Private Members' Business. - Health Bill, 1969: Committee Stage (Resumed). – Dáil Éireann (19th Dáil) – Wednesday, 26 Nov 1969

Private Members' Business. - Health Bill, 1969: Committee Stage (Resumed).

Question again proposed: "That section 31 stand part of the Bill".

Mr. Childers

I want to say again that under section 31 it is possible in future time for the Government in office to make any further contribution they want to make towards the expenses of the health services. There is nothing in the Bill that inhibits any change of policy that is considered desirable. There is nothing in the Bill which prevents the Government of the day from changing the method of assessing taxation on the people in ways suggested by Deputy Browne. There is nothing in the Bill that prevents the Government from altering the rating structure. There is nothing in the Bill that limits the Government to the present system.

Therefore, section 31 could be adopted by the House on the understanding that people in the different parties disagree as to how much should be raised from the rates and how much should be raised from taxation; disagree as to the manner of the imposition of taxation on the people. I could go into further arguments about it; I should point out in reply to Deputy Browne that if nobody was allowed to have more than £5,000 a year to spend in this country the total accretion to the Budget would be something of the order of £5 million a year and that would not solve the health service payment problem for more than a year as the health services advanced and as more services are provided. As I say, it does not mean that those who vote for section 31 are committing themselves to the principle and forever that the contribution of central taxation to health services will remain at the figure it is this year of 55 per cent, and I should like the House to look at the section in that spirit, because that is a fact.

Mr. Clinton

The Minister said in previous contributions to this that it was a very open section and that we could have another Second Reading debate on it and still be relevant almost, and that is very true. We said that we have had several discussions not only recently but over the years on the various methods that could be adopted to finance the health services. Our method of financing the health services has been put on the records of this House on numerous occasions. The Minister told us that it might be possible to introduce a contributory scheme to finance the health services, but that this is still under consideration. This must be at least the third Minister for Health that has told this House on various occasions that a contributory scheme was under consideration. One wonders when does consideration of any particular item cease in a Department or how long it takes to make a decision. Any firm would go out of business if they were to take several years to make a decision as to whether or not something was possible or advisable. I do not want to cover this ground again except to say I believe the Minister is being unreasonable when he says this is under consideration but that he cannot give a date. This is a major piece of legislation on the health services, and surely this is the time when we should have written into this Bill what everybody is satisfied is the best possible means of financing the health services.

I want to refer to a case made by Deputy P. Dockrell earlier on for a change in subsection (3) of this section. Deputy Dockrell put this in legal jargon, but stripping it of the legal jargon, what he is looking for and what I believe is right, is the division of the expenses of the health services between the five local authorities, say, in the eastern region, on a service rendered basis. Originally, when we had the unification of the health services in Dublin city, Dublin county and the borough of Dún Laoghaire, I happened to be chairman of the county council at the time. I represented the county council in the long negotiations that took place with the corporation and the borough of Dún Laoghaire in relation to the basis on which the contributions would be made from various authorities. We eventually agreed to this services rendered basis simply and solely because I was able to demonstrate at that time that we were paying £50 per patient in St. Kevin's Hospital to the Dublin Corporation, and nobody could deny that. All we wanted to do was to prove that the services we were getting from this joint authority were fair to all the parties concerned. We worked out this system and it was operated extremely satisfactorily since.

Surely it is reasonable to ask that, in the case of the eastern region, the five local authorities that compose this board should get together and decide on a fair and equitable basis of charge for the services they get from this overall authority because of the contribution that is being made from the rates. I say this apart entirely from the fact that we feel that the rates is the wrong way to pay for the health service. Seeing that the Minister insists that the rates make a contribution to financing the health services, I hope he will very seriously consider the satisfactory basis for the expenses of the combined authority that has been in existence now since 1960. I should just like to remind the Minister that this has been done under subsections (3) and (4) of section 11 of the Health Authorities Act, 1960, and this should be looked at again to see if this would not be a fair and equitable charge.

We are told in this section the Minister will decide the contribution that is to be paid by the various contributing authorities. The Minister will first have to get an estimate from the board. How then will the board decide what local authority will get what and how the contribution is to be assessed? This will be an extremely difficult job unless it is done sensibly in agreement with the five local authorities. This is the sort of improvement Deputy Dockrell was proposing in legal language. I am not putting it in legal language: I am describing it in layman's language, and I think it is right.

Many Deputies, even on the Government side, have said they believe we should have another look at this method of paying for the health services through the rates. Deputy Andrews seemed to be confused about what Deputy Tunney said. He seemed to think that Deputy Tunney suggested that the rates system was unfair. In fact, that was not what he said at all. Anybody listening to Deputy Tunney would get the impression that all the people who pay rates are rich people, people with tons of money, and that this was a fair and equitable way to get it. I would tell Deputy Tunney who has done little or no local authority work in his time that more than three-quarters of the people in cottages in County Dublin are in vested cottages and are ratepayers.

Every local authority house in reality is paying rates because there is provision for them in the rent. What he does not seem to understand is that the head of the house, who is bearing the burden of rearing the family, is being called upon—and it is continued in this legislation—to pay an exceptional contribution over and above that which is being made by people in good jobs who do not have the burden of keeping and running a house. Deputy Andrews said that rates are inequitable and that because they are inequitable it is not a good way of financing a scheme and I agree with him. However, Deputy Andrews seems to have misunderstood the contribution made by Deputy Tunney.

We, on this side of the House, want to put on record that we think this is wrong. We are not trying to delay the passage of the Bill in this House. Certain improvements are indicated in this legislation and we want to see that these improvements are made as soon as possible.

This is a very important section because it concerns so many people who are finding it extremely difficult to pay rates at the present amount. I know many people who have built their own houses, nearly at the risk of their health, and have these enormous repayments to make over a period of 35 years before they own their house. That is a fairly heavy millstone around their necks without having the rates increased by at least one-third because of the health charge.

The Minister has said that there is nothing to prevent him increasing his contribution. Before this legislation came in there was nothing to prevent him increasing his contribution. The Minister does not need to put it into legislation because there is already power there to do it. The Minister knows that on occasion an extra contribution was made by the Exchequer. I would now ask if that contribution was made illegally, because I should like to know how it was made. I do not see any necessity for subsection (2) (b) because the power of authority has already been used.

The question of regulations is dealt with in subsection (7) where it says: "Regulations under this section shall be laid before each House of the Oireachtas." I hate legislation on the basis of regulations because that means legislation by ministerial decree and no one knows what is going to be contained in those regulations. If regulations are mentioned in any part of the Bill, I think the Minister should have an obligation to tell the House more or less the type of regulations he has in mind so that Deputies would know the type of legislation they were passing and the type of power they were giving to the Minister. It is all right for the Minister to say that these regulations can be annulled by the House later on, but I think it is loose legislation.

Mr. Moore

I believe a contributory scheme could work out well but so far the schemes put forward have not been comprehensive. Until the Government come forward with their views on these schemes I shall withhold my judgment on the merits of them.

With regard to the financing of health services through rates I think Deputy Clinton may have misunderstood Deputy Tunney. I did not hear Deputy Tunney——

Mr. Clinton

If the Deputy did not hear his colleague he cannot comment.

Mr. Moore

——but I know what our policy is on this. If we were to take the health Vote off the local rates it would mean putting a huge imposition on otherwise. The other day I was looking at the valuation of a big industrial company in the city and I found that they paid £25,000 in rates on one section. If we were to take the health Vote out of the rates we would have to find all the money through taxation.

The Minister might consider giving a capitation fee to local health authorities for each medical card holder. We would still maintain the health rate at the present valuation, as regards the industrial and commercial undertakings, but we would be relieving the local rate for householders. In this way we would be helping the local authority and at the same time we would not be putting a further impost on domestic ratepayers.

Deputy Clinton mentioned that some other Deputy said the present rating system was inequitable. The first sentence of the report of the inter-departmental committee said that the present scheme was inequitable and should be replaced.

The Minister has power under section 31 to vary the amount and I would ask him to consider the question of a higher capitation grant to the health authority or the local authority in respect of holders of medical cards.

Sir Anthony Esmonde

I am aware of the fact that the Minister is anxious to get this Bill through as quickly as possible, but I do not think we should leave this section without fully discussing it. It seems to me that it is the bogus of the entire Bill. All the trouble in relation to health legislation has arisen recently over the drastic increase in local charges by every single local authority throughout the length and breadth of the country.

It is all very fine for the Minister to say that there is nothing to prevent him giving more money under this section. That is his way of getting around it. It may be that we can accept the word of the present Minister for Health, but we are legislating here for the future and there is no getting away from the fact that this is the vital problem which faces the health services here. To extend and increase health services and to reduce overhead charges it is necessary to have a sound financial arrangement at the root. I think the Minister would be the first to admit that the existing system is not satisfactory and is not likely to get any more satisfactory. He may feel against that on account of the introduction of this Bill, taking it as a whole, that the charges may tend to reduce overall in every section.

