Dáil Éireann debate -
Thursday, 23 Jul 1970

Vol. 248 No. 12

Health Boards Regulations, 1970: Motion (Resumed).

Debate resumed on the following motion:

That Dáil Éireann approves the following Regulations in draft:

Health Boards Regulations, 1970

a copy of which Regulations in draft was laid before Dáil Éireann on 8th June, 1970.

—(Minister for Health.)

Dr. Byrne

Before I moved the adjournment I had been speaking on the make-up of the health boards in the south-western region. I asked the Minister to give particular consideration to the rather unusual geographical distribution of the population in outlying districts in County Kerry. Whereas the population in the Kerry area might not be one-third that of the Cork city and Cork county areas, certainly the difficulty of administering in Kerry is unparalleled from the point of view of health administration, travelling, and so on. As one who has been in the front line in medical practice in the outlying regions of Kerry, I want it to go on record that there are great difficulties in administering medicine in these areas.

Today, the front page of the newspapers tells the story that the ex-councillors of Dublin Corporation— who, according to the Government, do not function any longer—are holding an emergency meeting amongst themselves to discuss the method of appointment devised by the Minister of local representatives to the Eastern Health Board. It is an example of how the Minister has endeavoured to give the under-populated counties—Wicklow and Wexford—a decent representation on the health board not in keeping with its population ratio. However, there is a great deal of discontent. I would ask the Minister to meet the ex-councillors. We in this party believe they still function as an integral part of the local government set-up; that they are, in fact, duly elected representatives and, as such, should be considered for appointment to the Eastern Health Board.

I am disappointed that, once again, we have boards and their subsidiary committees, and so on, which can unfortunately be used by aspiring politicians as platforms and forums from whence they can voice their likes and dislikes. Whereas the medical profession will be represented to a certain extent, as will the para-medical professions, on the boards, I feel the interests of the patients will take second place in many instances to the interests of the public representatives appointed in the Eastern Health Board region and in the other regions. It is unfortunate that we have had more or less to agree to a majority of public representatives in this connection.

I do not want to go into any detail about the composition of the individual health board but I should like to emphasise to the Minister that we should have representatives on these bodies who have a certain amount of experience in dealing with medical administration. The Minister will agree that there is no policy on education in the medical administration of the health boards. There is a diploma in hospital administration and hospital secretaries are briefed to some extent, but we are not making any attempt to train people in the administration of health boards.

The Eastern Regional Health Board will be the biggest health board in the British Isles. I believe the secretary or the chief executive officer should be instructed in certain details of administration. We should not just take in some councillors or some local authority elected representatives and put them in to run it. Even though the health boards will be subject to area control and to the control of the Minister, they will be the final administrators. As the Minister said, they will be meeting quite a lot. They will meet at least once a month, and more often if necessary. These boards should be as efficient as possible.

In certain instances the Minister is increasing the number of public representatives on the health boards, not because he thinks this will be more efficient, but because of the strength of the representations made to him by local authorities. This could be interpreted as being contradictory, and efficiency, which is the aim in the health services, is now lost. In other words, the optimum which the Minister could have gained by keeping to a minimum the number of public representatives on the board will be lost.

With faster travel we can now cover a bigger area with the same type of administrative board than we could some time ago. The Minister introduced a health board which will take in parts of Roscommon and Sligo. This again takes account of political considerations rather than administrative efficiency. In certain parts of the Minister's statement I detected signs that he has leaned with the wind and with the gale coming from the local authorities and the public representatives. I am sorry to read this into the Minister's statement. In one or two places the logical approach has been watered down a little. One does not like to see the trickle of water coming from the dam which will eventually result in the dam bursting. I should like to see the Minister putting his finger in the leak now and not bowing to any pressures from the local authorities but heading all out for full efficiency in the health boards.

