Authors: Noël Browne
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.
I
N 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.
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.
So far their concern had been strictly with temporal issues. There was a distinct cooling in the previously warm manner of the Archbishop. He questioned the right of the state to assume the
responsibility of ‘the education of mothers in motherhood’, or to provide a maternity and gynaecological service for women, and claimed that these were dangerous powers for the state to
arrogate to itself. He mentioned possibilities which in those days were quite unthinkable, even in many of the advanced western European countries. He postulated the inevitability of contraception
and abortion.
During the subsequent general election in 1951, these two forbidden subjects were to become examples of clerically-inspired ‘black propaganda’ and were frequently claimed to be part
of my health proposals. So also was euthanasia for the aged and sterilisation for the unfit. Quickly forgotten was the fact that I was the first Cabinet minister seriously to concern myself with
doing something for the sick and aged. At An Cnoc parish church in Connemara, where I spent weekends learning Irish, I was referred to during a sermon in Irish as being one of those people who
‘come amongst us disguised as friends, when meanwhile their real work is to poison the wells, and so kill off our stock’. This was clever and damaging imagery. How I valued the courage
of my good friends Seosaph O Cadhain, Seán O Conghaile and others who, under such pressure, refused to disown or repudiate me.