I cannot see that. There is nothing that has been said so far that suggests that costs will be reduced. The idea is to have greater efficiency as a result of this Bill. This is an enabling Bill to enable the Minister to do certain things and this is an enabling section, and nothing else, which enables the Minister to reduce the charge on the local authorities. It does not specify that it is mandatory on him to do so and he is in no way committed under the existing legislation to do it.

The Minister must know from the number of Deputies of all parties in the House who have spoken that everybody is dissatisfied with the rate charges and with this section in which they see no avenue for the future. There is nothing in the section which will contain the local rate charge. There is nothing in it that will contain any charge.

We have been given to understand, possibly not so much by this Minister as by his predecessor, in the original White Paper, that there will be considerable easement of rates. Therefore, it is necessary that we should discuss the section as fully as possible because it is the whole key to the future in regard to health legislation. There is no use in having health legislation which continues the same financial arrangements as operated heretofore, the sky being the limit. Many ratepayers have reached the stage where they are simply unable to meet their commitments. It is not economic to have high rate charges. The rates system in operation here is peculiar to this country. Across the border, there are no rates on land. In the United Kingdom there are no rates on land. Inevitably, the charges under this Bill will fall on people who are not able to bear them. There is a resistance and there always will be a resistance to legislation when there is a system in operation that is not functioning properly.

The Minister should make it clear to the House that not only is he in a position to reduce the charge and to accept a higher percentage of the charge as a central Government charge but that he intends to do that. This is a very important matter. The Minister should not be vague about it. He should make clear to the House what his intentions are. He can do that by giving us percentages. He must have at his command officials who have worked out the figures to the nth degree. We have often found, disastrously, that one can prove anything with figures. At least, figures are a basis for some sort of understanding.

We should like to see our own policy accepted here of having voluntary contributions. In that way there would be a considerable easement of the rates. For some reason best known to themselves—perhaps, it is that the idea originated from these benches— the Fianna Fáil Party are not prepared to accept that. There is nothing peculiar about that policy. In other places, the health services are financed by that means. It is peculiar to Ireland that the ratepayer bears the greater burden and he is being asked to pay more.

It has been suggested by my colleagues on the right, who possibly should be on the left, that there should be a specific charge on specific people. Of course, that is nonsense. One cannot legislate for individuals. The burden will be laid on the whole community and the community has reacted to that. The people are no longer able to pay.

I would earnestly exhort the Minister, if he wishes to proceed with this Bill and to meet the views expressed by every party in the House, to make a gesture and to give us some idea of what he intends to do and what percentage the Government have in mind as the contribution from central funds towards the financing of the health services.

Mr. P.J. Burke

Section 31 is a very important section. The Tánaiste has been Minister for Health for only a very short period but he has been most courteous and helpful to us in relation to this Bill in trying to meet the suggestions we have made and the amendments that have been put down.

Those of us who are members of local authorities hate having to attend the estimates meeting and the meetings that follow because of the glaring problems that are presented. While it would be an easy matter for the Minister as a politician to say that he will give 70 per cent, he has to go back to the Government and find out what he can do.

Mr. Clinton

What would the Deputy recommend? He is a generous, decent man.

Mr. P.J. Burke

If I thought that the money was there I, like the Deputy, would try to reduce the burden on the rates. That is one of the things we are obliged to do. It can be done under subparagraph (b). I shall deal only with the section. The section is so drafted that the Minister can do it provided he gets the money from the Minister for Finance. I have accompanied Deputies who are members of the health authority on deputations to various Ministers for Health to present the problems with which we were faced. There is a huge problem facing the Dublin Health Authority because the charges in respect of voluntary hospitals are going up. The capitation grants seem to be increasing all the time. There are more and more people receiving hospital treatment than there were 25 years ago. There are more elderly people going into hospital. With all the hospitals that there are under the health authority there is still not enough accommodation. There is no public man associated with the city or county of Dublin or Dún Laoghaire who is not continually making representations in an effort to get somebody into hospital.

The Minister has given himself power under section 31. If he can get more money he can make any order he likes under the section for the benefit of the ratepayers. I have implicit confidence in the integrity and honesty of the Minister. If he can do it, he will do it.

Deputy Esmonde spoke of voluntary subscriptions. Other Deputies spoke of a free-for-all service. A free-for-all service would require another £50 million which the Government would have to get through taxation. A Bill would have to be brought in and I am quite sure that there would be a great deal of opposition. We would be told, as Shylock in the Merchant of Venice was told, that we could have our pound of flesh but must not take a drop of blood.

There is a huge problem. There are many things to be done. All of us who are public men, including the Minister, would welcome a reduction in the demands made on the individual ratepayer. But what can we do? If the people have to pay by way of taxation then their butter and their bread, their sugar and everything else will be increased in price. I do not know whether direct or indirect taxation is the more acceptable to the majority.

Mr. Coughlan

Has Deputy Burke forgotten the White Paper?

Mr. P.J. Burke

These things may have appeared in White Papers but situations change when one comes down to practical economics.

Mr. Coughlan

The suggestion came from that side of the House.

Mr. P.J. Burke

I know, but we are dealing here with practical economics. The Minister will have plenty of scope for helping. I hope the financial position of the country will improve and that the Minister will be able to do something to solve the problem for us.

Dr. O'Connell

Section 31 enables the Minister to make grants to help health boards. In actual fact, the burden will fall on the ratepayers. It is obvious to me—it has been obvious to me since I came in here in 1965—that the Government have no awareness of the needs of the people and, secondly, they have no plans.

Mr. P.J. Burke

That is a ridiculous statement from any responsible Deputy. Of course, we are aware and, of course, we have plans.

Mr. Ryan

Then, if you are aware, you do not care.

Dr. O'Connell

I did not interrupt when the Deputy was speaking.

Mr. P.J. Burke

We like practical suggestions, but the man who says we are not aware——

An Leas-Cheann Comhairle

Order. Deputy O'Connell.

Dr. O'Connell

Why I should be met with this outburst from Deputy Burke I do not know. I am surprised he cannot conduct himself. All I am aware of here is hypocrisy. People say they are aware of the burden on the ratepayers and the demands being made upon them, but nothing is ever done to ease the burden. There is no plan. Deputy Burke says that, if the cost is not met by the rates, then there will be extra taxation. We are talking about entering the Common Market and adjusting our economy to meet that situation. We are talking about bringing up our standards so as to put us on a par with Common Market countries. But there are no plans.

It is obvious grants will not solve the problem. There is no proper plan for health or anything else. It has been said that comprehensive health services would cost too much. The late Minister for Education, Deputy O'Malley, came in here with a formula for providing free education at a time when it was said it was impossible to make any such provision. Unfortunately, we have had reactionaries since in the field of education. We have reactionaries also in the field of health. It should be possible to provide a proper health service. Only by providing for everyone can we have a proper health service. The alleged grants will in the long run lead to the ratepayers shouldering the entire burden. This is not an equitable system. Health services should be financed from the Exchequer. The Government are tinkering with our health services. The present system is degrading and nothing is being done to improve it. The system has been watered down as compared with what was contained in the original White Paper. This is not the answer. There is nothing in this Bill to provide proper health services. The burden will still fall on the ratepayers. That is not an equitable system and I strongly object to it.

Mr. J. Lenehan

The main trouble in this section is that there is a good deal of ambiguity. It is open to many different interpretations. The present situation is invidious. In Roscommon, for example, 55 per cent of the people have cards; in Mayo only 43 per cent have cards. I should like to know exactly what this section means. I will have to go back to my own county and explain to my people what it means. I was at a meeting in Athlone with the Minister some weeks ago and I was more than amazed to find so much agreement with the Minister on the propositions he put to us. The Minister will have to admit, however, that this is open to many interpretations. I think that is what is worrying the Oppositions. There should be some fixed decision so that we will know exactly where we stand. Ambiguity is a serious matter. If the ratepayers have to meet the increased charges, then may God help them. I do not believe they will have to meet the burden. I believe the Government through the Exchequer will shoulder the main burden of the cost of our health services.

We must take into consideration that the changes to be made are not likely to take place within the next four or five years and we all know that as far as highly specialised treatment is concerned, this is carried out in Dublin and the county councils have to pay for it. If the cost of that type of treatment continues to increase will it be the county councils or the Government who will pay for it in the future?

Of course, the attacks made on the Minister were made by people who never brought in a Health Bill in their lives and who never will. On the other hand, I must be realistic and looking at these sections and subsections I am afraid that it is possible to read them in several different ways. For instance, it is quite possible that instead of getting this one-half, we would get 75 or 85 per cent of the cost of these services but there is no clear indication in the Bill as to whether anything more than 50 per cent will be given.

