An additional sheet of amendments to this Bill was circulated to Members last night. This sheet contains amendments to section 7, namely, Nos. 8a and 8b which must be considered before amendment No. 9 on the main sheet of amendments.
SECTION 7.
Health Bill, 1969: Committee Stage (Resumed).
I move amendment No. 8a:
In subsection (3), page 6, line 39, after "Council" to add "and persons nominated by such organisations as, in the opinion of the Minister, are representative of officers and servants employed in the functional area of each local committee".
My fellow Deputies and myself have tabled this amendment because we feel that one of the major difficulties facing the Department of Health and particularly the regional health boards that will be established will be to convince the electorate particularly at local level that there will not be any undue bureaucracy and that there need not be any excessive allegations of domination by political party representatives, that there will not be a faceless public servant behind such committees unanswerable and generally unadvised by the persons employed in the functional area of each local committee.
It is essential that these committees should be more broadly based than is envisaged by the Minister in this Bill and that they should be seen to operate on that basis. There seems to be in this House and, indeed, throughout the country the belief that the only basis of representative capacity is the elected one of public representatives themselves. I suggest with respect that there is a very urgent need that those who spend their lives in public service should be given an opportunity, and have, in fact, the basic right and entitlement to have the opportunity, of contributing directly their advice and guidance to the benefit of the services themselves.
As we are fully aware, the health services are now a major growth sector in the social security system of the State. It is our desire and intention, as it has always been the policy of our party, that they should be extended on an even greater scale. If the local committees of these regional health boards to be set up by the Minister in 1970 right up to 1971 do not afford an opportunity for those employed in the services to contribute their advice and guidance, then the effectiveness and authority of those committees will be considerably diminished. There is a whole host of medical personnel in the State, doctors, surgeons, county medical officers, pharmacists, dentists and so on and while they have representation at committee level on a limited scale, there are many other categories who should be able to select from among themselves substantial representation on these local committees. It is a reflection on the democratic instincts of the State and on the representative capacity of our people that, for example, a whole range of para-medical staffs such as ambulance drivers, proters employed in hospitals, switchboard operators, ward attendants, laundry workers, dieticians, boilermen, radiographers, physiotherapists, social workers, almoners, together with the regular medical personnel, have, under this legislation, no formal involvement or participation at local committee level. Accordingly, I would recommend that the Minister would give very serious consideration to this amendment. It would be opening up, if I might bring in the vogue term, the concept of participative democracy, industrial democracy, whatever else one wants to call it.
I do agree with the Deputy that in the modern world there must be more participation in discussion in relation to Government matters or local government matters. The difficulty is how to provide for this without making the machinery unworkable. In this case the proposed constitution for each of these local committees is two county councillors for each county electoral area, the county manager, the county medical officer or his equivalent, the resident medical superintendent of the district mental hospital, one general hospital consultant, two other doctors in the county elected by the profession and two other persons. The two councillors for each county electoral area will be elected by the county council and the two other persons will also be elected by the county council.
It is more than possible that county councillors themselves would represent the interests of those who are regarded as staff and workers in an area. County councillors of all parties claim they represent, and listen to representations from, people in the trade union world. In their own right under the category of "two other persons", if they so choose, they can appoint a person with trade union interests in mind or who represents particular classes of workers taking part in health administration.
I find it very difficult to accept the amendment when I consider that there are some 15 organisations representing officers and servants of health authorities. I think it would be rather impracticable under present circumstances to provide that they should have their representatives attend the health committees. As the Deputy knows, conditions of employment are decided on by the chief executive officers of the health boards with an appeal to the Minister, and the trade unions have an ample opportunity to make such representation as they desire with regard to the changes in the conditions of employment. Negotiations for remuneration are provided by conciliation and arbitration machinery. Up to now this has not been a statutory machinery. In the past the trade unions have engaged in discussion with the county managers but when this Bill is passed they will engage in discussions with the chief executive officers. There is nothing to prevent any group who represent officers and servants of the health authorities sending a deputation to discuss possible improvements in the health service in that area with the local committee. That kind of work could prove to be most useful and I would regard it as a practical kind of participation. Some of these 15 organisations might play a very minimal part in relation to the number of officers and servants belonging to them; but if any one of these organisations felt they really could contribute something they should be received by the local committees who would examine their grievances in relation to the character of the service and examine their grievances in relation to improvement of the service. The committee could then make quite sure that the health board examines such proposals if the committee itself approved of them.
I simply could not see a proliferation of representatives over and beyond those I have already mentioned. There will be a considerable number of people on these committees who will be very much aware of the views in regard to health services expressed by the representatives of the officers and servants of the health authorities.
I appreciate the validity of what the Deputy is seeking in theory but I suggest the best way to deal with this is by discussion with the health committee. In that way the Deputy cannot say there is not participation. The health committee itself can make no decisions; it can only give advice to the health board. It can then make decisions in regard to recommendations if it so chooses, having met a deputation from any one of these organisations in an area.
I think we must make a distinction between advice given, participation within and representative capacity. I recall reading many of the Minister's speeches made in his other capacities during the last decade in which he was a consistent advocate of the concept of participation. It would be a rather futile exercise for any one of the 15 staff organisations referred to by the Minister to go cap in hand to give advice to the local advisory committee, who in their purely advisory capacity would in turn convey this to the regional health board.
I cannot honestly accept the Minister's assurance that because there are 15 organisations representing officers on the health side it would be difficult for representation to be given to them on these committees. The vast majority of the 15 organisations in question could nominate local committees on an area basis in the same way as the local harbour boards are nominated by the Trade Union Congress. It is all very well to say to the nurses in the local hospitals that they can have their medical superintendent on the local committee but they cannot have representatives of the nurses' organisations. The resident medical superintendent of the psychiatric hospitals may be on the local committee but the thousand nurses in the hospitals within the area of that local committee will have no representative. We are not asking for a very big concession because it has been clearly stated that the local committees are purely advisory ones. All we are seeking is greater participation. It can be quite easily alleged that they will become monolithic bureaucratic structures, as they are in Dublin, catering for 1,000,000 people. I hope that before the Report Stage the Minister will be able to find a solution to this matter.
I have sympathy with the Deputy in what he is seeking. The nearest comparison I can think of is the joint consultative council in CIE in which the management staffs in regional areas meet the operative staffs and consider suggestions for the improvement of the service. They also, of course, consider grievances, which are provided for in another way in this case. I shall think the matter over and, if there is any way of providing some sort of consultative council, and if it is practicable to do so without making inroads on other local government legislation, which might confuse the issue, then I will so provide. If I cannot so provide I still maintain that these groups of workers should be able to have effective participation through meeting the local committee on an arranged basis. However, I shall consider what the Deputy has in mind.
Amendment, by leave, withdrawn.
Amendment 8b in the name of Deputy Dr. O'Connell. Deputy Desmond may move the amendment, if Deputy O'Connell so wishes.
Not at this point of time, I regret.
Amendment No. 8b not moved.
I move amendment No. 9:—
In page 6, between lines 39 and 40, to insert the following new subsection:—
"(4) The number of members of the council of the county or county borough or Dún Laoghaire Borough Council, as the case may be, provided for in regulations under subsection (2) of this section shall exceed half of the total membership of a local committee."
The purpose of this amendment is to secure that on the local committee a majority will be given to the representatives of those who are called on to pay for the services provided. The Minister has already accepted the Fine Gael idea of providing that a majority on the local health board will be members of the local authority and the purpose of this amendment is to secure that a similar provision will apply in the case of local committees. It would appear from the Minister's proposals that in a number of local committees the elected representatives will have a majority. That would be the case where there would be eight electoral areas with two councillors from each area, which would give 16 councillors altogether; the people proposed by the Minister would number eight and that would give a two to one majority in favour of the local authority representatives.
In some areas there would be no more than four electoral areas which would mean there would be only eight local councillors matched, on the Minister's proposals, by the county manager, the county medical officer, the resident medical superintendent of the district medical hospital, a consultant from a general hospital, two doctors residing in the county elected by the profession and two other persons. The two doctors residing in the county would meet Deputy Dr. O'Connell's amendment but that amendment would, of course, impose a statutory obligation by giving such representation. For the Minister simply to indicate his proposals does not amount to a statutory obligation. The two other persons would presumably be the Minister's own nominees; both could be people of the calibre Deputy Desmond mentioned.
