by Noël Browne
A broad white silk shawl covered his frail bent shoulders, falling down on each side to cover his hands, in which he clasped the glinting gold processional monstrance. His dark eyes, glittering in a masklike face, were transfixed on the shimmering white sacred Host. He had a long, straight thin nose and a saturnine appearance, with an awesome fixity of expression, and the strong mouth of an obsessional. One shoulder was slightly raised; it was said that he had had a major surgical operation for tuberculosis (possibly a thorocoplasty). Drowsily fantasising on the imposing and fearful procession in a mixture of dream and nightmare, I was nudged into wakefulness by Laithwaite. ‘What an impressive figure, Noël: would he not make a notable addition to the distinguished company of Spanish Inquisitors?’
Some strange happenings during the whole period of the mother and child controversy have never been fully explained. For instance, the proposals under Section 26 of the 1947 Act to which Dr McQuaid and the Catholic hierarchy would later take exception had passed through the Oireachtas uncontested or unquestioned by any member of the hierarchy. Dr O’Higgins made no reference whatever to what he later described as the ‘socialisation’ of medicine involved. Neither did Dr. O’Higgins contest the mother and child health scheme proposals or refer to any aspect of the scheme whatever as being objectionable during our discussions in Cabinet on the Amending Bill to the 1947 Act, presented by myself in June 1948. My proposals for the amendment of the Fianna Fáil Health Act, as was the practice, had been circulated in advance to each member of the Cabinet.
Seán MacBride would later assert that I had gone ahead ‘impetuously’ with the free no-means-test scheme without the consent of the Cabinet. This was demonstrably untrue. The book of estimates for 1948 notes the sum of money agreed between my department and Mr McGilligan’s Department of Finance. Neither of us could or would have gone ahead with a scheme of that magnitude without the consent of the government.
Neither has it been clarified why the Taoiseach’s Department never referred to the fact that de Valera had privately received a protest from the Catholic hierarchy, on 6 September 1947, about the free no-means-test principle of the health scheme sometime after the passage of the Act.
It appears that the Catholic hierarchy, on 6 September 1947, had sent a letter privately to the Taoiseach’s office in which they belatedly expressed their disapproval of the new 1947 Health Act and its free, no-means-test proposals. This important letter claimed that ‘for the State, under the Act, to empower the public authority to provide for the health of all children, and to treat their ailments, and to educate women in regard to health, and to provide them with gynaecological services, was directly and entirely contrary to Catholic social teaching, the rights of the family, the rights of the Church in education, and the rights of the medical profession, and of voluntary institutions’.
The peculiar feature about that letter was that de Valera did not reply to it until 16 February 1948, that is, nearly five months after having received it and a mere two days before the general election in which his government was to be defeated. In his brief reply he made no attempt to protest about this clear intrusion by the bishops in a matter already decided on by the Oireachtas, and claimed that the matter was sub judice.
Following the change of government, Mr de Valera’s department appears to have made no attempt to warn the new Taoiseach, Mr Costello, about this threatening letter. It is true that in 1951, during the debate on my resignation, Mr Costello for the first time made a vague passing reference to having seen it. Why was it that the Department of Health did not appear to have been warned of the receipt of that letter? It is possible that de Valera did not choose to disclose the receipt of the letter to the Department of Health, yet he did write a letter to the Minister for Health, Dr Ryan, now available in the records of the State Paper Office in Dublin Castle. If the civil servants in the Taoiseach’s office knew of the letter, why did they not draw Mr Costello’s attention to it? If, on the other hand, they did tell Costello of the existence of this protest by the Hierarchy, why did he not refer to it during the Cabinet discussion of my amending Health Bill in June 1948? If Mr Costello knew of the letter of protest, why did he choose to ignore it? Did he fear the possibility of a conflict in Cabinet? Did he fail to read the file carefully? Did he fail to understand its implications? Did he understand its implications, and suppress the letter for later use against a troublesome Minister for Health?
While I always believed that a conflict with the medical profession was nearly inevitable, and I was well prepared for it when it did come, I had no reason to believe that there would be opposition from the hierarchy. Even if I had known I would still have expected the Cabinet to implement the law.
The amending Bill proposed by me to the Cabinet in June 1948 kept the no-means-test principle of the 1947 Fianna Fáil Act as it was. From the centre of the long Cabinet table, beside the Taoiseach, John Costello, and in the proletarian voice which he affected on such occasions, Bill Norton, the Labour Party leader, shouted down to me, ‘Yer not goin’ to let the doctors walk on ye, Noël?’ Before I could answer him, the Taoiseach asked, ‘What would you prefer, Doctor?’ I replied that I would prefer to keep the existing proposals, free of direct charge, and with no means test, already included in the Fianna Fáil Health Act.
Acting on the unanimous approval received in Cabinet, the Department of Health proceeded with difficult negotiations with the medical profession as well as with various interested departments, including the Department of Finance.
