Amendment Nos. 1 and 2 are consequential on amendment No. 5. Amendments Nos. 1, 2 and 5 can be taken together. Is that agreed? Agreed.
Health (Eastern Regional Health Authority) Bill, 1998: Report and Final Stages.
I move amendment No. 1:
In page 3, between lines 30 and 31, to insert the following:
"‘the Act of 1991' means the Child Care Act, 1991;".
This amendment seeks to amend the definition section by referring to the Child Care Act, 1991. Amendment No. 2 seeks to insert in the Bill the words "'The Acts of 1952 to 1997' means the Adoption Acts, 1952 to 1997;". In the context of the obligations of the eastern regional health authority, amendment No. 5 seeks to insert in the legislation that one of its obligations is "to ensure the provision of child care and adoption services within each Area Health Board pursuant to the Act of 1991 and the Acts of 1952 to 1997".
I will explain the purpose of the proposed amendments. The existing legislation does not contain explicit reference to the Child Care Act, 1991. That legislation requires each health board, including the Eastern Health Board, to provide protection for the welfare of children. It is also concerned with ensuring that where children are at risk appropriate action is taken and such action would include bringing court proceedings.
I drew to the Minister's attention on Committee Stage a concern I had to ensure that legal difficulties could not arise in the future in the context of the legal obligations and the legal powers of the Eastern Regional Health Authority and the individual health authorities when it comes to their operating under the provisions of the Child Care Act, 1991.
Paragraph (b), as detailed in amendment No. 5, seeks to ensure the provision of child care and adoption services within each area health board pursuant to the 1991 Act in the context of adoption services and pursuant to the Adoption Acts. I drew to the Minister's attention the fact that the Health Act 1970 was silent on this area and did not deal adequately with it. In a court case in 1988 we discovered the courts determined that as a consequence all the powers we believed could be exercised at that time by health boards, as conferred by the Children Act, 1908, to provide protection for children were found not to extend to health boards in the manner envisaged.
In the context of our child protection laws, which have been much in the spotlight in recent days, this amendment is designed to ensure there is not a lacuna in this legislation. The Minister said he would examine this issue further. I am anxious to ensure that there is no uncertainty in this regard. The Department of Health and Children might consider that an amendment of this nature is not essential, but if an amendment of this nature is not made there is a likelihood that the capacity of the individual health authorities to properly operate that legislation will end up being an issue that would be litigated in the High Court and the Supreme Court. If that issue were litigated, it may throw into uncertainty many existing child care orders and create a position whereby, for some months while such court case is pending, a health board feels paralysed in regard to taking steps it believes may be required in the interests of children's welfare. That is the thinking behind this proposal.
I draw to the Minister's attention that we know there are hundreds of cases of alleged child abuse reported to the Eastern Health Board that remain uninvestigated. This has been the position for some time. As of today, how many such cases remain uninvestigated? Are we still talking about many hundreds? Are there cases where reports of child abuse were made to the health board more than three or six months ago where to date the health board, due to the lack of resources or personnel, has not been able to undertake any family assessments or check into the position of individual children in respect of whom it has received reports that they may be at risk? I want an assurance from the Minister that in dealing with this issue the area health boards will have the capacity to respond speedily to reports of child abuse. Will the Minister indicate how the outstanding cases that require investigation or the cases that are currently the subject of assessment will be dealt with following the creation of the eastern regional health authority? Where will child care services be based? Will child care services be based in one area health board and service all three area health boards or will they to be split between the area health boards? What can he tell us about the continuity of assessment in the context of the personnel involved in this area? To what degree has that been thought out?
As regards adoption, each health board in the State, including the Eastern Health Board, has a function in the undertaking of assessments for both domestic and foreign adoptions. The Minister is well aware that there is widespread concern about the manner in which the Eastern Health Board is undertaking assessments of couples seeking to adopt abroad who need declarations of suitability. Has the Department received the independent report commissioned to investigate the manner in which the health board has been dealing with adoption assessments? If it has, when will it be published? If the Minister has the report, will he lay it before the House this week? If it is in his possession and it has not been laid before the House, why not?
There are widespread reports in the media, which could only have been leaked from limited sources, that this report is very critical of aspects of the approach of the Eastern Health Board to the assessment of couples for foreign adoption and that it recommends the adoption of a uniform approach by all health boards, which should have been in place a considerable time ago. Changes are recommended to the approach which up to now has been taken by the Eastern Health Board. Will the Minister tell the House what is happening? I am aware of a number of couples who have sought Eastern Health Board assessment for foreign adoptions and experienced a great deal of distress as a consequence of the manner in which they have been treated and their perception of the health board's attitude to adopting outside the State.
Will the Minister clarify what will happen to adoption services following the creation of the Eastern Regional Health Authority and the splitting up of the Eastern Health Board into the three area health boards? Will one area health board have responsibility for the adoption service of all three health boards or will services be separately run in each area health board? How is it proposed to deal with the backlog of couples awaiting assessment when the new area health boards are put in place and what will happen as regards the continuity of assessments?
These issues are of great relevance to the lives of children in need of care, children whose parents are experiencing difficulties looking after them and couples who hope to adopt. They arise under the Child Care Act, 1991, and the Adoption Acts of 1952 to 1997 and require more clarification than we have received to date during the passage of this Bill. I ask the Minister to constructively consider my amendments and to take them on board.
These amendments require the authority to fulfil its obligations under the Child Care Act, 1991, and the Adoption Acts by ensuring the appropriate services are provided within each area health board. As such, the amendments are unnecessary because this requirement already exists in the text of the Bill as it stands. I refer the Deputy to section 7(5) which provides that the authority is construed as a health board in the context of existing legislation. This means it will have all the powers, duties and functions of a health board, including those in the two Acts referred to in these amendments. Section 10(2) requires the authority to make arrangements with each area health board for the provision of services formerly provided by the Eastern Health Board. These arrangements will encompass services pursuant to the Child Care Act and the Adoption Acts.
The Deputy asked where the child care services will be based. This will be a decision for the authority when it is set up. The overall intention in the Bill is to devolve responsibility as far as possible to each of the three boards for services in their own area. The thrust of the legislation is to ensure continuity of care from the present Eastern Health Board services to the services provided under the new structured arrangements.
As regards what the Deputy said about adoption assessment procedures, the Department of Health and Children received a draft report of the independent consultants' review of foreign adoption assessment procedures and it is now being examined by the advisory committee set up to assist with the project. The comprehensive report contains a detailed overview of the current assessment procedures in health boards. It proposes a standardised framework for the carrying out of future assessments which accords with best practice in the field and delivers the service in the most efficient and sensitive manner possible. I expect to receive the consultants' final report in the next few weeks. We will then decide what to do as regards the recommendations. The draft is available and the advisory committee is considering it.
I am aware of the provisions in section 7 and I am concerned that their general nature may still give rise to difficulty. I am also concerned that particular difficulties may arise in child care functions in circumstances in which this House has not legislated for the designation of how these services are to be dealt with. This is not appropriate and there are legal difficulties with an issue, that is, whether one area health board should have responsibility for child care court cases or three different area health boards. There could be legal difficulties given that this will be determined by a decision of the Eastern Regional Health authority. As regards the serious issue of the courts processing child care cases, I am concerned we will discover a major lacuna in the law.
This issue is too important to be dealt with by the Eastern Regional Health Authority as a discretionary decision without legislative guidance. As matters stand, in theory, one of three things could happen – all such cases could be brought by the Eastern Regional Health Authority, one area health board could be designated to deal with such court applications in the area of child care on behalf of the other two or each could be given separate powers. Equally, we could end up with one service run by one health board applicable to the entire Eastern Regional Health Authority area which we now regard as too large and which we are seeking to separate into three area health boards or the service could be fragmented into three different areas.
