Vol. 243 No. 6
I move amendment No. 1:
In page 4, between lines 30 and 31, to insert the following subsection:
"(3) A reference in this Act to any enactment shall be construed as a reference to that enactment as amended or extended by any subsequent enactment."
This is a drafting amendment proposed by the Parliamentary draftsman for the purpose of clarification.
I move amendment No. 2:
In page 5, between lines 13 and 14, to insert the following:
"(iv) persons elected by all the manual workers over 21 years of age employed by the board."
This amendment was discussed by both Deputy M. O'Leary and Deputy Bruton on Committee Stage. The case for the amendment is coercive. I can see no reason whatsoever for the exclusion of the majority of the staffs involved from these health boards and this amendment proposes to give these people a voice. It proposes no more than that. The Minister's view on this is archaic; it belongs to ages past. The Minister says that only the medical people and public representatives will be on these boards. That is entirely wrong. It is not just contrary to what has grown up and come to be known as industrial democracy, but it is contrary to common sense. It is not only technologists or semi-technologists who make suitable representatives on public boards. Representatives of the ordinary workers are just as effective—very often more effective—because they bring a great deal of common sense to bear.
I do not suggest there should be a large number of these people on these boards. On Committee Stage the Minister spoke about the size of these boards and he took a figure of 25 and 26 and then a figure of 33 or 35 and he said that would be too many. This is not where the separation occurs. The separation occurs in very different territory. There are people who believe that seven is the most one should have. In governments, which might be regarded as super-boards, there are 15 to 20, not more. When you get up to 20 it does not matter whether you have one or two more, but it matters a great deal whether or not the majority of the workers in hospitals and health services are represented.
Under the scheme proposed by the Minister there is no representation for porters. Speaking for myself, I believe that porters are very important people indeed. I am not being sarcastic when I say this; I really mean it. If you want something done, or if you want to find out something, in nine cases out of ten it is the porter you ask, and it is the porter who tells you exactly what you want to know. Again, ambulance drivers and their assistants should be represented. I just do not understand the official thinking on this. I am not with it. It is completely contrary to the most rudimentary form of industrial democracy. There are numerous people involved. The wardsmaids, the cooks and all these people are involved and I see no reason whatever why they should not have a voice on these boards.
Deputy Bruton made a very strong case for this representation on Committee Stage. I believe the Minister should accept the amendment. I can see no great objection to it. The Minister gave an example of nine representatives in the case of the medical staff; I do not ask for nine even though these people are much more numerous than the medical staff. It is entirely wrong in the age in which we live that these people should not be represented.
We support this amendment. It was canvassed by a number of Deputies on Committee Stage. It is highly desirable that everybody operating the health services should be involved in the running of the health boards. By far the largest section so involved would appear to be excluded under the Minister's Bill as drafted. The Minister has had some experience as Minister for Transport and Power of appointing trade union representatives to the directorships of some of the companies he supervised. That was done to ensure proper social democracy and involvement by those engaged in commerce, industry and administration. The power of selection should be given direct to the workers themselves. I believe this would confer great benefit from the point of view of the relationships which ought to exist between a board and its employees. That sort of policy is a progressive policy and it is in line with the Minister's anxiety to have a spirit of co-operation and mutual involvement in the operation of the new hierarchy of the health administration. We strongly recommend this amendment. It will not give revolutionary powers to anyone. Its purpose is to ensure that the voices of the workers are heard in relation to matters directly affecting themselves. Happy employees will mean happy health services and happier people being helped by the health services. Therefore, we commend it strongly to the Minister.
As the Deputy who first raised this matter on Committee Stage, I should like wholeheartedly to support Deputy O'Donovan's amendment. It is very important that, if we give any section of the employees of health boards representation we should give all sections of employees of health boards representation. It is highly invidious to single out the doctors and to give them representation as employees of a health board and not to to give representation to all the employees.
The purpose of the amendment is to ensure that doctors are not singled out as being a privileged section of the employees of health boards as against the manual workers and other employees. I feel, and I am sure that Deputy O'Donovan and Deputy Ryan feel, that these manual workers will be very closely affected by various decisions taken by the health boards in relation to their working conditions. It is only right and just and in the interest of good industrial relations that they should have some say in these decisions. The amendment would give them a say. It would also ensure that there was good morale in the entire service and that there was no feeling of inferiority. The scheme outlined by the Minister, which does not give manual workers representation but does give doctors representation, would create a feeling of inferiority among manual workers in that they were discriminated against in that regard.
There is just one thing that I am wondering about. Does the term "manual worker" cover all people who are not represented at the moment? Would ambulance drivers, for instance, come under the term "manual worker" in the amendment? If not, then perhaps the amendment is not adequate in that it does not cover all sections involved. I would hope that this matter would be clarified and that steps would be taken to ensure that every employee of the health board would be given representation.
I am all for industrial democracy and morale but I do not find any employees of the health boards in the membership of the boards. There will be persons appointed by the local authorities and there will be persons appointed by registered medical practitioners. They are not necessarily employees of the board.
They are.
Not necessarily.
They can be on a contract of service.
They are not necessarily employed by the board. That is No. 1. Then there are the persons appointed by the Minister. Why should any one class, then, get the special privilege to be specially appointed by such boards? There is another point—the utter impracticality of this amendment. The following ancillary professions are not represented on the board: nurses, psychiatric nurses, wardsmaids——
Nurses are.
——ambulance drivers, gardeners, boilermen, chambermaids, manual workers. How you are going to get all of these represented on the board beats me flat. My principal point is that there is no specific person employed by the board in that list.
The ancillary services are specifically in the section.
Wardsmaids, ambulance drivers——
Yes, these are the people that I want to cover.
——boilermen. How are you going to define all these and get them organised?
Everybody — I mean every person.
The main point I want to get back to is membership of the board. Anybody employed by the board is not necessarily a member of the board.
May I elaborate further on the concept very clearly outlined by the Labour Party amendment? With due regard for the Minister and conscious that he has been in an extremely receptive mood throughout the Committee Stage of the Bill and not being anxious to delay him unduly in implementing the Bill, we would point out to him that he is introducing and perpetuating and enshrining in legislation a completely discriminatory aspect of representation. I would point out to the Minister that not one single representative of the vast army of clerical staff employed by the health authorities and the health boards as envisaged will have any say whatsoever on the boards. None of the senior administrative staff, through their trade union organisations in a representative position or on an elected basis internally will have any say whatsoever on the boards.
I find it utterly contradictory and quite ridiculous that you should say to psychiatric nurses, "You can put a psychiatric nurse on to the board" and you say that there can be a surgeon, doctors, physicians, the whole sheebang, if I may use that expression, of medical representatives—a full nine of professional medical representatives on the boards yet, clerical staffs, administrative staffs, radiographers, physiotherapists, the whole catering staffs, dieticians, hospital attendants, the whole range of welfare officers employed by such boards, will have not one single representative. There will be not one single representative of the hundreds and in some cases thousands of paramedical staff on such boards. We in the Labour Party feel very strongly about this aspect. We consider it to be built-in discrimination on an occupational basis being perpetuated by the Minister, perhaps inadvertently, in this Bill.