Mr McGilligan was concerned with the immediate and long-term financial charges on the Exchequer. He made provision in the 1950-51 book of estimates for £400,000 for the proposed mother and child scheme. There was a further provision in the book of estimates for 1951-2, for the expenditure of 1.8 million pounds.
At an executive meeting of Clann na Poblachta I explained what was being done to create the essential services infrastructure needed for a comprehensive scheme of this kind. On a scale never attempted before or since, we had set out to replace virtually all the existing dilapidated hospital beds, and upgrade all the existing hospital accommodation by the provision of major hospital and other building projects, supported by radical improvements in medical, nursing and para-medical facilities of all kinds. We wanted to remove the one valid argument which could reasonably be used by the medical profession, i.e. that the diagnostic or treatment facilities did not exist, and so could not bear the imposition of a greatly expanded health scheme. I was able to assure the executive that we were already making good progress with our building programme and the organisation of essential services such as mass radiography, a blood transfusion scheme, BCG and diphtheria inoculations and a national rehabilitation service. There was also a new highly ambitious national cancer diagnostic and treatment service. We established a series of independent limited companies to ensure speedy action in the achievement of these ends.
The party executive was enthusiastic about the proposals. But I reminded them that while we would do all that we could to mobilise the public on the side of the scheme there would be a conflict of interests with the wealthy consultants.
Some weeks after I had been given Cabinet permission to implement the mother and child scheme, I instructed my personal staff to devise a longterm public educational programme, with the help of Aodh de Blacam and Frank Gallagher. The enthusiastic public response in favour of the scheme in the general election that followed the collapse of our coalition showed just how successful this programme had been. Department of Health education and information services hammered home one simple message. Under this scheme there would be no more doctor’s bills, no more chemist’s bills, no more hospital bills, no more financial fear of ill-health. The message was unanswerable. The people welcomed the prospect of funding a health care service which would be freely available to anyone who needed it.
There is some irony in the fact that our proposals appeared so attractive to the public that everyone was eager to claim political
credit for them. Tom O’Higgins was quick to contradict Clann na Poblachta claims to have originated the scheme, and other Fine Gael speakers pointed out that ‘the mother and child scheme is not just a Clann na Poblachta scheme, it is a government scheme’. The irony lies in the fact that just as soon as the hierarchy intervened, it ceased to be a Fianna Fáil, Fine Gael, Labour Party, or even Clann na Poblachta scheme; it became the Dr Noël Browne mother and child health scheme.
10
Crisis
IN July 1950 we submitted a formal scheme for a mother and child health service to the Medical Association. It aimed to provide full free medical care before, during, and after childbirth. There was to be an entirely free family doctor medical-consultant service and, if need be, free G. P. and hospital care for all children up to the age of sixteen years. Visits to the home by a midwife were also to be free. Compared to the delay and sordid inefficiency of the dispensary service, it was not surprising that the public gladly welcomed the new scheme. There was no doubt about the well-merited unpopularity of the dispensary services. The Chairman of the National Health Insurance Council, Bishop Dignan, had said about it, ‘The poor law system is tainted at its roots now, as it was when introduced, of destitution, pauperism, and degradation’. Bishop Dignan was the only member of the hierarchy to write to me approvingly of the scheme.
It must not be thought that I believed doctors should be exploited by the state in their valuable humanitarian service to the community. On the contrary, as a doctor myself, I well knew the rigorous discipline needed in the long and costly seven-year primary training, with the subsequent further training practice needed as a consultant. A distinction should be drawn between the two types of doctors in practice. The consultant specialises in a narrow range of medical defects and illnesses over a number of years after his already long years in training to become a doctor in the first place. For this special knowledge he expects to be paid higher fees.
Looked at from the practical point of view of the consumer, it is the consumer who will suffer should the medical profession be dissatisfied with its working conditions in a national health scheme. As a practical act of consumer protection, it pays a government to make sure that the medical profession is happy. It is a notable feature of the British national health service that not only did it become the best health service in the world, but repeated surveys showed the medical participants to be satisfied with their working conditions.
With the increasing pressure on the politicians by the medical consultants and the bishops, it became clear that Cabinet enthusiasm for the scheme was waning. This growing coolness froze on 10 October 1950, when I was peremptorily ordered to Archbishop McQuaid’s palace by a telephone call from his secretary. I was told to attend a meeting, to be held on the following day, concerned with the proposed mother and child health service and the bishops’ position in regard to it.
I could not understand why any bishop should not be prepared to meet a government minister in his department. This was the practice where other citizens of whatever rank or religious persuasion were concerned. It appeared to me to be an affront to my Cabinet office, and to the public who had elected me, that a government minister should be ordered by any private citizen in this way. Yet my Cabinet colleagues informed me that it was in fact the practice, under Irish government protocol, for a minister to be expected to attend, when told to do so, at a bishop’s palace. They could not understand my point of view. Neither was I told the conditions under which I would be received; that there would be three bishops present while I, though requesting permission to do so, was bluntly told that I might not bring my Departmental Secretary.