It is provided that the county councils will appoint the two other persons on the committee. I accept the Deputy's suggestion and I will table an amendment on Report Stage.
I am most grateful to the Minister, but I did not observe that the nomination of the two other persons rested with the local councils.
It is they who will appoint. I hope they will consider individuals who have some particular interest in a particular aspect of the health services.
Where does this appear in the Bill?
It will be done by regulation.
What will be the position in Dún Laoghaire.
It will be the same as elsewhere.
There are three separate areas electing representatives to Dún Laoghaire Corporation.
There will have to be a sufficient number from each area so that they would have a slight majority over the remaining appointees.
Will Dún Laoghaire Corporation have at least six members on the health board?
Presumably, yes. We are dealing with the local advisory committees.
I am dealing with the local advisory committee for Dún Laoghaire.
There will be eight persons who, in the ordinary way, will be persons other than county councillors, of whom two need not be county councillors but can be county councillors and, therefore, in order to have a majority on the regional committee, there will have to be a sufficient number of borough councillors from Dún Laoghaire to be in excess of the eight appointed between the three electoral areas.
I am prepared to accept what the Minister says in good faith, but he is Minister for Health pro tem. There may be a change. We have only got the Minister's statement to go on. The section does not definitely indicate who the members of the local committee will be and I would be much happier if the Minister were prepared to embody this in legislation. There are usually four electoral areas. That is more or less the overall pattern, but it does not obtain in all cases. You would have eight elected representatives, two from each electoral area. On top of that, according to the Minister, you would have the county manager, the county medical officer, the resident medical superintendent of the district hospital, a consultant from a general hospital— that is four. It is all a bit nebulous because, as far as I understand the Fitzgerald report, consultants will disappear altogether out of some counties. There will be no hospitals. There would then be two doctors residing in the county elected by the profession; that makes six. And there would be two other persons. That means the local committee will be eight against eight. Is that a satisfactory state of affairs? Who has the majority? Is it the people outside the elected representatives who have the majority or is it the elected representatives who have the majority? It would appear that neither of these groups has the majority. It is eight and eight.
I have said that I am putting in an amendment on Report Stage.
Yes, but I am not very clear as to the Minister's amendment. The Minister said it was a matter of ministerial regulation. What I am looking for is hard and fast legislation. We are not getting that here. I am accepting the Minister in good faith. Personally, I have confidence in the Minister. I do not know if all my colleagues agree with that. But, the Minister is there pro tem.
I am putting in an amendment. It will have to go into subsection (3) of section 7 and it will have to state that I must provide for a majority of local authority representatives in whatever regulations I make. That, surely, is clear enough?
The Minister has said that he would accept the effect of the amendment tabled by Deputy Ryan and I think Deputy Ryan, on that undertaking, was withdrawing his amendment No. 9.
No, he has not withdrawn it. My mind is not clear on this. As I see the position at the moment, it is eight and eight. By regulation, the Minister is going to change that. Perhaps, I am rather more stupid than my colleagues but I have not heard yet that there will be a majority of elected representatives.
I have not simply given my word, which I hope would be taken——
I accept the Minister's word but he will not be there forever.
I hope I will still be Minister for Health by the time we reach Report Stage. What I am doing is that, although I make the regulations, in subsection (3) of section 7 there will be an appropriate sentence added making it quite clear that when I make the regulations I must provide for a majority of local authority representatives within those regulations. I hope the Deputy accepts my statement.
Certainly. Would the Minister like to tell us how he proposes to do it? I think he faces a rather difficult situation in the existing legislation.
I can see no other way of doing it than by simply adding to the number of county councillors per electoral area. If one does that, I do not think it will make for too unwieldy a body.
The difficulty arose because the Minister was talking about providing in the regulations for county councillors having a right to elect the two other persons and, certainly, on this side of the House we understood that he was going to provide for this only by way of regulation. We accept his statement.
Amendment, by leave, withdrawn.
I move amendment No. 9a, which stands in my own name and that of Deputy O'Connell, Deputy M. O'Leary and Deputy Cluskey:
In subsection (5) (a), page 6, line 45, before "on" to insert "and the general public".
The purpose of this amendment is to seek an expansion of the role of local committees. What we have suggested is that, in addition to a local committee advising a health board on the provision of health services in the functional area of such committee, it should also have devolved on it the obligation to advise the general public. It may be that objection will be raised on the grounds that this is an advisory board on the provision of services. We take the broad interpretation of the term "provision of services" and we consider that it is not enough that a local committee should advise the board on the need for the provision of services in an area but should also perform the very useful social and public function of giving to the general public essential information on the entire range of health services available in a given area.
I have in mind, for example, that there is an absence of effective public information and advice bureaux for a great many citizens entitled to health services. If the amendment is accepted it may be that the health board will give local committees some appropriation of funds to enable them to perform this kind of essential work which would be of major public benefit. I find that a great many constituents become befuddled and bemused by the complexity of the health services and are not aware of the facilities open to them or the precise manner in which they can avail of them. I am also conscious of the fact that if this kind of work were done by local committees, then the total absence of Deputies from this House who should be concerned with the major matters of national legislation would be obviated; Deputies would be more frequently here rather than trying to unravel for constituents the complexities of health legislation. This is the kind of work that local committees could do extremely effectively. They could delineate and make available in pamphlet form information for the public. Naturally, they would have close liaison with the welfare officers and other staffs in the areas of health committees. They certainly could perform an essential function.
I am not satisfied that at the moment there is full information on the range of facilities available to the public. Bearing in mind that the health services in many areas are administered on a selective, means test basis, and that there, therefore, must arise problems for many persons, it would be a very useful addition to this legislation if the Minister were to introduce an amendment on Report Stage to provide for this public necessity, if our amendment is not sufficiently precise.
Mr. J. Lenehan
There is one thing to be said in favour of Deputy Desmond: he did not go to sleep like the man who was left here a week ago to represent the party. The preoccupation of a great many Deputies who may also be members of local authorities appears to be with getting the maximum number of persons appointed to these committees. It is not the number that should be the important matter; it is the calibre of the persons appointed. If we are just going to appoint persons to committees purely and simply for the sake of giving them travelling expenses——
On a point of order. I suggest that Deputy Lenehan is out of order.
Mr. J. Lenehan
I am not. I have been longer in this House than the Deputy.
The Chair would draw the Deputy's attention to the fact that the amendment before the House is not concerned with numbers, but merely with the dissemination of information to the general public.
Mr. J. Lenehan
If some of the members of local authorities that I know are going to be the persons who are to disseminate information to the people, the only thing I have to say is, may God help the public. Most of the long-winded contributions made to this debate on all Stages of this Bill were made by Deputies who are not members of local authorities.
Remarks by Deputies about "sleeping Deputies" and about Deputies being absent from the Chamber do very little for the traditions of this House.
Deputies
Hear, hear.
Mr. J. Lenehan
When I want advice in that regard from the Deputy, I shall ask him for it.
What I say has a bearing on remarks of that nature from all sides of the House. It does nothing to build up a decent tradition in this House. To come now, to the amendment, I consider it a very worthwhile amendment. I can foresee a situation in which a lot of pressure would be taken off the shoulders of local and public representatives if this information were freely available from the local authority. An advisory service should be set up to make known to people their entitlements. I urge the Minister to give this amendment serious consideration. It would dispel a lot of thinking in the minds of theorists that public representatives do not go to a lot of trouble to find out the position for people or alternatively claim they got the entitlement for them. This is not to say that Deputies and county councillors do not do much good work for the people they represent. However, the more information that emanates from the central or the local authority the better for the body politic and the better from the point of view of the esteem in which public representatives are held by the public.
It simply says that the function of the local committee is to advise. They can take on themselves any other function. To my mind, that is inferred. If I were a member of a local committee I would press the committee to make its views known to the public and to invite meetings of interested people.