It is a mark of a civilised, democratic and fully representative community that everybody gets the opportunity to be represented on such boards. With due regard for the Minister's anxiety, about which he has often spoken, for representative democracy and for people having every possible participation in social and industrial legislation, I would suggest that all that the Minister need do is to bring in an amendment saying that the general staffs, paramedical staffs and all other analogous grades in the services shall, by nomination by the bodies recognised by the Minister, be represented. I am thinking quite frankly of the public services committee of the Irish Congress of Trade Unions who represent as a committee some 15 different trade unions. A multitude of unions are co-ordinated in the public services committee. They should be given a representational right of nominating, say, two—I would even be satisfied with one at this stage —from their general paramedical staff, on to such boards and within that trade union organisation they could have their own elections.
If the Minister allows the Bill to go through as now proposed, in ten or 20 years time we can stand up in this House and say that he discriminated exclusively in favour of the medical profession—I do not think the medical profession want that—and gave a miserable sop: he allowed on one psychiatric nurse and one general nurse. All other analogous grades are completely excluded from representation on the board.
Therefore, I make a final plea to the Minister. It is not impossible to concede what we want at this stage and it would be, perhaps, one of the major innovations. We shall have a situation in, say, the eastern health board within two or three years where they would be spending £20 million on health services and employing thousands of workers in the hospital complexes. You will have a board very narrowly constituted of some 16 people employing thousands of workers without one opportunity open to them to make representations at board level as to the policy or conduct of the administration and the general outlook and tone of such a board.
We make this point strongly as it was made earlier on Committee Stage by Deputy O'Leary and myself. We were very strongly pressed by the workers concerned to make these representations and I do not think any almoner, social worker, clerical or administrative worker in the Dublin Health Authority will thank the Minister if he allows this opportunity to go by without making this fundamental and very elementary change in the Bill, a change which is very long overdue.
(Cavan): I do not like the word “discrimination” used by Deputy Desmond but there is much to be said for the amendment. It would probably, if accepted, create better relations on these boards. Deputy Lenihan is technically correct in saying that possibly none of the persons mentioned at paragraph 2 (a) (2) will be in the employment of the health boards. I concede that is quite possible but it is likely that they will. The likelihood is that some of the medical people and those employed in the ancillary professions will be in the employment of the boards.
Almost all.
(Cavan): Deputy Lenihan is correct in that they could be from outside the employment of the board but the likelihood is that these people will be recruited or elected from people in the employment of the board. It is only reasonable that those described as the manual classes should be represented to some extent and should have a voice there. In the end this would lead to more harmonious relations in the board and between the board and its employees. When we are giving representation to the various categories mentioned in the section, to persons appointed by relevant local authorities and persons appointed by election by registered medical practitioners and by the election of members of such ancillary professions as are specified in the appropriate regulations under the subsection, the Minister should go the whole way and give some representation to the other interests involved.
I know that the Minister could use the power conferred on him by the section, the power given him to appoint certain persons on the board, to appoint persons covered by the amendment; but at a time when we are moving towards industrial democracy it would be a nice gesture to write it into the section. It would mean that the categories not covered by the section would see that they are entitled to representation on the board as of right. They will not have a majority on it; that is unlikely. If they could be there and speak for those they represent it would lead to better relations within the board and between the board and its employees. It would also probably lead to a better service for those being served by the board.
I shall certainly not take issue with Deputy Desmond on the matter of labour relations. I appreciate his vast knowledge in this field, but as a layman I can see one or two problems arising. While we have been talking about democracy we may be doing a disservice to democracy in that we are trying to sectionalise. I think Deputy Desmond will be at variance with Deputy Murphy in this connection. Deputy Murphy has said he wants to see the public representatives having this power on the board. The public representative may not be committed to one section or another and will have to face the electorate to give an account of his stewardship. That system more or less is operating at present. We have members of different unions as elected representatives of the local authority. I think it would be unwise to take that power from them. These representatives are answerable to the whole community and that is how it should be. With due respect to Deputy Dr. O'Donovan I do not think you can make the case for a gardener having a contribution to make in medical matters——
Why not?
I do not think so. I would expect that later when another Bill comes along Deputy Dr. O'Donovan will be making the same case for the porter in UCD to have a controlling voice——
It is not a controlling voice; it is a voice.
If I am a boilermaker sitting on this board it is natural that I would be more inclined to look after the needs of boilermakers rather than gardeners.
And the surgeons will look after themselves.
We have seen that you can get conflicting interests at that level which will not give us the best results. What is wrong with the situation where you will have on the board a man like Denis Larkin, or Deputy Cluskey or Deputy Desmond, men who are familiar with all aspects of all sections concerned?
My job is to sit here, not on a board.
I mentioned others outside who are not Members of the House and are members of the local authority. If you pursue this line of giving representation to everybody I think we should contemplate guaranteeing that the people who are paying 50 per cent of the money, the ratepayers, would have representation on the board.
They will have representation.
Public representatives need not be all the time concerned only about ratepayers. We know that is not always the case. I suggest that heretofore the interests of the ratepayers in the matter of financing health services have not been looked after as I think they should have been.
I think the interests of all workers should be left in charge of the public representatives and that that will lead to more harmonious settlement of any disputes that may arise. From public representatives I think you will get a combining of interests rather than a sectionalising. I think it would be a pity that we should sectionalise to the extent where some people might suffer.
I agree in principle with this amendment. I should like to see the representative being one of the people working under the board. I do not think that the medical profession are over-represented on any of these health boards. I do not know if any manual worker over 21 could contribute anything to the health board which would result in more efficient health services; but purely from the point of view of making communication more readily available between the professional members of the health board and the manual workers, who in some cases have to work side by side with the professional members, it would be a good idea. There is the contention among manual workers that professional people can look after themselves and sometimes they have the idea that a surgeon has never done a day's labouring and therefore does not understand the problems of manual workers. This could possibly be true to a certain extent. However, surgeons do work hard and in every way expend as much energy as manual workers. I feel that if manual workers of over 21 are going to be represented other interests should also be represented; in particular those who are paying for the service, the ratepayers, should have a specific representative——
They have.
——solely representing the ratepayers' associations.
This would seem to be outside the scope of the amendment.
We are on Report Stage and we cannot start to discuss whether ratepayers should be on the board. We would be here all night if we started to discuss that sort of thing.
I agree with Deputy Tunney's assertion in that regard. From my own experience, having worked in hospitals, I feel that greater communication between the manual employees and the professional staff, the professional representatives, would in some way help to render the service more efficient.
I am afraid I must turn down the amendment. First of all, there are too many groups involved. There are not only manual workers but radiographers, physiotherapists, social workers, opticians, almoners, laboratory technicians and so on. You have, too, the administrative and the clerical staffs and in my view it would be utterly impossible to devise a method by which you could have representatives appointed from all those different groups on the board without swelling the board to an undesirable size. I want the boards to have between 25 and 32 members at the outside so that they can work effectively.