If we refer to other bodies for an indication of their efficiency and their representation, we find that the agricultural council is composed largely of farmers or people who have agricultural interests. An army council or a war council is usually composed of at least 90 per cent of people with military experience or a military background. A law council is usually composed of solicitors and barristers. Unfortunately, in this case the majority of the members of the health boards, who will be responsible for administering them for the next 20 or 30 years, will not have a medical background and will have no experience at all of medical administration. The Minister has power to issue a directive or a circular to all the local bodies. He has power to appoint people in areas where local bodies have been abolished and to advise that a person with experience in the medical profession could possibly make the health board more efficient if he were appointed to it.

The Minister said that many of the consultants and many of the doctors who will be selected will have difficulty, because of the pressures of the profession, in attending the meetings. I have gone through the number of doctors who are available, and I discussed this with the Minister a short time ago, and I believe there are many people in the medical profession who would be more than willing to participate on these boards, who are not fully engaged or fully active in the medical profession, but who have the experience which would be necessary to make the boards more efficient.

We wish the Minister the best of luck in setting up these health boards and in making the regulations dealing with them. In certain areas he has infringed the integrity of county borders and there are other areas in which he has permitted this integrity to be interfered with. I was disappointed at that. I was disappointed that the earlier dynamic approach towards overruling county boundaries in the interests of the efficiency of the service was watered down. I can only interpret this as being the result of local political pressure. This local political pressure is not for the benefit of the patient. It is for the benefit of aspiring politicians in these areas who wish to use the health boards, or possibly will attempt to use them, as forums or platforms for their own personal political ambitions. Services in the health board areas may suffer as a result.

In a private business enterprise this would not be tolerated. Inefficiency because of attempts to provide local representation would not be tolerated. I am afraid the efficiency of these boards has been watered down because of this and the new health services may suffer as a result—how much we do not know. I would have preferred if the Minister had stuck to his original draft of the health areas.

I was also disappointed that the Minister increased the number of local representatives on the health boards. My interpretation of it, without being pessimistic, is that it could lessen the optimum effect which the Minister could have achieved by sticking to his original proposals. In any case he says that in many cases he did not want to increase the local representation but because of the pressures he did come to a compromise on a figure which would be in between the two. This was the easiest way out.

We see in the paper today that the Dublin councillors are meeting because they are not satisfied with the way in which the representatives from the Dublin Corporation area are being appointed to the Eastern Health Board. I would ask the Minister to take their views into account and possibly meet representatives from this meeting. They are duly elected representatives and, although the Government may have held that they failed in their duty when they did not strike the rate required or whatever it was, perhaps the Minister would give consideration to their views.

Mr. Murphy

Fianna Fáil have been playing around with Health Acts and health regulations over an extended period going back to the thirties. They changed their minds frequently. When the last change came about in 1960 and when the unified health services Act was being implemented and the regulations set out we were told by the then Minister, Deputy MacEntee, that this was the be-all and end-all in regard to health administration. Despite the lengthy statements he made at the time in support of that measure, that is all scrapped now and the present Minister for Health tells us the health services need remodelling, that we must change the system. What Deputy MacEntee said was so efficient is no longer fit to continue operating and that system must be thrown aside. If I may say something of my experience——

Mr. Childers

We have already had some agreement under the Health Act and, after prolonged discussion, the general principle of regional health boards was accepted. What we are now discussing is that if we are to have health boards I must make proposals about them. I gave the proposals for these regulations in fair detail in the form of a memorandum to Deputies recently. We have agreed on the principle.

Mr. Murphy

This is all relevant. The day that agreement was made I was unable to attend the House.

Mr. P.J. Burke

The Deputy will accept majority rule?

Mr. Murphy

Yes, but I am entitled to have my say.

Mr. Childers

The principle of health boards has been accepted by the House.

An Ceann Comhairle

Deputy Murphy is no doubt aware that the debate is confined to the Health Board Regulations, 1970. This does not open up a debate on the Health Act.

Mr. Murphy

My remarks are all incidental to the establishment of the health boards and to my mind are quite relevant. I want to be helpful. I know that there is a great deal of business to be dealt with but the question of health administration is important. It is no harm to "recap" on former health boards.