The following afternoon I set out for the Archbishop’s Palace. Dr. McQuaid brought me into a small anteroom, and courteously invited me to sit down. Contrary to what I expected, he had a particularly warm smile.
In opening the conversation Dr McQuaid chose, of all subjects, to discuss child prostitution, informing me: ‘the little child prostitutes charge sixpence a time’. Concluding this strange interlude, he invited me into a larger and more imposing room, where two bishops were introduced to me as Dr Staunton, the Bishop of Ferns, and Dr Michael Browne, the Bishop of Galway. As soon as we were settled, a letter from the hierarchy was read to me by Dr McQuaid.
10 October 1950
Dear Taoiseach,
The Archbishops and Bishops of Ireland at their meeting on October 10th had under consideration the proposals for a Mother and Child health service and other kindred medical services. They recognise that these proposals are motivated by a sincere desire to improve public health, but they feel bound by their office to consider whether the proposals are in accordance with Catholic moral teaching.
In their opinion the powers taken by the State in the proposed Mother and Child Health Service are in direct opposition to the rights of the family and of the individual and are liable to very great abuse. Their character is such that no assurance that they would be used in moderation could justify their enactment. If adopted in law they would constitute a readymade instrument for future totalitarian aggression.
The right to provide for the health of children belongs to parents, not to the State. The State has the right to intervene only in a subsidiary capacity, to supplement, not to supplant.
It may help indigent or neglectful parents; it may not deprive 90% of parents of their rights because of 10% necessitous or negligent parents.
It is not sound social policy to impose a state medical service on the whole community on the pretext of relieving the necessitous 10% from the so-called indignity of the means test.
The right to provide for the physical education of children belongs to the family and not to the State. Experience has shown that physical or health education is closely interwoven with important moral questions on which the Catholic Church has definite teaching.
Education in regard to motherhood includes instruction in regard to sex relations, chastity and marriage. The State has no competence to give instruction in such matters. We regard with the greatest apprehension the proposal to give to local medical officers the right to tell Catholic girls and women how they should behave in regard to this sphere of conduct at once so delicate and sacred.
Gynaecological care may be, and in some other countries is, interpreted to include provision for birth limitation and abortion. We have no guarantee that State officials will respect Catholic principles in regard to these matters. Doctors trained in institutions in which we have no confidence may be appointed as medical officers under the proposed services, and may give gynaecological care not in accordance with Catholic principles.
The proposed service also destroys the confidential relations between doctor and patient and regards all cases of illnesses as matter for public records and research without regard to the individual’s right to privacy.
The elimination of private medical practitioners by a State-paid service has not been shown to be necessary or even advantageous to the patient, the public in general or the medical profession.
The Bishops are most favourable to measures which would benefit public health, but they consider that instead of imposing a costly bureaucratic scheme of nationalised medical service the State might well consider the advisability of providing the maternity hospitals and other institutional facilities which are at present lacking and should give adequate maternity benefits and taxation relief for large families.
The Bishops desire that your Government should give careful consideration to the dangers inherent in the present proposals before they are adopted by the Government for legislative enactment and therefore, they feel it their duty to submit their views on this subject to you privately and at the earliest opportunity, since they regard the issues involved as of the gravest moral and religious importance.
I remain, dear Taoiseach,
Tours very sincerely,
(Sgd) James Staunton,
Bishop of Ferns,
Secretary to the Hierarchy.
&nbs
p; Having read the letter to me, the bishops appeared to assume that the interview was over. In spite of this I chose to tell them that there were a number of mistaken assumptions and assertions on which they had based their memorandum, arriving at false conclusions which appeared to me to invalidate many of their claims. For example, there was no question of compulsion for either patient or doctor.
Dr. McQuaid asked why it was necessary to go to so much trouble and expense simply to provide a free health service for the 10% necessitous poor. This comment was not only wrong, since the percentage involved was thirty and not ten, but surely represented a strange attitude from a powerful prelate of a Christian church towards the life and death of the ‘necessitous poor’ and their children. I replied that if I were an ordinary member of the public, then such a position was possible through ignorance. As a doctor, I believed that a free health service was an essential pre-requisite to an effective and a just health service. As Minister for Health the necessitous poor, a considerable sector of our society, were my special responsibility. I was implementing a Cabinet decision, in accordance with the law passed by the Oireachtas.
Bishop Browne then took up a question dear to his heart, that of the burden of rates and taxation. He claimed that it was unfair to tax the rest of the community in order to give the poor a free health service. I pointed out that taxation was surely not a matter of morality; as far as I was concerned, it was a problem for the government, the Minister for Finance and myself.