I also want to dispel the idea that the regional health boards will be concerned with conditions of employment and remuneration. These matters are specifically left to the chief executive officer. No doubt the board will be interested in these matters and will not want to make any decisions that would have the effect of making the life of the staff burdensome. The fact remains that staffs of these boards will have the new arbitration and conciliation machinery available to them. I can say without disclosing any secrets that the basic document for this has been prepared. The staff will have an opportunity of bringing their grievances with regard to remuneration and also conditions of employment to the notice of the CEO who can determine the action to be taken and they can then have an appeal to the Minister for Health. It just works that way and that has been found to be the best way, not to have the county councils or the regional health boards take part in specific matters relating to the conditions of staff. As far as I know, the system has worked fairly well and I have not seen any great reports that this kind of system has broken down and that as a result in the last five or ten years conditions of staff have not been thought about and considered on a reasonable basis. The staff, too, have their own organised trade unions and associations in many cases.
I realise, at the same time, that in the world in which we are living there is a greater desire for participation, but the difficulty is to get the right kind of participation. I do not know of any means whereby one can ensure that if the manual workers in a particular group exceeded all others they would not have the representative appointed whom they wished to have, if we had one single person representing the manual workers. There are all sorts of practical difficulties. Having drawn attention to the expanded grievance machinery to which the staff would have access, I would say that there is nothing to deprive the regional health board from having a consultative committee of people not directly represented on the board. They can do this if they wish and they could have suggestions for the improvement of the service. They can hardly have any suggestions for better remuneration or conditions of employment as that would be a matter for the chief executive officer and the unions using the conciliation and arbitration machinery. Suggestions of this kind might lead to some useful results. It might lead, for example, to the formation of some kind of group who in the years to come could provide a representative. Sooner or later this health legislation will be amended and at that point it might be considered if they considered consultative machinery was not sufficient.
In relation to the professional classes of people on the board, they are not necessarily employees of the board. A nurse could be elected from a voluntary hospital which was not run by the board; a pharmacist could be elected who was not employed in a hospital. It is by no means certain all the professionals on the board will represent the people who are interested in running the board and who are also employees of the board. I want to see a board which operates the health services. Matters concerning staff or remuneration or conditions of employment and matters concerning the particular interests of a county should either be related to the conciliation and arbitration machinery or to the county advisory committee who will meet regularly and give their views. I want these boards to be executive boards.
I should like to have done this but I must shy away from increasing the size of the boards. There is absolutely no way that I know of doing this without having far more than one representative because of the variety of workers and the difficulty of getting an understanding. I am afraid I will have to turn down the amendment. Let us start with the consultative committee.
Either the Minister completely misunderstood the purpose of my amendment or he is drawing a veil over it. He partly understood it because of his suggestion about the consultative committee. What I really wanted to do for this section was to bring it, so to speak, into the modern world—in the words of the famous report "The world of 1980". I am thinking of the 1970s. It is possible the Minister might concede that other people should be represented also. It is not my experience, nor that of people who deal with numbers of this sort, that somewhere between 25 and 30 will be an effective board. For an executive board—seven people. The Minister says there could be a consultative committee but that complicates the matter, whereas my amendment does not. There are elections nowadays of all kinds of bodies: some semi-State, universities, and so forth.
The Minister spoke about the grievance machinery. I was not interested in grievances but in representation. It is true, technically, for the Minister and for Deputy Tunney and for Deputy Lenihan to say, for example, that the medicos on these boards need not be employees of the board itself. In the great majority of cases they will be employees of the board.
Would the Minister consider this matter when the Bill goes to the Seanad? The insertion of "a person" would satisfy what I want done here. It is one of the most noticeable defects remaining in the Bill. One could not but admire the manner in which the Minister worked on the Bill. I would ask him to think again on this matter.
I shall consider it again.
I move amendment No. 3:
In page 5, line 19, after "a health board" to add ", but the first appointments to a health board under paragraph (a) (iii) shall include appointments made on nominations of bodies which, in the opinion of the Minister, are representative of the medical and ancillary professions or of particular branches thereof".
This amendment meets an undertaking given on Committee Stage that, in connection with the appointment of the first board, even before the statutory arrangements are set up, we would provide for the nomination of the professional members of the board by the professions concerned. I think it is quite clear.
While I welcome the Minister's amendment I think it confirms the anomalous position into which he has worked himself. He concedes that for such health boards there shall be a right of nomination of bodies representative of the medical and ancillary professions and branches thereof. How can he justify that and yet deny the right of nomination to such boards of representatives of, for example, the Irish Local Government Officials' Union, representing thousands of workers in the health services, the Workers' Union of Ireland and the Irish Transport and General Workers' Union? The Minister is continuing an inherent contradiction in the Bill and one which these organisations will note.
Fine Gael welcome this amendment. Our point was that if six members be nominated by the medical profession for a selection of three, we would avoid placing the Minister in the position of having to give preference to nominees on grounds possibly which would not be related to their professional ability or to their ability to represent the medical profession on the health board.
I have nothing to add to what I said on Deputy O'Donovan's amendment.
I move amendment No. 4:
In page 5, between lines 51 and 52, to add the following subsections:
"(2) The Minister may, by order made at the request of a health board, substitute in relation to that board a different rule for any of the following rules set out in the Second Schedule, namely, rules 15, 17, 20, 21, 22, 23.
(3) Where an order is made under subsection (2), the Second Schedule shall apply in relation to the relevant health board with the substitution of the rule set out in the order for the relevant rule in that schedule.".
This arises out of a discussion on Committee Stage when Deputy Ryan suggested there should be some flexibility in connection with rules made for the operation of these boards. I said that some rules obviously should be left standard for all the boards but I agree that I should enable some rules which are referred to in the schedule to be left open to change by order if I were requested to do this. The rules that can be changed in the second schedule are rules 15, 17, 20, 21, 22, 23. I do not think the House will have any objection to this amendment to have a reasonable attitude taken towards this business of the changes that might be made in rules without, so to speak, creating anomalies in the general operation of the health boards.
I take it this amendment is merely to allow the different boards a certain degree of flexibility to make their own committee arrangements.
Some flexibility, that is right.
In that respect it seems to be a reasonable amendment.
I move amendment No. 5:
In page 6, line 42, to delete "shall include" and to substitute "such regulations shall provide for more than half of the members of the committee being persons who are".
I need not say anything about this. This was a concession I made at an early stage to enable the subsection to read:
The membership of a committee shall be specified in regulations under this section and such regulations shall provide for more than half of the members of the committee being persons who are members of the council of the county or county borough....
It is in connection with the request that the local health committees should have a majority of local authority representatives.
I move amendment No. 6:
In page 6, line 51, after "the committee" to add ", and a health board shall consider any advice so tendered to it".
This amendment was suggested by some Deputies, and principally Deputy Esmonde, who felt that the health committees should be strengthened in some way in regard to what they recommend to the health boards. We are proposing this amendment to provide: "It shall be the principal function of a local committee to advise the health board on the provision by the board of health services in the functional area of the committee and a health board shall consider any advice so tendered to it." It is recommendatory.
I move amendment No. 7:
In page 8, line 13, to delete "holding a local inquiry" and substitute "causing a public local inquiry to be held".
The point was raised by a number of Deputies that the Minister, in ordering the removal from office of the members of a health board, should do so only after a public local inquiry was held into the board's performance of its duties. I do not imagine that future Ministers will remove many health boards from office, but I think it perfectly right that there should be a public inquiry if the House so desires.
