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Seanad Éireann debate -
Wednesday, 6 Apr 1960

Vol. 52 No. 10

Health Authorities Bill, 1959—Committee and Final Stages.

Section 1 agreed to.
Question proposed: "That Section 2 stand part of the Bill."

Subsection (5), paragraph (iv) of Section 2 says:—

a person appointed may resign by giving notice in writing signed by him to the secretary of the council, but the resignation shall not become effective until the meeting of the council held next after the receipt of the notice given to the secretary;

Would it not be more appropriate to say "at the beginning or at the end of the meeting"? In page 27, it is provided that "the resignation shall not become effective until the commencement of the meeting..." I am referring to page 27, line 24. It might be important to state, in the first instance, when the resignation actually takes place.

The Senator has referred me to subparagraph (iv) (c) of subsection (5) and he read out:

a person appointed may resign by giving notice in writing signed by him to the secretary of the council, but the resignation shall not become effective until the meeting of the council held next after the receipt of the notice given to the secretary;

If I followed the Senator's point, he then referred me to Article 5 of the First Schedule, paragraph (1) and he read out:

(1) Where a member of the authority was appointed by the council of a county, he may resign his membership by giving notice in writing signed by him to the secretary of the council, but the resignation shall not become effective until the meeting of the council held next after the receipt of the notice given to the secretary.

He seemed to think there was some slight discrepancy as between the two provisions which he read out. I do not think there is. They seem to me to be exactly the same, are they not?

I referred the Minister to page 27, which states, at line 23, onwards, "but the resignation shall not become effective until the commencement of the meeting of the authority held next after the receipt by them of the resignation."

I wonder if we are looking at the same text? The correct one is marked "As amended on Report." There is not any inconsistency. I assume the meeting would first be called to order and the fact that a member had resigned would then be reported by the Secretary. It would be neither at the beginning nor at the end. The meeting would decide whether or not to accept the resignation. Therefore, it would have to be at the relevant point of the meeting where this item appears on the Agenda.

Question put and agreed to.
Sections 3 to 10, inclusive, agreed to.
Question proposed: "That Section 11 stand part of the Bill."

I want to draw the Minister's attention to the fact that the Dublin County Council made one very reasonable request, namely, that the charges be on the basis of services rendered. I can assure the Minister and everybody else that it is very hard on the Dublin County Council to have to hand over all their authority to the Dublin city authorities. The Minister is generous in the number of nine members which he has given to the county council, and three for the Borough of Dún Laoghaire, but as the Corporation has 15 members, it is obvious that any say the county council has is very small.

The Minister must further be aware that in the corporation the line of administration is not the same as that in the county council. We are very disappointed that the Minister has not embodied in the Bill that payment be for services rendered. I am sure Senator Carton knows that we have opposed, time out of time, the handing over of our authority to Dublin Corporation. I appeal to the Minister to introduce an amendment on the Report Stage to meet this point. We are asking nothing for nothing. We are asking that charges be made on the basis of services rendered.

It may be asked: "Why should there be any question of an agreed amount when it is a question of justice?" The tragedy with us in county Dublin is that the corporation has us crucified. A few years ago, it took away portion of county Dublin. A couple of years ago, it took away at least 21 per cent. of the rateable valuation of county Dublin. Now it will take away our rights as a health authority. I speak as one who has been associated with the health authorities in Dublin city and county for the past 30 years. It is 30 years since I first became a member of the council and also of the board of assistance. I look back with pride on the work done in certain directions by the board of assistance and the county council.

Tied up to the corporation now, and heretofore tied up to the borough corporation of Dún Laoghaire, it is very hard for rural county Dublin to exist. On that point, I would appeal to the Minister. We are not looking for anything special. All we are asking is that charges be made on services rendered and we should like to see that embodied in the Bill.

I agree with Senator Tunney that charges for services rendered would be good for the county but I disagree with him that we shall be a poor relation in association with the city. I am satisfied the Bill is good in so far as the greatest number of members will, I hope, prevent overlapping. I think that is the purpose the Minister has in mind. It will prevent a tremendous amount of overlapping.