These are major policy issues of sufficient seriousness that the Dáil should make decisions on them. These are not decisions for which we should abdicate responsibility. They are essential policy issues. The correct approach is to ensure, as the Minister has generally expressed, services are as local as possible. The Eastern Regional Health Authority area is vast which is why the three area health boards are being created. It should not be necessary in the context of the areas covered that such services be particularly centralised in Dublin as regards each of the three area health boards. The correctness of the policy decision is copperfastened by the practical difficulties which have been experienced to date with the ability of the Eastern Health Board to carry out its child care services in a responsive way and which indicate that each of the three area health boards should be performing these functions. That is of great importance to ensure that if a child at risk in a particular local area requires protection it is extended to him or her by way of a local service rather than a centralised service. The local service should be staffed by men and women with the necessary local knowledge who are sufficiently close to the alleged events that they are able to investigate them speedily and undertake family assessments.
In the context of the Child Care Act, 1991, my amendment is appropriate and I will press it. The Minister still seems to experience difficulties in obtaining information from the EHB because he was not able to tell me the up-to-date position on how many hundred reports of child abuse to the board currently remain uninvestigated. He is welcome to intervene if he has this information because every Member is concerned about it. The fact that that is the reality flies in the face of the Taoiseach's announcement on Tuesday of last week when he recognised the need for a comprehensive policy to address issues of child abuse but failed to address the reality that the largest health board in the country currently lacks the capacity to fully investigate and speedily respond to all allegations of child abuse or children at risk as a result of neglect which it receives within a reasonable time.
It is a major problem and high powered announcements in the form of media events do not take from the reality that hundreds of children remain at risk in this State who may still, because their cases have not been investigated, be victims of abuse and who in years to come as adults will discover that more lives have been blighted because of the failure of the State to extend to them the protections to which they were entitled. Yet again they will be in a position where the only way they can vindicate their rights is to seek compensation. I hope that a commission will not need to be formed in 2010 to investigate the failures of the 1990s, which occurred because health boards lacked the capacity to respond to allegations of child abuse.
I will press amendments Nos. 1 and 2 because I am not satisfied that the service provided currently by the EHB in the area of adoption, particularly the manner in which couples who have sought to adopt abroad have been treated, is appropriate. I have raised this issue in the House for four years as a result of representations I have received from various people who experience difficulties in the assessment process. It took until last autumn for the Government to take this issue seriously and for any group to be put in place to investigate the issue.
I am pleased the Minister has the draft report but I am concerned that it is being looked at by an advisory committee. It might look at it to ensure accuracies but I am always concerned about internal departmental advisory committees which receive independent reports and then, often for the sake of protecting bureaucracy, try to persuade the people responsible for the reports to emasculate them and moderate their language to avoid upsetting people who have failed to properly fulfil their functions in the interests of the people. The Minister should be wary of how the draft report is changed by the advisory committee. I have no doubt that I will seek the report under the Freedom of Information Act, 1997, and I would be surprised if Deputy McManus is not equally interested to ensure the final report that is published is in no way emasculated or watered down. It is of great importance that a knowledge of what has gone wrong in this area is out in the open as rapidly as possible and the Government is taking action to get it right.
In that context foreign adoption assessments should be dealt with by individual health boards, as should child care functions. They should not be centralised within one large bureaucracy which has a tendency on occasion to develop ideological views which may be out of touch with reality and substantially divorced from the needs of children and the concerns that need to be investigated in this field to determine people's suitability to adopt.
Amendment put.
Tá
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Ahearn, Theresa.Barnes, Monica.Bell, Michael.Boylan, Andrew.Bradford, Paul.Broughan, Thomas.Browne, John (Carlow-Kilkenny).Bruton, John.Bruton, Richard.Burke, Liam.Burke, Ulick.Carey, Donal.Clune, Deirdre.Connaughton, Paul.Cosgrave, Michael.Coveney, Simon.Crawford, Seymour.Creed, Michael.Currie, Austin.Deasy, Austin.Deenihan, Jimmy.Dukes, Alan.Durkan, Bernard.Farrelly, John.Ferris, Michael.Finucane, Michael.Flanagan, Charles.Gilmore, Éamon. |
Hayes, Brian.Higgins, Jim.Higgins, Michael.Kenny, Enda.McCormack, Pádraic.McGahon, Brendan.McGinley, Dinny.McGrath, Paul.McManus, Liz.Moynihan-Cronin, Breeda.Naughten, Denis.Neville, Dan.Noonan, Michael.O'Shea, Brian.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Sargent, Trevor.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Stagg, Emmet.Stanton, David.Timmins, Billy.Yates, Ivan. |
Níl
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Ahern, Bertie.Ahern, Dermot.Ahern, Michael.Ahern, Noel.Ardagh, Seán.Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Browne, John (Wexford).Byrne, Hugh.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Cowen, Brian.Cullen, Martin.Daly, Brendan.Davern, Noel.de Valera, Síle.Dempsey, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Gildea, Thomas.Hanafin, Mary.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.Keaveney, Cecilia.Kelleher, Billy. |
Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael.Kitt, Tom.Lawlor, Liam.McCreevy, Charlie.McDaid, James.Martin, Micheál.Moffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Donoghue, John.O'Flynn, Noel.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Malley, Desmond.O'Rourke, Mary.Power, Seán.Roche, Dick.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Walsh, Joe.Woods, Michael.Wright, G. V. |
Tellers: Tá, Deputies Sheehan and Stagg; Níl, Deputies S.Brennan and Power.
Amendment declared lost.
I move amendment No. 2:
In page 3, between lines 32 and 33, to insert the following:
"‘the Acts of 1952 to 1997' means "the Adoption Acts, 1952 to 1957;".
Question put and declared lost.
Amendments Nos. 3, 4 and 20 are related and are to be taken together.
I move amendment No. 3:
In page 5, line 15, to delete "service" where it firstly occurs.
On Committee Stage I accepted an amendment from Deputy Shatter which changed the term "mental handicap" in section 2 to "intellectual disability". I indicated then that some further amendments might be required as a consequence. The word "service" appears twice on page 5, line 15. The first of these amendments simply corrects the text of the Bill to read "voluntary intellectual disability service provider". The other amendments change the references in sections 2 and 22(e) so that they accord with the new terminology.
My Department has searched the Health Acts and other related legislation and has found no other references to the term "mental handicap" which require amendment.
I support these amendments. I raised this issue on Committee Stage and it was agreed that other sections in the Bill would be looked at before Report Stage to ensure they coincided with the Committee Stage amendment. Amendment No. 3 arises out of a typographical error more than anything else and amendments Nos. 4 and 20 ensure a continuity of approach in the Bill. They are fully supported.
Amendment agreed to.
I move amendment No. 4:
In page 5, line 16, to delete "mental handicap" and substitute "intellectual disability".
Amendment agreed to.
I move amendment No. 5:
In page 7, between lines 4 and 5, to insert the following:
"(b) ensure the provision of child care and adoption services within each Area Health Board pursuant to the Act of 1991 and the Acts of 1952 to 1997,".
Amendment put.
Tá
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Ahearn, Theresa.Barnes, Monica.Bell, Michael.Boylan, Andrew.Bradford, Paul.Broughan, Thomas.Browne, John (Carlow-Kilkenny).Bruton, John.Bruton, Richard.Burke, Liam.Burke, Ulick.Carey, Donal.Clune, Deirdre.Connaughton, Paul.Cosgrave, Michael.Coveney, Simon.Crawford, Seymour.Creed, Michael.Currie, Austin.Deasy, Austin.Deenihan, Jimmy.Dukes, Alan.Durkan, Bernard.Farrelly, John.Ferris, Michael.Finucane, Michael.Flanagan, Charles. |
Gilmore, Éamon.Hayes, Brian.Higgins, Jim.Higgins, Michael.Kenny, Enda.McCormack, Pádraic.McGahon, Brendan.McGinley, Dinny.McGrath, Paul.McManus, Liz.Moynihan-Cronin, Breeda.Naughten, Denis.Neville, Dan.Noonan, Michael.O'Shea, Brian.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Stagg, Emmet.Stanton, David.Timmins, Billy.Yates, Ivan. |
Níl
|
Ahern, Bertie.Ahern, Dermot.Ahern, Michael.Ahern, Noel.Ardagh, Seán. |
Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Matt. Brennan, Séamus. |
Níl–continued
|
Browne, John (Wexford).Byrne, Hugh.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Cowen, Brian.Cullen, Martin.Daly, Brendan.Davern, Noel.de Valera, Síle.Dempsey, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Gildea, Thomas.Hanafin, Mary.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.Keaveney, Cecilia.Kelleher, Billy.Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael. |
Kitt, Tom.Lawlor, Liam.McCreevy, Charlie.McDaid, James.Moffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Donoghue, John.O'Flynn, Noel.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Malley, Desmond.O'Rourke, Mary.Power, Seán.Roche, Dick.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Mary.Walsh, Joe.Woods, Michael.Wright, G. V. |
Tellers: Tá, Deputies Ferris and Sheehan; Níl, Deputies S.Brennan and Power.