I share the view that it is imperative not only to make the services technically available but to make them actually available and this requires a knowledge about the availability of the services. There is no use in pretending that we assist the least fortunate in our community unless these people see to it that the services are there for them. The danger is that we will make the administration of the services more remote from the people whom the services are intended to benefit. The further we remove the administration of services from people the greater will be the possibility that people will not be aware of the services available to them. I agree with Deputy Lenihan regarding the Bill as originally drafted. It is within the competence of a local committee to exercise the function of communicating to the people the availability of services but I cannot see anything wrong in Dáil Éireann's imposing it as a specific statutory obligation. It is undesirable to leave everything to the possible goodwill or good intentions or possible good practices of local committees. There might be local committees who would say, in effect: "This is not our function. It is part of the function of the Department of Health and we shall not bother with it". If this is something which the local committee should do, let us write it into the Bill itself.
In clause 99 of the 1947 Health Act, health authorities are permitted to provide information and advice on matters relating to health and it may be disseminated by the Minister or by local authorities through advertisements, notices, pamphlets, lectures, radio, cinema exhibitions or any other means. I hope that one of the functions of the health board will be to provide information offices and, with them, information officers. I agree that a considerable number of people are not aware of the scope of the services and how they apply to a particular case.
There are some information offices already. One is run by the Cork Health Authority—there may be some in Dublin, too—which, I am told, operates very satisfactorily. The provision of information offices depends on the raising of the necessary funds. The health board might not be able to accept proposals for too many information officers. The health committee will have a very valuable function in advising where its information offices should be. There is no need to write into the Bill a requirement that they should give advice to the general public because they are an advisory committee, reporting back to the health board and the county council. Therefore, I would ask the House to leave this to the intelligence of the health boards who will be encouraged to promote information offices and the local committees can give them information as to where these should be.
As one with experience in Cork I may say that this is in operation there for 12 months or more and is very satisfactory. The local councils will know best where these centres should be placed. It seems to me, however, that every representative will have in mind a place in his own locality and that we could have a multiplicity of centres as it would be very hard to refuse anybody's claim for his own locality, no matter how small it might be. Once we say that the public should know exactly what they are entitled to —what the law provides for them—I think we are doing all we should do. We should have some confidence that the local authority will know best where these centres should be provided.
(Cavan): The object of this amendment is to provide that the public shall have more information on the health services and that it shall be a statutory obligation on a local committee to give this information on the health services within its functional area. I gather from the Minister that the Act under which we operate at present contains a provision by which health boards and health authorities may give this information, but the object of this amendment is to impose on the committee a statutory obligation to give that information. This is a good thing and, as a matter of fact, there should be a statutory obligation on local committees to advise the public regarding health hazards.
At the moment the drug problem is very much before the public mind and I share the Minister's concern about this problem. I do not intend to deal with it at length. I am glad that it is now recognised by all that there is such a problem in our midst. No opportunity should be lost to bring home to the public and the young people in general what the dangers are to health in drug trafficking or dabbling in drugs. The statutory obligation which is imposed here could be used in the future to expose the danger of a similar problem. While the drug problem is advertised considerably, I do not think that the danger to health and the ruin that can be brought to young lives is fully stressed. I have in mind a programme on Radio Éireann last week when three young people were interviewed about the problem and the ways and means of getting drugs was discussed. The difference between the heavy drug and the less habit-forming drug was discussed but listening carefully to the programme, I noticed that sufficient emphasis was not given to the danger that can be done to health and lives through drugs.
There should be a statutory obligation on a semi-State body like Radio Éireann and a statutory obligation on our local health committees and boards that when such subjects as drugs are being discussed it should not be taken for granted—I do not want to be critical of the programme which I am sure was very well-intentioned—that all young persons or people generally who are likely to be tempted to use drugs know all about their effects. I am afraid that this programme in which these teenagers took part assumed that every other teenager in the country knew the great danger involved even in experimenting with drugs. The programme was spoiled because a few minutes were not devoted to emphasising that even experimenting or dabbling in drugs for the sake of experience could lead bit by bit to a habit-forming practice which could end up by people who started to experiment for "kicks" or experience spending the rest of their lives in and out of mental or similar institutions. Let me return to the amendment and become completely relevant. If a statutory obligation were placed on a local health committee to advise not alone a health board but the general public on the health services and health hazards in general it would be a very good thing.
I should like to accept the undertaking given by the Minister and I would urge him to ensure that when local committees are being set up they should receive circulars so that a situation in which there would be advisory offices set up, would come about.
In view of the support given to this matter, perhaps, the Minister, on Report Stage, could under Part V incorporate the suggestion about public information. I have no great objection to health boards having this function and disseminating information at local committee level. Perhaps the Minister would consider introducing an amendment on that basis on Report Stage. We welcome the Minister's innovation in regard to drugs but there is no point in prohibiting drugs if people do not know what their effects may be.
Members of the House have given me some very useful advice on this and on Report Stage and, perhaps, we will consider bringing in an amendment which would impose on regional health boards the obligation of establishing information offices, but the number of them and where they would be located would be for the health board. However, as in everything connected with health, this would depend on finance because we would have to plan in such a way that an over-enthusiastic regional board could not establish information offices in far too many areas, having regard to present day travelling habits and the facilities of communication. I will consider that.
In regard to dangerous drugs—we do not want to have a debate on this— I agree with a great deal of what Deputy Fitzpatrick said. We have not received any advice yet on the particular form of publicity to be used in connection with dangerous drugs, from the dangerous drugs working party. I understand from the experts that human psychology is something that has to be attended to with great care because there is an awful fear that if you give too much publicity to drugs you encourage drugs even though you warn people of their effects. I am not an expert and I am awaiting more advice.
(Cavan): I do not want to be misunderstood about this. I know that the Minister is very concerned about the drug position but what I am concerned about is that there is a considerable amount of publicity about drugs, and rightly so, but that publicity seems to assume that every teenager and every adult has been fully instructed and advised about the dreadful dangers inherent even in embarking as an isolated experience on taking drugs. I am afraid the danger is not as fully or as widely appreciated as the experts think. Even at the risk of using a mallet to kill a fly, every time the drug question is discussed or mentioned the inherent dangers should be ventilated.
Amendment, by leave, withdrawn.
Question proposed: "That section 7 stand part of the Bill".
On Second Stage I mentioned that it might be desirable to ensure that at least some members of the local committee should also be members of the local health board. The advantage of that is to have a situation in which members of the local health board would be acutely and directly aware of local health needs. It is quite possible that this will, in fact, occur that some of the members of the local committee and of the health board will be the same people. I think that is desirable. It may be difficult to write it into regulations but it is probably something local authority members will bear in mind in making the appointments. It is something we should think about because of its desirability.
In some respects it is a pity that the Minister is proposing that the local committee will be only an advisory body because there are some areas which are geographically remote from centres of concentrated population which will have peculiar difficulties and which, perhaps, should be administered locally. It may be insufficient to have a local advisory body without any administrative powers. Therefore, we urge on the Minister that the peculiar problems of isolated districts receive special consideration so that where you have hospitals and other services far removed from the centre of a health area, local executive powers would be given to the local committee. If you do not do that there is a grave danger that the services would become inefficient and unobtainable in the more remote areas. If we are careful in making the regulations we can avoid these things. One of the great drawbacks about this section is that the regulations which the Minister is to make creating the local health committees, dealing with terms of appointment, tenure of office, disqualification, removal of members, appointment of the chairman and vice-chairman, holding of meetings and so on will not be reviewed by this House. They will not be open to suggestions by this House although they will probably be open to review under amendment by this House. They are to be made by the Minister only after consultation with certain local authorities but he may consult them and feel in no way bound by the advice he receives from them.
We think it undesirable that regulations so far-reaching in their effects, so far as health services are concerned, should be made by the Minister without having to come before this House for consideration at the time of the initiation of the regulations. We would like to know what steps the Minister proposes to take to have further consultations regarding the regulations that he will make.
I think I have given enough indication of the method by which these local committees will be appointed and I hope the House will take my word for it. Naturally, there will be no change when I publish the regulations. I think we are sufficiently democratic here, certainly to the point where if I were to publish regulations that did not, in fact, come before this House—they do not have to under the Bill—there would be certain protest in the House if I quite obviously departed from what had been clearly said in the House. I should be a very foolish man to do so.