A point which Senator Tunney has laboured for years is that the city of Dublin has acquired our rateable property. They will now monopolise the health side of it. County people will have to travel long distances to acquire the benefits of the Health Act. It would be advantageous to county Dublin, therefore, if the Minister in his wisdom and final decision considered Senator Tunney's suggestion.

I could not accede to Senator Tunney's request unless I were to throw over one of the vital features of this Bill, namely, that, so far as possible, the allocation of expenses will be settled by agreement. Senator Tunney would like to have the allocation based upon services rendered. There are other authorities to be dealt with in the Bill who would prefer to have it on a valuation basis. A great deal of time has been wasted in trying to get some statutory formula which would satisfy everybody. In order to get over that crux, I thought of getting the various statutory bodies who will be represented on the representative unified authorities around a table with the gentle coercion that if they did not come to an agreement, some person would make a determination for them. That is what, I think, is the measure of hope which is embodied in this Bill. Let me be quite clear. I am not imposing any principle of allocation upon any one of the four statutory authorities. I am relying upon their common sense when they are brought to face the facts. For that reason, I could not now, at this late stage, insert in the Bill the principle of laying down a statutory basis for agreement in relation to Dublin which I would find would not be accepted by Cork, Limerick or Waterford. For that reason, I do not think that at this late hour I can possibly accept the suggestion.

I make no suggestion, as far as Cork, Waterford or Limerick are concerned. There is agreement as far as the authorities in Dublin are concerned. Dublin County Council, Dublin Corporation and the Borough Council of Dún Laoghaire are already agreed upon the suggestion I am asking the Minister to put in the Bill— payment for services rendered. Why the Minister keeps that out of the Bill, I do not know. I appreciate that there has been a lot of unnecessary talk in connection with the Bill.

The point I make is very important in relation to the future estimates of county Dublin. There is no guarantee that we shall always have a Minister who will try to administer everything in the same manner as this Minister who has had a long association with county Dublin. It is futile to talk about payment on valuation in regard to the residents of Oldtown, Garristown and Ballyfermot. I think it would be a crime. The three authorities have agreed that payment for services rendered should be embodied in the Bill.

In other directions, I may have great sympathy with the Minister in trying to get this Bill fixed up, but on this occasion I cannot understand what should deter him from having that embodied in the Bill as we have already agreed on it.

As the authority which the Senator represents has agreed with the other authorities covered by this Bill, there is not any reason why I should legislate in order to copper-fasten what is an agreement, I hope, between honourable men. It is not necessary to legislate once you have agreed. I think that one of the advantages of the present system is that it is very flexible. If circumstances change, it will be open to any of the authorities associated with any of the unified health authorities to ask that the position be reviewed with a view to reaching a new agreement or to having a fresh arrangement made. If I were to do as the Senator suggests, the authorities would lose the benefit of the flexible arrangement embodied in the Bill. As we cannot foresee the future very far in these days, it is better to leave the arrangement in the Bill stand as it is.

I do not like to oppose the Minister. I appreciate the action of the Chair in allowing me to speak. I ask the Minister very specially to look at the matter before the Bill is finally passed We may not always have the type of men who will be honourable and reasonable. For the protection of the farmers and people living in rural county Dublin, I make a very special appeal to the Minister.

Last week, the Minister answered a question in the Dáil in regard to medical cards. If the Minister looks up that reply, he will find that there are nearly as many people in one dispensary district in the city of Dublin on medical cards as there are in the whole rural county Dublin area. It is a grave injustice to the farming community, the labourer and the rural people of county Dublin to join them up with the city and bind them to an agreement.

I appreciate that we have nine members but what good is that number against 15, plus three members from Dún Laoghaire. It is handing over the health affairs of county Dublin completely to the corporation of Dublin. I am pleased with everything else in the Bill but I appeal to the Minister to consider my suggestion before the Bill passes. Every Senator will appreciate that my request is a very honest and reasonable one.

Question put and agreed to.
Sections 12 to 31, inclusive, agreed to.
Question proposed: "That the First Schedule be the First Schedule to the Bill."

