asked the Minister for Health the way in which the present organisation of the health services leads to unnecessary and unworkable conflicts in the loyalties of local managements in their reporting relationships to their board members and to the Minister for Health and his Department as stated by him on 30 January; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Health Services.
34.
I presume the Deputy is referring to the penultimate paragraph of the text which I circulated to Deputies on 30 January 1986.
The comment reflected what I see as a growing dilemma for the chief executive officers of health boards. They are understandably torn between loyalty to their employers, the health boards, and their duty, under section 31 of the Health Act, 1970, to manage the services within the resources made available by the Minister to the boards. The Deputy will note that, in the paragraph to which he refers, I acknowledge that the problem had become acute because of constraints on resources forcing a concentration upon agreeing priorities. It is obviously difficult for the management of health boards in those circumstances to deal with the serious conflicts which arise from the differing views of representatives of various political parties, nominated professional interests, and persons appointed by local authorities who now make no financial contribution to these boards.
I see this as one of the major problems in the present arrangements. The proposals on the future structures for the planning and delivery of health services, which I will submit soon to the Government, will seek to overcome the present difficulties.
Would the Minister not consider that this statement constitutes a slur on the executives and indeed members of the various health boards — people who have been endeavouring to provide a level of service with greatly reduced allocations from the Minister over the past three years? Is the key to the problem not contained in the last part of his reply where he says they are making no financial contribution to the health services in their areas? Is this merely a ploy by the Minister to bring control into his Department, where there will be no decentralised administration of the health services?
I do not think it is a matter of control or of any wish on the part of the departmental officers or myself to centralise control. Rather is it an effort, admittedly for the first time in 15 years, to bring some degree of control into what is happening to the health services for the common good, in the national interest and in the interests of developing our health services.
Our health board system is not working despite the fact that in this House in 1970 I spoke warmly in favour of the establishment of the health boards by the late Erskine Childers. I gave him my full support because the system prior to that was manifestly incapable of working, namely the local health authorities. They were totally diffused and in total chaos. We now have to look at what is going on and try to bring about a better system. It is not a matter of centralisation. Basically, it is a matter of trying to establish priorities in our health services. We are spending £1,276 million a year to the best possible advantage of the Irish people.