This Bill deals with the reorganisation of the health board, a mammoth job that has been talked about for many years. I have never been a member of the Eastern Health Board, unlike my colleague opposite, Deputy Shortall. Perhaps people who have been members, particularly those who have chaired it for a few years, know their way around it, but I have always found it to be an absolute monster in my dealings with it. I found it very difficult to tap into it. In my many dealings with officials over the years, I often got the impression that many of them did not know what was going on in their own organisation. I accept, therefore, the argument for change and reorganisation.
We had a briefing last year which Deputy Shortall organised. At the beginning of the briefing they talked about the number of locations of the health board, which was over 300. While I might criticise the health board for its lack of organisation, the number of locations in which staff are based puts some of my views in context. Obviously, it is difficult for an organisation of that size to know what is going on within it.
The Minister spoke about the need for a new organisation which would be more patient-focused. The health board is already a big authority and I am concerned that it might turn into an even bigger bureaucracy if we give it more functions. I have seen reorganisation occurring in other State and semi-State bodies; sometimes the original purpose of the reorganisation is forgotten along the line and it turns into the creation of more jobs for the girls and boys. In the midst of the petty squabbling which may occur, the basic service and client is forgotten. I hope the new authority will keep its real purpose in sight and realise it is not about the glorification of individuals within it.
I am pleased about the number of public representatives on the new authority. Although I have never been a member of a health board, some eight or ten years ago I was involved in local health committees which I found very beneficial. For the past 14 years I have been a member of a local authority which elects members to represent it on the health board. I do not hear from them in any formal way, although that may be as much my fault as theirs. The local health committees provided me with direct access to some health board officials. I would like to think public representatives who are not members of the authority would be consulted on a regular basis.
I have read the reports which have recommended change in the health board structure. However, one must be cautious when a group wants more control and power. I am concerned about health boards or health authorities trying to get their hands on the voluntary hospitals. I wonder whether that would be a good thing or whether we would be playing into the hands of control freaks. This Bill has been in gestation for many years and the groups it will affect have had plenty of time to reflect on what might happen to them.
The Eastern Health Board does some marvellous work. The Minister referred to the manner in which the health board has changed in the past 30 years to deal with the increase in population levels and social problems. In my constituency, the health board has been slow to deal with some of these social problems, such as drug addiction, homelessness, child care and so on, although it has become more involved recently. Perhaps funding was one of the problems, but it was not always the stated reason. The health board appeared to be rather bureaucratic at times in its failure to reach out to the community. Perhaps it did not receive the full backing of public representatives in many cases. However, even when such support was forthcoming, the health board was slow to reach out. Child care will be the major challenge facing it in the future. A great deal of taxpayers' money goes towards the funding of the health board and it is important that patients and clients are kept centre stage. I am concerned that the new authority will not be hijacked by people seeking to put themselves centre stage.
Concern has been expressed by voluntary hospitals in regard to some of the structures being proposed. Those concerns will have to be taken on board. Amendments could be considered on Committee or Report Stages to assure the voluntary hospitals that they are not being taken over. Voluntary hospitals have done a great deal of good work over the years and their concerns should be addressed.
I understand some specific concern has been expressed about section 8(3)(e) which states that the new authority, in performing its duties, should have regard to the rights of persons operating voluntary hospitals to manage their own affairs in accordance with their independent ethos and traditions. The phrase "have regard to" is considered by some to be very weak. Concern has also been expressed about section 8(4) which some people feel confers an unfair advantage on Tallaght Hospital over other teaching hospitals in the region. It has been suggested that one interpretation of the section could render it contrary to Article 44 of the Constitution which provides that the State shall not impose any disabilities or make any discrimination on the ground of religious profession, belief or status. These concerns have not been allayed fully.
The Minister has had his battles with Tallaght Hospital. He may feel he was too hard on it and, like a good gentleman from the midlands, wants to kiss and make up. Perhaps he is conferring a stronger status on it in the Bill than that enjoyed by other hospitals. That may put him into the good books with Tallaght Hospital and restore relations between it and the Department of Health and Children. However, in reaching out the hand of friendship to Tallaght Hospital is he being fair to the other voluntary hospitals? Is he bestowing on Tallaght Hospital a higher status than that given to other voluntary hospitals? We all know Tallaght Hospital has not been in existence for long and that it is an amalgamation of three hospitals. We also know it has difficulties and problems with its charter. Perhaps the Minister must be seen to try to make the administration there happy, but there is a concern that the legislation has gone too far and favours Tallaght over the other voluntary teaching hospitals. I would like to hear his comments in this regard and hope that if my comments are valid amendments will be considered. The time to consider amendments is on Committee Stage, not when somebody outside wishes to push the issue and when lawyers begin fighting in the courts, something which would cost us all a fortune. All voluntary teaching hospitals should be treated in the same way and none should be favoured above another.
