Health Bill, 1969: Committee Stage (Resumed).
Debate resumed on the following amendment:
In subsection (9), line 44, after "board" to add:—
"and within two months of the vacancy falling due the Minister shall instruct the Local Appointments Commissioners to select under section 14 a person for appointment as chief executive officer of the board."
My purpose in putting down this amendment is that simultaneously the Department and the Minister could appoint a temporary officer and set machinery afoot, through the Local Appointments Commission, to have the permanent officer selected. I suggested that that should be done within a period of two months. The Minister made a statement saying that he felt that two months might be tying his hands, the hands of the commissioners, of the Department, too much in that different qualifications may be applied to the appointment. If different qualifications are to be applied to any appointment those qualifications should be worked out beforehand and not when the appointment arises. I do not see the necessity for the delay on account of this. The main purpose behind this amendment is not to leave anyone too long in the position of a temporary officer, especially in such an important position as this one is. It is unfair to the board itself, it is unfair to the temporary officer involved and it possibly may have an influence on the Local Appointments Commission if there is a delay in the appointment of a permanent officer. I am not saying it happens but even members of the Local Appointments Commission are human beings and it may affect them in their decision on the appointment of the permanent officer. I would like to see all permanent appointments made as expeditiously as possible because that method lends itself to the effective working of any body or board such as this. If, as the Minister said, there are extra qualifications or different qualifications necessary for an officer of a board, those qualifications should not await the change of officer. They should be worked out before the vacancy arises whether on death, removal or for any other reason.
Nobody should wait until the vacancy arises. We have know excessive delay over the years in appointments to other bodies. I am not referring particularly to health appointments but I have known officers in temporary positions for years. It is to avoid this that I put down this amendment. I want to avoid such a thing as the "temporary" Victoria Wharf in Dún Laoghaire, which is there now since 1830. That is my purpose in putting down this amendment and I hope the Minister will consider it carefully. If two months is too short I might concede a certain time if the Minister comes within the range of the time I have suggested.
Amendment No. 23 in the name of Senator Bourke is cognate with No. 22 and the two could be taken together.
My amendment is essentially the same as Senator Belton's except that mine reads "three months". I endorse what Senator Belton has said about making temporary appointments. It would be wise if we introduced a limit on this and I feel that three months is a reasonable period. I do not want to speak at any great length on this but, apart from what has already been said, I think there are two vices in temporary appointments. First of all, they can continue indefinitely. Temporary appointments continue for a number of years. This is a bad situation both for the person holding the temporary appointment and for others who might wish to put themselves up for appointment to that office. Secondly, it is bad for the security of tenure of the person who holds the office if it is only a temporary appointment.
Therefore, I feel this amendment is reasonable. I understand the points made by the Minister; but if the procedure for making a permanent appointment is set in motion after three months, this is reasonable within the Act and no more leeway than this should be left by the parent Act for ministerial regulation. That is why I introduced the amendment independently of Senator Belton. Substantially it is the same except that this gives an extra month for the institution of this procedure.
I should like to be associated with the remarks of the two previous speakers. The health services have seen perhaps more than any other service a very large number of temporary appointments which on occasions have gone on for decades. We feel very strongly about this because once a temporary appointment drifts on for a while the security of tenure of the person in the position becomes weaker as each year goes by. Furthermore, the authority of the person is naturally never quite the same. We realise that there are occasions when it would be difficult, perhaps, to fill an appointment within the stipulated period of time, but these must be very rare indeed, and it is, I am sure, possible for the Minister to arrange that is such circumstances a special exception by ministerial order could be made. But I think it would be wise if the Minister could review this section and if at all possible stipulate that in ordinary circumstances a fixed period should be established in which appointments should be made.
Surely the purpose of Senator Belton's amendment is not that the appointment should be made within two months but that the machinery should be set in motion and the temporary appointment could be made after that time. Everybody would be satisfied as long as within two months of the vacancy occurring the machinery will be set in motion.