I move amendment No. 8:
In page 8, to delete lines 28 to 30, and to substitute the following:
"(3) Within two years of the removal from office of the members of a health board under this section, the Minister shall by order provide for a new appointment of members to that board".
This arises from a discussion on the possibility of health boards that were dissolved being left out of action for some time. Having regard to the likely manner in which health boards will operate in future, I feel it is just as well that we should fix a period by which the Minister must reconstitute the board. I put it at two years. Some Deputies felt that was too long but a dissolution of a health board might take place within two years of the end of the term of office of the members. If this were to happen it would be desirable to have flexibility so that the new board need not be appointed for a term of office that might last for a few months only. If by any unhappy chance a Minister had to dissolve a health board within two years of a local election, when all the health boards would be renewed, there would not seem to be much point, after waiting to see what the position was, and examining what had gone wrong with the health board, in having to arrange for two health boards. I think two years is a reasonable compromise.
We must express our disappointment that the Minister, notwithstanding very strong representations from us, has refused to accept our suggestion of a one year period of vacuum on the dissolution of a board. If in the last two years of a board's existence prior to the next local elections the board becomes alarmingly obstreperous, this is an incentive to the Minister to dissolve it and reconstitute it after the next local elections. I suggest that it is quite undemocratic and undesirable in this age that there should be written into Irish legislation a provision which, to the best of my knowledge, is unique in the world, whereby any Minister of State can dissolve a board and not reconstitute it for two years. It is a fuddy-duddy anachronism in terms of permissive legislation.
Once a board is removed from office and immediate obligation devolves on the Minister to re-appoint it. I would suggest that it should be re-appointed within a period of six months. Otherwise the whole thing becomes a complete farce. Before the Minister goes to the Seanad and has his head bitten off, if I may use that phrase, by Senators because of the nonsense contained in that section, he should agree to re-appoint the board within six months. I do not think any board would be worth re-appointing if it were not re-appointed as quickly as possible rather than waiting for the next local elections. I have these reservations about the section.
If we have a publicly elected board and if the Minister deems it desirable to remove that board from office, that does not mean that the democratic principles should fall down and the board should be left in vacuo for a number of years, perhaps. When a board is removed from office—a democratically elected board —every effort should be made to have it replaced by the democratic process as soon as possible. The Minister gives himself the elbow room of two years here, but I think the democratic principle obtains that a board should be reconstituted as soon as possible.
I have personal knowledge of a public authority which was removed from office for a rather small offence on the part of two or three members. The entire board was removed. Many members who had not done anything wrong were removed from office and the board was replaced by a commissioner for many years. Things happened during those years. Far greater excesses were indulged in than were indulged in by the public board. What the public board did was open for everyone to see, but what was done by a commissioner was less obvious. In general, it is far safer to have a board reconstituted as soon as possible if it is deemed necessary to remove it.
The Minister has certainly improved the position in so far as he has departed from the idea of allowing himself an indefinite number of years. Until this amendment was introduced the board could be removed—I do not say the present Minister would do this but some Minister might, perhaps, for personal reasons or petty reasons—and not be re-appointed. The amendment does not go the full distance. If a public board is removed it should be re-appointed as quickly as possible. Otherwise there is no point in saying that we are trying to practise democratic principles here.
I move amendment No. 9:
In page 8, line 33, after "modifications" to insert "required to permit such appointments to be made and".
This amendment also goes to meet a point raised on Committee Stage. The amendment makes it clear that any modifications made by the Minister will only be such as are required for the mechanics of making the new appointment. An example of a modification which might be required could be a change in rule 1 (2) which requires appointments of members to be made at the annual meeting of a council held next after every quin-quennial election of the members of the council. It is simply to enable the board to be formed in the same way as before but enables slight alterations in the rules relating to the rest of the enactments in the Bill. It is a sort of drafting amendment.
I move amendment No. 10:
In page 8, to delete lines 40 to 48 and substitute the following:
"(2) (a) Where a chief executive officer will for any reason, other than suspension from performance of his duties, be temporarily unable to act as such, he may, after consultation with the chairman of the health board (or in his absence, the vice-chairman), appoint one of the other officers of that board to act as deputy chief executive officer for the duration of such inability.
(b) Where a chief executive officer has for any reason become temporarily unable to act as such and either he has not made an appointment under this subsection or an appointment made under this subsection, whether by such chief executive officer or otherwise, has become terminated under paragraph (d), or on account of the death or resignation of the appointee, the chairman of the health board (or, in his absence, the vice-chairman) may appoint one of the other officers of that board to act as deputy chief executive officer for the remainder of the duration of such inability.
(c) The Minister may specify classes of officers who may be appointed as deputy chief executive officer and any appointment under this subsection shall comply with any such specification.
(d) An appointment as deputy chief executive officer may at any time be terminated by the chairman of the health board with the consent of the Minister.
(e) An appointment as deputy chief executive officer shall terminate on the chief executive officer ceasing to be such officer.".
This amendment is related to amendment No. 24 under which a change is proposed to permit each board to elect its own chairman and vice-chairman. It is also related to points raised by Dublin Deputies in relation to section 16 of the Bill on Committee Stage when they urged me to apply, at least for the initial period, the provisions of the County Management Act to the eastern health board. The difference between the existing subsection (2) and that in the amendment is that a change would be made so that the chief executive office, after consultation with the chairman or vice-chairman, would normally appoint the deputy. The procedure in the amendment is similar to that for the appointment of a deputy county manager. As in practice it is unlikely that there would be disagreement between the chairman and the chief executive officer on such a matter, the effect of the amendment is not likely to be such as to alter the personnel who would be appointed as deputy. However, the amendment does go somewhere to accentuate the point that the chief executive officer will, in fact, be chief executive of the board with the same status in the appointment of his deputy as a county manager. I think that makes the position clear. It is to relate the choice of chief deputy officer to the change that is being made in relation to the appointment of the chairman.
I move amendment No. 11:
In page 9, line 25, after "the Minister" to add "after consultation with the chairman of the board or, in his absence, the vice-chairman of the board".
This is another simple amendment in which a temporary appointment of a chief executive officer may be made by the Minister but only after consultation with the chairman or the vice-chairman of the board. It is in order to give the chairman and vice-chairman more interest in such a matter.
I move amendment No. 12:
In page 9, to delete lines 40 to 43 and to substitute the following subsection:
"(5) In making an appointment of an officer or servant, the chief executive officer shall act in accordance with the directions of the Minister, but no such direction shall be in conflict with section 14.
(b) In making a determination under subsection (3) or (4), the chief executive officer shall act in accordance with the directions of the Minister and shall have regard to any arrangements in operation for conciliation and arbitration for persons affected by the determination.".
This amendment, following on observations by Deputy Desmond, provides for the recognition of conciliation and arbitration machinery.