Mr. Coughlan

What is the Deputy talking about?

Mr. J. Lenehan

I am talking about the Front Bench over there.

Mr. Coughlan

I am not sitting on either the Front Bench or the Back Bench but from where I am sitting I am asking the Deputy what he is talking about. He should ask his own Minister. It is the Minister who stands charged.

Mr. J. Lenehan

The Labour Party will not give us anything anyway.

I did not intend to stand up again on this section but I raised a few matters which I hope the Minister will comment on before we leave the section.

Mr. Childers

I was about to do that, Deputy.

Mr. Clinton

I had hoped that the Minister might spell out the procedure to be followed under subsection (3), on what will the decisions in regard to contributions be based by the Minister and the Minister for Local Government. Who will draw up the estimate in the first instance? I assume it will be the board. Who will draw up the estimate of the overall requirement and by what procedure will the cost be apportioned as between the various authorities composed in each of the boards? We are entitled to know this but it is not spelled out in the subsection. I also asked the Minister why it was necessary to have (b) of subsection (2). As far as I know there is not a clause of this kind in the existing legislation and on four or five occasions we have had the type of grant specified here paid already. If this was not necessary in previous legislation why is it necessary now?

I should also like to draw the Minister's attention to section (a) of subsection (6) which reads:

Where a sum is due and payable under this section to a health board by a local authority, the amount of the sum may be deducted from any money payable to that local authority by any Minister for any purpose whatsoever.

Why is this being introduced into the section? It was not in previous legislation but the Minister for Local Government had the power, some way or other, to make a demand according to the estimates of the various health authorities and he got his money without this type of procedure. To me, this does not seem necessary. In fact, we have a precedent and it now appears that it is an illegal precedent but at the time of the farmers' rates campaign, the Minister for Local Government stopped certain grants because the farmers refused to pay rates. He was challenged in this House that that was illegal but he said quite definitely that it was not and that he had power and authority to do so. I should like the Minister to comment on those matters before we leave the section.

Dr. Thornley

I do not wish to delay the Minister but I find myself in the unusual but rather pleasant situation of largely agreeing with Deputy Lenehan on this subject. I do not intend to dwell on the Bill in general because this is not the point at which to do so but we must congratulate the Minister on bringing a very high degree of order into a very considerable degree of chaos. While we in the Labour Party share the views expressed by Deputy O'Connell about the shortcomings of the measure as a whole, in the light of the golden promises held out by the White Paper, nevertheless, the Minister has achieved a remarkable degree of co-ordination in certain aspects of this Bill but he does so largely within the confines of—he might well be the first to admit this himself—a less than ideal and ramshackle system of financing and one which, if we were in a position to start again from scratch, we should be very happy to repair and to bring up-to-date.

The provisions in section 31 bring home this precise point about the ramshackle nature of financing extremely clearly. Deputy P.J. Lenihan has brought this out with his customary pungency and tenacity in debate in this House. The method of financing by rates is a highly complex and old fashioned one. Before I became a Member of this House, which is of recent date—indeed, I have been described as an arrival from another sphere—I did some work on 19th-century rateable valuations. There are aspects of 19th-century rateable valuations which remain essentially unchanged down to the present day. It is surely an anomaly that a small house built around 1850, 1860, 1870, 1880 or 1890, with a rateable valuation of, say, £20, £25 or £30, should now be mulcted to sustain an attempt to modernise in general the health services.

Furthermore, recent figures have brought out that the national average price of a house has increased to the region of, £4,750. These are houses subjected to rateable valuations in the region of, say, £40. Is it really valid that a young couple getting married today and purchasing at great difficulty some such house should find, either immediately or at the end of a period of rates remission, that they are liable for section 31 (2) of the Health Bill which they do not understand any more than Deputy P.J. Lenihan understands it and which mulcts them extensively in their annual income?

I regret that the Minister has not broken through the network of rateability which is a form of regressive taxation, no matter on whom it falls, and grasped the nettle of one really substantive change in the whole structure of health financing in this country.

Given the hardworking and diligent Minister that he is, I honestly believe Deputy Childers, the Minister for Health, would have looked to it if it was in his power to do it. At least it would have abolished very wide geographical disparties in the financing of the health services in this country of which all of us are, I think, very conscious.

I think that this Bill has provided a marvellous opportunity for the reduction of complexity in the entire structure of health services financing and in the social welfare financing in this country. This is something of a hobby horse of mine. I shall not dwell on it at great length. It is my very deep and fervent belief that the very complexity by which our social services of all kinds are financed and organised in this country plays into the hands of a situation by which the people are unconscious of their rights and attempt at every level to invoke the work of some intermediary—usually a Dáil Deputy—to try to get for them what are, in fact, their rights under constitutional law with the result that all of us are engaged in what is to some extent a disedifying competition in explaining to people their own entitlements under the law. If the Minister is incapable of explaining these rights to Deputy Lenihan, it is correspondingly all the more difficult for us to explain the same rights to the ordinary citizen in the street.

The Minister may here have missed an opportunity which, pending a change of Government, will not recur in really radically changing the structure of our health services here.

My final point is that the burden of rates charges and the burden, in terms of health expenses, fall with wide disparity on different areas in Ireland. It is hardly necessary for me to dwell upon this point as it has so often been made in this House before. There are constant questions about the provision of blue cards, the financing of the health services. The burden of health payments upon the rates, particularly in cities such as Dublin, bring home this point again and again. I would stress that this is a problem which does not fall merely upon those sections of the population which the Labour Party traditionally represents or like to regard themselves as traditionally representing, but that it falls more and more upon a wide middle-class section of people, young people, many of them with families, who have to sustain this disparity in payment in order to maintain a ramshackle service. Therefore, while this Bill and the section have their merits, I think the Minister might have gone a lot further to earn for himself an even more significant niche in the history of Irish legislation which unquestionably he will hold if he had grasped this nettle more firmly and recognised the inequity of rates as a means for sustaining health services in this country, if he had gone the whole hog to a more direct form of taxation.

Mr. Childers

Deputy Clinton suggested there might be some method by which the separate county councils and Dublin Corporation might agree on the allocation of the health rate between them as in the 1960 Act. I can see reason in that. I am prepared to go to the Minister for Local Government, between now and Report Stage, to see if he would be agreeable. It might militate against his examination of the principle of rate equalisation. There will obviously have to be some point very definitely specified by which somebody will have to decide—an arbitrator or the Minister himself. I think that is a reasonable suggestion. It has been proposed indirectly on this side of the House as well. Deputy Clinton put it forward first. I see no reason why I should not attempt, between now and Report Stage, to have this examined. It might give a chance for an equitable settlement between the various county ratepaying authorities and the Dublin Corporation of arriving at an agreement in regard to this.

So far as the rest of the debate is concerned, I want to say that I, like my predecessor, will do my utmost to ensure the largest possible supplementary grant. It now works out at 55 per cent which we paid for the health services for local authorities. The supplementary amount paid in the passing year is £2,640,000 which will considerably be added to owing to the increases in salaries, wages and costs of materials to hospitals. That is all I can say. I can also state that we did have an inquiry into a possible method of paying contributions. I am not delaying the examination of that. It is coming before the Government almost immediately. I have said it is full of difficulties. It presents many difficulties but at least we have got to the point where we are now examining proposals for some contribution for the middle income groups through the payment of contributions on a semi-insurance basis. The difficulty is, as the House knows, that taxation has to be politically and psychologically acceptable. Already the rates bear very heavily on people. If you put forward a concept of a contribution, you say to yourself: "Can the middle income group afford one per cent, two per cent or three per cent of their incomes?" The resultant rate of contribution, on a flat rate or on an earnings basis, could be just as serious in its impact on people as the present rates. It is a matter that can be argued in the House as to whether a contributory system would be more acceptable to the middle income group than the present method. That again relates to the amount the Government can provide by way of grant to mitigate the effects of the rates.

In so far as the whole country is concerned, I want to state again that the Government, including the agricultural grant—I think it is permissible to include the agricultural grant in the proportion it bears to total local authority costs—pay 75 per cent of the cost of the health services. The cost bears more severely on the rates in large cities. That is admitted. In the case of Mayo, for example—we heard Deputy Lenehan speak about that—the ratepayers are paying only 15 per cent of the total cost of the health services, if one takes into account the proportion that the agricultural grant bears to the cost of health services as a percentage of the total services provided in County Mayo. In Roscommon it is 11 per cent and in Galway it is 20 per cent. Therefore, the position varies from county to county.

Deputy Clinton asked me why we introduced subsection (2) (b). We did that simply to put into legislation a grant that was formerly provided from the Department's Vote. We have now put it in the Bill. It has no significance other than that. It is stated in the Bill that there will be supplementary grants as determined by the Minister with the consent of the Minister for Finance.

