent. I was the youngest minister ever to have been appointed to a new ministry on his first day in parliament. To the apprehensive Mr Kennedy I must have appeared to be a woefully inexperienced person. I had been appointed to the post of Minister for Health, and at the same time I was a doctor, in conflict with the accepted convention of parliamentary politics; it is preferred that the political head of a department should not himself be involved in the speciality controlled by that department.

  Further to Mr Kennedy’s worries, I had no administrative experience. I had worked as a medical officer in sanatoria in England and in Ireland. A technocrat I might be, but without any serious administrative experience. Not surprisingly, Mr Kennedy, a mature and experienced civil servant who at one time had worked with Mr de Valera, felt apprehensive about working with his new Minister for Health. It is probably true to say that my innocence of all that was involved was in many ways a useful cushion between myself and my intimidating new responsibilities.

  I set out with many of the layman’s misconceptions about a politician’s life, and what it entailed. With the end of the cheers, flashbulbs, photos and congratulations, an early assessment showed that there was a price to be paid.

  The serious-minded Cabinet minister must work very hard. He is a departmental head and attends twice-weekly Cabinet meetings. He must meet hundreds of citizens, individually or collectively, who wish to consult him. He undergoes the critical and trying ordeal of parliamentary work, including parliamentary questions. As a working politician, he must keep in touch with his political base in his own constituency. Then there are his family and his children. Because of his frequent absences, they grow up with all the disadvantages of a one-parent family; family life becomes impossible.