I am not very clear on this matter. I was not here when this section of the Bill was being discussed. Neither am I an expert on local government officers' arbitration schemes. However, I understand there are some difficulties about their employment, which have been expressed by both doctors and nurses and I think the matter is applicable to this section. They state they can discuss salary with the county manager but they are apparently precluded from discussing conditions of appointment, such as time off, under the scheme of arbitration. Further than that I am unable to help the Minister very much because, as I said, I am not very familiar with the ins and outs of the matter. However, I think I have fulfilled my function if I draw his attention to the fact that there is some measure of dissatisfaction in this sector as regards that aspect.
There is new arbitration machinery coming along which will include the conditions of employment.
That is excellent.
It is in order to ensure that when that machinery comes along the working of section 13 will be in conformity with it. Conciliation and arbitration machinery will then be in operation.
We shall have an opportunity of discussing it then.
I move amendment No. 13:
In page 11, to delete lines 12 to 16 and substitute:
"(1) In the performance of their duties, the chief executive officer and the other officers of a health board shall act in accordance with such decisions and directions (whether of a general or a particular nature) as, subject to subsection (3), are conveyed to or through the chief executive officer by the board, and in accordance with any such decisions and directions so conveyed of a committee to which functions have been delegated by the board.
(2) When the chief executive officer or another officer of a health board performs a duty in accordance with subsection (1), he shall be deemed to act on behalf of the board."
This is an interesting amendment. It arises from points made by Dublin Deputies on Committee Stage, and subsequently I met Deputies Paddy Burke, Clinton and Dockrell with the city manager and officers of the Dublin Health Authority. The general tenor of the case made in the House and in my discussions with the Deputies and the local officers was that, because the scale of operations of the eastern health board will be so much greater than that of any of the other health boards, the managerial system which at present applies to the Dublin Health Authority should, for the initial period at any rate, be applied to the new board. Fears were expressed that the administrative system might break down because of the enormous number of decisions that might have to be made by the health board if they operated the Bill in its literal sense and only left to the chief executive officer or any deputy officers the actual matters deliberately reserved in the Bill in relation to control of staff and so on.
Perhaps, I should summarise for the House the management system as it applies in the case of the Dublin Health Authority or in the case of the Cork, Limerick and Waterford Authorities. The County Management Act, 1940, and the City and County Management (Amendment) Act, 1955, contained detailed provisions of how this system operates and how functions are divided between the elected members of a local authority and the manager. The basis of the 1940 Act was that the manager exercises and performs for the council all the executive functions of such council, the executive functions being defined as all the functions of the council not reserved to the members. The second schedule to the 1940 Act listed 22 reserved functions of the elected members. Most of these, however, related to functions which are specific to county councils, such as making bye-laws, appointment of persons as members of other bodies, nominations of persons as candidates in Presidential elections. For the purposes of the Dublin Health Authority and similar bodies, the only important functions actually reserved to the council lie in the preparation, adoption and variation of its estimates and the borrowing of money.
As well as having these functions reserved to them, the elected members had from the beginning powers to control the manager in the performance of the executive functions. These powers were extended and improved under the 1955 Act, which provided that the members may by resolution direct the manager to inform them before he performs any of his functions, and they may, by resolution passed after due notice is given, require him to do anything within his executive powers, but they cannot direct him in the exercise of his powers in relation to the eligibility of individuals or in relation to the control of staff.
In so far as the initiative lies mainly with the manager in the execution of policy, the balance of power in the management system is weighted towards him, as against the members. The fact is that he is liable to be directed by the members in the exercise of most of his functions, as I have already indicated, under the 1955 Act.
We could have written into this legislation the management system as contained in the 1940 and the 1955 Acts. My predecessor discussed the proposed regionalisation of the health services with all the health authorities and they suggested the system that we have now adopted in which the regional health boards have very wide powers other than those clearly indicated in section 16.
The Bill does not depart from the management system to the extent of vesting all functions in the board. It specifically states—in section 16 (3)— that functions relating to decision on eligibility will be reserved to the chief executive officer. It is now intended that the executive functions will be exercised by decisions and directions of the board through its chief executive officer and, under him, its other officers.
Deputies raised two issues on the Committee Stage. The first was whether the Bill was specific enough in establishing the authoritative position of the chief executive officer in relation to the other officers and servants of the board. I do not think there was really much doubt about this in the Bill as circulated because section 12 (1) indicates that the chief executive officer will act as such; section 13 makes it clear that he will determine the conditions of employment and the duties of the other officers and the servants; section 15 provides for him to delegate functions to other officers; section 16 (3), as I have mentioned, reserves specific functions to him and section 30 (2) gives him a special status, analogous to that of the secretary of a Government Department in relation to the financial responsibilities of the board. Now, section 16 (1) was never intended to be interpreted so that the board would by-pass its chief executive officer in issuing decisions and directions but, to remove any temptation for a board to attempt to do this, the amendment now moved substitutes a new subsection making it quite clear that the board's decisions and directions will be conveyed through the chief executive officer in all cases. I am assured that there can be no doubt but that the chief executive officer will be the undisputed administrative head of the board. It is, of course, essential that this should be so for the evolution of a proper management structure.
The other point of concern was whether, under the system proposed in the Bill, the board would become involved in so much detailed executive work that the members would either have to meet very frequently or else the administration would become entirely clogged. This, of course, was never intended. The basis of section 16 of the Bill was that the board would issue general policy decisions and directions and leave it to the chief executive officer and the staff to carry these out. The new subsections proposed to be introduced by this amendment are designed to make this quite clear. They indicate that the board can give either general or particular directions and that, where an officer of the board carries out his duties in accordance with these directions, he will be deemed to act on behalf of the board. It should be clear from this that a board will not be required to consider specific cases to any greater extent than they consider necessary and that, in fact, the section will not stop a board from operating very much as the Dublin Health Authority operates at present.
The essential difference between the provisions in the Bill and the Management Acts is, however, that it would be easier for the members of a board to succumb to the temptation of interfering too much in relation to the performance of detailed executive functions. I do not think that a board, many of whose members will have been used to the operation of the county management system, are likely to do this. It does, however, seem to me to be democratic to leave to the members of the board the freedom, perhaps, to err in this respect and learn by experience what the proper balance should be between themselves and their chief executive officer.
It is planned to establish the health boards next October and to arrange-for them to take over the administration of services the following April. This will give six months for them to settle down and during those six months I propose to have studies done with regard to the best managerial methods for the boards and I shall make the results of these studies available to the boards. The best way of doing this is now being considered.
I am absolutely convinced in the case of a very large board like the Eastern Health Board, that it would be impossible for the board to make all the decisions that they could make if they wanted to make use of their full powers under the Bill. They would be working for hours and hours dealing with minor things. They might, for example, vote an annual sum for the repainting and maintenance of certain dispensaries, and them find that a particular dispensary needed painting more than others. They could well spend hours and hours arguing whether dispensary D needed painting more quickly than dispensary C—and they would get nowhere. In the case of the present Dublin Health Authority this kind of thing is dealt with under a review of dispensaries when all matters regarding them would be discussed.
I hope this amendment will allay the fears of the Dublin Deputies who spoke on the Committee Stage on this issue. I think this is all I can do at the present time. I do have an alternative under section 16 (3) (e) where I could delegate certain functions to the board far and beyond those, but I think the section, with the amendment I have put in, clarifies the position that the whole operation should go smoothly.