Subsection 6 (a) of section 31 is the usual disciplinary clause which provides that, if a local authority fails to pay to the health board its particular contribution from the rates, the amount of the sum may be deducted from any money payable to that local authority by any Minister for any purpose whatsoever. It is just an inevitable disciplinary clause. I hope we will never have to make use of that clause.

Mr. Clinton

Is it a re-enactment of an existing clause?

Mr. Childers

I am told that there is a precedent in some other Act. I could not quote the Act.

Deputy O'Connell said that there was no plan for the health services. Perhaps we have not devised a plan that is satisfactory to him but at this stage of the Bill it would be wrong for me to read out the list of additional services which will be provided under this Bill, and which have very definitely been planned, and the list of other services which will gradually come into operation as the State grows in prosperity. In reply to Deputy Desmond, we have managed to maintain a rate of health expenditure which is fairly constant in relation to the growth of GNP. As the country grows more prosperous more and more is being spent on health services.

Mr. Coughlan

When will that be?

Mr. Childers

I want to say quite frankly—I have always been frank with the House—that I think there is a tremendous problem in relation to what can be done about the rating system, whether the rating system provided only 25 per cent of the cost of the health service or 45 per cent, as at present. As the House knows, there has been a constant examination of this by a special committee set up by the Minister for Local Government. If one reads their reports one will find that they had great difficulty in suggesting positive, constructive methods for replacing the rating system by any other, or in devising a system of re-rating. They made some vague proposals for a local sales tax to replace rates. They did make certain proposals that have been adopted—for instance, the proposal in the last rating Bill enabling county councils to strike an extra rate in order to relieve necessitous persons of rates. However, I do not think that goes far enough. The position will have to be examined again.

Having said that, it is also true that, if one takes the industrial earnings in the city of Dublin for the last ten years, they have about doubled and in that period the rates have about doubled in line with the doubling of industrial earnings. In the same period many of those people—we always hope there will be more—have gone into new houses that have a temporary element of derating, which gradually diminishes over a period of ten years. Equally, there are other people in Dublin whose incomes have not doubled in the last ten years. There is an inequity in that which everybody is striving to remove, including the Minister for Local Government.

I shall do my utmost to see that when this Bill comes into operation— and indeed next year under the present system even before the Bill comes into operation—that the largest possible supplementary grant will be voted. However, all these services compete with one another. For example, if we were to arrange to pay 75 per cent of the health rate, after allowing for the reduction of the agricultural grant, that would mean an extra £8 million on the Budget. It is easy to say we could find the £8 million. How would one find it? We would have to increase income tax by a good number of pence. Then we would have to be careful about income tax because it would affect the income of workers. Alternatively, turnover tax could be increased by 1 per cent.

Quite apart from that, every other Minister seeking to improve the life of the people by increases in social welfare services, by increases in the sphere of education, by payments for subsidies for housing loans, would be equally competing for whatever available receipts there are from existing rates of taxation and from increased taxation, if we have to undertake it. It is no good making idle promises and simply saying that it would be easy to find £8 million. Everybody knows that the Minister for Finance of the day, no matter from what part of the House he came, would find sums of that kind extremely difficult to raise.

I think I have dealt with section 31 adequately. I want to make it clear that I will try to provide a supplementary grant as large as possible with the permission of the Minister for Finance.

Mr. H.P. Dockrell

Before the question is put may I ask the Minister a question in relation to the payment of grants by his Department? The present position is that his Department pays grants quarterly. I wonder would it be possible for the Department to make the payment to the authorities more often—monthly, for example?

Mr. Childers

This has been taken up by my Department with the Department of Finance but so far we have not been able to get agreement for payment other than quarterly. However, if Deputies feel the instalments should be paid more regularly, at shorter intervals, I shall take it up with the Department of Finance. Quite frankly, I would much prefer to be assured of a large supplementary grant than to be assured that the payments would be made monthly rather than quarterly.

Mr. H.P. Dockrell

The Minister will realise that this puts bank interest on the ratepayers.

Mr. Ryan

As there is no change in principle in the system of financing the health services we have no option but to vote against this section.

Question put.

The Committee divided: Tá, 64; Níl, 48.

Tá

Aiken, Frank.
Andrews, David.
Barrett, Sylvester.
Boylan, Terence.
Brady, Philip A.
Brennan, Joseph.
Briscoe, Ben.
Brosnan, Seán.
Browne, Patrick.
Browne, Seán.
Burke, Patrick J.
Carter, Frank.
Childers, Erskine.
Colley, George.
Cowen, Bernard.
Crowley, Flor.
Haughey, Charles.
Healy, Augustine A.
Herbert, Michael.
Hilliard, Michael.
Hussey, Thomas.
Kenneally, William.
Kitt, Michael F.
Lalor, Patrick J.
Lenehan, Joseph.
Lenihan, Brian.
Lenihan, Patrick J.
Loughnane, William A.
Lynch, Celia.
Lynch, John.
McEllistrim, Thomas.
MacSharry, Ray.
Cunningham, Liam.
Davern, Noel.
de Valera, Vivion.
Dowling, Joe.
Fahey, Jackie.
Faulkner, Pádraig.
Fitzpatrick, Tom (Dublin Central).
Flanagan, Seán.
Foley, Desmond.
Forde, Paddy.
French, Seán.
Gallagher, James.
Geoghegan, John.
Gibbons, Hugh.
Gibbons, James.
Gogan, Richard P.
Meaney, Thomas.
Molloy, Robert.
Moore, Seán.
Moran, Michael.
Nolan, Thomas.
Noonan, Michael.
O'Connor, Timothy.
O'Kennedy, Michael.
O'Malley, Des.
Power, Patrick.
Sheridan, Joseph.
Smith, Michael.
Smith, Patrick.
Timmons, Eugene.
Tunney, Jim.
Wyse, Pearse.

Níl

Barry, Richard.
Begley, Michael.
Belton, Luke.
Belton, Paddy.
Bruton, John.
Burke, Joan.
Burke, Liam.
Burke, Richard.
Burton, Philip.
Byrne, Hugh.
Clinton, Mark A.
Collins, Edward.
Conlan, John F.
Coogan, Fintan.
Corish, Brendan.
Cosgrave, Liam.
Cott, Gerard.
Coughlan, Stephen.
Creed, Donal.
Crotty, Kieran.
Desmond, Barry.
Dockrell, Henry P.
Dockrell, Maurice E.
Donnellan, John.
Dunne, Thomas.
Enright, Thomas W.
Esmonde, Sir Anthony C.
FitzGerald, Garret.
Fitzpatrick, Tom (Cavan).
Flanagan, Oliver J.
Fox, Billy.
Governey, Desmond.
Jones, Denis F.
Kenny, Henry.
L'Estrange, Gerald.
Lynch, Gerard.
McLaughlin, Joseph.
O'Connell, John F.
O'Donnell, Patrick.
O'Donnell, Tom.
O'Donovan, John.
O'Higgins, Thomas F.
O'Reilly, Paddy.
Ryan, Richie.
Taylor, Francis.
Thornley, David.
Timmins, Godfrey.
Tully, James.

Tellers:—Tá: Deputies O'Malley and Meaney; Níl: Deputies R. Burke and L'Estrange.

Question declared carried.

SECTION 32.

Question proposed: "That section 32 stand part of the Bill".

Mr. Ryan

This section is one which enables a health board to borrow money subject to conditions specified by the Minister. I now take up the point which Deputy Dockrell raised on the conclusion of the last section. Much of the money which health authorities are obliged to borrow arises because of the fact that they must pay their hospital accounts, the accounts of extern institutions, in the month in which they receive the bills. Although this obligation lies on health authorities, in practice the Department of Health do not pay their share of the bill for a period of three months, and sometimes for a much longer period, afterwards. The result is that health boards invariably find themselves in debt, to the tune of one-quarter of their annual expenditure, on hospitalisation.

We received on numerous occasions when we went to the Minister for Health assurances that he would take up this matter with the Department of Finance because it was considered unfair that the rates should be asked to carry the entire cost of the interest on money borrowed to pay for health services. Unfortunately, we find that under section 31 and 32 health boards apparently still will be obliged to borrow money to pay bills which are presented to them, but they will have to wait, if the present practice continues, for several months before they receive payment. Therefore, I should like some indication from the Minister that he will endeavour to shorten the period between presentation of bills by health boards to the Department and payment by the Department of their share. If this is done it will remove a completely unnecessary burden because this is a charge on health services which does not confer any direct benefit on the people whom it is intended health services should benefit.

At present, rates in different areas are between threepence and sixpence in the £ more than they would be if the Department of Health paid their health bills when they received them from local authorities. Everybody will agree there is not sufficient loose money available to be spent unnecessarily in this way, paying bills which would not arise if the national Exchequer paid its accounts with greater rapidity. If we could achieve this improvement in payment on the part of the Department of Health, or else an undertaking by the Minister for Health to relieve interest on expenditure on loan charges in respect of health services, there would be considerable benefit for the health authorities and, indirectly, for the ratepayers and taxpayers.