Mr. Childers

We "recapped" for hours and a very interesting debate it was and the House then agreed as a whole on the principle involved. They had then available as information the rough constitution of the eight health boards. They had all that at the time of the Health Bill. It was not a question of my producing eight boards. The general principle had already been established. Every county council had the data for the eight health boards. The only question was the exact number of representatives from the local authorities and the consultants. That was all that had to be done. We even had a statement in regard to that. That was all agreed by the Dáil and the Seanad.

Mr. Murphy

Whom does the Minister think he is lecturing?

Mr. Childers

I am only telling the Deputy; he said he was not here.

Mr. Murphy

What happened was that the Government came to a decision and the party members had to support it. By virtue of the Government's majority they were able to legislate.

Mr. Childers

Fine Gael and Labour agreed to the general principle

Mr. Murphy

We have eight health boards established and one thing that strikes me about them is that we are moving closer and closer to the system of administration which obtains in the eastern part of this continent where they do not allow representatives elected by popular vote to have any say in administrative matters. They are just rubber stamps. You could not describe them, I suppose, as being elected by popular vote. In these health boards we are following that practice closely. We are appointing boards composed to a great extent of non-elected personnel. I am a believer in democracy and whether you are a doctor, a farmer, a labourer or unemployed you have the right to go before the people for a Dáil election or a local authority election and get approval to become a public representative.

The health boards are established and the equivalent of a commissar is appointed. He will be known as a chief executive officer. The main functions and duties of the boards centre around the CEO or, in Eastern European terms, the commissar. That is what he will be. The ordinary person who has a complaint has no more hope of getting within speaking distance of the CEO than I have at present of flying from here to New York in two minutes. These people are not available to discuss little grievances about why a medical card was not granted or a child's medicine was not approved and the thousand and one things about which representations must be made in regard to health services. The local representative did that job.

Mr. Childers

Representatives can still make an appeal.

Mr. Murphy

We are dealing with health boards.

Mr. Childers

One can still make an appeal. I made that clear in the debate. There is opportunity for a democratic appeal by an elected representative, or a member of the county council. In fact, anybody can make an appeal.

Mr. Murphy

If the Minister is speaking about county councils, take Cork County Council. There are 46 members elected to Cork County Council and 39 of them will not be or cannot be members of this board. With all due respect to Deputy Byrne, some of those members got more votes in order to be elected to Cork County Council than he got to be elected to the Dáil.

What the professionals of both Fianna Fáil and Fine Gael, be they lawyers or medical men—and there is a reasonable scattering of them on both sides—want to do jointly, irrespective of any differences and irrespective of this floor which is dividing them, is to abolish local administration.

Mr. P.J. Burke

No.

Mr. Murphy

I am surprised that Deputy P.J. Burke could think otherwise. It is quite evident what the reason is. Every one of us is entitled to express his individual opinions and if these people feel that local authorities should be abolished and health, social welfare and everything else should be administered from a centralised authority, let them say so.

An Ceann Comhairle

We cannot discuss that matter on the regulations.

Mr. Murphy

I am discussing the health boards.

Mr. Childers

This was all accepted at the time of the Health Act. I should like a ruling.

An Ceann Comhairle

There are ten regulations before the House and the Deputy should address himself to them.

Mr. Murphy

I am dealing with——

Mr. Childers

The Deputy is dealing with the general principle. He is not dealing with the regulations. We had a most prolonged and interesting debate and we all agreed on the general principle. This spells out the application of the general principle.

Mr. Murphy

There are ten regulations and what are deemed to be statutory instruments contained in this booklet. I am dealing with what the booklet contains. It would take longer if I were to deal with the members of the board. There are so many people appointed here, I could start reading out the names of the appointees and the professions from which they are called, but I want to short-circuit it and not take up too much time. I want to address myself to the new thinking of the Minister and of the majority of the Government, the thinking that is approved of fully by members of Fine Gael. Deputy Byrne tells us here about aspiring politicians down the country and on local councils who are trying to get into this House. He reflected on them as an unscrupulous lot. He said they would use any means to get in here, that in discussing health legislation at local level, the composition of the boards or the areas specified in the regulations, they would not speak objectively but selfishly and cunningly. I resent that.

