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Dáil Éireann debate -
Thursday, 19 May 1977

Vol. 299 No. 9

Ceisteanna—Questions. Oral Answers. - Hospital Staffing.


asked the Minister for Health the manner in which hospital staffing is arranged between his Department and Comhairle na nOispidéal.

The relevant statutory functions of Comhairle na Ospidéal as specified in section 41 (1) (b) of the Health Act, 1970, are to regulate the number and type of consultant medical posts and of senior registrars and top-grade biochemists and to specify the qualifications for such posts. I think that answers, if not all, part of the Deputy's supplementary question on the last question.

Before creating or filling any of these posts, a health board or hospital authority must, therefore, first seek the approval of Comhairle na nOspidéal. Health boards and hospital authorities approach an Comhairle direct for such approvals and are expected to present a fully documented case in support of each proposal. After an Comhairle's approval to an appointment has been obtained, it is then necessary for the health board or hospital authority concerned to have cleared with my Department all the financial aspects of the matter, including the direct remuneration costs, the costs and numbers of any ancillary staff, together with any non-pay expenditure of a revenue or capital nature, which may arise. The conditions of service—especially remuneration—must also have been approved by my Department in the case of all new posts and changes in existing appointments. When these matters have been cleared and my Department's approval obtained, the making of the appointments may proceed.

Would the Minister not agree that Comhairle na nOspidéal cannot make any decision on any of those posts except one prescribed?

No, that is not so. As I said in my reply, the health board or the hospital authorities, in the first instance, must approach Comhairle na nOspidéal. If they refuse it, they refuse it, and that is their right. If they agree to it, then it comes to the Minister for Health. He must decide, not on whether or not the post should be assigned to a particular health board or other hospital, but if he is satisfied that the rate of remuneration and other expenses in connection with the post are justified.

Section 41 states that Comhairle na nOspidéal only enter in when those positions are prescribed. I suggest to the Minister that, before they are prescribed, somebody must make a decision that they be prescribed; this is the initiating and important decision, the one that lies with the CEO and the Minister, and that in fact it does not give Comhairle na nOspidéal any primary or initiating right to decide on what positions are to be filled.

They have initiating rights but they have also, so to speak, the powers of veto if they do not appoint consultants to a particular hospital. If Comhairle na nOspidéal accede to that request, it has to go a step further for the Minister for Health must determine whether or not the remuneration or other aspects of the appointment are satisfactory to him.

I suggest that a difference of opinion and a misunderstanding arises because the Act does not say that a request goes to Comhairle na nOspidéal. The Act says that positions must be prescribed. Would the Minister not agree that he is using terms not included in the Act? The section of the Act says——

I am afraid we cannot have quotations at Question Time. The matter may not be debated either.

They are to regulate the position as prescribed. This is a cause of misunderstanding and there is a total difference between prescribing and requesting. The Minister must agree that when one prescribes, first of all, somebody must take a decision and then somebody else must step in and make a further decision on it, as to the people who should take up the positions which have been prescribed by both the Minister and the CEO.

We cannot dwell overlong on this question.

It must be known by every Deputy in the House now that, as far as consultancy appointments are concerned, Comhairle na nOspideál—apart from the money factor —are the be-all and end-all of such an appointment.

I do not think so.

Order. I shall have to proceed to another question. I have allowed the Deputy a lot of latitude. We cannot remain unduly long on any one question.

I must ask the Minister if he does not agree that this is an interpretation that has been built up because he and others use the word "request", talking about those situations, and thinking in those terms, when in fact the word used in the Act is "prescribe" which has much stronger force?

This is leading to a long argument. It must now come to finality. A brief question from Deputy O'Kennedy; I am moving on to the next question; I mean that.

I have not asked a question yet, Sir. Might I ask the Minister, when he designates a hospital as being a general hospital sharing staff and facilities—as in the case of the County Hospital in Nenagh—does the Minister not then acknowledge that he has a responsibility to ensure that adequate staff and facilities are made available there? Arising from what he said yesterday, a general hospital, by definition, involves at least two consultant surgeons and physicians. Would the Minister not agree that, to be consistent, he should take steps immediately to implement the appointment of such personnel, or initiate the County Hospital in Nenagh?

Again, that is a matter for Comhairle na nOspideál but the Department enter into discussions to try to resolve the problems.

But, where it arises——

Next question.

But where the Minister has designated on that basis surely it would come back to him to ensure that the consequences of his designation would be implemented?

And that a hospital would not be designated without having the services which should in fact follow?

The Minister cannot over-ride Comhairle na nOspideál in this but he can try to facilitate the arrangement vis-à-vis Nenagh, to which the Deputy refers.

Question No. 5.

The Minister must agree that 13 is the operative section.

The Minister. I have called the next question. No. 5, please.