Mr. Tully

There is another angle. Many local authorities during a number of years have adopted a practice of budgeting for a credit balance. At a certain period of the year it is not unusual to find a local authority with a credit balance of up to £250,000 or maybe more. The reason they try to do this is that they have to borrow at certain other periods because various Departments, such as Health and Local Government—Local Government in particular—will not pay them money due. In these circumstances, local authorities, to ensure that they have money, try to retain a credit balance. This means that they are, in fact, artificially increasing the rate by using money which they should normally not require. Some local authorities felt it wrong that this should continue and succeeded in having the credit balance used for useful capital works. It was then found that the position was worse than before because they had to borrow tremendously high sums to bring them over a period when they had not money and the Department of Health or other Government Departments would not give it to them.

It is all right when money is being raised by an Act of this House—the money is made available. But I think it is entirely dishonest of any Government Department to retain or fail to pay money due. If we want to cut down the rates—and we hear enough about this—this is one way in which it can be done: let the State meet its commitments as they fall due. Deputy Ryan suggests that there should be a subsidy towards loan charges but this would not be necessary if the State paid the money as it falls due. This is the obvious answer and the Minister should seriously consider this.

I know that his predecessors and other Ministers may advise him that this is not good business, not the way things should be done; that the money should be let run and eventually the local authority would have to be satisfied with what they get. In my personal experience, apart from comments made about the percentage of money due by the State, very much less than that amount is made available by the State when the money becomes due. Therefore, I ask the Minister not to be persuaded by those who have carried on the bad old system for many years that this has been established as the way it should be done and that it should continue. The Minister is an intelligent man able to think for himself and he should see the injustice of the present system and he should decide that the money should be paid at the very latest, monthly, to the local authorities. This would have a big effect on the health rate of local authorities throughout the country.

Mr. P.J. Burke

This is a matter that was the subject of representations on quite a few occasions when we went on deputations to the previous Minister for Health. The present Minister has told us that this matter is under consideration with the Department of Finance. All I can say is that I have confidence that he will keep up the pressure to see if this can be done. If it cannot be done, perhaps, he could allow 50 per cent towards the loan charges?

Mr. P.J. Lenihan

It is not a question of monthly or quarterly payments. The system of accountancy carried out by county councils is antiquated.

Mr. Tully

The Deputy is not.

An Ceann Comhairle

Deputy Clinton.

Mr. Clinton

Deputy Lenihan's approach seems to be sensible, if I understand it correctly, in that there are lean periods in local authorities when they have no money and are, in fact, borrowing money. It should be possible on those occasions for the Department to pay in advance. In future, the demand will be decided by the Minister who has got that power in the previous section. When he specifies the amount he knows the amount of money in that year that will be due to the local authority or health board. There is no reason why, in lean periods when the health board is not in credit, the Minister could not decide to advance money to them so that they will not have to incur bank interest charges. That is making the best use of available capital. It is a very sensible approach and I hope the Minister will look into this. He has already said that he will concern himself to see that payments are made more promptly but I am asking him to consider the possibility of making advance payments in order to overcome the need for servicing of debt when a local authority is borrowing.

On the whole, this is a very sensible section about which there can be little controversy. I am glad to see in subsection (5) of the section that there is provision for a health authority to accept gifts. We have had the extraordinary position for years that no local authority could accept a gift, even the smallest, for any purpose from anyone. There was nothing in legislation to enable them to do so. This holds in local government all over Ireland and I am glad that some Minister had the good sense to include this subsection.

Mr. Childers

As the House knows, and I may as well be frank about this, the Minister for Finance at certain times in the year is short of money himself and has to raise it by shortterm Exchequer bond issues and so on, on which he pays interest. There is also the delay in payment of rates in two moieties. I hope the instalment system provided for in the recent rates Bill will operate fairly freely or, perhaps, a system whereby people purchase rates stamps. I was reminded of this in reading the last report of the rating committee presented to the Minister for Local Government in which they pointed out that at the then rate of taxation a person who paid £60 rates on his house, paid £65 in petrol tax if he drove a medium-size car 10,000 miles a year and almost the same amount of money if he smoked 20 ordinary cigarettes a day.

Part of the difficulty of rates is the great impact of lump sums in two moieties. That does not say that rates are not still a heavy impost. To some extent they might be described as a psychological imposition but they are a heavy imposition. I hope the instalment payment system will grow. If it does, the money will come into local authorities more regularly. But, having said all that, I shall do my best to approach the Minister for Finance on this matter. I can see that sums spent on paying interest to banks for overdrafts for carrying out these services restrict the local authority, or the health board as to the amount it can spend on various services, restrict expenditure on capital works, maintenance and improvements and so on. I shall do my best about this but it is no good pretending it is an easy problem to solve. In view of the tremendous increase in rate charges for the health services that has already been experienced, it will be my duty to urge as far as I can the Minister for Finance to take into account the views of all sides of the House in regard to this matter as expressed by Deputy Burke and other Deputies.

Question put and agreed to.

SECTION 33.

Mr. Clinton

I move amendment No. 32a:—

32a. In page 17, between lines 14 and 15, to insert a new subsection as follows:

"(2) (a) If immediately before the commencement of this section Eugene O'Keeffe was Chief Executive Officer of the Dublin Health Authority, he shall become by virtue of this subsection Chief Executive Officer of the Eastern Health Board.

(b) If immediately before the commencement of this section James Joseph Nolan was Assistant Chief Executive Officer of the Dublin Health Authority, he shall become by virtue of this subsection Assistant Chief Executive Officer of the Eastern Health Board.

(c) If immediately before the commencement of this section Randal Neal Lamb was Secretary of the Dublin Health Authority, he shall become by virtue of this subsection Secretary of the Eastern Health Board."

When we sat down to draft this amendment the question of whether or not the names of individual people should be included in the amendment arose. This was something we were anxious not to do but, unfortunately, when we looked up precedents for this, we found that, in fact, actual names had been put in, and we felt there must be some good reason why this had been done.

There are a number of precedents which can be cited and which can be looked up, and that is why the names of the three persons are mentioned here. This is something we all want to avoid in this House if we can, because we are speaking of people who are outside the House. We put down this amendment because we felt that some clarification was called for from the Minister in relation to the three people mentioned in the amendment who at present hold the three senior posts in the Dublin Health Authority.

These people have been members of the staff of the Dublin Health Authority since 1960. Previous to that each one of them held very important posts of one sort or another, and they came into their present positions with considerable experience. The chief executive officer was the city and county manager in charge of the health services of the seven boards then existing and providing the health services for the entire area. The secretary of the health authority had previously been secretary of two very important hospital boards. The third person mentioned in the amendment was, in fact, a senior officer in Dublin Corporation for a number of years, and was very much concerned with the introduction of the 1953 Health Act in the Dublin area.

I want to explain that these three people are in exceptional positions in so far as there is no other official in the whole of the country in the same position. They are whole-time officers of a health authority and in the most senior positions in the largest health authority in the country. In no other case is there a whole-time CEO of a health authority. In no other case is there a whole-time secretary of a health authority. In no other case is there a whole-time assistant CEO of a health authority. These people are in a special position.

There are a number of precedents in previous legislation, notably in the 1940 legislation, of people who were transferred in a manner similar to the manner recommended in this proposed amendment. We want to get an assurance from the Minister if possible that, as a result of the proposed reorganisation of the health services, these three extremely able and experienced people will not find themselves in inferior positions, so to speak, and that they will be assured that they can continue on in their present positions. I do not think there will be any contention about this. There are two other health authority areas, Wicklow and Kildare, added to the present number of authorities in the Dublin Health Authority. I do not think there will be any opposition to this because, as I say, in no other health authority in Ireland, in no other local authority in Ireland, will anyone lose a position as a result of this change.

A man who was CEO of a health authority was also a county manager. The same goes for secretaries of existing health authorities. They were also secretaries of the local authorities concerned. They will continue in that position. We want to ensure that three able experienced people do not lose their positions because of this reorganisation and enlargement of the eastern region of the health authorities.

Mr. P.J. Burke

I rise to support this amendment. I appeal to my colleagues, the Minister, because I know that he is in a dangerous position when he starts creating precedents——

Mr. Clinton

He is not creating a precedent.

Mr. P.J. Burke

Allow me to develop this. There is no precedent here. This is the only regional health authority we have had in Ireland since 1960. These men have carried out their duties in a very conscientious way over the years. They have been trained to do the work of the regional health authority in dealing with three local authorities. A precedent was established in a previous Health Bill. I do not want to mention names, but there was a precedent for this when the regional health authority was set up. The then assistant city manager and the city manager were mentioned in the Bill.