As regards remote areas, in subsection (5) (b) of section 7 it is provided that a local committee shall perform such other functions as may, subject to any limitation specified by the Minister, be delegated to it by the appropriate health board. As the House is aware, this is a complex piece of legislation and we want to make quite sure that the new regional health boards operate not only efficiently but with due regard to the health service needs in every area. The delegation of functions by a health board offers interesting possibilities. I do not pretend that at this stage I have thought them over.
One of the possibilities is that one might give specific executive authority to a health committee in relation to a particular service in a remote area. This must be very carefully examined. We do not want to make regional health boards ineffective through too much delegation of work to executive committees. At the same time, we want to ensure that a health board, as Deputy Ryan suggested, should not become monolithic and indifferent. I think we shall arrive at this partly through the advice we shall receive from health boards who can make suggestions to me about delegation of functions and partly through some ideas we may have in the Department on this matter. I think I could satisfy the Deputy by telling him that it is possible that a local committee could have some particular function, especially in a remote area where there are problems but, of course, they cannot have the function of raising finance.
Would the Minister have the question of general practice in mind as distinct from hospital to hospital control or local government committees?
I have not really thought it out. I hope the Deputy will forgive me. This is an immensely complicated measure and I have not thought it out but I suppose that under the circumstances a local committee might have an executive function in relation to the provision of the general medical service and the operation of medical service and the operations of financing that particular service must come to the regional health board but they might be able to give very valuable advice in areas where questions arose about the choice of doctor scheme or the appointment of additional dispensary officers because the choice of doctor system was not providing sufficient medical assistance or in dealing with areas where, because of their remoteness, it is very hard to find a doctor. I shall not commit myself to this but it is a good example of what could be done.
I take it that with the establishment of the local committee the present health committee will cease to operate?
Yes.
Those health committees in some counties rarely met. There seems to be no machinery for convening them except for ad hoc purposes. I take it that it will be provided by regulation or otherwise that those local committees will meet at some regular intervals?
I shall consider that. As everybody knows, if an advisory committee is effective it is ultimately the result of enthusiastic members. If they are to be effective they cannot be talking-shops or exercise their function of visiting without due preparation and, as everybody in local and national government knows, an advisory committee depends for its success on the enthusiasm of the members in asking for an agenda, for reports, for discussion on particular matters, services and problems. I think I must leave it to the initiative of the committees.
As the Deputy says, there are some quite effective health committees throughout the country and there are others where the members, in their wisdom, have not been active. It is not for me to criticise them or pronounce on their activity or inactivity. This is part of what Deputy Desmond described as participation. The local committees will have to listen to the voices of those who say: "For heaven's sake, participate." They must have an agenda, work to do, specific objectives, so that they will ask for reports in advance, make inspections and do work. If they simply sit and talk, and listen to some report prepared for them by the local medical officer, they will quickly vanish.
I know that these committees will be quite capable of doing very useful work in stressing the needs of the health services in a regional board which covers a number of counties. This will be a spur to them. Now that there is a regional board, one county council area will be very anxious to make sure that it participates adequately. Perhaps, the regional board concept will result in these committees being more active than voluntary committees established in connection with county councils.
Would the Minister not agree that the local committees to a certain extent will be rather filleted boards? They are in the position that they can give advice to the regional boards. I see certain controversies that are likely to arise in the general pattern and set-up of the new idea with regard to the health services being transferred on a regional basis.
For instance, without going very deeply into it, there is one thing that will arouse the widest controversy and that will be the question of the spacing of regional hospitals. The local committees who, naturally, will be the people in the best position to advise on what is beneficial and necessary to their own particular interest, are there purely in an advisory capacity. That is all right. They will give their advice for what it is worth to the regional board, but there is nothing in the Bill to support them in any way.
For instance, if I happened to be on a local committee and the Minister, say, was on a regional board and I proffered certain advice to him, it could simply be marked "Read". That is all. I should like to see some measure introduced in this legislation under which it would be necessary for the regional board to take cognisance of the advice offered to them by the local committee. Perhaps, the precedent for that would be in the National Health Council. The National Health Council is the advisory board that comes to mind in this instance. It advises the Minister. The advice which this board gives to the Minister is known because a report is issued at the end of every year. It is placed in the Library and becomes an official document.
I can envisage a local committee having a particular grievance and meeting and making certain suggestions to a regional board on which they have only a limited number of representatives and might be outvoted. They express their opinion to the regional board and the board say: "We will not take any notice one way or the other." Where do we go from there? If they have no statutory function, so to speak, they have no means of enforcing their opinions. They have virtually no official publicity other than what they can get in the press. We do not know whether their meetings are to be private or public. We must bring democracy into the health services. We cannot deal with them entirely by regulation. We must give every section and every area the right to express their opinion.
I agree that the concept here is good and that a local committee should be set up to deal with local problems but there is nothing to ensure that they will be listened to. I have a feeling, with the best will in the world towards this section, that it is not giving the local committees the opportunity of making their opinions widely known and not endeavouring to create a situation in which the regional board must take cognisance of what they say and the recommendations they offer whether they accept them or not. I should like the Minister to give us his opinion on the opinion I have expressed.
While I agree with what Deputy Esmonde has said, I think we come back to what Deputy Ryan said, namely, that there should be members of the regional boards on the local health committees. I should like to make sure that the Minister will continue the local health committee that has been working in Dún Laoghaire for many years. I would say to Deputy Dr. Gibbons that it works there very successfully and I should like to see it continuing to do so.
Unfortunately for us in Dún Laoghaire, in the Minister's origional suggestion we were to have only one member on the regional board. I should like to press the Minister at this stage to tell us how many he will put on the regional board so that we can service the local health committee in Dún Laoghaire.
(Cavan): This section proposes to set up local committees which will be purely advisory bodies. Even in that capacity, under section 7 (5) (a) they can do good work provided that the Minister does not kill them before they are brought into existence, so to speak. It is essential that these local committees should not be regarded as a replica of the Custom House or as committees controlled absolutely by the Minister's office.
As these committees were envisaged in the memorandum circulated by the Minister, they were to consist, in an average county with four electoral areas, of eight elected representatives and eight other persons. Between the elected representatives and the people appointed by the Minister or by the medical services, et cetera, that would be——
I am not appointing any of the health committees.
(Cavan): I thought that the Minister's memorandum, No. 7, read, “two other persons”. I wonder will the Minister say how they are to find their way on?
They are appointed by the county council. I do not blame the Deputy for being confused because there are so many complications in this Bill.
(Cavan): Perhaps, it is that I am so accustomed to assuming that anyone who is not specifically appointed by anyone else will be appointed by the Minister.
Two other persons will be appointed by the county council.
(Cavan): I am glad to hear that. I gather that they need not be elected members of the county council but that they will be appointed by the county council.
That is right. They need not be representatives but they could also be two additional county councillors.
(Cavan): I am glad that has been clarified. I also understood the Minister to say in reply to Deputy Esmonde that he proposes to introduce an amendment on Report Stage which will provide that a majority of each will be members of the county council.
That is so.
(Cavan): I gather that the Minister has not worked out in detail how that will be brought about. I notice that in the memorandum it is provided that two councillors for each electoral area of the county will be on the board. In an average county there are four electoral areas. If the Minister says that there shall be three councillors from each electoral area in the county so much the better. It might be hoping for too much to think that the Minister would undertake to go that far.
I have got to think this over. One of the ways of doing it is that you could have, say, two from each electoral area and then you could also provide that these persons could co-opt an additional number which would give a majority. The Deputy should not ask me to make up my mind about it at this stage. There are two ways of doing it: By having an increased number per electoral area, or by giving powers to this group to co-opt additional people until you have a majority.
(Cavan): I can see that there might be difficulties and that this is something that needs thinking out. However, I would urge on the Minister that he should, perhaps, do it in the way he has suggested or even suggest that they vote——
Why not make it four other persons nominated by the county council, instead of two?
(Cavan): I heard the Minister saying that additional councillors would be elected from the electoral area. I just want to repeat that if that is one additional from each electoral area that is all right, but if it is to be less than one from each electoral area, if there is to be an uneven number from each electoral area, then it would want to be thought out very carefully.