I recommend all health boards to get an idea of the work load they will have. I am going to ask every county manager in the country to give me the number of orders he makes that are not orders in relation to what clearly are his reserve functions but are orders in relation to the general running of the health authority so that the regional health boards with the aid and advice of my Department's officers will be able to see what kind of work load they are going to have. This should enable them to do their work effectively without spending an inordinate amount of time at it which will, in turn, give them more time to design, provide and think of the services as a whole. They will deal with matters of prime importance as well as being able to deal in an intelligent way with important complaints that have arisen.
I agree with the Minister that if a board of this nature wants to do its job properly it should confine itself to general policy considerations and not get bogged down in detail. Even in the present county councils one finds that the general work has to be done by executives. It would be impossible for them to find time to go into all these matters even if they were trained to do so. One finds that the trained official, with his objective approach, handles these matters in a very effective manner. One does, however, like to feel that the public authority retains the necessary power. The only effective legislation at local level which we have at the present time is the City and County Management Act, 1955, which was brought into this House by Deputy O'Donnell. Section 4 of that Act enables the local authority to command a manager to do anything that is legal. It is a very useful controlling section—although it is sometimes abused. The Minister might try to incorporate some measure analogous to it when he is finalising his ideas about these boards. Obviously, he is feeling his way at the moment, trying to work out in his mind what could be the most effective operative measure and how he can operate it to the best advantage. I do not think a section of that nature would be opposed by regional boards. I believe there would be sufficiently reasonable people on the boards not to oppose it and yet something analogous to that would have to be retained so that they would ultimately have the power vested in them should they care to use it
I want to thank the Minister for meeting us to some extent in regard to the amendments we tabled to this section on Committee Stage, but I do not think the Minister's amendment goes far enough. When we saw the Minister we stated we would prefer to have the managerial system in the eastern region. One of our difficulties was that this would be a completely new board and almost 50 per cent of the representation on that board would also be completely new to local government, never having sat on a local authority before, and I believe that when such a board meets it will be very difficult for them to give the general directions set out in the Minister's amendment. Even if they do that at their first meeting there is nothing to stop them revoking these directions at the next meeting. I would ask the Minister to reconsider this and to amend the section further when the Bill goes before the other House. I know the Minister has told us that he has been asked down the country not to amend in this way but for the eastern region, at any rate, he could give us this.
I do not think the Deputy need worry about this. I have noticed a very, very strong feeling about this in the eastern region and I imagine the people in the Cork health authority and the Limerick health authority will feel the same. We could compromise. When the eastern regional health board meets in October, if they do not take what I think would be a good comprehensive attitude towards this, they should at least operate for a year on the same system and see what their work load will be. I know the work load is a very heavy one. If, at the end of that period, the members of the eastern regional health board approach me I could, under section 16 (3) (e) say: "I will not take the risk of there being almost administrative chaos in the operation of this very important board, which has worked so well" and I would write in more functions for the chief executive officer. I could do that for a year and if, at the end of that period, there were some members who said: "We have had a very, very small work load" then I need not renew the regulation. That would be a good compromise. In the case of the major city areas it would be quite reasonable I think for me to do that. Nobody could say I was being undemocratic. I am perfectly certain, having discussed this with Deputy Burke, Deputy Clinton and Deputy Dockrell, that the new members of the board will realise that, with a board of this complexity, it would be only right to preserve the management functions as they were hitherto in the chief executive officer. There is no other way of running the board. I hope Deputy Dockrell will accept this suggestion.
I move amendment No. 14:
In page 12, line 23, after "satisfied" to insert ", following a local inquiry,".
This is a very simple amendment. For the removal of a chief executive officer there will have to be a local inquiry.
In section 11 there is provision for a public inquiry. Why is it only a local inquiry in this case?
Because it might not be in the man's interests to have a public inquiry. I made that quite clear.
I move amendment No. 15:
In page 12, line 31, after "may" to insert, ", after consultation with the chairman or, in his absence, the vice-chairman of the board,".
This is another undertaking that I gave. An officer will not be suspended by the chief executive officer without consultation with the chairman or vice-chairman of the board.
We are in complete agreement with the Minister, but we would like to see some limitation on the duration of the suspension.
This was discussed in Committee.
Could the Minister say what the duration is likely to be?
It would depend on the circumstances. It might be in the interests of the person concerned to be suspended for a longer period in certain circumstances. We decided we would not limit the length of the suspension.
A suspended employee would not be able to take up other employment and he will not receive any remuneration during the period of suspension.
We can deal only with the amendment before the House now. We cannot go back on Committee Stage.
I should like the amendment to ensure that the cause of the suspension is investigated with all possible speed.
Having regard to public opinion on the rights and privileges of individuals, it is inconceivable that there would be an excessive length of time between the suspension and the final decision.
I move amendment No. 16:
In page 12, line 36, after "this section" to add ", and shall state the cause of the suspension to the officer and to the Minister".
This again is a very obvious amendment. The cause of the suspension must be notified to the officer suspended and he must be told the reason why he is suspended. This is a very reasonable amendment.
I move amendment No. 17:
In page 13, between lines 36 and 37, to insert the following subsection:
"(3) Nominations of persons to a panel referred to in subsection (2) (b) shall be for such period as is prescribed and new nominations shall be made from time to time to fill vacancies on the panel."
This amendment is to ensure that new nominations will be made from time to time to fill vacancies on the panel. It is a very obvious administrative suggestion.
I move amendment No. 18:
In page 21, between lines 22 and 23, to insert the following subsections:
"(4) A health board shall not exercise its powers under subsection (3) in relation to the discontinuance of the provision and maintenance of a hospital, sanatorium or home save with the consent of the Minister.
(5) The Minister shall not give a direction under subsection (3) in relation to the discontinuance of the provision and maintenance of a hospital, sanatorium or home save after having caused a local inquiry to be held into the desirability of the discontinuance.".
This is an amendment which relates to a request from all sides of the House that a local inquiry should be held before a Minister would direct the discontinuance of a hospital, sanatorium or home and restores the position in this sector of the Bill to what it was under the Health Acts 1947 and 1953. The same thing applies where a health board takes the initiative in the discontinuance of a hospital, sanatorium or home. The consent of the Minister will be necessary for the closure. I do not think that these kind of inquiries are likely to arise very much. If a building is not in a state of collapse or hopelessly outmoded and outdated, then within the next 20 years there will be some use for it, either as a geriatric institution or for some purpose or other. Nevertheless, I heartily agree with the suggestion that there should be a local inquiry.
There is some public misunderstanding about this amendment that the Minister now proposes to insert in the Bill and this arises as a result of the FitzGerald Report. Some of the public had taken it that this public inquiry would be held in reference to hospitals such as the county hospital in Roscommon. I should like if the Minister would further enlighten me on this problem. In the case of the county hospital in Roscommon it is not proposed to close it but what is in this committee's report is that surgical facilities be withdrawn from it or, more correctly perhaps, acute surgical facilities. If I am correct in assuming that under those circumstances it is not necessary to hold a local inquiry according to this amendment, I would urge upon the Minister that such an inquiry be held before any change would be made in such hospital.