There is a danger here that we may be doing an injustice to three very conscientious men. I agree with this amendment, although my name is not down to it. We agreed to do this. I know the Minister would not like this Bill to be responsible for doing any injustice to any member of the regional health authority. It is the only regional health authority we have in operation. As Deputy Clinton rightly stated, this matter does not arise in any other constituency, or in any other health area. The secretaries of the various councils and the county managers in the various areas will not be displaced. Their positions will be just as they are. There will be the creation of new posts in the regional health areas as cited in the Bill.

We are dealing here with a specific case. I would not like—and I know my colleagues would not like—an injustice to be done to three most conscientious men, men who have distinguished themselves. I have worked with them for nine years. I got to know them and I could not speak too highly in their praise. I do not want to overemphasise it but I want to appeal to the Minister to see that justice is done in this case. I would be grateful to the Minister if he could consider favourably what I have said.

Mr. H.P. Dockrell

I want to endorse everything which Deputy Clinton and Deputy Burke have said about this amendment. The amendment comes before the House as a result of a meeting of the Dublin Health Authority at which it was unanimously decided that we should put down this amendment. The Minister is a reasonable man. Mr. O'Keeffe, the first named in the amendment, gave up the assistant city managership to take over the Dublin Health Authority; Mr. Nolan gave up his position in the Dublin Board of Assistance; and Mr. Lamb gave up his position in the Dublin Corporation. It has already been stated that these three are the only whole-time members of the health authority and I would press the Minister to accept these amendments, but if he is not prepared to accept these amendments then I would press him to insert into this Bill some method of compensating these three men who have, as I have said, given up positions in the service and who might be passed over with the setting up of the new regional health board.

Mr. Andrews

I concur in principle with what has been said. With respect to Deputy Clinton and Deputy Dockrell, the naming of names is not really contentious. For the Minister's information—there were precedents mentioned in relation to the naming of these three gentlemen—the County Management Act of 1940 made provision for a similar situation which existed then, and apparently now exists in relation to this Bill and this section.

The three people mentioned—the CEO, whom I know very well, the acting CEO, and the acting secretary, whom I know to a lesser extent—took over a conglomerate of seven health authorities. They took over the health authority of Dublin Corporation which comprised the largest staff. They took over the Dublin Board of Assistance which at that time ran St. Kevin's Hospital. They also took over the Dublin County Council health staff, Dún Laoghaire health staff, the staff of Rathdown Health Authority and the staff of Balrothery Health Authority. The Rathdown authority covered the south side of the city, while Balrothery covered the north side.

As a Deputy who has some considerable experience of dealing with the Dublin Health Authority, I have nothing but the highest praise for the efficiency with which these men brought these seven health authorities together and made an efficient unit, and it is a difficult thing to meet that type of demand nowadays. I can only speak of the Dublin Health Authority per se, I have no experience of the disparate authorities before the Dublin Health Authority became one unit; they look at cases not so much from the financial aspect or from the point of view of how much they are going to lose but rather from the humanitarian aspect of an individual's situation. They are a humane authority and that is good enough for me in dealing with any such body.

The section as it stands is not strong enough to bring in the amendment that Deputy Clinton calls for. However, if the Minister cannot include the names in the section I know he will give this House an assurance that no injustice will be caused to these three individuals named in the section. I should like to see them getting compensation if the Minister does not see his way to accepting this amendment or a similar amendment to the section. I want to ensure that these men will be placed in exactly the same position as they are now in. I want to see that they are placed in the eastern regional health board as if their lives were not upset at all by the creation of this new health board. Therefore, I would ask the Minister to transfer them holus bolus to the new health board with no upset to their lives. They have made their commitment by the manner in which they have done their duty to the city and county of Dublin, and that is why I concur with Deputy Burke on the one hand and Deputy Clinton and Deputy Dockrell on the other hand.

Mr. Tully

Lest there be any idea, from the fact that there has been no comment from the Labour benches, that we are not in agreement with the suggestion in Deputy Clinton's amendment, let me say we are prepared to support it. We hope the Minister will do what is asked either through this amendment or in some other way if he does not think the amendment covers the problem.

I am interested to hear Deputy Andrews describing the gentlemen whom I only know across the table from me in negotiating for wages and conditions for employees. They have been very tough and very fair. I have no experience of how they carry out their other duties but I shall take the word of Deputy Andrews and other Deputies who say they have been very humane. Might I ask the Minister to be as humane as these gentlemen apparently are and to ensure that not alone will those three be looked after but that any employee of the Dublin Health Authority who might be displaced because of this move will also be considered.

In section 38 (2) (d) of the Bill it is required that Mr. O'Keeffe be transferred to an office, similar to his present office, with the same remuneration, the same superannuation rights and the same status. This means that his status within the new administration would be at the level immediately under that of the chief executive officer, who would correspond to Mr. Macken in the new health board and that, I might say, is of course if Mr. O'Keeffe is not the person selected at the Local Appointments Commission examination for the position of chief executive officer. I can guarantee to the House I will make the order in the manner in which I have said.

Exactly the same will apply to Mr. Nolan and Mr. Lamb. They will be transferred to similar offices under the eastern health board. This position does not arise only in the Dublin area. There is an assistant manager in the Cork Health Authority who works under the city manager; there is a secretary to the Cork Health Authority in addition to the assistant manager; there is a secretary to the Waterford Health Authority; and there is also a secretary to the Limerick Health Authority.

Mr. H.P. Dockrell

Mr. P.J. Burke

Yes, that is true.

Mr. Ryan

The only change, as far as the Dublin region is concerned, is that the £2 million spent in Wicklow and Kildare a considerable part of which was spent in the Dublin region anyway is to be added to the £13 million already spent by the Dublin Health Authority. At the moment the expenditure of this £13 million relates to expenditure in 59 hospitals in Dublin city, county and Dún Laoghaire. There is £2 million being spent in hospitals in Wicklow and Kildare, which, and I say this with no disrespect, are not comparable to most of the hospitals in the Dublin region. The position is that here we have three officers successfully administering what will in effect be nine-tenths or more of the new health authority expenditure. Does Deputy Burke see that I am not making a partisan argument? I am making one which supports all we are saying and I am making it on the basis of the efficiency of the people who have successfully done this.

I think it is true to say that there were many doubts on all sides of the House when the Dublin Health Authority was amalgamated because it was felt it would become too big and that it would not operate successfully. I have some reservations about this new proposal. I think we are going too far and that this may be the last straw which will break the camel's back. The fact is we have three people who most successfully amalgamated these areas. They are in the prime of their life. There are many years ahead of them. It is in the public interest, apart from what we should consider, the interests of the three men concerned, that they should be given the three most senior offices under the new region.

Again, I give a final figure to support my argument, the figure of population. The population of the region at present covered by the Dublin Health Authority is practically 800,000 and the population in Kildare and Wicklow is 126,000. So, again, these three men are successfully operating a health service, within existing rules, in the Dublin region for a population which is almost seven times greater than it is proposed to introduce. All these things point to the correctness of providing that these three officers should be appointed to these positions. They are in most responsible positions and they are in them because they were successful in their applications through the Local Appointments Commissioners and they were appointed by the Local Appointments Commissioners to these positions. People who have done that and who have been successful in their posts should not be required because of a minor change in the area of their authority to again submit themselves to the process of the Local Appointments Commissioners.

Of course, it could be argued that if they were all that successful they would probably be successful through the commissioners but there could be many other qualifications which could be imposed in the conditions of service which might eliminate them and that would be unfair.

To my colleagues on both sides who suggested, as an alternative, compensation for these men I say the law already provides for compensation but no man in the prime of his life, if he is worth a damn, is looking for compensation and I do not believe that these men are. I am a member of the health authority but the Minister for Local Government will not allow me to exercise my functions as such at the moment and, therefore, I was not a party to any discussions which occurred in relation to this but I speak out of conviction about the fairness of the argument. I speak out of a knowledge of these men and out of what I would say was a personal revelation to me. I was and still am extremely critical of health services.

I suspected before I became a member of the health authority that there were bureaucrats in the health authority who were out of sympathy with the unfortunate people whom I would like to see helped. But I can say, having had the experience of being on the health authority, that these three officers and, indeed, all the officers and staff of the Dublin Health Authority, are passionately anxious to come to the assistance of every person who is requiring medical and social attention and they work far beyond the call of duty. Again and again I have been amazed at the large number of members of the Dublin Health Authority staff that I have seen on innumerable occasions in what should be their time off attending to carry out charitable works. This is the kind of mettle of which these men are made and it would be churlish, indeed, if we were not to recognise it and to pass this section without securing them in the principal positions in the new health board, securing it because they are personally entitled to it and also because, I believe, the people in the region would benefit by having such experienced men there.

