Mother and Child Scheme
The Mother and Child Scheme was a healthcare programme in Ireland that would later become remembered as a major political crisis involving primarily the Irish Government and Roman Catholic Church in the early 1950s.
The scheme was referred to as the Mother and Child Service in legislation. A brochure, "What the new service means to every family", was prepared. It explained the new service but was not issued to the public. The scheme was engulfed in crisis before this could happen.
Since the establishment of the Irish Free State in 1922 responsibility in the government for healthcare had lain with the Minister for Local Government and Public Health. No significant reform of healthcare occurred in this time and the Catholic Church still retained effective control through the ownership of hospitals and schools, while family doctors still largely practised in isolation of other medical professionals.
Seán MacEntee started the process of reform as Minister for Local Government & Public Health in 1943. After the Second World War there was renewed optimism after the depression of the preceding decades. Once the Emergency was over the political agenda started to shift from Irish Civil War politics, which had dominated politics, to the domestic agenda and social issues. In particular issues like employment, health and housing came to the fore and this manifested itself in a move away from Fianna Fáil and Fine Gael.
Regarding healthcare, international trends such as in the National Health Service of the United Kingdom and elsewhere in Europe were noticed by the Irish political system. The Minister for Health was created as a separate Minister of the Government by the 1946 Ministers and Secretaries (Amendment) Act; this act also created the Minister for Social Welfare. Problems, such as a high infant mortality, increased concerns and the Fianna Fáil government published a much delayed White Paper in 1947. This paper was followed by the 1947 Health Act, in which the scheme was provided for in Part III of the act. However the 1948 general election resulted in the surprise fall of Fianna Fáil from government and instead the First Inter-Party Government would be left with the responsibility of implementing the scheme.
Noël Browne became Minister for Health in 1948; however he did not immediately introduce the scheme, but rather concentrated on other aspects of reform of healthcare. Even before the introduction of the scheme, there was some disquiet among the Roman Catholic Church and medical profession. While in opposition, Fianna Fáil pushed for the introduction of the scheme.
In 1950, Browne proposed introducing a scheme which would provide maternity care for all mothers and healthcare for children up to the age of sixteen, funded by the taxpayer. It met with ferocious opposition from conservative elements in the Catholic hierarchy, often at the behest of the medical profession. The Catholic Church leadership was divided between those like Archbishop of Dublin John Charles McQuaid who believed that it was the exclusive right of all parents to provide healthcare for their child, and younger moderates like William Philbin who saw some merit in state assistance to families. Browne received supportive advice from Francis Cremin, a Maynooth professor of theology and canon law. Some bishops, like McQuaid, also feared that it could pave the way for abortion and birth control. Though some Catholic Church leaders may have been privately sympathetic to Browne and wished to reach an accommodation, what was viewed as Browne's tactless handling of the Catholic Church forced the moderates into silence, allowing the anti-Mother and Child Scheme members of the hierarchy under McQuaid to set the agenda.
Many doctors disapproved of the scheme, some on principle, others because they feared a loss of income and a fear of becoming a kind of civil servant, referring to the plan as "socialised medicine". Browne refused to back down on the issue but received little support even from his Cabinet colleagues, most of whom he had alienated on other matters, notably his failure to attend many cabinet meetings and the lack of support he had shown them in other crises. Isolated in cabinet as a 'loner' who did not consult with his more experienced cabinet colleagues, he also faced the hostility of his own party leader, Sean MacBride, with whom Browne had also fallen out, as he had with most members of the Clann na Poblachta Parliamentary Party, who resented his appointment to cabinet over the heads of more senior colleagues, and who were also offended by his treatment of them.
In April 1951, MacBride demanded Browne's resignation as a Clann na Poblachta minister. Browne duly submitted his resignation to the Taoiseach John A. Costello for submission to President O'Kelly. The resignation took effect from 11 April 1951.
In his resignation statement, Browne told the House:
I had been led to believe that my insistence on the exclusion of a means test had the full support of my colleagues in the Government. I now know that it had not. Furthermore, the Hierarchy has informed the Government that they must regard the mother and child scheme proposed by me as opposed to Catholic social teaching. This decision I, as a Catholic, immediately accepted without hesitation.
...if this matter had been handled with tact, with understanding and with forbearance by the Minister responsible, I believe we would not have had the situation which has been brought about to-day.
Dr. Browne explained his approach to the Dáil by saying:
I might say that my question to their Lordships was: Is this contrary to Catholic moral teaching? The reply, as you all know, was that it is contrary to Catholic social teaching. I was not aware — the Taoiseach can verify this — until I had asked each member of the Cabinet separately what he proposed to do, what he had been given to understand by Dr. McQuaid when that decision was taken. He then told us that that morning he had been informed by Dr. McQuaid that Catholic social teaching and Catholic moral teaching were one and the same thing.
The following month a general election was called and in June 1951 a new government was formed as a result.
A derivative of the scheme was implemented subsequently by the Fianna Fáil government which returned to power as a result of the general election. This achieved legislative effect in the 1953 Health Act; this and later legislation that created the Voluntary Health Insurance Board in 1957 removed the compulsory attempts of government to reform healthcare. Thus what became called the two-tier system was born, the private and public systems existing side-by-side, later reinforced by the 1970 Health Act, which was the next significant legislative reform.
- Ministers and Secretaries (Amendment) Act, 1946
- Health Act, 1947
- President O'Kelly convened a meeting of the Council of State in 1947, to consider whether Part III should be referred to the Supreme Court, but he decided against doing so. See Kelly, Hogan and Whyte The Irish Constitution (4th ed., LexisNexis Butterworth, 2003) par 4.5.110.)
- According to James Dillon, Browne's cabinet colleague, he had a quiet word with the moderate Archbishop of Tuam, Dr Walsh, in an attempt to defuse the row. Walsh agreed to try to calm down the controversy and secretly meet Browne. When Dillon told Browne, Browne went down to Walsh's residence without first arranging an appointment. Walsh was away on Church business. In what Dillon saw as a disastrous error, Browne travelled to meet the neighbouring bishop, Dr. Dignan, a "lunatic" in Dillon's view and one of Browne's most trenchant critics. They had an argument that inflamed the situation. In revealing that he had originally gone down to see Walsh, Browne compromised the position of the potential go-between, who was forced to row in reluctantly with his more hardline colleagues.
- Gabriel Kelly et al. (eds), Irish Social Policy in Context (UCD Press, 1999) p.29.
- Maurice Manning, James Dillon: A Biography (Wolfhound Press, 2000) p.228.
- Dáil Debates: 11 April 1951 Vol 125 Col 641.
- Dáil Debates: 12 April 1951 Vol 125 Col 667.
- Dáil Debates: 17 April 1951 Vol 125 Col 954.
- Dáil Debates: 17 April 1951 Vol 125 Col 947–948.
- Health Act, 1954
- Health Act, 1970