Deputy Byrne is miles ahead of Fianna Fáil, although they are travelling fairly fast, on the road to the abolition of local bodies. Imagine a Deputy telling us here that the health services should be administered by the medical profession only, and I am not misquoting him when I say that. We are to collect £8 million in Cork and give it to those fellows to administer it. There is to be no such thing as a public representative or a Dáil Deputy. That is the new thinking of the Fine Gael Party.

Mr. Timmons

It is the "just society".

(Interruptions.)

Mr. Murphy

Everyone appreciates the importance of health services and surely the Deputy could not substantiate the case that these health services should be handed over to the medical profession entirely and completely?

Mr. Childers

The Deputy need not worry. They have not been handed over.

Mr. Murphy

Will the Minister not allow that I am entitled to comment on statements made by Members of the House? I am addressing myself to the Members of Fianna Fáil and Fine Gael and indeed of the Labour Party. Eyes should be opened here. There are dangerous men moving around the legislative centre of this city. They have more power than they are entitled to. I do not know whether there is connivance or not, but the one thing I believe these people agree on is to do away with local bodies, to do away with the elected county councillor, borough councillor, urban councillor and town commissioner.

An Ceann Comhairle

I cannot see how we can discuss this point on the regulations.

Mr. Murphy

It is written all over the health regulations here.

An Ceann Comhairle

It does not arise on the regulations before the House. The Deputy should pay some attention to what we are discussing. He is getting further away from the regulations.

Mr. Murphy

I was discussing the thinking behind the regulations. You will accept that the idea is to give greater powers or greater authority on local bodies to non-elected personnel.

Mr. Childers

That was all discussed on the Health Act. It has all been debated and finished.

Mr. Murphy

Yes. Before I finish on this point let me say I have been aware for years of the thinking behind regulations such as these by some of our top people here in Dublin and in other centres as well. These professional Deputies, be they lawyers or medical men, are afraid of these unscrupulous representatives down the country, such as Deputy Byrne described, who have been fighting for the local needs of the people and putting their grievances at local authority meetings. As a result at the ensuing elections some of these people may be preferred to the professionals and seats will change in this House. Every man and every woman is entitled to contest Dáil elections if he or she wishes. It is a good thing that there are people from all walks of life willing and anxious to go before the people. That is my view. Surely no one would suggest that this should be a kind of closed shop? There are sentiments expressed here by people who could be termed to have superior educational standards, who think they know what is good for us, who formulate policies and hand them over and say, "Look here, that is good enough, we know more about this than you; we are better educated; we have several letters after our names and some of us have handles before our names." I am not reflecting on people with degrees or qualifications but they have no right to dictate to other people in the manner in which they have been, saying, "This and that must happen and you do not count." I want to say to all Deputies to be aware of these fellows.

An Ceann Comhairle

The Chair has been very lenient with Deputy Murphy but unless he comes to discuss the ten pages of regulations before the House I am afraid I will have to ask him to resume his seat.

Mr. Murphy

There is no question of having to ask me to resume my seat. I will now look at the position of the south western region. The health board in my district will consist of 33 members, five of whom will be appointed by Cork Corporation, five out of 31, seven will be appointed by the Cork County Council, seven out of 46, and five by Kerry County Council, that is five out of 26. As the health board will be the statutory body all the other local members will have no say so far as health board discussions are concerned. We have a number of appointments made by the medical profession, by the Minister and by others. Down through the years all these people attended health authority meetings in an advisory capacity but it now appears that they will be masters and the others will be servants. They will have a dual role under these regulations. What will happen the other elected representatives? Will the Minister not accept that each county council or borough council member should have the right to make representations at some committee level of the health services? The committees are to be formed by the health board and I assume that the membership of the health board committees will be confined to members of the board. There will be a local committee consisting of two or three members from each electoral area. Will that be the final committee? Will there be any district advisory committees? At present County Cork is divided into three regions, north, south and west and we have three advisory committees meeting on a local basis to discuss local matters. We sent a resolution to the Minister in regard to the necessity for making regulations which would cover the continuance of such committees. I wonder did the Minister see or read the recommendation or was it thrown into a wastepaper basket before he saw it?