I should like the Minister to make clearer the position in connection with the appointment of the members. What is the position of the Dublin County Council in connection with the members of the Dún Laoghaire Borough Council? The matter is made reasonably clear but it is not made fully clear. It states that 1, 2, 3, 4, or 5 areas elect one member and that the others can form into groups. I wonder if any of the eight members of the Dún Laoghaire Borough Council can form into a group or will it be a majority vote as far as they are concerned. As members of the Dublin County Council, they have a perfect right to attend the meeting; they have, as members of the council, a perfect right to arrange to be present.

I appreciate that this is a very awkward position as far as the other members of the council are concerned. Eight men are elected county councillors, the same as for other areas, and they are to attend a meeting and they cannot form into other groups. I appreciate that the Minister has made the position clear as far as the first four groups are concerned but I want to be very clear on the grouping after that, and on the voting. Have those members from the Dún Laoghaire Borough the right to propose and to vote any two of the other five additional members?

I think it is reasonably clear. Article 2 of the First Schedule is the relevant one and prescribes in the case of County Dublin, excluding the borough of Dún Laoghaire, that one member of the authority shall be appointed from among the county councillors elected for that area.

Well, now, I think that it prescribes, first of all, there will be one from each area. That means that group having made its choice is then precluded from participating in the selection of the others. The balance of the members of the authority can then come together and among themselves they can form a second group. They can elect one member and that can be a free member, who need not necessarily be one elected as representing any one particular district, and so on until the number is exhausted. The whole thing is to ensure that every district is represented on the authority. Having provided for that in the case of Dublin, and by ensuring that there would be at least one member after that, those who have not already exercised their choice are free to come together and free to decide what is going to happen to the others.

I agree there are only four groups concerned, as far as Dublin County is concerned, with the election. After that can those members on the Dún Laoghaire Borough Council, who are elected for No. 5 area, form into any group? If so, they, by virtue of having one-third of the total council, can have a very big say in who will be elected, if it were to be on a majority vote. Many more members of the council are not quite clear on that point and are very anxious that it should be clear.

I think it is reasonably clear. Sub-Article 2 states what is going to happen. Sub-Article 2, to which I did not refer originally, states "in sub-paragraphs (b) to (e) of the foregoing paragraph ‘councillors' and ‘councillor' do not, in relation to the council of the county of Dublin, include any councillor elected for the county electoral area which is coterminous with the Borough of Dún Laoghaire" so that Dún Laoghaire having exhausted its choice in relation to one person has no right to come in and vote in relation to other areas.

It means they can elect one. I did not consider, nor do I consider, that they are entitled to elect one because they have elected three of their own.

Perhaps I misunderstood the Senator.

I am trying to be helpful.

The Senator has succeeded in mystifying me.

There is a confusion here. The Senator led me to overlook the fact that Dún Laoghaire has a separate representation on the Dublin county authority and therefore it is not included. Its representatives have no right, having its three members, to vote to select as members of the county council other members of the unified authority.

That is the point on which I wanted to be clear. Then they will have no right to take part in the election of the other nine members for county Dublin and cannot vote.

I think it is only right to say that over the period this Bill was being prepared and the Minister in contact with Dublin County Council, the Dún Laoghaire Borough Corporation and Dublin Corporation, he exercised extraordinary patience waiting for us to decide how many we would have from Dún Laoghaire, from the county and Dublin Corporation. We succeeded this far and the Senator was mystifying me but I think we are both clear now.

He made me walk into dreamland, too.

Mr. O'Dwyer

I think it would be very desirable and make for the better working of the health authorities if the Minister were not confined strictly to nominating members from the county councils and corporations. If we provided for outside members, you would have people with fewer public duties which would make for the better working of the service.

I do not agree with Senator O'Dwyer. After all, you may nominate somebody to go on a board and it has yet to be proved whether he will be of any value. On the other hand, if a person stands for election, he has a claim from the people because the people will not elect a representative unless they feel he has certain qualifications.