You could not have an uneven number from each electoral area.
(Cavan): The Minister would propose then to have two from each electoral area and what would be called a floating one or two.
That would be one way of doing it.
(Cavan): Perhaps, the Minister would think about it between now and Report Stage and let us know his mind on it. I urge the Minister to make sure that these boards are alive, that they will take an interest in what is going on in the county and regard themselves as carrying some weight, because if not they will fizzle out and die.
Section 7 (2) provides, amongst other things, that the chairman or the vice-chairman of these local committees shall be appointed in accordance with regulations made by the Minister. I only hope that the chairman and the vice-chairman will be appointed in the ordinary democratic way by the local committees themselves because otherwise the life will be knocked out the committees before we bring them into existence. As we know, one of the most controversial functions and, therefore, one of the most interesting functions of any council is the appointment of a chairman or vice-chairman. If the Minister intends to take unto himself as he did in regard to the health boards, the appointment of a chairman and vice-chairman, he would be making a mistake and he would be doing something to downgrade the local committee.
The chairman and the vice-chairman will be appointed by the committee under normal types of regulations.
(Cavan): The Minister will excuse me if I do not read that into section 7 (2) which says:
Regulations under this section shall contain provisions relating to the appointment, tenure of office, disqualification and removal of members of a local committee, the appointment of a chairman and a vice-chairman to a local committee, the holding of meetings and the quorum for and the procedure at meetings of a local committee.
I am satisfied if the Minister says now that it is his intention to provide in the regulations relating to these local committees that the chairman and the vice-chairman will be appointed, as he himself says, in the ordinary democratic way by a majority vote of the committee as constituted. If he says that I am quite happy, it is good to clear up that and to know that.
I have a particular concern in the functions and duties of local committees in any area, especially the remote areas referred to by the Minister. In the FitzGerald report it has been stated that there are relatively few areas outside the scope of the improvements which will be brought in under this new Health Bill. I wish to inform the Minister that I reside within an area which could be described as a remote area. In the FitzGerald report it has been recommended that the closure of the county hospitals in County Clare will take place and I think that in this House I should try to get an assurance from the Minister—and I am depending on the Minister not on any local or regional committee.
We shall never get through this Health Bill if we discuss the provisions of the FitzGerald report. I have made it absolutely clear that I would hear deputations from any county council or any well represented group of people in a county before a decision is made to change in a material and major way the functions of a hospital. We shall never get through this Bill and the services which should be available to the public by April, 1971, will then not be available if we start discussing the FitzGerald report in this connotation.
(Cavan): Surely it would be relevant on section 40 of the Bill?
Perhaps, when we get to section 40.
By 1971.
I am still not going to make any decision.
I am attempting to impress on the Minister that these committees which are to be formed will serve no purpose if now we cannot get from the Minister an assurance that at least a county should have a county hospital on which to report and make recommendations.
The Chair is loath to interrupt or to curtail the Deputy's maiden speech, but it must be pointed out that this section, as the Deputy says, deals with the establishment of local committees. The question of the provision of hospitals would arise at a later stage.
When will I have an opportunity?
On a point of order, section 7 says that the local health committee shall perform such other functions as shall be assigned to it, subject to limitation by the Minister. I respectfully submit that Deputy Taylor is quite in order in making a request that these limitations of the Minister would not preclude County Clare or any other county from performing the hospital and other services which he believes the local committee should be performing.
The Chair does not wish to limit the discussion. The Deputy is aware that there are many sections of the Bill on which this matter would arise at a later stage. This section is concerned only with the formation of the committees.
And their functions. Deputy Taylor is arguing that their functions should include the administration of a local hospital.
If a discussion on the functions of the committees were dealt with at this stage we could keep at this section of the Bill and ignore the main sections.
This is probably the only opportunity we shall have of discussing the functions of the local committee. This is a very wide section and it covers practically everything. I am sure the Chair will bear with Deputy Taylor in his maiden speech. He is citing the local hospitals only to drive home his point.
The Chair is in agreement that the Deputy is entitled to put forward a point of view in regard to committees. The Chair is pointing out to the Deputy that at this stage details such as those contained in the FitzGerald report or details of particular hospitals are not appropriate on this section.
The Deputy is only stressing his argument.
I accept the ruling of the Chair. The point I am trying to make is that if the Clare County Hospital is closed it will mean long journeys either to Limerick or to the teaching hospitals in Dublin and Cork for the sick people and their relatives.
Is the Minister not going to reply to some of the arguments advanced by the last three or four speakers?
I thought I had replied by describing the general functions of these committees. They are advisory committees. They can give advice in the ordinary way on all sections of the health service in their area. They can advise the regional health board as to what they consider should be the function of a particular hospital in that area. Quite obviously, if we are going to accept the regionalisation principle and everything implied therein, local committees will administer the health services in general in their area. They cannot make decisions in regard to a number of aspects of the health service in that area and the reasons for this have been explained.
In the modern world it is essential to enlarge the area of health administration. It is being done in all civilised countries. It arises from modern techniques of medicine; it arises because of the enormous costs of health and hospital services in every country; it arises because of the growth of specialisation and the scarcity of certain types of specialists, which is likely to continue for some time; and it arises because of the high cost of the very complicated equipment and machinery now being used. This has been explained at great length and it has been accepted by a great many people from all sides of the House.
The local committee might be given some comparatively minor executive function but it is the business of the regional health board to provide the services in the area. There will be a regional hospital board, arising on another section, which will give advice on the planning of all the hospitals in a regional area, and the appointment of Comhairle na nOspidéal will arise for consideration later in the Bill.
I have never seen any lack of publicity arising from strong feelings held by our community in regard to changes in its way of life. I do not think we can make any change in this Bill, by way of amendment, which could prevent representations of the most massive kind being made in any country area or any town area, if public opinion were strongly against a proposal to change materially the function of some very big unit of health administration —and everyone in this House knows exactly what I mean by that.
I do not think the Minister has quite understood the point I was trying to make. I am not against the regional system; I just want adequate safeguards. There must be local problems and the position with regard to the local committee is that they may issue advice but there is nothing to certify that they will be listened to. I want it to be mandatory on the regional board at least to discuss and consider the advice they receive from a local committee. That would satisfy me and I think it would satisfy the local committee as well. As the legislation stands at the moment the position is that the local committee may offer profound and good advice to a regional committee but there is nothing to stop the regional committee from putting a red mark through it and ignoring it. Surely the Minister could devise some scheme whereby it would be mandatory on the regional committee to take cognizance of the advice of the local committee? We cannot deny that the existing health authorities are being virtually abolished so far as the conduct of their own health and sanitary affairs is concerned. They will have to rely on what the regional committee decides to do. I feel the local committees have the right to be heard and the right to receive some communication from the regional board to say that their case is at least being debated. That is the point I am trying to make.
If the Deputy still requires it I am quite prepared on the Report Stage to put in such a clause. I do not think it is necessary but if Deputies think this clause would have a good effect by compelling a regional health board to take cognizance of recommendations made in regard to health services in an area, I am quite prepared to put it in. I do not think it will have the effect that the Deputy imagines it will. There are two points of view about that. My own belief is that these regional health boards will be bound to take cognizance of such recommendations, but to satisfy the House and give more teeth to the local committees I will put in an amendment stating that they must have cognizance of the local committees.
Our experience in Cork has not been like that suggested by Deputy Sir Anthony Esmonde. A regional board in the new situation will have a majority of public representatives and some of these people will, more likely than not, be on the advisory board. They will have public meetings as at present. Public representatives are never slow in ventilating any grievance they have; they will make sure that the regional health board will take cognisance of them. If it were to happen that the regional health board did not do so there would be a tremendous amount of criticism of the regional board at the next meeting. As the principal voice in both the local committee and the regional health board will be that of the public representative, there is no doubt whatever that cognisance will be taken of any legitimate claim or grievance.
Question put and agreed to.
SECTION 8.
Question proposed: "That section 8 stand part of the Bill".
What kind of committee has the Minister in mind under section 8? How will it differ from the local committees already under discussion?