Mr. Childers

There can be three advisory committees if Cork County Council want it for Cork county. Nothing in the regulations prevents that. I will listen to any council that wants to split the advisory committee into more than one.

Mr. Murphy

Yes, but they will allow only one committee with a limited number of members——

Mr. Childers

The county electoral areas——

Mr. Murphy

The Minister is going to cut adrift from any advice on health matters from several of our county council and borough council members. Apart from the health boards under the 1960 Act the county councils acted as health authorities but that will all be done away with. Now we have this new system of appointing this chief executive officer and the nearest pattern you can find from which it was copied would be in Eastern Europe.

An Ceann Comhairle

I have pointed out already to the Deputy that this does not arise on the regulations. The Deputy is talking generally.

Mr. Murphy

I am making comparisons in regard to the regulations and the Minister is going to appoint——

Mr. Childers

There is nothing in the regulations about a chief executive officer. That has already been decided.

Mr. Murphy

I say that the CEO's functions will be somewhat akin to the functions of a commissar in Eastern Europe.

(Interruptions.)

Mr. Murphy

I think it is you fellows who are moving eastwards.

An Ceann Comhairle

There is nothing in the regulations about a CEO. The Deputy is continually harping on that point which is completely out of order.

(Interruptions.)

Mr. Murphy

I notice that Deputy Healy is here. Deputy Healy will remember the great little discussions we had the time we were in Warsaw and East Germany and Poland. You were there yourself, a Cheann Comhairle. We had—I will not say the privilege—of discussions with some commissars, local chief executive officers, and hence my argument here. Maybe the system there is a good one. It has been in existence for some years. It is the system we are trying to impose here now. Will the Minister deny that?

Mr. Childers

Utterly untrue. This has all been decided in the Health Act, as passed. The chief executive officer of the health authority will have slightly less power than the county manager. The Deputy is utterly irrelevant. He is completely out of order. All this has been discussed.

Mr. Murphy

I want to focus attention on the fact that the Government with the aid of members of other parties—not the ordinary members of the Fianna Fáil Party—are moving onwards on the road to destroying local administration. This is the forerunner of steps to abolish local authorities, as we know them today. It is on that I am focusing attention.

An Ceann Comhairle

We cannot have a discussion on that particular point.

Mr. Murphy

The Minister said there is nothing to preclude county councils from having a number of subcommittees. The Cork Health Authority has been in existence for ten years and I have been a member of it for those ten years. It could do with a little streamlining, but not the kind of streamlining proposed in these regulations. We have the advisory committees from north, south and west. I understand the corporation has representatives on the south Cork advisory committee. We have mental hospital visiting committees. What will happen visiting committees to mental hospitals? How are they covered in the regulations here?

Mr. Childers

That was dealt with on the Health Bill.

Mr. Murphy

We are getting snappy now.

An Ceann Comhairle

Will the Deputy please discuss the regulations?

Mr. Murphy

This is the place to ask questions because, once the regulations are approved, we will have no further say. If we ask questions we will be told the matter was discussed here in the Dáil on the morning of 23rd July and why were we not present then to ask questions. I have a certain amount of respect for the Minister but it is beginning to decline. It has been declining during the past few months. I do not like these snappy comments when Deputies ask questions. We have no retinue of civil servants to do the work for us. I have no assistant of any kind to do any of my work. I may not have the same capacity as the Minister and his advisers for going through each line of a Bill and analysing it. People holding public office should not be snappy.

Coming to Deputy Dr. Byrne's suggestion about the medical profession and representation on these boards, under these regulations what channel of complaint will Mary Murphy have against a medical man, or some other public official, and what chance will she have of getting her complaint investigated? She will go to one of the medical men on the board. He is quite likely to be a close associate of the person about whom she wants to complain. These people probably dine and wine together. What will happen to Mary Murphy and her complaint? It is unnecessary to give the answer. It is happening today. I have read the regulations made by the British board when it was in operation here. The ordinary person with a grievance had a better opportunity then of getting that grievance satisfactorily investigated than she has today. Any person with a grievance today has great difficulty in getting that grievance investigated. There is nothing in these regulations to help such people. The person with the complaint today comes along to her local member. He may be doubtful about the best approach but, no matter what approach is made, very little happens. That is the position today. It is likely to be worse when these regulations come into operation. Despite all the legislation and all the expenditure the people are not getting the service to which they are entitled.