Finally, may I assure our colleagues in the Labour Party that we will certainly be giving our full support to the amendment in the name of Deputy Desmond and others to provide that the conditions of employment of existing officers and servants shall not be worsened. You are going to worsen the conditions of employment if you demote them in status, as you will if you do not give them the positions in the new health boards that this amendment seeks to secure for them.

Mr. Desmond

Mr. P.J. Lenihan

No, it is not. There are eight other regions.

Mr. H.P. Dockrell

I suggest to the Minister that his argument that the senior county manager in other regions would have to be appointed because of Mr. O'Keeffe's appointment in Dublin is utterly fallacious. The senior county manager, or any other county manager, elsewhere in the country would not have the same right as Mr. O'Keeffe because he is not a full-time health official. That is how Mr. O'Keeffe can be described and he is the only official in the country in that position. I do not understand how the Minister can drag county managers, or anybody else, into the argument.

Mr. Herbert

I would like the same consideration now being asked for for the people in the Dublin Health Authority to be extended to the secretary and accountant. The 1954 Act amalgamated Dublin city and county and there is a full-time secretary and accountant and I would ask the Minister to give these people the same consideration he is asked to give Mr. O'Keeffe.

Mr. S. Browne

I would like the same consideration for Waterford.

Mr. Connolly

I would like to include the secretary of Offaly County Council in this.

Dr. Gibbons

May I put in a word for Mayo?

An Leas-Cheann Comhairle

All this is irrelevant. All these are outside the amendment before the House. Is the amendment withdrawn?

Mr. Clinton

Does the Minister want to make any further observations?

Mr. Childers

I have, I think, copperfastened the situation as far as I can.

Mr. Clinton

We accept the Minister's assurances.

Amendment, by leave, withdrawn.

Section put and agreed to.

Section 34 agreed to.

NEW SECTION.

Mr. Childers

I move amendment No. 33:

In page 18, before section 35, to insert the following new section:

"(1) On the commencement of section 6 the following property—

(a) all health institutions, and all other property, whether real or personal (including choses-in-action), which, immediately before such commencement, was vested in or belonged to or was held in trust for a local authority (other than a sanitary authority) and was property which was solely for the purposes of services to be transferred on such commencement, and

(b) all other property, whether real or personal (including choses-in-action), which, immediately before such commencement, was vested in or belonged to or was held in trust for a local authority and had been designated by that authority as property to be transferred to the health board,

and all rights, powers and privileges relating to or connected with any such property, shall, without any conveyance or assignment, but subject where necessary to transfer in the books of any bank, corporation or company, become and be vested in or the property of or held in trust for (as the case may require) the health board for all the estate, term or interest for which the same immediately before such commencement was vested in or belonged to or was held in trust for the local authority, but subject to all trusts and equities affecting the same and then subsisting and capable of being performed.

(2) All property transferred by subsection (1) to a health board which, immediately before the commencement of section 6, was standing in the books of any bank or was registered in the books of any bank, corporation or company in the name of a local authority shall, on the request of the health board made at any time after such commencement, be transferred in the books by the bank, corporation or company into the name of the health board.

(3) Every chose-in-action transferred by subsection (1) to a health board may, after the commencement of this section, be sued on, recovered, or enforced by the health board in its own name and it shall not be necessary for the board to give notice to the person bound by the chose-in-action of the transfer effected by that subsection.

(4) After the commencement of this section, every bond, guarantee, or other security of a continuing character made or given by a local authority to another person, or by any person to a local authority, which was in force immediately before such commencement and which related solely to services to be transferred on the commencement of section 6 to the health board, and every contract or agreement in writing made between a local authority and another person which was not fully executed and completed before such commencement and which related solely to services to be transferred on such commencement shall be construed and have effect as if the name of the health board were substituted therein for the name of the local authority, and the security, contract or agreement shall be enforceable by or against the health board accordingly.

(5) After the commencement of this section, every rule and regulation lawfully made by a local authority which was in force immediately before such commencement and which related solely to services to be transferred on the commencement of section 6 to the health board shall, so far as it is not inconsistent with this Act, continue in force and have effect as a rule or regulation made on such commencement by the health board for the residue then unexpired of the period and in respect of the area for and in respect of which the same was actually made by the local authority and, accordingly, every such rule and regulation may be continued, varied or revoked, and penalties and forfeitures arising thereunder before or after such commencement may be recovered and enforced by the health board in the like manner and as fully as the same could have been continued, varied, revoked, recovered or enforced by the local authority if this Act had not been passed.

(6) After the commencement of this section, every resolution passed, order made, and notice served by a local authority before such commencement, the operation, effect or term of which had not ceased or expired before such commencement (being a resolution, order or notice relating solely to services to be transferred on the commencement of section 6 to the health board) shall, so far as it is not inconsistent with this Act, continue in force and have effect as if it were a resolution passed, order made, or notice served by the health board on the date on which the same was actually passed, made or served by the local authority and as if the functions of the health authority were on that date performable by the health board.

(7) All loan charges which are in respect of money borrowed for the purposes of property transferred by subsection (1) to a health board and become payable after the commencement of this section shall be payable by the health board.

(8) Any debt of a local authority in respect of which loan charges become payable by a health board under subsection (7) shall become and be a debt of the board.

(9) Where—

(a) property falls to be transferred from a local authority under this section,

(b) the entire functional area of that authority is not included in the functional area of one health board, and

the Minister shall nominate the health board to which the transfer is to be made, and references in this section to a health board shall be construed accordingly in relation to that property.

(10) The Minister may by order provide for the transfer of any specified health institution to a regional hospital board and may in such order provide for the application of any provision of this section to such transfer in the same way as it applies to a transfer to a health board.

(11) Where the Minister has made an order under subsection (10), the relevant property shall not be included in the property transferred to a health board under subsection (1)."

Mr. Ryan

Why is this new section being inserted? In what way does it differ from the original?

Mr. Childers

The transfer to the health boards will not take effect until the date on which the health boards take over responsibility for the operation of the health services under section 6. We hope to appoint the health boards before they become operational in order that we can appoint the regional hospital boards before April, 1971, and in order to give the regional health boards and the regional hospital boards time to become acclimatised to their work and to get a proper understanding of the situation in order to prepare for the new administration.

Amendment agreed to.

An Leas-Cheann Comhairle

The acceptance of this amendment involves the deletion of section 35 of the Bill.

SECTION 36.

Mr. Childers

I move amendment No. 34:

In subsection (1), page 20, line 9, to delete "Upon the establishment of a health board under this Act" and substitute "On the commencement of section 6".

Yes.

Amendment agreed to.

Mr. Childers

I move amendment No. 35:

In subsection (1), page 20, line 11, to delete "the establishment" and substitute "such commencement".

Amendment agreed to.

Mr. Childers

I move amendment No. 36:

In subsection (2), page 20, to delete lines 19 to 25 and substitute the following—

"(a) any officer whose duties relate solely to services which, on the commencement of section 6, are to become transferred to the health board,

I move amendment No. 41a:

To add to the section the following new subsection:—

"(8) The conditions of employment of existing officers and servants to be transferred to health boards shall not be worsened."

I move this amendment because of my concern to ensure that the conditions of employment of existing officers in the service who are to be transferred to health boards shall not be worsened. The Minister has given an assurance on this already but we would like it inserted in the Bill. This amendment would ensure that the conditions of officers and servants will not be worsened. Servants and workers under the health board may find their duties and the conditions of employment worsened very much. It is to prevent this happening that we tabled this amendment.

Mr. Childers

I dealt with this at considerable length before. It is inconceivable within the present age that the position of officers and servants could be noticeably or visibly worsened. I look forward to the completion of the negotiations that are being worked out in the Department of Local Government for a conciliation and arbitration scheme which will be of a more modern type than that involved at present and which would provide for conditions of employment as well as for remuneration. I gave the assurances about that; that this scheme is being worked out; that there would be a special joint council representing the health boards. As the Deputy knows, the present position is that existing officers' duties are decided by the manager of a local authority from time to time and there is an appeal to me. Therefore, again, simply in the ordinary process of democracy, I should really be in desperate trouble in this House if the position of some officer or servant had quite clearly been worsened. When officers are transferred, sometimes there could be what might be described as disagreement on what constitutes worsening. The officer might think his position was worsened when, on the other hand, three out of five people would say it was not worsened, that his work was just as agreeable or demanding. His pay would be the same, in any event. There would be no question of a reduction in pay. It is inconceivable that I, as Minister, would give a series of decisions which would have the effect of really worsening the position of these people. One can imagine the questions I should have to answer in this House. I think I can be relied on to take the right point of view in regard to this. There is the special joint council which will operate during the period when the transfers take place and the trade unions concerned can use their full authority in this matter.