Amendment declared lost.
Amendments Nos. 6 and 7 are related and may be discussed together, by agreement.
I move amendment No. 6:
In page7, between lines 8 and 9, to insert the following:
"(d) provide in its annual report an account of measures taken to monitor and evaluate services and an account of the outcomes of such measures,".
There was some discussion on Committee Stage about the annual report of the authority and whether it should reflect the role of the authority as overseer of the services provided within its region. I agreed at that stage to give some thought to the matter. As is the case with all health boards, the authority will be obliged by section 15 of the Health (Amendment) (No. 3) Act, 1996 to produce an annual report. I agree with the point made by Deputy Shatter that the authority will be in a unique position among health boards because it will have a statutory role in overseeing, evaluating and monitoring the services provided. This amendment reflects that position. It provides that the authority will include in its annual report, details of the measures it has taken during the preceding year to monitor and evaluate services and the results of such measures.
With regard to Deputy Shatter's amendment, the authority and the area health boards will not be unique in having complaints made against them. This is an issue for all health boards. The provision in the Health (Amendment) (No.3) Act, 1996 allows the Minister to specify particular items which might be included in a health board's annual report and how they should be presented. It would be more appropriate to address the issue of complaints in that context than as a particular provision of this Bill. Accordingly I do not propose to accept that amendment.
I welcome amendment No. 6 tabled by the Minister and the provision proposed in it which will ensure that the annual report gives an account of measures taken to monitor and evaluate services provided in the Eastern Regional Health Authority area, and of the outcomes of such measures. This issue was raised on Committee Stage. It is very important that the annual accounts are more than a financial exercise and that the authority is recognised as having a responsibility to report annually on the manner in which it is exercising its monitoring functions of the services provided by the area health boards under its aegis. I fully support the amendment and thank the Minister for taking our discussion on the issue into account. I am pleased that this aspect of matters is being addressed properly.
Amendment No. 7 seeks to address a related issue. I am proposing that an additional subsection (e) be inserted in the Bill which would require the Eastern Regional Health Authority to "provide in its annual report an account of bona fide complaints received about health board ser vices, detail the steps taken to investigate such complaints and an account of the outcomes of such investigations". While I fully accept that this is an issue which affects not only the Eastern Regional Health Authority and the area health boards but also the other seven health boards, we are starting out on a new adventure in the eastern region and setting down principles and approaches which we recognise are desirable in the provision of health and social services which fall under the aegis of health boards. We are living in an era of greater openness and accountability. Powers are vested in the Ombudsman to investigate complaints against health boards and report on the outcomes of such investigations.
Given the vast population that it will provide for, it is of great importance that we know that the Eastern Regional Health Authority will be genuinely responsive when difficulties arise in the provision of services by area health boards. We need to know that it will not select services to monitor. Where complaints are made, they should be investigated and addressed speedily. Where they are spurious, this should be clearly stated and where they are valid, there should be immediate redress for the complainant. This is an essential ingredient of a modern health authority.
The fact that the proposed subsection (e) would not extend to the other seven health boards is not a reason for not making it a statutory imperative for the Eastern Regional Health Authority. It can be made a statutory imperative for the other seven health boards when the Minister comes to legislate for them. It is only right that the Eastern Regional Health Authority should start with a new and more open ethos than might be the case at present.
Those Deputies who live in the Eastern Health Board area regularly come in contact with it concerning difficulties experienced by constituents about the manner in which they have been treated by the hospital service, alleged discourtesies and, in particular, the difficulties which arose in adoption assessments. I have written to the board about children at risk, where there was a belief that action should be taken and was taken only after I had made representations. These are issues with which public representatives should not have to deal.
The Eastern Regional Health Authority will have a unique role in monitoring the service. It should be required to detail in its annual report the numbers of complaints received, to give examples of bona fide complaints made while preserving the anonymity of complainants, if they so wish, and to indicate the measures taken in response. This would ensure that it will be a responsive authority, that it is on its toes. The message would go out that it can be called to account for a failure to respond within a reasonable time to bona fide complaints received.
I urge the Minister to consider accepting my amendment. I am loath to call a formal vote which, given the realities in the House, the Opposition does not have the numbers to win but it is not about winning. The Minister has a genuine wish to break new ground in the context of the Eastern Regional Health Authority. He has been willing to accept constructive proposals from the Opposition. The aim is not to score party political points but to ensure that those who live in the Eastern Regional Health Authority area receive a service that is responsive, that the authority lives up to the purpose for which it is being partially created, and that some of the issues which ultimately fall on the lap of the Ombudsman are dealt with more speedily without the Ombudsman having to become involved. The Ombudsman is entitled to publish the outcome of his investigations into such complaints. There should be a statutory obligation on the Eastern Regional Health Authority to do likewise.
I am anxious that the Minister, if he is not in a position to accept the amendment today, will give further consideration to it before the Bill is taken in the Seanad. This is an important issue in respect of which the Minister may be receptive.
I said on Committee Stage that in bringing forward new legislation it is important that there is consistency. It is important that specific additional statutory obligations are not placed on a particular health authority. That would not be good legislative practice.
It has been argued that there is a need for openness. The freedom of information and Ombudsman legislation has brought about a change in culture in health boards. Complaints about the administrative decisions of health boards are dealt with in the Ombudsman's report every year. There is no need, therefore, to refer specifically to that aspect of their operations in legislation.
Section 15 of the Health (Amendment) (No. 3) Act, 1996, allows the Minister to specify particular items which may be included in the annual report of a health board and how they should be presented. This is a matter to which I would like to give consideration in the context of all health board reports rather than place an explicit statutory duty on a particular board. Under existing guidelines health boards are required to provide information to the public on how complaints are dealt with.
Legislation is being prepared in the Department of Finance to extend the remit of the Ombudsman to voluntary hospitals. Therefore, we can see the means by which we may achieve wider accountability in the area of complaints in the health and hospital services, and that is by extending the remit of the Ombudsman Acts, which are the responsibility of the Department of Finance which is preparing legislation at the moment.
For all those reasons, I do not believe I should accept the Deputy's amendment other than to say, without making any explicit promises in the House, that under the Health (Amendment) (No. 3) Act, 1996, there is a provision enabling me, as Minister, to specify if I require further information in the annual reports. I will give consideration to that on the basis of it being a requirement of all health boards, including this authority. For that reason, we should not insert a specific provision in this Bill.
Amendment agreed to.
I move amendment No. 7:
In page 7, between lines 8 and 9, to insert the following:
"(e) provide in its annual report an account of bone fide complaints received about health board services, detail the steps taken to investigate such complaints and an account of the outcomes of such investigations,".
Amendment put and declared lost.
I move amendment No. 8:
In page 9, line 17, after "hospitals," to insert "not less than 2 non-consultant hospital doctors,".
The amendment is a very simple one which seeks to ensure a full complement of representation for doctors. At the moment it is proposed that there will be no fewer than two consultants in general hospitals, no fewer than one consultant psychiatrist, no fewer than two general medical practitioners and no fewer than one registered medical practitioner with special knowledge or experience of preventative medicine. It is a glaring omission that the key personnel who staff our hospitals are not included in that list. I refer to the NCHD, the junior hospital doctor.