An Ceann Comhairle

That is quite outside the scope of the debate on these regulations. The Deputy has been told that already on more than one occasion.

Mr. Murphy

I am examining the regulations from the point of view of a person having a complaint to make. To whom will she complain? Is it to the Minister's three representatives? Is it to the medical men or the psychiatric nurse or the other people? Her only possible avenue of complaint is a member. He will take it to the chief executive officer. Invariably the chief executive officer is a close personal friend of the man about whom she wants to complain. That finishes it. That is what is happening today. Let us not close our eyes to it. I have tried to get satisfaction here. I know how far a person can go with complaints here.

An Leas-Cheann Comhairle

The Deputy knows that this is not relevant on these regulations.

Mr. Murphy

I know it is, but I do not see anything in the regulations to help a person with a justifiable complaint. I defy contradiction when I say that it is of no avail at the present time, and has not been over the past 20 years, to make complaints against a Fianna Fáil official; he is the avenue of approach to the Minister.

An Leas-Cheann Comhairle

The Deputy will appreciate that this does not arise on these regulations. The Deputy knows that.

Mr. Murphy

This is very important. The Minister may sneer because the Minister is in a position to attend to the needs of his own constituents. Mark you, he will want to watch out. They are getting doubtful about him. Do not sneer.

Mr. Childers

I am not sneering. I answered these questions in detail on the Health Bill.

Mr. Murphy

Let me emphasise the difficulties and troubles of people with complaints. It is well known that many complaints could be deemed imaginary but it is also well known that some complaints are justifiable. As the system operates today, the complainant has little hope of success.

An Leas-Cheann Comhairle

The Deputy is dealing with a matter outside the scope of the regulations.

Mr. Murphy

To whom does one complain?

An Leas-Cheann Comhairle

At the moment, the House is discussing regulations under which boards will be set up.

Mr. Murphy

I am discussing regulations. I do not see any help in them——

An Leas-Cheann Comhairle

The Chair cannot allow the Deputy to depart from the content of the regulations.

Mr. Murphy

I am trying to get information about the investigation of complaints. In the National Library I examined the position of health services in the early part of the century. I found that complaints were followed up and closely investigated. That no longer happens. We have this group of people closely knitted together. If you complain about one to the other, what happens?

An Leas-Cheann Comhairle

The Deputy must come to the regulations. These matters could be dealt with on the Estimate for the Department of Health or on the boards, when they are established.

Mr. Murphy

This is the last time, probably for some years, that we shall have an opportunity of discussing in detail the health boards regulations. I suggest that, as far as possible, even at advisory level, all councillors should be on the local committees. Why not have seven locally-elected members on the committee? If a given electoral division elects seven members—this is apart altogether from the health board —I do not see why only three should be on the advisory committee and the other four should not.

An Leas-Cheann Comhairle

This case was argued on the Health Bill.

Mr. Murphy

It is evident that it is this group that is running the country. I suppose they are civil servants. Some Ministers are leaving their Departments to this section——

An Leas-Cheann Comhairle

The Chair cannot allow this discussion.

Mr. Murphy

They are not favourably disposed towards the idea of the local public representative or towards the democratic system. Some of these people—not too many, fortunately— are miniature Hitlers in their own mind.

An Leas-Cheann Comhairle

Will the Deputy please come to the regulations?

Mr. Murphy

Why not give representation to all elected members of county councils and borough councils?

Mr. Childers

That came under discussion on the Health Bill. I made it clear in reply to the Deputy that there was ample opportunity for complaint. There is nothing to preclude representations to the CEO in regard to services——

Mr. Murphy

Hold it. Do not take up any more time. What happens the complaints?

Mr. Childers

Exactly what happens at present.

Mr. Murphy

To complain against a known Fianna Fáil public official——

Mr. P.J. Burke

That is wrong; it is uncharitable.