Mr. P.J. Lenihan

It seems to me it is a very poor reflection on local authorities, on unions and on everybody concerned to have to write in something like this. I can conceive of no situation which could demand it. In subsection (5) of this section it is implied, in any transfer of people from the authority, that, if there is anything wrong or if their conditions of service are in any way worsened, there is an appeal to the Minister. Apart from the appeal to the Minister, their associations and unions are composed of reasonably well-educated men. I can see nothing happening that would worsen a situation. To write it into an Act seems to express a grave doubt as to the good intentions of all the people concerned in this measure. Honestly, I do not think it is necessary.

Mr. Ryan

Contrary to what Deputy Lenihan says, it has happened that it has been written into Acts before. Perhaps we have progressed—I hope we have progressed socially since then —to a point where it no longer, perhaps, is absolutely necessary to write this into legislative form. If my memory serves me correctly, in the Act which amalgamated the old National Health Insurance Board with the Department of Health, there was a provision that the conditions of service would not be worsened.

Mr. P.J. Lenihan

When was that?

Mr. Ryan

The 1945-47 period. I had not reached the age of political maturity then. But this is my recollection. I was reminded of it since by some people who felt that their statutory rights had been infringed. One of the terms of promotion in the Civil Service was, of course, fluency in the Irish language. The old National Health Insurance Board did not have this Irish language requirement. People in the employment of the Department of Health and of the Department of Social Welfare found themselves under an obligation to undergo tests in Irish for promotion which they would not have been obliged to undergo if they had been in the old National Health Insurance Board.

Another condition for promotion imposed by the Department was that officers had to serve for a period in employment exchanges in different parts of the country. This again was not a condition of service in the old National Health Insurance Board and, because of the provision in the legislation at the time, this condition which the Department sought to impose was only of short duration. I can see a certain wisdom in the amendment and we in Fine Gael gladly support it.

Again, if you want another precedent, if my memory serves me right —and nobody would be better than the Tánaiste to confirm or contradict this—we have had a provision in transport legislation that conditions of service would not be worsened and that, if people felt they were worsened, they had certain rights of appeal to have compensation provisions, and so on, determined. Perhaps it was not in the legislation but in the regulations made under it but certainly it had something in the nature of statutory enforcement. I cannot see that there is anything wrong in writing into the Bill something which the Minister and his colleagues say will, in practice, operate. Why not state in a Bill what we all agree should operate?

Mr. Childers

In the Transport Act, there was an appeal to an arbitrator if there was worsening of conditions in his transfer. The arbitrator in this case is the Minister.

Dr. O'Connell

Would the Minister make a comment on the old National Health Insurance Board mentioned by Deputy Ryan?

Mr. Childers

The situation has changed very much since then. Officers and servants of local authorities are very well represented by their organisations, by the local authority representatives and by the people on the new regional health boards. It seems to me inconceivable in this modern age that this situation has not entirely changed. I have given an assurance in regard to this matter. I have given an assurance that, if any appeal is made to me, and if there is any obvious worsening of conditions as a result of a decision, I would accept the appeal of the officer or servant concerned. I want to limit that statement by saying that, as the House knows, what constitutes worsening of conditions in the sense of what might be described as absolute details of work that a person does, is a matter about which there will always be opinions. In other words, some servant—it is a terrible term but still it is in use in the Act—of a health board might be moved to some kind of position where he would think his position was worsened, although perhaps three out of five people in this House, asked to judge the case, would say it was not worsened. If there was any obvious worsening of his or her position, I would naturally see to it that the appeal against such a worsening was upheld. I cannot do more than that. In connection with appeals that have been brought under the previous Health Acts, I think there has not been any great complaint about the action of my predecessor or his predecessor in regard to people. I do not recall many Parliamentary Questions over the years on this matter. I hope I can continue the same tradition.

Dr. O'Connell

We are responsible for this. We accept the situation now. However, we have an obligation to write this into this Bill. Many questions may not occur to us at the present time. I cannot see the objection of the Minister to writing this in. There may be the case that with the extension of this board, a man may be asked to travel 40 miles. He may be transferred, within the area, maybe 40 or 50 miles away. Would the Minister consider that that was worsening the conditions of his employment? These are just isolated cases. Why can we not write that into this Bill? That is what I should like to know. The Minister says, in effect: "I do not like this now. Well, in this day and age, there is no need to do it." We are trying to produce a Bill that is in the best interests of the public. This amendment ensures this. I do not think it will create problems. Write this into this Bill and everyone will be very happy. I do not think it is wrong to do this. If the Minister is so sure, why does he not accept it?

Mr. Healy

As one with over 20 years experience in health and local administration, and while appreciating the anxiety of those who wish—as we all would, indeed—that no worsening of conditions would appertain to any employee, I think the Minister is right. If we write it in, there is a suggestion that they could be worsened and that this is put in to protect some people. To protect some people from what? Are we to take it that this is to be put in to protect some people from the local administrators, the majority of whom are public representatives who would be most anxious, in my experience, no matter to what party one might belong, jealously to safeguard the interests of the humblest worker? He has only to come to a public representative, as I am sure Deputy O'Connell knows, to see that his case will be ventilated. But, if you had a bit of a crank or a crackpot, or if the situation in the area was such that the chairman needed, even for a temporary period, the direction of an official or a medical officer, then surely the public representatives should be given enough freedom to exercise their right. While allowing the person the right of appeal we should at the same time give them some latitude. I say this because I have never known—and things have greatly improved since the time Deputy Ryan was speaking of— of any man, from the highest to the lowest, who had a real grievance that went unheard, or whose case was not met fairly by the representatives. In the old days the public representatives perhaps did not have as great a say in the matter as they will have under this Bill. Therefore, I believe the fears of those people are unfounded. I say that in all sincerity. I do not believe there is the slightest fear of this happening in the future.

Dr. O'Connell

We are legislating for the future.

Mr. Healy

It is covered in the legislation.

Amendment put.

The Committee divided: Tá, 36; Níl, 64.

Tá

Barry, Richard.
Belton, Luke.
Belton, Paddy.
Bruton, John.
Burke, Liam.
Burke, Richard.
Bruton, Philip.
Byrne, Hugh.
Clinton, Mark A.
Cluskey, Frank.
Fitzpatrick, Tom. (Cavan).
Flanagan, Oliver J.
Fox, Billy.
Governey, Desmond.
Jones, Denis F.
L'Estrange, Gerald.
Lynch, Gerard.
O'Connell, John F.
Collins, Edward.
Conlan, John F.
Corish, Brendan.
Creed, Donal.
Crotty, Kieran.
Desmond, Barry.
Donnellan, John.
Dunne, Thomas.
Enright, Thomas W.
FitzGerald, Garret.
O'Donnell, Patrick.
O'Donnell, Tom.
O'Donovan, John.
O'Leary, Michael.
O'Reilly, Paddy.
Ryan, Richie.
Taylor, Francis.
Timmins, Godfrey.

Níl

Aiken, Frank.
Andrews, David.
Barrett, Sylvester.
Blaney, Neil.
Boylan, Terence.
Brady, Philip A.
Brennan, Joseph.
Briscoe, Ben.
Brosnan, Seán.
Browne, Patrick.
Browne, Seán.
Burke, Patrick J.
Carter, Frank.
Childers, Erskine.
Colley, George.
Collins, Gerard.
Connolly, Gerard C.
Cowen, Bernard.
Crowley, Flor.
Cunningham, Liam.
Davern, Noel.
de Valera, Vivion.
Dowling, Joe.
Fahey, Jackie.
Faulkner, Pádraig.
Fitzpatrick, Tom. (Dublin Central).
Flanagan, Seán.
Foley, Desmond.
Forde, Paddy.
French, Seán.
Gallagher, James.
Geoghegan, John.
Gibbons, Hugh.
Gibbons, James.
Gogan, Richard P.
Haughey, Charles.
Healy, Augustine A.
Herbert, Michael.
Hussey, Thomas.
Kenneally, William.
Kitt, Michael F.
Lalor, Patrick J.
Lenehan, Joseph.
Lenihan, Patrick J.
Loughnane, William A.
Lynch, Celia.
McEllistrim, Thomas.
MacSharry, Ray.
Meaney, Thomas.
Molloy, Robert.
Moore, Seán.
Moran, Michael.
Nolan, Thomas.
Noonan, Michael.
O'Connor, Timothy.
O'Kennedy, Michael.
O'Malley, Des.
Power, Patrick.
Sheridan, Joseph.
Smith, Michael.
Smith, Patrick.
Timmons, Eugene.
Tunney, Jim.
Wyse, Pearse.

Tellers:—Tá: Deputies Desmond and Dr. O'Connell; Níl: Deputies O'Malley and Meaney.

Amendment declared lost.

The Dáil adjourned at 10.35 p.m. until 10.30 a.m. on Thursday, 27th November, 1969.

Dáil Éireann debate - Wednesday, 26 Nov 1969