It is a great deficiency in the Bill that the Minister intends to exclude what is certainly the largest cohort within the medical profession, the cohort which deals most directly with the patient and which is, in effect, at the coalface in providing services to the patient. When one looks at the health board hospitals, it is the junior hospital doctors who are the backbone of the service. They man the accident and emergency units and are the first member of the medical profession to deal with public patients coming into hospital, yet they are excluded from representation in the health board structures.
I am sure there are traditional reasons for this, but I suggest the Department and the Minister are failing to recognise what is happening in the medical profession by specifically excluding this sector. It is very important that the deficiency is put right because junior hospital doctors are frustrated and, more importantly, fearful about their position and their area of responsibility in relation to patient care. The health boards and the Department of Health and Children do not recognise the risks involved in the current status of junior hospital doctors.
The strains are showing and they are very severe indeed. If we do not address this issue, we are pointing the way to an incident which will create a crisis for some unfortunate junior hospital doctor who will simply take on a workload which is unacceptable and untenable. We need to recognise that and to ensure these people are accommodated by way of representation appropriate to their needs and to the needs of the service. We need to hear from junior hospital doctors, in a structured way, about their needs, pressures and strains. It is not adequate to depend on explosive statements that appear now and again in the media or to wait until pressure points start to be felt when there is conflict between the junior hospital doctors and the Department. That is not the way forward. The way forward is to ensure there is a platform for junior hospital doctors to express their concerns and to make an input into ensuring high quality.
The Minister will say that because junior hospital doctors are transient, it is somehow impossible to ensure they can be accommodated on the new health board structure, but I do not accept that as an argument. It would be very wrong for it to be used as a shield to prevent junior hospital doctors from being included. The nature of the system of appointments is certainly transient and short term. It may not always be so, but that is certainly the case at the moment, with very short-term contracts of six months or so for junior hospital doctors.
The IMO, the medical organisation, has been able to establish a committee representative of junior hospital doctors which provides continuity and representation. If the IMO can do that, it is not beyond the capability of the Department of Health and Children and the health boards to ensure that they provide continuity of representation for junior hospital doctors. It is a matter of will rather than an inability to deliver.
The fact that junior hospital doctors are not covered by the Organisation of Working Time Act is of grave concern. Anybody attending or working in hospitals, in whatever capacity, has an interest in ensuring junior hospital doctors are not exploited. I have had a number of complaints, particularly from staff working in allied professions in hospitals who have witnessed the strain experienced by junior hospital doctors. A nurse told me that she pitied anybody coming into the accident and emergency unit of her hospital on a Sunday night because of the likely experience they would have in meeting an exhausted junior hospital doctor who is simply not capable of making a clear judgment on health care. That is the type of complaint I am receiving. I have no doubt the Minister, who is not a stupid man, is well aware that this poses a risk in our hospitals.
The general public is probably not aware that there is no restriction on hours of work for junior hospital doctors under the Organisation of Working Time Act. There are arrangements with the representative bodies, such as the IMO, but we all know these arrangements are being abused and that some doctors are working 100 to 130 hours per week, which is untenable. The system of breaks is not statutorily based in terms of overtime, holiday cover and sick cover.
These are the issues junior hospital doctors would like to see addressed and which have a significance when it comes to decision-making within health boards. We will not deal with them by keeping junior hospital doctors outside the health board structure. If we ensure junior hospital doctors have no voice, it is inevitable that these issues will not be addressed by any management structure within health boards. Do members of health boards and those who will be on these new boards appreciate that when a junior hospital doctor is required to work overtime the rate of pay they receive is lower than the national minimum wage being proposed by the Government? The average member of a health board would find this quite startling. I know one junior hospital doctor who worked on Christmas Day which, because he had to pay for travel and meals, cost him money.
Many elected and other members of health boards would want to ensure that in making decisions in terms of management and the running of health boards people working for them are not exploited. At present it is clear there is much ignorance and a certain amount of concern about the status and functioning of junior hospital doctors. I appreciate the relevance of legal measures and that there are issues relating to the EU directive which are not related to the Bill, but if we are to deal with the ongoing questions concerning junior hospital doctors we must have them represented on the boards. There is no other way to proceed.
Hospital consultants will probably not even be aware of some of the concerns of the NCHD. Psychiatrists and those involved in preventative medicine do not directly experience what the NCHD experiences. Even at this stage the Minister should accept a representational role for the thousands of junior hospital doctors who are in effect ensuring our acute hospital service is kept going. If such representation is not accommodated, another pressure will be put on junior hospital doctors. At the end of the day this will create unbearable pressures which will lead to the possibility of industrial action which could be avoided if we ensure their inclusion.
Will the Minister ensure that when we talk about the medical profession being represented on the boards we include junior hospital doctors, the largest cohort of which is at the coal face and which is experiencing the greatest strains of all those in the medical professions who are providing excellent care.
Both I and Deputy McManus have tabled similar amendments in relation to non-consultant hospital doctors, an issue which was discussed on Committee Stage. I do not disagree with anything Deputy McManus has said. At the very least non-consultant hospital doctors should have a guaranteed representation on the authority given the burden they bear and the responsibility they have for the functioning of our health services within the Eastern Regional Health Authority area. I know the Minister may say that non-consultant hospital doctors may work outside the Eastern Regional Health Authority area or outside the country. However, that is not unique as currently when members of health boards resign they are replaced by an appropriate person.
There should be a minimum of two guaranteed places on the authority for non-consultant hospital doctors. Their concerns should be part of the discussion which takes place in the authority when it is formulating policy.
In the context of working time legislation and the working time directive, I am appalled to learn that in discussions with the EU the Government is seeking to extend to 11 years the timeframe within which we may have to comply with a 48 hour working week. The working week non-consultant hospital doctors are expected to work is not only unfair to them but poses serious risks to patients. I do not believe people who work for 65, 70 or 80 hours per week and who are under pressure in hospitals are always in a position to make the necessary, essential and speedy judgments in the interests of patients, for no reason other than their sheer tiredness and the pressures under which they work.
Our health service is far more complex and the technologies are far more sophisticated than they were decades ago, and the manner in which non-consultant hospital doctors work and the times they are expected to work do not reflect the difficulties under which they work in the modern health service. This is to the detriment of doctors and their patients. It is a concern in the context of the provision of a quality health care service in which people are treated equally and undermines this commitment which we wish to see implemented.
In the context of the Bill we cannot resolve all the problems of non-consultant hospital doctors. However, the Bill will represent a continuing failure to recognise their value in our health service if we exclude them from representation on the new authority. I urge the Minister to take on board the amendments tabled by Deputy McManus and me. I also ask the Minister in his reply to clarify Government policy in the context of the EU directive. I noted that the Minister of State, Deputy Moffatt, is reported in one of this week's medical journals as saying that we are seeking an 11 year extension in the application of the working time directive to non-consultant hospital doctors. This is a disgrace: we should not seek that amount of time to comply with a draft EU directive which is seeking to put in place a provision to protect patients. The protection of patients is the primary issue, in addition to our concern for the health of non-consultant hospital doctors. Seeking such a substantial derogation from that directive will not only say to non-consultant hospital doctors that we do not care about the pressures they are under, but will say to patients that we do not care about the risks those pressures present to them when they seek assistance and medical help in the hospital service.
The issue of representation on the authority of the registered professions was discussed at some length on Committee Stage. I explained on that occasion that the representation of the medical profession in the Bill is similar to that which currently applies to the Eastern Health Board. The same categories of medical doctors are represented on all health boards.
The representation proposed is based on the recommendation of the task force on the Eastern Regional Health Authority which was established by the previous administration to examine the issues involved. The task force stated in its report that the issue of a broader representation for the professions over and above that which currently applies on the Eastern Health Board was one which would have implications for the membership of all health boards. I am not proposing in the Bill to reform the membership of health boards – that is a matter for another day. What is being proposed here is a structure which will allow the health services in the eastern region to be planned, managed and delivered in a more efficient and effective way. The membership proposed is consistent with the membership of all other health boards, something I do not propose to change.