I do so for two reasons. The primary reason which was offered on Committee Stage is that this idea must be sold to the people, that the people must be convinced that it is absolutely right and all the figures and information available should be made available to the people and the best machinery for doing that is an inquiry. Secondly, I ask the Minister further to amend this, if that is necessary to deal with the case I refer to— and I know that this applies to other county hospitals. Rightly or wrongly the public assume—I am taking my own constituency in relation to the Roscommon county hospital—that before surgical facilities are withdrawn from that hospital, if, unfortunately, that is so decided a local inquiry will be held. It would cause great disappointment if that is not the position. I would ask the Minister to make a more specific statement on it. If my information is correct, the Minister should go further and provide an amendment whereby no facilities would be withdrawn from any county hospital, either surgical, maternity or medical, without a local inquiry being held.
Deputy Dr. Gibbons has some slight misunderstanding about this. This amendment is in relation to the discontinuance of a hospital, sanatorium or home. I do not think there is any mention in the FitzGerald Report of closing any major hospital whatever. It was a question of changing the function. I said on Committee Stage—column 2027, volume 242 of the Official Report—that when we come to discuss the regulations for the setting up of Comhairle na nOspidéal, the central hospital council, a statutory provision will be inserted therein that a local health committee will be consulted before any action is taken by Comhairle na nOspidéal. In other words, there is ample opportunity for full public expression of opinion because Comhairle na nOspidéal would not be able to take a decision not to re-appoint a single surgeon in a hospital without having a committee of this kind. So, that would come before the Dáil for discussion at a later date because the regulations in regard to the setting-up and actual constitution of the regional hospital boards and Comhairle na nOspidéal have to come before this House next year for discussion, when all this matter can be considered.
A Leas-Cheann Comhairle——
The Deputy will understand that we are on Report Stage and that when the Minister gets up to reply he is concluding on the amendment?
I took it that the Minister was replying to Deputy Dr. Gibbons.
If the Minister is prepared to hear a point at this stage——
I do not mind, if the precedent is not continued.
I merely want to get clarification on one point.
The Chair would hope that what is happening on this occasion would not be taken as a precedent because on Report Stage Deputies may speak once. The mover of an amendment has the right of moving and replying but once the reply has been given further discussion is out of order.
I appreciate the point. I take it that the Minister is drawing a distinction between the discontinuance of an institution as such and the discontinuance of acute medical services of an institution. The first is dealt with under this section and the discontinuance of acute services in an institution will be dealt with under regulations to be made later on, when, he says, he will consult the local health committee on that point but as regards the discontinuance of an institution which is mentioned here—a premises—he mentions holding a local inquiry. Does that mean just a private inquiry or is it a local public inquiry?
No, it would be a public inquiry.
Because in the amendment the words "local inquiry" are used and that may be interpreted as merely a private inquiry. "Public local inquiry" is mentioned elsewhere in the Bill.
We did not think it necessary to put it in there because it is inconceivable that you could have a private local inquiry about such a matter.
I move amendment No. 19:
In page 22, line 47, after "with" to insert ", or on nominations of,".
Deputy Desmond of the Labour Party would have liked to have the professional members of the regional hospital boards nominated by the interests concerned and I said that I was quite determined, at least at the beginning, to appoint them myself as the regional hospital boards are going to do the work of quite a number of sections of my Department in planning and examining the future organisation of the hospital services over a large area. I did agree to make it optional so that the Minister of the day could either, after consultation, appoint his professional members to these boards or he could accept nominations by representative bodies. I presume he could also do a mixture of the two. That was a compromise made in an undertaking to Deputy Desmond who felt keenly about this and, I think, some other Members.
Amendment No. 20 is consequential on amendment No. 24. Amendments Nos. 21 and 25 are also consequential and, therefore, amendments Nos. 20, 21, 24 and 25 may be discussed together.
I move amendment No. 20:
In page 23, line 1, to delete "17" and substitute "18".
These amendments are the result of considerable discussion in the House. Health boards will elect their own chairmen and vice-chairmen. This arrangement will not extend to the chairmen of Comhairle na nOspidéal which is the head consultative council for the whole country, or the regional hospital boards. I intend to appoint the chairmen in these cases. They are controlling, organisational and advisory bodies taking over work which was very largely being done on central level and it is quite appropriate that the chairmen should be appointed by the Minister.
Amendments Nos. 24 and 25 arise from an undertaking given on Committee Stage to change the procedure so that the health board will elect its own chairmen and vice-chairmen, any member who is an officer or servant of the board, being excluded from appointment. In other words, anybody who is an officer or servant of the board should not be appointed chairman. Amendment No. 24 makes the customary provision that the person in the chair for the election of the chairman or vice-chairman of the board does not have a casting vote. There are many precedents for that. All these amendments are a result of the debate in the House.
The only observation I wish to make on amendment No. 21 is that the Minister decides here to appoint the chairman of the regional health boards, whereas he has been more democratic, shall we say, in his views in regard to the health boards. I am not quite satisfied with the reasons he has given, that these are high executive functions and that he feels it appropriate that he should nominate the chairmen and vice-chairmen of regional health boards. I know the Minister has probably made up his mind very definitely about this but I have reservations about the Minister appointing the chairmen. Some other method of selection might have been more properly utilised.
I should like the Minister to take us a little bit more into his confidence as to why he has kept the appointment of chairmen and vice-chairmen in his own hands. I thought that on the Bill as a whole we had established with the Minister that in all cases of boards and other bodies under it the appointments would be made by democratic vote.
I considered this very carefully. These regional hospital boards will be partly doing in a sort of decentralised way the work of the Department of Health. They will have extremely important functions of a most complex character. They will have on them representatives of each of the regional boards so that regional boards will be able to exercise their influence. They will have very important functions trying to integrate the voluntary hospital services and local authority hospital services in so far as they affect those who come under the Health Bill, either in middle income or lower income groups. They will try to avoid proliferation of appointments of a competitive kind. They will see how a better out-patient diagnostic service with expert consultants can be afforded and promoted to try to keep people out of hospitals. They will see how best the whole hospital system can be integrated and, particularly, they will try to draw the consultant hospitals more closely into the field of integration with local authority hospitals.
They will have the power actually to employ consultants and the expenses will be recouped by the voluntary hospitals in so far as a consultant works for a voluntary hospital and by the local authority so far as he is employed by the local authority. In view of that and of the great complexity involved I thought it quite reasonable that I should appoint the chairman of the hospital boards and of Comhairle na nOspidéal which will start to regulate the appointment of consultants all over the country. It is only reasonable that the Minister should appoint chairmen of boards of this kind. There are a great many examples but I shall not bore the House by giving them. I did agree that the Chairmen of the county committees, the advisory committees and of the health boards should be appointed by the boards themselves.
I move amendment No. 21:
In page 23, between lines 5 and 6, to insert the following subsection:
"(4) (a) The Minister shall from time to time appoint, from amongst the members of a body established under this section a chairman and a vice-chairman.
(b) A chairman or vice-chairman appointed under this subsection shall hold office for the period specified by the Minister at his appointment unless—
(i) he ceases to be, or becomes disqualified for being, a member of the body;
(ii) he resigns the office of chairman or vice-chairman and his resignation becomes effective under this subsection;
(iii) the Minister terminates his appointment as chairman or vice-chairman.