I should just like to say something about that point. We cannot forget that these bodies which are now to be set up will have the control of a very vast share of public funds and naturally the people who should have responsibility for the disbursement of those funds should be elected representatives. Therefore we cannot have people not really representatives of the people who may be just merely a choice of the bodies sitting on the local committees. We could not have them coming and determining what the expenditure is going to be.

Question put and agreed to.
Second, Third and Fourth Schedules agreed to.
Title agreed to.
Bill reported without amendment.
Bill received for final consideration.
Agreed to take remaining Stages today.
Question proposed: "That the Bill do now pass".

Of course it is useless speaking now because the Bill is about to pass but I must express my disappointment in regard to the point I raised earlier. As far as the residents of county Dublin are concerned, and for that matter, those of the city of Dublin, this is a very important Bill. It deals with the health of the people and with a section of the people least able to help themselves. I followed the Bill carefully through the Dáil but I am disappointed and I want to put it on record that the affairs of the people of county Dublin as far as health is concerned are now being placed in the hands of Dublin Corporation.

There is a great difference in the respective methods of administration. I do not know how it is, but it does happen that there is some kind of waste associated with anything the Corporation has to do with. Despite the fact that 21 per cent. of our assets were taken away into the city of Dublin—had that not taken place, I believe the rates in County Dublin would be only about 27/- in the £ now —the Corporation did not reduce the rates.

The Senator is going outside the scope of the Bill.

It is very seldom that I go outside the scope of a Bill and for that reason I think the Cathaoirleach will be lenient with me. I should like to put on record that we have had a very raw deal from Dublin Corporation over the years. There is something wrong there. Again, is it to happen that the officials of Dublin Board of Assistance who have been dealing with the health side and have done the spade work in connection with this Health Act are to suffer? They have got it through very reasonably and while they may be conservative as far as medical cards are concerned, by and large, they made a very honest effort to get this Act operating. I hope they are not to be left on one side and officials of Dublin Corporation put over them.

I appreciate the Minister's action in connection with Cherry Orchard Fever Hospital. It is what I would expect. Speaking as one who has been an active member, I appreciate his attitude and I think it would be a pity if anything should prevent voluntary workers continuing to give the good example they have shown. They have been coming there as early as 8.30 in the morning and giving their time with good results. I should like it put on record that the health authority, whoever they may be—and possibly I shall be a member myself—should not put their hands on Cherry Orchard. It is being very well run and they should keep away from it altogether. I make that suggestion to the Minister and I would not make it, were I not satisfied that any interference or change in the position and the methods of running the hospital would be bad for it. I hope that the new health authority, whatever else they do, will keep away from that.

It looks as if this is a county council day out. I should like to say that I hope the Minister and his officials who have given a lot of thought to this Bill will find that it fulfils their expectations. I am at one with Senator Tunney in his plea on behalf of the county and I must be conscious also that the Minister has done a tremendous job. We believe that this scheme will justify itself economically.

With regard to Senator Tunney's remarks, one important factor is that we in the county could always get treatment for our patients in the various voluntary hospitals we had attached to our panel much more cheaply than we could get it in the hospitals indicated to us by Dublin Corporation. The facts and figures were available which showed a difference of nearly 6/- a day in certain cases, and we had the situation being created in a discussion in the council where the health manager seemed to be nearly touting for patients for the Dublin hospitals, particularly the one at Blanchardstown. We had one councillor who has made a great study of health and has been associated with hospitals, who gave a picture that was somewhat frightening, but that was in the interim period.

I am satisfied that the Minister will be closer from now on to this complete operation than he was when there were 20 or 30 little committees running the health services of the city and county. Therefore, I have not the same fears as Senator Tunney about this Bill. I feel that under the Bill the Minister will get full efficiency into the running of the hospital system and that it will prevent overlapping. The council will have to suffer; there is no doubt about that. It would be out of keeping with the whole business to ask the Minister to alter the position at this stage.