The issue of majority representation of public representatives is in line with the terms of reference given to the task force at the time and I agree fundamentally with it.
It is regrettable that the Minister is being so conservative on this matter. Saying that something was done in the past is not sufficient reason for us to continue doing it into the future. Similarly, saying it does not apply elsewhere in the country is not a sufficient reason for us not to provide for it in the Eastern Health Board region. We are debating a Bill which is establishing something different from that which exists in other parts of the country as it is recognised that there are different conditions in the eastern region. Although there are many similarities with other health boards, the structures being put in place are different. Certain aspects of the authority recognise that we are dealing with a region which has particular needs and a particular scale. The number of junior hospital doctors in the Eastern Health Board region is significant. There is nothing in the Minister's reply to prevent him from introducing this modest reform which would appeal to, rather than threaten, other health boards. They would see it as a step towards modernising health boards and a recognition of the strains in our acute hospital services.
The Minister would show intelligence and wisdom if he accepted this amendment and recognised that things change and problems deepen. A good decision made by a previous Government in terms of democratic accountability does not prevent the Minister from accepting this amendment and ensuring we are not frozen in time. He is in power to make decisions and changes as the need arises. Although he is a conservative Minister, he is not afraid to make decisions or to face up to the problems in the health boards and acute hospital services.
I urge the Minister to examine the needs of junior hospital doctors and, more importantly, the needs of patients for good quality and safe care. These problems will not go away, they will deepen. This amendment will not solve them but it is a measure of good intent. It will help to establish a line of communication and to encourage partnership, about which the Minister continually speaks and which is promoted in hospitals, although with some difficulty because of hierarchical hospital structures and traditional views which the Minister is reinforcing instead of challenging. I urge him to take this opportunity to accommodate people and to live dangerously.
This is living dangerously.
I am glad the Minister is laughing because he can see how ludicrous it is.
It is not as ludicrous as the point the Deputy is making.
It is ludicrous to have a structure in place where almost every element of the medical profession, which has enormous influence, is represented, yet those people who have the most direct relationship with the patient, particularly in terms of acute and emergency care, are kept outside the system for no good reason. I urge the Minister to accept this amendment.
Amendment put and declared lost.
Amendment No. 9 arises from Committee proceedings. Amendments Nos. 9, 10, 12, 13, 15 and amendment No. 1 to amendment No. 15 are related and may be discussed together. Recommittal is necessary in respect of amendment No. 15 as it involves a charge on the Revenue. I ask the Minister to move to recommit the group of amendments to Committee.
Bill recommitted in respect of amendments Nos. 9 and 10.
I move amendment No. 9:
In page 9, line 27, to delete "one" and substitute "three".
This amendment seeks to provide for the representation of three members of the general nursing profession on the Eastern Regional Health Authority, while amendment No. 10 seeks to provide for the representation of two psychiatric nurses. While we talked about these amendments on Committee Stage, we were unable to fully pursue them because the manner in which they were framed would have increased the numbers on the authority beyond 55 and would have resulted in an additional charge on the Exchequer.
The nursing profession is grossly under-represented on the Eastern Regional Health Authority. While junior hospital doctors make a vast contribution to our health service – it could not function without them – nurses make a greater contribution as they tend to be more permanent and less transient than junior hospital doctors. Nurses are at the coalface of our hospital service. Experienced nurses frequently assist newly qualified junior hospital doctors in their work. It is wrong that we have made a provision for the appointment of only one general nurse and one psychiatric nurse to the authority.
I am conscious that the amendment the Minister has tabled tries to overcome one of the difficulties raised on Committee Stage, namely, that if only two nurses were represented, one general and one psychiatric nurse, it would not be possible to ensure that each area health board had a nursing representative on the authority. The Minister is proposing that a member of the authority or of one area health board shall be entitled to attendance rights in other area health boards. That is welcome in so far as it may ensure that representatives of under-represented professions, such as dentists and others, have an opportunity to attend area health board meetings of a board of which they are not a member. It also places an onerous commitment on the individuals on the Eastern Regional Health Authority who represent their profession.
Each area health board should have a minimum of one nurse with general nursing experience on the authority. I amended the provision from one psychiatric nurse to two rather than from one to three because that would be out of order as it would increase the membership of the overall authority.
I urge the Minister to extend to nurses the recognition to which they are entitled. Nurses can make a valuable input to the running of the Eastern Regional Health Authority and the deliberations of each area health board. We need their input, expertise and views on how the health service is operating and on its needs. Nurses are the Cinderella of this authority. While general practitioners and consultants will have extensive representation, the representation for the nursing profession will be kept to the bare minimum. That is not in the interests of the authority. I urge the Minister to accept the amendments.
On Committee Stage concern was expressed by the Opposition about representation on the three area health boards for those registered professions which have only one representative on the authority. The professions in question are general nurses, psychiatric nurses, pharmacists and dentists. I accepted there was a problem and put forward a suggestion that perhaps those professions could be given observer status at the area health boards of which they were not a member. This idea appeared to be welcomed by the Opposition and, accordingly, I am now bringing forward that amendment.
This is an amendment to section 16 which deals with the membership of the area health boards. It proposes a new subsection (7) which provides that the members of the authority who are representatives of the general nurses, psychiatric nurses, dentists and pharmacists will be entitled to attend meetings of the two area health boards of which they are not formal members. They will be allowed to participate in the discussions at those meetings but will not have voting rights. The proposed new subsection (8) amends the existing subsection (7) to ensure that expenses can be paid to those attending meetings in an observer capacity.
The amendments put forward by the Opposition in this regard do not, in my view, adequately address the problem which was identified on Committee Stage. With regard to those put down by Deputy Shatter, there are four registered professions affected by this problem but these amendments deal with only two – nurses and psychiatric nurses. Also only two psychiatric nurses are proposed, leaving us with the problem of how to allow for two individuals to serve on three area health boards.
To allow for the increase in membership, amendment No. 12 proposes to delete the provision by which the Minister appoints three members to the authority. This provision is in line with existing legislation whereby the Minister of the day appoints three members to each health board. I see no reason this ministerial privilege should be discarded on this occasion.
The effect of amendment No. 13 tabled by Deputy McManus would be that each of the four individuals concerned would be full members of all three area health boards. This would add two or three new members to each area health board and would upset the balance of membership between local authority members and others. In two of the three boards the effect would be that the local authority members would no longer be in the majority. The amendment I have tabled addresses the problem in a way which does not interfere with the overall balance of membership on the authority. Accordingly I ask Deputies to withdraw these amendments and to support the ministerial amendment which, I believe, represents the most equitable solution to what has been acknowledged by all to be a difficult problem.
With regard to Deputy Shatter's amendment to amendment No. 15, I appreciate the Deputy's concerns on this issue. It would be important that the timing of the various meetings of the area health boards be such as to facilitate, so far as possible, the participation of all. I am sure the members of the area health boards and their management will be conscious of this when making their arrangements. However, I do not consider that an issue such as this is appropriate for primary legislation; it is an administrative matter which can and should be left to the area health boards.
I am still of the view I expressed with regard to nurses. The Minister's amendment is welcome and I would not oppose it as it gets over the problem with the other professions to which he referred. The problem derives from the extent of the membership of the authority which will render the deliberations of the authority difficult. In that context it is accepted that the authority will not exceed 55 members. The flexibility the Minister is introducing to allow members of area health boards to attend other meetings is welcome. I hope that flexibility will not be used by any member other than in circumstances in which they have a genuine interest in the deliberations of the other health authority. I am anxious to ensure it is not seen as a mechanism whereby some people may claim expenses to attend meetings in which they have no interest.
That is unfair.
That is an important issue. The Minister's proposal will work only if we have an assurance that meetings of area health boards will not coincide either by day or time. If the three area health boards decide to meet on the first, second, third or fourth Monday of the month at a particular time, there would be a theoretical right to attend an area health board meeting of which one is not a member. That would not be right but, in practice, it can be exercised.