An Leas-Cheann Comhairle

The Chair wants the Deputy to come to the regulations.

Mr. Murphy

Deputy Gus Healy is laughing.

An Leas-Cheann Comhairle

The Deputy must keep to the ten pages of regulations.

Mr. Murphy

It is all right now for you fellows over there. The people are going to change. The blitz is not over yet. It has subsided but it is not over by any means.

An Leas-Cheann Comhairle

The Deputy must come to these ten pages.

Mr. Murphy

People are inclined to become dictatorial. It is all right for members of the Fianna Fáil Party; they can go along to the Minister. If a poor devil on the Opposition side puts his foot astray, he gets the whip.

Mr. P.J. Burke

The present Minister for Health is the most impartial man——

Mr. Murphy

There is no such thing as impartiality here.

An Leas-Cheann Comhairle

The Chair wants the Deputy to deal with the ten pages of regulations and no more.

Mr. Murphy

Take any one of the health districts listed here. The health board is only an advisory body. All the power is invested in the CEO.

Mr. Childers

That is decided under the Act.

Mr. Murphy

The Minister is not an MA here or a Mr. Know-All. I am entitled to discuss these two booklets.

An Leas-Cheann Comhairle

The Deputy may not discuss the powers of these boards. We are dealing with the composition of the boards.

Mr. Murphy

The functions and composition are taken together. That is only natural.

An Leas-Cheann Comhairle

What are here are the areas covered by these boards and the membership of them.

Mr. Murphy

So far as the areas are concerned and so far as the membership is concerned, the areas are established by the Government. It is quite evident that, so far as this House is concerned, representations or contributions made to discussions by Members of the Opposition carry little weight. We had reached the stage last April, after the 1969 election, when the then Government had the most dictatorial attitudes one could expect to find in any Parliament.

An Leas-Cheann Comhairle

Unless the Deputy deals with the regulations the Chair will have to ask him to resume his seat.

Mr. Murphy

They were reduced to size. They were so full of themselves that they blew up internally. They very nearly blew themselves out of this House. This is how boards are established here. They are established on a dictatorial basis. Recommendations made from the floor of this House were not accepted by the Minister. The only recommendation I know of which was accepted was to give Cork County Council an additional member on the board because, if the Minister did not accede to that request, it was most likely that the Fianna Fáil group in Cork County Council would have only two representatives on the board. By being given an additional representative they will have three. It is no harm to bring that to mind.

I am concluding now and I do not think I have taken up too much of the time of the House this morning. This is what I want to emphasise here. I will put it in a nutshell. These regulations are completely dictatorial. They are dictatorial in every sense of the word. They go further than previous legislation in minimising the powers of local elected representatives. They are bringing us nearer to the day when the local authorities will be completely abolished. I want the Irish public to know that. I want the ordinary county councillor, urban councillor and town commissioner to be aware of that fact.

I want to emphasise that it is mainly the professional group in this House who are trying to bring that about. They are possibly more vocal than other classifications of representatives here. That is what is happening. So far as these regulations are concerned, the ordinary person with a complaint to make will have no greater rights than those they enjoyed during the lifetime of the past health authorities, and those rights were not of much account.

I want to say in conclusion that, despite the millions of pounds expended from central and local funds on health administration, a substantial and sizeable majority of our people are dissatisfied with the services, and there are people in the lower income group who are completely dissatisfied with them. It is well known that these small people were often treated by highly paid personnel in the health services administration in the most contemptuous way possible. It is unfortunate, indeed, that any Member should have to get up in this House and say that about the administration of so vital a service as the health service. It is a well-known fact that too many of our people are being treated with contempt today and have no redress. I will resume my seat on that note.

Minister for Health (Mr. Childers)

First, I want to thank the vast majority of Deputies for their constructive comments on the health board regulations. I want to deal with a few of the points that were made. Many of the points concerned matters that were already the subject of a decision by the Dáil and the Seanad in which there was no great reflection of party differences on the general principle of establishing health boards of the general size indicated in these regulations.