Perhaps, as Senator Tunney has said and, as I believe, we shall get in the month and years ahead a situation in which the county will have suffered somewhat financially. The figures can be obtained for the Minister, if he wishes to see them. I believe the savings in the all-over picture will in the coming year reach many thousands of pounds and I think Senator Tunney will agree with that. I believe this Bill will do a lot to level the cost and the Minister and his officials will be closer to the situation, and will be able to watch it. I welcome the Bill, despite the fact that Dún Laoghaire Borough Corporation representatives are coming in, because they are very intelligent people.

This is unspectacular legislation, and unspectacular legislation has always meant a great deal of hard work for the Minister involved. I want to pay tribute to the Minister for the manner in which he listened to those of us who made representations about the awkward corners in the proposals before us. This is a valiant effort to make a complicated social service work. There will be awkward corners in it regarding the transfer of executives and staffs and I only hope that commonsense and goodwill will enable these to take place with as little upset as possible.

I still think that this service as a whole will be run efficiently only by the State. I suspect that that will prove to be the only efficient solution to the problem of providing health services. That, however, will require a revolutionary change, to take the whole thing from the sphere of Local Government. In the meantime, I wish the Minister success in these proposals which may make my forecast wrong, though I do not think I am wrong. None of us can be satisfied with what is happening in the development of health services. It has become so vague now and it will continue to grow through this trial. After a time, I believe, we shall have to try changing the whole system of running the service.

At this stage, I want to say only that we are now starting on a scheme which, after some experience, we might look at again to see how it is working, and to see how far we can rationalise and regionalise the health administration and other branches of Local Government administration in the country so as to spread them evenly all over the country.

The Senator is now going outside the scope of the Bill.

If that is done, a good case can be made for this Bill. An examination has been made by the Minister with a view to regionalising and rationalising the health services as between the different health authorities in Dublin city and county. I argue that the Minister should have——

The Senator will have to argue that on another occasion. He may not argue it on this Bill.

I take it the Chair is ruling that I may not draw a parallel?

I am ruling that the Senator is out of order.

I bow to your ruling, Sir, but I think I have got my point in.

I am very grateful for, and, need I say, very flattered by, what has been said by Senators in relation to this Bill, but I should like to disclaim any idea of taking all the credit for it. It was initiated by my colleague, Dr. Ryan; it was certainly debated up and down the country by my immediate predecessor, Deputy T.F. O'Higgins; and, perhaps I am garnering the fruits of the seeds which they sowed in very difficult times.

Suggestions have been made that I should keep in very close contact with these unified health authorities, but I should like to say that I do not think that is my function. These responsibilities will be imposed on the authorities. They will, of course, be responsible to the Minister, whomsoever he may be, for the manner in which they discharge their duties, but the responsibility for making these services work smoothly, efficiently and effectively will rest upon them. So far as I am concerned, there will be the minimum of interference.

When this Bill was being discussed in Dáil Éireann, it seemed to me that the people in Cork county had a very poor opinion of the people in Cork city. I had to come to the Seanad to find that apparently some people in Dublin county have not a very high opinion of people in Dublin city.

But they are not Dublin county men.

I should like to emphasise that.

The main thing from our point of view is that whether they are nominated to the unified authority by the Corporation of Dún Laoghaire, the Council of County Dublin, or the Corporation of Dublin city, they are all there to work together for the common good of the 700,000 people for whom they will ultimately be responsible.

I think the method which I have chosen in this Bill in relation to the allocation of expenses is the best possible one. If I were to say that the allocation in Dublin had to be based upon a certain principle, it might happen in a very short time that the people who ask me to do that would ask me to legislate to change that position. There are at least three possible ways of which I can conceive: allocate the expenditure on the basis of services; allocate it on the basis of valuation; or depart from all that and say that Dublin county will pay a certain fraction of the total costs and the remainder will pay a certain fraction which may take into consideration both valuation and services rendered.

I gather that the members of the bodies nominated or appointed to the unified authority have agreed upon a certain basis. I suggest that the best thing is to do the work on that basis and if county Dublin are dissatisfied with what is done in the city, they can always ask to have the position reviewed by agreement or determination.

Question put and agreed to.