There is also concern among some voluntary hospitals in relation to funding for their specialties. The Eastern Regional Authority will be concerned for the patients and clients within the region. However, the voluntary hospitals have pursued and been recognised as having national specialties in different fields. I often think they are more interested in expanding their specialties than in looking after patients in their casualty departments. Voluntary hospitals are very proud in this context and are always pushing out the boat in terms of their national specialties. There is concern that the status of these specialties may not be fully recognised by the new authority. I understand that the interim report examining the new authority discussed this issue, but I am informed it is not mentioned in the Bill. This is perceived as an omission which must be rectified.
Will the new authority say it is only interested in people if they come from Dublin, Wicklow, Kildare or Meath, and that those coming from Galway or Kerry are the responsibility of somebody else? Perhaps this has been thrashed out at length, but concern still seems to exist. There is a communication problem somewhere. I know we all fear change in certain respects, but there is nervousness and concern that if control is passed over to, for example, Dr. Steeven's Hospital, the national specialties of hospitals will not be recognised as they previously were.
Concern has also been expressed about capital expenditure. The Bill makes statutory provision for the payment of current expenses for services but does not provide for capital expenditure which is essential for delivering services in the future. These concerns must be addressed. Perhaps it is correct that the Department should control the purse strings in relation to capital expenditure and perhaps it will not hand full control to the new health authority. It may be necessary to make amendments on Committee Stage.
There are also concerns about the overall funding mechanism. Some people feel there is a conflict of interest on the part of the ERA as the purchaser of services is also ultimately responsible for the delivery of statutory services by the three area health boards. Perhaps the Minister will clarify the precise decision-making mechanism in relation to the allocation of funds. In particular I would like to know the decision-making process in relation to the allocation of funds by the Minister to the authority and by the authority to the health board areas and the voluntary sector.
The Bill includes the phrase "the resources available to the authority". Some people are asking that this be defined for the purposes of the Bill to ensure it includes those services being provided by voluntary bodies within the functional area of the authority. It is important that any such definition does not mean the service will only be provided to people residing in the functional area of the authority as this could run contrary to the mission of voluntary hospitals.
Similarly, there is concern that due recognition be given to the additional resources required by acute voluntary teaching hospitals to fulfil their teaching commitments. There is also concern that section 10 appears to delegate to the authority the function of determining future policy as to whether developments within the health services should be primarily in the voluntary sector, the institutions under the management of health boards, or in combination. Some voluntary bodies have obtained legal opinion. I am always dubious about legal opinion as I think one can get whatever legal opinion one wants depending on who pays for it. However, the time to sort out conflicting opinion, if such exists, is before the Bill is passed rather than having various bodies wasting time and energy and using taxpayers' money fighting a battle for control instead of dealing with the real problems faced by the health service.
There is also a request that the Bill include a definition of a voluntary body. Currently the Bill simply specifies a voluntary body for the purposes of the Bill.
These are some of the concerns of voluntary hospitals. I know these views have been submitted directly to the Minister and I am sure they are being studied in the Department. I like to think that an attempt will be made to keep everybody on board so that everybody can identify with the Bill, feel it is fair, claim ownership of it and look forward to a new structure for health services in the eastern region, and that it is not a case of bureaucracy or the control freaks winning.
In such measures where things are being drawn together some people will fear that they might be losing some authority over their patch. Every opportunity should be taken to reassure people in this regard, specifically in the context of Tallaght Hospital which I know has had a difficult birth. Some of the other voluntary hospitals have connections with Catholic orders and while the day of giving special recognition to one church may be gone, we should not be seen to be going in a particular direction in this Bill. The perception of some people is that Tallaght Hospital is being recognised and is receiving a status over and above that given to the other voluntary hospitals. It is a touchy subject and the Minister may be playing all sides against the middle and walking a tight rope, but I like to think that further work will be done and that some amendments will be brought forward to perhaps change some of the sections, thereby allowing all voluntary hospitals feel they are part of the new structure and feel happy within it.