My amendment to amendment No. 15, which seeks to add the words "and to facilitate such attendance, meetings of each Area Health Board shall not coincide and shall be arranged for different days", is a sensible mechanism which should be in primary legislation. We should set out clearly the thoughts of this House on this issue. There is no reason that amendment cannot be adopted and taken on board and I ask the Minister to accept it. The mechanism discussed on Committee Stage to provide for the possibility of members of one area health board attending the meetings of another could be at naught by simple administrative or bureaucratic practice where it is determined that it is convenient for particular area health boards to meet on a certain day. There is a serious risk that the meetings will coincide.
This is an issue for primary legislation because it is about the entitlements of nurses, dentists and others to avail of their rights to attend these meetings. There is no point in having a theoretical right if the meetings coincide. In the context of the Minister not accepting the other amendments I have tabled with regard to increasing the number of nurses who will be represented on the area health authority, I want to make certain that the nursing representatives have the possibility of attending area health board meetings other than those of the board to which they are appointed. I ask the Minister to reconsider his approach to my amendment to amendment 15 and to take it on board in the same spirit as other issues have been discussed as we work through this legislation.
I support Deputy Shatter on this point. I welcome the fact that the Minister has come some way in terms of opening up the possibility of nurses and dentists attending area meetings although, given the way they work, it will be difficult for them to attend all the meetings. Dentists and nurses working in the health board system, particularly in the Eastern Health Board, are already under a great deal of pressure. This is a positive move but I do not think it will have the desired outcome unless Deputy Shatter's amendment is accepted.
We all know custom and practice are different from the intent of a Bill. The practice of any board can sometimes be determined simply by a majority of board members whom it may suit to have meetings on a certain day; minorities are not always catered for unless protected by statute. I do not like the idea of a Minister ever saying the intent of the Bill is such and such, so we do not have to spell it out in the Bill. The intent may be correct and genuine but the custom and practice that develop at local level can be very different from the intent. That is human nature.
In this instance an onus is being put on nurses, dentists and pharmacists to take up an option which will create difficulties for them in time terms because it is not spreading the load but leaving it to a small number of individuals. If the Minister does not ensure meetings are held to accommodate these people, I have no doubt we will end up with a system where meetings are held that will exclude these people from time to time. They will be seen as extraneous to decision-making. People who are not automatically members of health boards will be seen as being there on sufferance. From time to time their requirements will be made secondary to the overall needs of the majority of the people on the health board. There are dangers involved in this area.
The Minister has come some way towards ensuring that these people are accommodated but it will be half hearted if he does not protect their interests regarding the times of meetings. Everybody has the freedom to go to the Ritz, but it does not work out that way. People may have the freedom to attend meetings, but it will not work out that way if a tradition evolves where all the meetings are held on the same day. The Minister must be realistic and firm about what he is doing. Given that he is in discussions with his officials, I hope he will accept this simple amendment.
I have no problem saying "yes" when I am persuaded by the argument. However, in this case I am not persuaded by it. There were discussions on committee stage and on this Stage about improving the prospects of representation for these professions on health boards. However, Deputy Shatter made the unworthy comment that he hoped I was not inserting an additional requirement that people should be paid proper subsistence and travelling expenses to attend meetings on the basis that, in his opinion, they would not be required to attend all the meetings in any event. This is a basic inconsistency in his approach.
I did not say that about any of the professionals.
The Deputy was specific. His comment was unfair and unworthy. Those motives should not be ascribed to any member of a health board. The purpose of the provision is to ensure that a problem which has been identified in the transition from the health board to the health authority is addressed while also ensuring that people are not out of pocket. This is a legitimate aim and unworthy motives should not be ascribed to it.
It is not the purpose of primary legislation to indicate when State agencies should meet. If that was done, people would then want the standing orders of bodies included in primary legislation. Deputy Shatter and Deputy McManus are experienced legislators and are aware that it is not the practice of the Oireachtas to incorporate in primary legislation when and how bodies meet in conducting their business. That is a matter for the boards which are established. The provision states it is the view of the House that observer status should be given to members of the authority on all the area health boards.
It is not the case that the chief executive officers of area health boards and the Eastern Regional Health Authority will undermine the position by holding all the health board meetings at the same time in different places so that people cannot attend them. There is no basis for this view. It is management practice to ensure that all members attend. This ensures a full and inclusive debate and that everybody is aware of what is happening. This avoids problems at the next meeting such as a 30 minute row about the minutes of the previous meeting. We should be practical and sensible about this matter.
The provision seeks to meet the needs in this area. I spoke informally to people who are the subject of this dilemma. I am not overstating the case by saying, despite all the problems which prevail in resolving this matter, they are happy with my proposal. It meets the requirement for them to be able to attend and contribute to meetings. They understand and respect the task force recommendation on the overall numbers. They also understand and support the majority representation by public representatives. The administrative matters which will enable them to participate fully at area board level will be respected by any reasonably good management. I have no reason to suspect that will not be the case.
Amendment put and declared lost.
Amendment No. 10 not moved.
Bill reported without amendment.
I move amendment No. 11:
In page 10, to delete lines 1 to 5 and substitute the following:
"(iii) 3 shall be nominated for appointment by such person or organisations as the Minister considers to be representative of the voluntary physical and sensory disability service providers in the functional area of the Authority,".
The amendment seeks to insert representation of the voluntary physical and sensory disability service on the Eastern Regional Health Authority. As the section stands, there is provision for three persons to be nominated to the authority for appointment by such person or organisations as the Minister considers to be representative of the voluntary intellectual disability service providers in the functional area of the authority. The voluntary physical and sensory disability service providers are not given any such representation. The amendment proposes the insertion of an additional provision that three shall be nominated for appointment by such person or organisations as the Minister considers to be representative of the voluntary physical and sensory disability service providers in the functional area of the authority.
A number of bodies and organisations fall within that definition. It is important that they have the same representation on the Eastern Regional Health Authority as the groups and organisations providing voluntary intellectual disability services. I hope the Minister will take on board the proposal which requires the deletion from the Bill of a general provision which allows three people to be nominated for appointment by such persons or organisations as the Minister considers to be representative of other voluntary service providers.
I am conscious that the other voluntary service providers may include organisations which provide services for people suffering from physical and sensory disabilities. However, it is important to set out our commitment to placing those who suffer physical and sensory disability and the people who provide services to them on an equal footing to the people who provide services to those who are intellectually disabled in the Eastern Regional Health Authority area. I urge the Minister to accept the amendment.
I support the amendment. It is most important that those who provide services to people with physical and sensory disabilities are recognised in the Bill as having a certain right to nomination. It has also been brought to my attention that the organisation Rehab is not included in the Second Schedule to the Bill. Perhaps the Minister could refer to that matter in his response.
I am sure the Minister is aware that an association of not for profit organisations has developed. It represents the key organisations which provide services to people with physical and sensory disability. I am most impressed with its approach. It is developing a most efficient approach which is based on partnership and co-operation. The amendment gives the Minister an opportunity to formally include these groups in terms of nominations. It would address a perceived imbalance between the attention and focus on people with intellectual disabilities rather than those with physical and sensory disabilities.
There is a perceived imbalance in focus. This offers an opportunity for the issue to be addressed fairly. It will not make a major difference to the Bill but it will be significant for service providing organisations.
The provisions regarding members of the authority are based on the recommendations of the task force set up by my predecessor. The specific instructions given to the task force on its establishment were that the authority should include "persons drawn from the voluntary hospitals, mental handicap agencies and other voluntary bodies". The term "other voluntary bodies" is deliberately broad. It allows for the possible inclusion on the authority of small, community based voluntary groups as well as the established voluntary service providers in the area of physical and sensory disability, services for the elderly, drug abusers, the homeless and child care services.