The health board could appoint a committee to discuss, for example, the general organisation of the medical service and the choice of doctor. They could discuss how far the crossing of county boundaries would make such a service more effective, and the executive committee would then report back to the regional health board. It could even be given a function of overseeing the general medical services for an entire area for as long as the regional health board desires. That is only one of many examples. It would have another committee examining district hospitals within the regional board area, making reports on their operation, on their efficiency and on the work they were doing. I could think of any number of examples. We do not want to exhaust the members of a regional health board by their having too many executive committees. In the matter of good management and, at the same time, attention to detail it would be very difficult for me to spell it all out at this stage. There are committees of local authorities, as Deputies are well aware, and it is a matter of working out what type of executive committee is advisable.
Question put and agreed to.
SECTION 9.
Amendment No. 10 in the name of Deputy Ryan has been ruled out of order.
Question proposed: "That section 9 stand part of the Bill".
The amendment which has been ruled out of order is an amendment which sought to delete from this section the words "with the consent of the Minister for Finance". It is appalling that in a Bill of this magnitude, under which £50 million will be spent, there is this unnecessary insertion which provides that puny expenditure cannot be incurred by a responsible health board, under the advice and control of a responsible Minister for Health, after it has been processed from the local committee to the local health board to the regional hospital board, to the Department of Health, until their majesties, in the guise of some executive officer in the Department of Finance, say: "That is all right. You may increase the mileage allowance from 1/- to 1/1d. per mile." This is appalling nonsense. You have this duplication of the deadhand of bureaucracy running through this whole Bill and it was in relief of the taxpayer and the ratepayer, and to avoid the folly of undue processing of every minute expenditure, that I sought to have this deleted. It is an appalling reflection on the Minister for Health, on the regional hospital boards, on the health boards and the committees to provide that every expenditure they consider proper and valid cannot be incurred until some junior official in the Department of Finance applies his great brains to the matter. This is the kind of nonsense which brings Parliament and the administration of the State into well-deserved contempt. I urge the Minister and his colleagues, the Members of this House and the Members of the Seanad and the Parliamentary draftsman to put an end to this unnecessary consultation with the Department of Finance in relation to matters which are certainly not deserving of the enormous administrative cost and waste of time involved in this kind of unnecessary consultation.
I notice this section deals with travelling expenses in relation to health boards and committees. Is it proposed that regional health boards should sit in one specific area or will they be able to hold their meetings in different counties at different times?
One would imagine that regional health boards would, for administrative convenience, meet wherever the central administration was established. Regional health boards will be able to decide where the central administration should be. If they cannot agree amongst themselves, then I shall have to decide. There is nothing in the Bill to prevent them rotating their meetings, if they so desire, but such rotation might make it difficult for the staff of the health board who would have to travel around with all the information and records that would be required. There is, however, nothing in the Bill to prevent rotation.
Do I understand from the Minister that the regional boards will decide the administrative centre in each area?
Yes.
And the Minister will not initially make a designated place the administrative centre?
No.
It is important that we should understand that.
I agree whole-heartedly with what Deputy Ryan has said about the last phrase in this section. The fact of the matter is this is undiluted hogwash. The section should read: "Payments under this section shall be in accordance with a scale determined by the Minister." That would be both sensible and reasonable. Presumably, he will determine the matter for the whole country. Put in here, probably by some clerk in the Department of Finance when the Bill was being drafted, is the phrase "with the consent of the Minister for Finance". Actually that has no meaning, but I agree with Deputy Ryan that this is the kind of thing which has brought the Oireachtas into contempt. Allowing clerks in the Civil Service to behave like this has earned for this Oireachtas the well-deserved contempt of a great many people. I could talk about this at length. As one of the newspapers remarked last week, what was being discussed here last week was the kind of society we are to have and this kind of thing—creating expenditure, not saving money—is anathema. There is expenditure involved in typing letters and memoranda and sending them to the Department of Finance, in circulating these around the various divisions, in opening files and all the rest of it. I know the whole story though, indeed, the Department of Finance was much smaller when I was there and it had a great deal more control and better control over expenditure than it has today.
The Department of Finance like certain people exists by sticking its nose into everything. I remember a man asking me on one occasion to describe the functions of the Department and, when I had finished, he said: "You know, the Department of Finance must be the greatest lot of Nosey Parkers ever." This is an example of Nosey-Parkerism and nothing else. Literally, there is no meaning in it. What the Minister puts up will be accepted, but some officials will write to one another between the two Departments and some officials will do the same in the Department of Finance. I do not mind officials in the Department of Health writing to one another inside the Department of Health because someone has to come to a decision as to what the proper expenditure should be. But this is not a complicated or a difficult matter. We have, of course, the position where even the expenses of this House are determined with the consent of the Minister for Finance, an absurd and ridiculous position. It would be very easy to talk at length about this. I agree with Deputy Ryan that this last phrase is an utter absurdity.
The Minister would not consider taking it out?
I do not want to start a controversy on this subject.
Does the Minister consider that by taking it out it would add to the cost of the health services? If that is the ground on which my amendment is deemed out of order, it could not possibly add to the cost of the national Exchequer. I do not think for one moment the Minister would act unreasonably or that his advisers would act unreasonably. This piece of undiluted hogwash, to use Deputy O'Donovan's description, is repeated ten times in this Bill.
Could I ask the Minister, is this to ensure some type of uniformity or standardisation in the allowances, say, for Agriculture and other Departments?
That is right—in order to maintain some relativity.
One of the privileges enjoyed by Labour Deputies is that they need not necessarily agree with one another. I could not accept Deputy Ryan's amendment at all nor could I support the concept. There is the basic question, whether we like it or not as Members of this House, the question of public accountability and the ultimate accountability—the accountability of public officers, of elected public representatives, to the Exchequer for every penny of national expenditure—and it would be quite inappropriate that, for example, the Minister for Health should fix scales of expenses, travelling rates and so on, in respect of these boards, which could be quite heavy because of the large distances to be covered by the members in the performance of their duty and that similarly other Ministers of State could have equal leniency in fixing rates. Equally, there would be the overall problem of individual pressures being brought on Ministers. I know that one can be very critical of the Minister for Finance and so on but if it is £50 million that must be spent, it must be spent properly.
I disagree with the Deputy. I do think that subsection (2) is superfluous. It would be a very easy thing for the Minister for Finance to specify for all Departments a schedule of expenses, either travelling or subsistence, and this would get over the accountability problem. It would be quite a simple thing to do and would, I imagine, speed up payments.
This applies to all sections of the Bill.
I am well aware of that.
Question put and agreed to.
SECTION 10.
Question proposed: "That section 10 stand part of the Bill".
This is, perhaps, a legalistic matter. Nevertheless, I should like it clarified. There is provision in subsection (3) (d) and (e) for the use of a common seal by a joint board and this runs into two lengthy subsections. I notice that the same matter is got over in one simple subsection in section 5 subparagraph (c) in relation to a single health board. That subparagraph says:
the board shall provide and have a common seal and all courts of justice shall take judicial notice of the seal;
but, when we come to a joint board we say:
the board shall provide and have a common seal which shall be authenticated by the signature of the chairman or some other member authorised to act in that behalf and the signature of an officer of the board authorised to act in that behalf.
and in (e):
judicial notice shall be taken of the seal of the board and every document purporting to be an order or other instrument made by it and to be sealed with its seal (purporting to be authenticated in accordance with paragraph (d)) shall be received in evidence and be deemed to be that order or instrument without further proof unless the contrary is shown.
I do not know why it is necessary to spell the matter out at such tremendous length in section 10 when it was able to be dealt with in a very simple way in section 5.
The section does look rather immense to me, too, but, apparently, the simplest thing to do was more or less to copy section 45 of the Health Act, 1953, and this is to enable us, if necessary, to appoint health boards as bigger units than the proposed health boards. They can be appointed, apparently, for specific administrative purposes. In other words, you can have two health boards joined together for the purpose of drug pricing and payment of doctors under the general medical service, as an administrative device to save expense in administration. There are a number of matters where it would be possible for two health boards to reduce expenditure by combining together and, apparently, if they do this, such is the general law in regard to boards— Deputy Ryan may know about the legal side—you do have to have all these provisions in regard to perpetual succession and so forth, even if the joint board so created may have very, very limited powers.
