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.