While I can understand the Deputy's concerns the amendment would have the effect of permanently excluding all these groups from membership of the authority except for those dealing with physical and sensory disability. On the other hand, retaining the provision as it stands allows the Minister, at his or her discretion, to ensure a balance prevails. If necessary, the Minister's three appointees to the authority could be employed to redress any imbalances arising.
I am disappointed with the Minister's response. The imbalance is now built into the Bill. Many sufferers from physical and sensory disability and many service providers feel their needs are not being fully and properly addressed by the Government. They are not being given the attention they deserve and their voice is not being heard. Part and parcel of hearing their voice is to give them membership of this authority as of right. They should not be one of a variety of groups who might be represented.
Each health board should have a representative of the groups who provide services to the intellectually disabled and one of those providing services to the physically and sensory disabled. We had this debate in the context of nursing and other professions. These are a broad range of groups doing extraordinary voluntary work for people with specific and identifiable needs, and it is of the greatest importance that health boards should contain a representative of each of these groups to ensure a proper focus of the needs within the communities which the boards represent of those who suffer from intellectual, physical and sensory disability.
It is unfortunate the Minister is not taking this amendment on board. In tabling it I anticipated there was a reasonable possibility that he would do so. We should not treat the report which gave rise to this Bill as if it were written on tablets of stone, as if since it was written our understanding of needs remains immutable and unchanged. We are entitled to take account of needs which were not fully recognised in that report. The House has a duty to ensure those suffering from physical and sensory disability are not treated differently to those suffering from intellectual disability. This legislation should not contain an in-built discrimination against service providers in the voluntary sector for the physical and sensory disabled. This is an important amendment which I hoped would not divide the House but, sadly, it will.
Question put: "That the words proposed to be deleted stand."
Tá
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Ahern, Bertie.Ahern, Dermot.Ahern, Michael.Ahern, Noel.Ardagh, Seán.Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Briscoe, Ben.Browne, John (Wexford).Byrne, Hugh.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Cowen, Brian.Cullen, Martin.Daly, Brendan.Davern, Noel.de Valera, Síle.Dempsey, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Gildea, Thomas.Hanafin, Mary.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.Jacob, Joe. |
Keaveney, Cecilia.Kelleher, Billy.Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael.Kitt, Tom.Lawlor, Liam.McCreevy, Charlie.Moffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Donoghue, John.O'Flynn, Noel.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Malley, Desmond.O'Rourke, Mary.Power, Seán.Roche, Dick.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Woods, Michael.Wright, G. V. |
Níl
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Ahearn, Theresa.Barnes, Monica.Bell, Michael.Boylan, Andrew.Bradford, Paul.Broughan, Thomas.Browne, John (Carlow-Kilkenny).Bruton, John.Bruton, Richard.Burke, Liam.Burke, Ulick.Carey, Donal.Clune, Deirdre.Connaughton, Paul.Cosgrave, Michael.Coveney, Simon.Crawford, Seymour.Creed, Michael.Currie, Austin.Deasy, Austin.Deenihan, Jimmy.Durkan, Bernard.Farrelly, John.Ferris, Michael.Finucane, Michael.Flanagan, Charles.Gilmore, Éamon.Hayes, Brian.Higgins, Jim. |
Higgins, Joe.Howlin, Brendan.Kenny, Enda.Lowry, Michael.McCormack, Pádraic.McGahon, Brendan.McGinley, Dinny.McGrath, Paul.McManus, Liz.Moynihan-Cronin, Breeda.Naughten, Denis.Neville, Dan.Noonan, Michael.O'Shea, Brian.Penrose, William.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Sargent, Trevor.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Stagg, Emmet.Stanton, David.Timmins, Billy.Wall, Jack.Yates, Ivan. |
Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Sheehan and Ferris.
Question declared carried.
Amendment declared lost.
Amendments Nos. 12 to 14, inclusive, not moved.
Bill recommitted in respect of amendment No. 15.
I move amendment No. 15:
In page 12, to delete lines 47 and 48, and in page 13 to delete lines 1 to 4 and substitute the following:
"(7) A member of the Authority who has been appointed to the Authority in accordance with section 11(2)(b), other than subparagraph (i), shall be entitled to attend a meeting of an Area Health Board of which he or she is not a member and to participate in the deliberations at such a meeting, but shall not be entitled to vote on any question arising at such a meeting.
(8) The Authority may make payments to a member of an Area Health Board or to a member of the Authority referred to in subsection (7) in respect of travelling and subsistence expenses incurred in attending a meeting of an Area Health Board or otherwise in the pursuance of the business of an Area Health Board in accordance with a scale determined by the Minister, with the consent of the Minister for Finance.".
Amendment agreed to.
Amendment reported.
Amendment No. 1 to amendment No 15 not moved.
I move amendment No. 16:
In page 15, between lines 44 and 45, to insert the following:
"(8) Any reference to the Eastern Health Board in an order made by a court before the establishment day shall, on the establishment day, be construed as a reference to the Authority.".
This is an amendment to section 19 which deals with dissolution of the Eastern Health Board. On Committee Stage, Deputy Shatter queried whether there was a need for a specific provision to protect the validity or continuing in force of care orders made under the Child Care Act, 1991, in favour of the Eastern Health Board. My officials considered this matter and obtained legal advice which indicates it could be argued that care orders are adequately protected already in this section as it stands. Given the particular sensitivity of child care orders and the risk, however small, of a court taking a different view, I decided to put the matter beyond doubt. This amendment provides unambiguously that all orders made by a court in favour of the Eastern Health Board will transfer to the new authority on the establishment day.
Deputy Shatter raised two other issues about the Child Care Act on Committee Stage. He requested clarity as to which area health board would be responsible for a child in care following implementation of this legislation and asked whether the area health boards could apply for such orders in their names. The legal advice I obtained on these issues is that all health board functions under the Child Care Act, 1991, can be delegated under this Bill by the authority to the area health boards. The relevant sections are sections 9 and 17. In addition, section 15(5) will allow an area health board to apply for care orders in its name. Therefore, there does not appear to be a need for any further amendments. I thank Deputy Shatter for bringing these matters to my attention.
I thank the Minister for tabling this amendment. I hope in time the difficulties we discussed in this area on Committee Stage will prove to have been satisfactorily resolved. I am conscious of the advice the Minister received. I hope his amendment will ensure no doubt or difficulty can arise about the validity of orders, particularly child care orders, obtained by the Eastern Health Board following the establishment of the new authority and the area health boards.
Amendment agreed to.
I move amendment No. 17:
In page 16, between lines 14 and 15, to insert the following:
"(2) Where, but for this section, the Organisation of Working Time Act, 1997, would not prevent the Authority or a Board from entering into or approving a contract of employment which provides for hours of employment (including training and on-call periods) of more than 52 hours per week in any week, averaged in accordance with that Act, no such contract of employment may be made with or approved by the Authority or a Board.".
I do not intend to repeat the earlier points I made about junior hospital doctors. It is important that certain standards are met by health boards in terms of their employment and pay and conditions. This rather unwieldy amendment provides an opportunity to ensure the abuse in terms of the number of hours junior hospital doctors are required to work at present will not be perpetuated into the future. Acceptance of this amendment would be a statement of goodwill that health boards must ensure junior hospital doctors work a reasonable number of hours and not be expected to work to the point where they would be a danger in terms of patient care, which has become increasingly evident. Acceptance of this amendment would also ensure the principle laid out in it would be adhered to by the health boards. At present it seems almost unlimited demands are placed on junior hospital doctors. That has been facilitated by a loophole in the Organisation of Working Time Act whereby the maximum hours of employment outlined do not apply to junior hospital doctors and that is likely to be the case for some time to come.
The Minister was asked earlier to specify his approach to the discussions that will take place on 23 May at EU level and his views on a watering down of the Commission's draft directive, which at least would set a time limit on the ongoing open-ended approach to junior hospital doctors' working time. I ask him to take this opportunity to refer to that matter. He has been asked twice to indicate his views on this ongoing serious problem that may prove to be critical if an error is made by some unfortunate junior hospital doctor.