On the question of the seal, there is the general provision in regard to the seal that is in section 30 of the Second Schedule which says:
The seal of the board shall be authenticated by the signature of the chairman (or some other member authorised to act in that behalf) and the signature of an officer of the board authorised to act in that behalf.
That is the best way of describing the meaning of the section.
One is in the Schedule and the other one is in the Act.
That is right.
Question put and agreed to.
SECTION 11.
I move amendment No. 11.
In subsection (1), page 8, between lines 22 and 23, to insert the following new paragraph:
"(e) a draft of an order which it is proposed to make under paragraph (a) of this subsection shall be laid before each House of the Oireachtas and the order shall not be made until a resolution approving of the draft has been passed by each House."
Section 11 is that section of the Bill which purports to give the Minister power to remove from office the members of a health board if it does not do certain things which the Minister considers the board should do. The effect of our amendment is to provide that, if the Minister feels that way, he ought to come to the Houses of the Oireachtas to justify the opinion which he has and to justify the action which he is about to take. The effect of this, therefore, would be to prevent a Minister taking punitive action against a board which was in disagreement with him. The effect of our amendment is such that the Minister would have to justify before that bar of public opinion, before his peers in the Houses of the Oireachtas, action which he wanted to take. It might also help to have a public debate upon the issue upon which a board and a Minister might be in disagreement.
If one considers the position which exists in Dublin, one can see merit in the proposal which we have tabled. In Dublin, the health authority is spending about £10 million, half of which comes from an area which is not represented on that health authority because the Minister for Local Government saw fit to dismiss from office the councillors of the Dublin Corporation who were of the same opinion as is held by all parties in this House, that the rates were not a proper system for the financing of the health services, and the only difference between Dublin Corporation and other people who have the same view is that Dublin Corporation said that not only do we consider the doing of the thing to be wrong but we will not do what we consider to be wrong and because Dublin Corporation were loyal to their own convictions and refused to do what they considered to be unjust, they were abolished.
It does seem to be wholly undesirable that in circumstances in which responsible elected public representatives find themselves in conflict with the Minister on a matter of principle, the Minister can simply by an order signed at midnight dismiss them from office and appoint his own gauleiter to conduct the affairs of the local authority and to presume to represent the people who are being taxed in such a severe way. It is essential where there is taxation, that there should be representation. We have not that in the Dublin region at present. We are seeking to insert this amendment to ensure that if ever the Minister wants taxation without representation he must come to the Oireachtas to justify what he is about to do. If the Minister is certain he is doing the right thing he should have no reason to fear coming before the Houses of the Oireachtas to justify his action. If the Minister is unwilling to accept our amendment it would appear the reason is that he fears an occasion might arise when he could be embarrassed if he sought to justify in public the abolition of a health board. The matter is crucial. It goes to the very roots of democratic practice. It is an amendment which any Minister, confident that he is doing the right thing, should not hesitate to accept.
I want the House to appreciate that not included in this section is power to remove a board where there is a dispute in relation to the raising of necessary finance for carrying on the health services: that remains within the power of the Minister for Local Government. He alone could take this action which he has taken, I believe quite rightly, but it does not arise on this Bill. The reasons for removing from office a health board are clearly stated here. They do not relate to any crisis that would arise of the kind that arose in the case of Dublin Corporation.
Members of the House can read for themselves the circumstances under which I can remove from office the members of a health board. I do not think it needs a debate here to do this. I do not see why I should not have the power. It will be exercised only very rarely. Quite obviously, there will have to be some extraordinary circumstances for me to remove a health board. Quite evidently, the health board would have collapsed: there would be malfunctioning in such a way that the health services would be in a state of chaos. This is most unlikely to happen. If it does happen, I think the Minister for Health of the day should have the powers provided in this section.
I support the amendment. It gives a built-in safeguard of general public accountability of the Minister for Health to this House in relation to his actions. No analogy should be drawn between local government and the functions of county councils or borough authorities and, literally, the mini-Dáils, on a health basis, that we are now constituting. I think the members of these very large bodies—30-odd members on average— should be given the maximum possible security of tenure as appointed or elected members in the performance of their functions. It is unwise, undemocratic and generally undesirable that any Minister of State should arrogate to himself the power, even in the extreme he has outlined, to dismiss and abolish such a board. Deputy Ryan's proposition that a draft order for the abolition of such a board should be laid before this House and should not be promulgated until the House has approved of it is a reasonable, rational and utterly desirable approach.
Dublin Health Authority has now an income of some £10 million. While the effect of disbursement of that money is a matter of national concern, I do not think that the entire scrutiny of such boards should lie in the hands of any one Minister. While we regard the present Minister as relatively more enlightened, we tremble to think that some of his colleagues in the Cabinet would share health responsibility at this point of time. We should be very perturbed as to what they might do if a health board in the 1970 or 1971 period became somewhat obstreperous. As can arise in any of these health board areas, you could have the explosive, very emotional issue of hospital functions, of the siting of regional hospitals, of a whole range of services under the health board, which could bring a health board into very sharp conflict with the Minister. Any Minister would be extremely wise to have recourse to the House for full backing if he came into such public conflict which warranted their summary and general dismissal.
The Minister also refers to a local inquiry in paragraph (a) of section 11 —wherever he is satisfied, after holding a local inquiry into the board's performance of its duties, that the duties are not being duly and effectually performed. I am concerned that there is no outline to the House as to what would constitute a local inquiry under the health board. It may well be contained within the regulations. I think, however, it should clearly be outlined here in respect of local inquiries because many of us are rather cynical about these particular operations, on occasions.
The Minister would be unwise to take this power to himself. Consider, for instance the board representing the greater Dublin region. It will operate for some one million people. I do not think final authority should rest with the Minister in relation to the disbandment of the boards. We are seeking Ministerial accountability to this House for actions he might wish to take.
We do not accept the outline of the function in the explanatory memorandum in which we read that, under section 11, the Minister will be given power similar to that which exists in respect of local authorities in Part IV of the Local Government Act, 1941, to remove from office, and so on, members of a health board. While the powers are now similar as contained in this Bill, the conception of the whole arrangement, of the whole rationalisation of the health services as now envisaged is so totally different that it cannot be given any comparison with local authorities or urban district councils which might become obstreperous and be removed overnight by the State. With the health board, at long last, bringing the regional concept into Ireland, we should be extremely careful about built-in safeguards and devices which Deputy Ryan has quite rightly proposed to the House.
I disagree with the last Deputy. Paragraphs (b), (c) and (d) of subsection (1), of section 11, spell out clearly where the board is automatically removed—if and whenever the board has refused or neglected to comply with a judgement, order or decree of any court; if and whenever the board has refused, after due notice, to allow its accounts to be audited by the auditor appointed for that purpose under section 27 or if and whenever the members of the board capable of acting are less in number than the quorum for meetings of the board.
A Deputy
What about paragraph (a)?
The Minister may by order remove from office the members of a health board if and whenever (a) he is satisfied, after holding a local inquiry into the board's performance of its duties, that the duties are not being duly and effectually performed. He will hold the usual public inquiry and that is the best means of getting at the truth in any event. It is not a departmental inquiry, it is a public inquiry and I think we are all used to them. The Minister will tell us the type it will be but I take it that it will be of the normal model. There is in this section a built-in safeguard for the public that these mini-Dáils, as somebody described them, will do their job.
Contrary to what Deputy Lenihan said, there is no built-in safeguard for the public in the section but we are endeavouring to put in the safeguard by requiring the Minister to justify his action here at the bar of public opinion in Dáil Éireann and Seanad Éireann. We say that if he proposes to tax people in respect of services and then deprive those people of representation he should justify doing that through the national Parliament That is the built-in safeguard. We do not think there is adequate protection in having a local inquiry conducted by an inferior in the Minister's own Department who will be conscious of whatever resentment the Minister may feel and will go to the public inquiry to collect the evidence which will justify the conclusion he brings into the inquiry. That is the nature of a local inquiry of the kind we had in Dublin last year. That is the nature of all such local inquiries. We do not think that is protection for the public, the ratepayer, the taxpayer, the person for whom the services are intended to be provided.