Deputy R. Barry suggested that the Minister for Health should not appoint three members to each board. In view of the fact that the central authority provides about 75 per cent of the total cost of the health services, and that the Minister for Health, advised by the Government, advised in turn by the Dáil, must have general responsibility for the health services, I felt that for the Minister for Health to appoint 10 per cent of the total membership of the boards was fairly reasonable.

Deputy Barry also said that good doctors would be too busy to attend board meetings. I have about 30 consultative medical boards of one kind or another, in the case of only two of which the members are remunerated. I have had the most splendid service from the medical profession through these bodies and I have no reason to suppose that the medical profession will not be able to participate adequately in the work of the boards.

Deputy Dr. Browne spoke about the amount of autonomy given to the health boards. Of course they will be given the maximum amount of autonomy consistent with general health policy and consistent with the amount of money to be raised by the boards through the county councils.

A number of Deputies asked me questions about the appointment of the boards and the relationship of the new boards under these regulations to the appointment of chief executive officers. The chief executive officers and the boards will be appointed before the boards come into operation in April, giving an opportunity to the boards to get to know their work. In that connection, I am glad to say that I have on the one hand appointed a consultative joint staff council to deal with all the matters relating to the movement of staffs consequent upon the creation of the boards and in which there will be full discussion and, on the other hand, I have appointed a very reputable firm of management consultants to assist the boards in deciding how they will carry out their activities in the enlarged areas which are involved in this way.

The consultants, of course, will be instructed to do this in such a way as to ensure the best possible service to the community with maximum efficiency and with the least amount of unnecessary transfer of staff. In other words, the consultants will be helping the chief executive officers and the health boards to devise the best possible system of administration. I hope the result of those two appointments will be that we will be able to have efficient health boards which will, at the same time, be able to satisfy the public that they are engaging in proper administration and giving good service to the community.

Deputy Ryan made a suggestion that the Eastern Health Board region should be divided into two. This would mean splitting Dublin. That would be rather like what happened in the case of Solomon and the child. It would be most dangerous for me to split Dublin in two for the purpose of providing two health board administrations. It is not practical policy.

A number of Deputies mentioned the point raised already at great length by Deputy Murphy about representations. There will be no lack of opportunity for representations to the chief executive officers. They can be made either to members of the health boards who will be skilled in these matters, and who might be the best people to take them on to the chief executive officers, or they can be made direct to the chief executive officers. I am perfectly certain that, with the advisory committees and the existence of the Deputies and Senators in the areas, and with the presence of the health boards, there will be no diminution in the opportunity to make representations either in regard to eligibility for charges or the making of charges. I am perfectly certain that the amount of representation will be absolutely adequate and that I have done nothing to diminish the democratic right of the people of this country to make complaints in regard to the health services made available.

Mr. Murphy

That right has already been diminished substantially as a result of Government policy—the right to make complaints.

Mr. Childers

Deputy Dockrell referred to the fact that in some cases public representatives have only a bare majority of one on the health boards. In fact the majority ranges from three, to two, to one. As I said before—and I am glad to say it and Deputies on both sides have agreed with me—I do not think there will be a clash of interests at the principal meetings between professional representatives and local authority representatives. Perhaps I shall be told I am an idealist. I do not believe there will be such a clash. I believe they will work together and if there are differences of opinion and even votes in the health boards I should be very much surprised if one group of professionals does not vote with one group of local authority representatives against another group of local authority representatives and another group of professionals. I do not believe there will be a continuing clash of interests, with the professionals looking angrily at the local authority representatives. I believe there will be effective collaboration between the two groups.

A number of Deputies from some of the smaller counties suggested that their representation was not sufficient. I have already made it clear that the smaller counties have more representation than would be justified in order to ensure that their interests will be well looked after. I think I can go no further in that regard.

In conclusion, I was very glad that, taking the debate as a whole, there were practically no complaints of importance as to the actual proposed distribution of local authority representatives on the health boards as compared with the professions. Very few people suggested that I had appointed too many from one county or too few from another. Those complaints were made to me when I visited every area in the country and spoke to the county councils and, as a result of listening to such representations as I received and which I felt were reasonable, I think I have managed to construct these regulations in a way that has given general satisfaction.

Question put and agreed to.