I support Deputy McManus. I raised earlier with the Minister the Government's position on the European Union directive and I do not want to delay the House by repeating what I said. It was noticeable the Minister did not respond when I asked him to articulate Government policy on this area. I hope he will take this opportunity to do so.
The Organisation of Working Time Act sets out statutory rights for employees in respect of rest, maximum working time and holidays. These agreements apply either by law as set out in the Act, in regulations made under the Act or through legally binding collective agreements. Employees working in the new authority would be covered by such arrangements and their interests in relation to working time are adequately dealt with under such legislative arrangements. It would be inappropriate to attempt through this legislation to put in place arrangements in relation to working time, which would be more properly dealt with under the Organisation of Working Time Act, 1997.
It is assumed the Deputy's principal concern is the working hours of junior hospital doctors. This group is not covered currently by the rest and maximum working time rules. At present, collective bargaining agreements incorporate various methods to deal with the issue. The contract for non-consultant hospital doctors, which came into effect on 1 January 1997, arose from detailed discussions with NCHD representative groups and includes agreement on the number of approved rostered hours, the arrangement in relation to unrostered episodic hours, the mechanism for dealing with persist ent unrostered hours and payment arrangements for hours in excess of 39 and Sunday work.
The Deputy should also note that the EU Commission has brought forward proposals to amend the Working Time Directive 91/104/EC. Discussions are ongoing in the Council on the implementation of the Working Time Directive for doctors in training and other excluded groups. These discussions have underlined the complexity of the issue of excessive hours and the difficulties in implementing the Working Time Directive for this group.
The Commission's proposals and the resultant discussions have already raised issues concerning definitions as well as questions regarding reference periods and transitional periods. Such amendment does not recognise these complexities and, therefore, would not be implementable given the existing structures of medical manpower and the operation of rosters at hospital level. Moreover, it would be neither practical nor appropriate to attempt through this legislation to bring in arrangements which would cut across the ongoing discussions on EU legislation dealing specifically with the issue. The matter will come before the Labour and Social Affairs Council on Tuesday, 25 May.
As to the Government's view on these issues, Ireland is committed to the introduction of a 48 hour week for doctors. We want to be certain we can comply with the obligations imposed by Community legislation in this area. Hence we need a set of proposals that recognise the difficulties we will encounter in moving to the agreed objective of 48 hours per week.
The Presidency is seeking to come up with a consensus proposal. We are happy with the general outline and structure of the Presidency's revised proposals, as circulated. We would like to proceed with finding a consensus view based on the Presidency's proposals. We could probably agree with the transitional period as proposed by the Presidency. We would like an additional year, making it three years in terms of its implementation and a transition period of nine years. We could accept reference periods proposed by the Presidency as outlined to us. We are not prepared to accept periods beyond that, which I understand is the present position of Deputy McManus's colleagues in the British Labour Party.
There is nothing to stop the Minster accepting this amendment. Just because a directive specifies the absolute limit of junior doctors' working time does not mean we cannot act. There are countries in Europe in which junior hospital doctors are already covered by the working time legislation. I assure the Minister that the socialist movement across Europe has been a major force in ensuring the protection of workers' rights and their working time.
I am not sure whether the Minister is saying the Government is now supporting a 12 year lead-in period. The expectation was that it would be an 11 year period but now we are talking about nine years plus three. Will the Minister state the position clearly? There has been a certain amount of debate and discussion and it appears from what emanated from Brussels that the Irish Government was at least considering supporting the British Government view. Is the Minister now stating that the Irish Government is supporting a 12 year lead-in time? This is a rather lengthy period for Irish junior doctors.
There is nothing to stop the Government from being progressive in relation to any directive, as other European countries have been. We should have regard for that and not always look for the absolute minimum when it comes to improvement and progression in relation to workers.
I am saying the Presidency's proposals form the basis upon which a consensus can be achieved. The Government will be guided by that when we enter discussions on 25 May. The Commission's original proposals were not practicable or acceptable and did not obtain support around the table. The Presidency has listened to member states and taken on board their concerns. Our nearest neighbour is seeking a transition period beyond what we would regard as reasonable in the circumstances. However, every member state has its problems and they are entitled to put their position as they see it.
The working time directive negotiations will be concluded on the basis of a consensus being achieved. The Presidency, in its role as President of the Council is trying to do that. We are prepared to attend the Council meeting on that basis. We do not have a problem with the Presidency's proposal because we obviously want a consensus on the issue.
Amendment put and declared lost.
Carlow-Kilkenny): Amendments Nos. 18 and 19 may be discussed together as amendment No. 19 is cognate. Is that agreed? Agreed.
I move amendment No. 18:
In page 17, line 10, after "direct" to insert "following consultation with each health board".
I raised this matter on Second and Committee Stages. I am concerned about the commitment to set up a health board executive. I do not have a problem with the idea of an executive as there are arguments to be made in favour of strategic planning, co-ordination and streamlining across the various health boards. However, I have serious reservations about the lack of accountability.
There is already great alienation at local level due to setting up independent authorities such as the EPA or the National Roads Authority and the lack of connection between local authorities and national bodies. The title of this body is the Health Boards Executive. However, the reality is an executive comprising chief executive officers who are directly responsible to the Minister and have no accountability to their health boards. Acceptance of my amendments would not radically change the situation but would acknowledge that health boards make decisions for their localities and areas of responsibility and provide local democracy, which is important. In the perception of the public, local democracy is being continually eroded. There is a sense that non-elected officials make decisions, whether they are county managers or chief executive officers of health boards, without accountability to public representatives. A great deal of this alienation will be expressed in the upcoming local elections.
Will the Minister accept the small measure provided for in this amendment to consult and allow this form of connection to be made. Otherwise, he will create a parallel system which is secretive, unaccountable at local level, and to which health members will have no access. It will be controlled in effect by the Minister and is a centralising edifice rather than one based on subsidiarity.
This issue was adverted to by the Deputy on second and committee stages. Despite my best attempts I have been unable to persuade the Deputy it is not the serious issue she believes. These amendments propose I should consult with each health board before deciding what functions the executive might carry out and before making regulations under this section.
I emphasised during the committee stage debate that the functions to be exercised by the Health Boards Executive will be executive only. It will not make policy decisions, supersede or undermine the boards in the implementation of policy. All of those functions of the board which are reserve functions under the Health (Amendment) Act remain with the boards. This section is not germane to the setting up of the Eastern Regional Health Authority. We are using the introduction of the legislation to put the Health Boards Executive on a statutory basis to enable boards to carry out functions for the whole country rather than expecting eight different areas to carry them out, perhaps not properly. It ensures that people will work together efficiently in implementing policies with a national perspective, for example, an immunisation programme etc. in the interests of the patient.
That is the purpose of this body. There is no hidden or subterranean agenda. It is expected to do what is done administratively anyway which is, consult and work out best practice in the executive daily management of the boards. There is no question of it overtaking or interfering with the remit of the functions of the elected members or the board generally. Because it is not germane to the Bill, people felt it was being included in a smart way but that is not so.
There is no question of keeping members of health boards in the dark about the activities of the executive. They will be kept informed by their chief executive officers in accordance with existing legislation. It is not correct to say the executive is not obliged to inform health boards of their actions. It is required to do that under existing legislation because it is exercising executive functions. It is accountable to the board for those decisions. Similarly, this executive, acting as a collective, will be responsible to the respective health boards in which it has jurisdiction, that is, the eight chief executive officers will be answerable to the eight health boards.
The Deputy's amendments are unnecessary and would add to the bureaucratic and administrative machinery to no great effect. First, under existing legislation the executive is answerable to the boards. Second, we are talking about executive functions being taken together where it is in the interests of chief executive officers to do it in that way as regards the delivery of health services.
Amendment put and declared lost.
Amendment No. 19 not moved.
I move amendment No. 20:
In page 19, line 37, to delete "mental handicap" and substitute "intellectual disability".
Amendment agreed to.
Bill reported with amendment and passed.
Sitting suspended at 1.30 p.m. and resumed at 2.30 p.m.