(c) A chairman or vice-chairman appointed under this subsection may at any time resign his office of chairman or vice-chairman by giving notice in writing signed by him to the Minister, but the resignation shall not become effective until the commencement of the meeting of the body held next after the receipt by the Minister of the resignation."
I move amendment No. 22:
In page 29, to delete lines 4 to 6, and to substitute: "maintenance at home of—
(a) a sick or infirm person or a dependant of such a person.
(b) a woman availing herself of a service under section 61, or receiving similar care, or a dependant of such a woman,
(c) a person who, but for the provision of a service for him under this section, would require to be maintained otherwise than at home,
either (as the chief executive officer of the".
This is a clarifying amendment arising out of the discussion on Committee Stage when I undertook to have another look at section 60. Quite a number of Deputies made the point that the home-help service provided might include the case of a widow who would be unable to work unless her children could be looked after during the day. The amendment makes two definite changes. It makes clear that a woman receiving maternity services or dependants of such a woman will be clearly within the categories covered by the section and also by the new paragraph. The section states more clearly that home help service can be given for the purpose of keeping a person out of an institution. That covers the point made by Deputy Ryan and by Deputies on this side at the same time.
Thank you very much.
I move amendment No. 23:
In page 36, line 39, after "office" to insert "not exceeding five years".
We had a debate on this matter and it was felt that in the case of the regional health boards it was not fair for the Minister to appoint his nominees for an unstated length of time. After some debate I said I would limit the time of Ministerial nominees to five years, and that would provide for an element of continuity and at the same time ensure that if a new Minister for Health was appointed, or if the Government changed, there would not be a great delay if the new Minister wished to appoint new people.
I move amendment No. 24:
In page 38, to delete lines 25 to 39 and to substitute the following:
"17. (1) The board shall from time to time elect one of its members (not being a member who is an officer or servant of the board) to be chairman of the board and another of its members (not being a member who is an officer or servant of the board) to be vice-chairman of the board.
(2) A chairman or vice-chairman of the board shall hold office for the period specified by the board at his appointment unless—
(a) he ceases to be, or becomes disqualified for being a member of the board;
(b) he resigns the office of chairman or vice-chairman and his resignation becomes effective under this rule;
(c) the board terminates his appointment as chairman or vice-chairman.
(3) A chairman or vice-chairman of the board may at any time resign his office of chairman or vice-chairman by giving notice in writing signed by him to the board, but the resignation shall not become effective until the commencement of the meeting of the board held next after the receipt by the board of the resignation.
(4) Whenever, at the election of a chairman or vice-chairman of the board, there is an equality of votes for two or more persons, it shall be determined by lot which of those persons shall be chairman or vice-chairman of the board."
I move amendment No. 25:
In page 39, line 49, after "board", to insert "(other than the election of a chairman or vice-chairman)".
I understand that the Minister wishes to make a statement.
First of all, I want to thank Deputies on all sides of the House for the very constructive debate we had on Committee Stage. It was conducted at the very highest level. Opposition Deputies are perfectly entitled to criticise the ambit of the Bill but when it came down to detail we made very good progress on what is a very complicated piece of legislation. I want to go into some matters which were raised during Committee Stage and about which I cannot take any action specifically in the form of amendments.
First of all, Deputy Dockrell and Deputy Clinton made a suggestion whereby local authorities appointing members to a health board could be allowed to agree on the allocation of local contributions between them, on the understanding that if they failed to agree this would be decided by an arbitrator appointed by the Minister. I consulted the Minister for Local Government who said, that if the constituent local authorities were able to agree on a reasonable basis for allocating local contributions, there would be much to be said for letting them do so. However, I would draw the attention of the House to paragraph 117 of the White Paper on the Health Services which envisaged that a formula would be worked out to provide for a more equitable distribution of the burden of health rates between local authorities. This principle would have to be sacrificed, at least in part, if the suggestion made by Deputies Dockrell and Clinton were adopted in full. I am going to think about this before the Seanad meets to see whether I could not devise some kind of formula which could be revoked in part or in whole if the Minister for Local Government decided to carry out an equalisation plan. Deputies will realise that, if we reached finality in this, by then the obviously agreed sharing of contributions between the different constituents could hardly be carried out in a simple way and there might have to be some special formula. I will consider this before the Seanad meets because the idea is a good one.
A number of Deputies raised questions about whether I could possibly dictate the kind of treatment of any patient and the legal adviser tells me that I could not possibly do this. I now have something good to tell the House. Many Deputies asked that the administration of home assistance should be administered by the health boards and not by the local authorities and a number of excellent observations were made by Deputies Burke, Clinton, Dockrell and Ryan and others that under modern conditions the paying of home assistance is ultimately linked with the operation of the health services; people come out of hospital and they have to be given assistance when they return home and there must be an absolutely clear co-ordinating link, particularly in the case of a great institution such as the Eastern Regional Health Board will be. I am glad to say that I have the agreement of the Minister for Social Welfare that it is highly desirable that the operation of this service should be co-ordinated with the services of the health boards. I want to make it clear, however, that we could not have the position that the health board would have a free hand in deciding the amount of money to be expended on home assistance, seeing that the local authority will have to foot the entire bill for home assistance as distinct from health expenditure until, and if, there is any other change made as a result of the Minister for Social Welfare conducting a general inquiry into the operation of all the assistance services. As a result it is intended to propose to the local authorities throughout the country that they and the health boards should make arrangements under section 24 so that the boards would deal with the administration of home assistance on behalf of the local authorities. In this way the authorities would retain budgetary control on the amounts spent. This is the most satisfactory approach to the problem in the first instance.
I do not want to bring in a provision compelling local authorities to transfer their functions relating to this local service to health boards but if later it appeared that there was a reluctance by local authorities to co-operate with the health boards, and this was causing considerable difficulty, I would have no hesitation in bringing in a short Bill to rectify the matter. In other words, if the local authority and the home assistance officers simply refused to co-ordinate with very great care with all the health services operated by the regional health board I would certainly bring in a short Bill to rectify the matter.
I hope all the health authorities will take advantage of section 24 which quite clearly states that they are entitled to delegate authority. I am glad to say that the Minister for Local Government will give his consent to this. That solves the problem of Dublin Corporation, Dublin County Council and Dún Laoghaire Borough Corporation and so on, whose representatives spoke to me about this.
Thank you very much, Minister, for the concession.
The Deputy was not alone. He cannot claim all the credit this time.
Another suggestion made by some speakers was that I should enforce the provision for a great number of information officers. Section 99 of the Health Act, 1947, will remain in force and will apply to health boards. I do not think it is necessary to impose an obligation on the boards to provide information officers because I believe that by the time the health boards get going, and as we go on in this modern age, the matter of communications is going to be considered so important that I do not believe there will be any difficulty in arranging for the provision of information officers, perhaps first of all in one town and later on an expanded basis. I want to make it clear that the first appointments of chief executive officers will no doubt take place through the Local Appointments Commission. There is a lot of talk about this and I want to give an absolute assurance that this will be the case.