I am prepared to accept that there is no need for either a local inquiry or for a justification to the Houses of the Oireachtas if a board should refuse or neglect to comply with the judgement of a court, or refuses to have its accounts audited, or if it becomes so depleted in numbers that it cannot discharge effectively its duties, but allowing for that we can on the Report Stage make further amendments to ensure that the particular safeguard we are bringing in is not applied unnecessarily in circumstances in relation to which there can be no answer. However, this does not in any way qualify what we have said in favour of our amendment where there is a clash of opinion between the Minister on the one hand and the local health board on the other as to the way in which the local health board should be discharging its duties.
Under existing legislation it is open to a local health authority to provide a service even if the Minister for Health does not approve of it, provided it is paid for out of the local rates. A number of such services are being provided for throughout the country and more power to the local authorities who do it, even where they have to carry the full cost from the rates. They do it because they are much closer to the needs of the public than the Department of Health. Under this legislation such power is taken away from the local representatives so that in future if the local representatives with their immediate knowledge of the needs of a neighbourhood, in the exercise of their own inclinations to be humanitarian, decide to provide certain services for which the Minister is not prepared to pay, or towards which he is not prepared to make a contribution, they may find themselves in a situation in which the Minister may say "We will not allow you to do that because we will not allow it to be done in other areas." In such a case there could be a clash and it should be imposed on the Minister as an obligation to come before the Oireachtas to say why he considers such a service should not be provided.
The Minister replying to some of my earlier remarks said that my remarks were not justified because the Minister for Local Government was the person who now had and in future would have the power to abolish the health authorities if they did not do what Dublin Corporation would not do, and that is strike a rate for the health services. The Minister, however, in his explanatory memorandum says that in this Bill he is seeking the same power as the Minister for Local Government had until now so that he can exercise it. In other words, he will not have to rely on the Minister for Local Government to exercise it, in future. He is seeking to do exactly the same thing as happened in the Dublin region. The Minister may say that striking the rate is a matter for the local authority and not the health authority and technically he is right. But in the health board the annual estimates have to be adopted and the local health board will then have to send a warrant or a mandate to the local authority for the amount of money required to service the health services within the board's area. However, if a board in its wisdom decides that a warrant or the bill should not go to the local authority but to the Minister, then the Minister for Health would use the power he seeks in this to abolish the board for daring to send the bill to him even though all parties in this State pretend to believe that the rates are not a proper system for the financing of health services. But if any health authority in pursuance of its own convictions, in discharge of what it says to the public it knows to be the right thing, proposes to act in accordance with its beliefs then the Minister can abolish that health authority. We believe that in that case the Minister should come before Parliament and justify his action and if he is not prepared to do that he stands condemned.
While Deputy Ryan and Deputy Desmond are very anxious to get rid of the Minister here neither of them has made a convincing case, because hearkening back to what happened in the case of Dublin Corporation is not a very good comparison. So far as the Minister for Health is concerned the function of financing falls to the Minister for Local Government and the local authorities. I would ask the Deputies to suppose the Minister for Local Government had not been able to exercise the power he exercised elsewhere what would have been the state of health of the community in the city of Dublin and its surroundings? Who was going to provide the wherewithal——
The Minister.
——to provide the necessary services for the people of Dublin? It is all very fine for Deputies to stand up and try to whitewash the actions of the people who undertook a specific job and when the bill was presented ran away from it, in effect. I do not accept that sort of argument in discussing the power provided here for the Minister.
It seems to me that the Deputies opposite have a great trust in the human element and, in making a case for mitigation as it were of the Minister's powers, have put forward the argument that all members of society, shall we say, who are members of local authorities are above reproach. You could meet various obstacles and I think it wise that the Minister should have power to deal with disciplinary matters of this kind.
The former Health Act was mentioned in connection with this amendment and in connection with health boards. This is the first time in our health system that a board will be a statutory corporation, which means that the board may sue and be sued and therefore, to my mind, has a prime responsibility for the administration of the health services in its area. Therefore, it seems that if there is a refusal on the part of any health board or, for example, if a health board persist in holding meetings with full representation from the various counties, or at least a quorum, then the Minister should rightly have the power to inter — vene and call for a local inquiry — and these are the words — to suspend the health board.
I should like to support Deputy Ryan's amendment. In doing so I am sorry that the draft of an order which should come before these Houses should also refer to paragraphs (1) (b), (c) and (d) as well as paragraph (1) (a) because in paragraph (1) (a) the type of local inquiry is not specified, whether it is to be Departmental or judicial. The Minister should specify the type of inquiry he has in mind. In paragraph (d) I should like definition of the words "capable of acting". This is very loose terminology and open to political bigotry which is something that we are trying to avoid in the administration of this new Health Bill. To safeguard the public interest it is essential that the Minister should accept Deputy Ryan's amendment because unless members of local authorities are guaranteed a certain amount of freedom from interference by the Minister, the public will lose interest and respect for them. The Government should take heed of this.
In view of the confusion in Deputy Carter's mind on this I wish to emphasise to the House that we in the Labour Party are not in any way objecting to paragraphs (b), (c) and (d) of section 11. If the health board fails to comply with the judgment of any judicial court I have not the slightest objection to its being disbanded. Likewise, if it refuses to allow its accounts to be audited they should get a hammering on that basis or if the members were so indolent as to fail to turn up for meetings of the board, let us "scrub" them, to use popular terminology. We do strongly object, above all, to the phrase used by the Minister "duly and efficiently performed". This is an extremely subjective concept. How am I to say whether the Minister performs his duties in a duly effectual manner? I submit that any Minister, if perverse enough—and we are legislating for the next 40 years in this measure in relation to the new composition of the health boards—who arrives at such a conclusion would be given freedom under this provision to invoke that particular paragraph.
There is also the serious objection in relation to the local inquiry. I know that you can marry into this particular piece of inquiry apparatus the provisions relating to local government, but we are concerned that where a local inquiry is held it should, above all, be seen to be a public inquiry. I do not think that any officer or servant of a health board, if he is conscious that he has performed his duties to the best of his ability, would fear a public inquiry, whether he be the CEO or any subordinate officer. Therefore, a clearcut statement by the Minister that it would be a local, public inquiry into a health board would mitigate our objections to this particular section. But I think Deputy Ryan's amendment, namely, that where you want an abolition you can bring a draft order before the House to justify it is an eminently sane and reasonable proposition and in the best interests of health and the people working in these health boards and is well worthy of support. I do not think Deputy Carter's preoccupation with the abolition of the Dublin local authorities has any particular relevance to the points we have made here.
I shall compromise with the views of members of the Opposition by putting down an amendment specifying "a public local inquiry". In fact, I understand the inquiry would be public. It is inconceivable that, if a board was so unsatisfactory that we had to have an inquiry, despite its being composed of members of local authorities from all the parties, or at least the major ones, professional consultants and other persons with a high reputation in their county, in most cases, for good service to the community, the Minister would intervene in this way unless something very serious had gone wrong. The inquiry will be in public and I shall arrange for the necessary amendment.
I want to get out of everybody's mind the connection with—although I defend the Minister's decision in every way—what the Minister for Local Government did in relation to Dublin Corporation; it so happens that the question of what he did then is not apposite to the amendment put down here. Deputy Ryan said that a health board could refuse to send a warrant or demand for the local contribution to the local authority and could be dissolved for this reason. Section 31 (3) says:
Each local authority required under this Act to appoint members of a health board shall each year make to the board at the times specified by the Minister such contributions as may be specified by regulations made by the Minister for Local Government.
The obligation, therefore, is on the local authority to contribute and would come from regulations of the Minister for Local Government. There will be no statutory demand by the health board on the local authority. Accordingly, the issue of the removal of members for refusing to make a demand could not arise. In other words, if people in their great unwisdom chose to do the same thing as Dublin Corporation did it would have to be the county councils of the health board area who would have to take the step of saying: "We refuse to raise the rate for this purpose." That will get us over a long and, perhaps, interminable debate on this other question on which I defend my colleague, the Minister for Local Government, absolutely. It does not arise on this amendment.
Would the Minister be good enough to repeat the section to which he made reference?
Section 31, subsection (3).
Progress reported; Committee to sit again.