I have had a pretty long experience indirectly of watching these appointments being filled and I would like to say that you cannot legislate for efficiency. That is my firm belief after 30 years experience in the Dáil, that you cannot enforce efficiency by legislation. Efficiency comes about through people, Ministers and local authorities with a lively interest in their permanent office. I refuse to believe that by depending on regulations you can enforce efficiency. That is my belief about this, and it certainly is derived from a very prolonged experience of public life.
I could accept this amendment in the interest of enforcing a lively attitude towards the appointment of a chief executive officer, but it is actually a fact that, if at the end of a period of experience of the present system devised in this Bill it is proposed to reorganise health boards, or it was even found that certain counties should be transferred to others or that an area should be enlarged or reduced, and if during that period an appointment might fall vacant, it would be very embarrassing to the Minister of the day if he was unable to postpone the appointment. If he was proposing to alter the character of the board or proposing to place regulations before the Dáil and Seanad suggesting some changes—this is just one example of the kind of circumstances which might arise. If I could devise an amendment which would provide that unless a whole lot of things were to occur then arrangements for filling the vacancy must be prepared within three months, then I think that could be accepted as an amendment, but I do not think it is possible to get a satisfactory amendment. It would be extremely difficult to introduce an amendment which would include a whole lot of conditions which would be required to be followed in given circumstances. I am afraid that I cannot accept the amendment though I fully appreciate the reasons for it being put down.
I appreciate the Minister's difficulty and I am also very much in sympathy with the purpose of these two amendments. We all do know that in fact very often temporary appointments persist in certain instances for a very long time, which creates great difficulty both for the person who holds the post and for people who hope to succeed to that post when the permanent appointment is made. I agree with the Minister that you cannot enforce efficiency by legislation, but I think that you should discourage inefficiency, and this is a blatant example where in many instances inefficiency has crept in. The Minister has suggested that he could look into the proposal and indicate that he might bring forward some exceptional cases in which it would be necessary to continue a temporary appointment over a prolonged period. If he could frame an amendment covering this I would be very happy.
I appreciate the Minister's difficulty in this but I still am of opinion that the difficulties which the Minister says confront him do not outweigh the points that the people who spoke in favour of this amendment have put forward. He said that there might be a change of boundaries of the boards and suggestions of that nature, but what happens if there is a change of boundaries when there is no vacancy? Is the Minister going to have to wait to change the boundary until somebody dies, is suspended or removed from office? In other words, if the board finds that it could be run more efficiently by excluding a county or adding a county or portion of a county, is it going to allow that inefficiency to continue until there is a vacancy occurring in this board? I do not see the validity of that argument at all. I have some sympathy, but I think that my sympathy does not outweigh the arguments that I feel are in favour of having a time limit on the appointment of a temporary officer. I am quite prepared in this amendment, if the Minister suggests it, to extend the time. I do not want to be rigid about this time, but I do not think that it is valid to suggest that he may want to make changes in the boundaries of boards and that that can only be done when a vacancy occurs, because that of course would also lead to inefficiency, because you would be perpetuating inefficiency if you had to wait until that time.
I will think it over before the Report Stage. I have a great deal of sympathy with everything said here, that I am sure is held by many on this side of the House in regard to this, but I have been given expert advice that this cannot be done. Quite evidently if the question which Senator Belton raises were to arise, about deciding to alter the character of the boards, we would be altering their character where CEOs were in employment and any such arrangements would have to include arrangements to be made under the Bill for their transfer.
It was made clear in the Dáil that their position could be worsened if there was a change in area. Apparently it would be impossible to advertise a position for an area if the area were to be changed in the meantime. It is something we cannot do. However, I will think it over before the Report Stage and see if I can devise any way of shortening the period in which this decision can be taken. I can see the value of what has been said.
There is a great deal in what the Minister has said to the effect that in certain circumstances it would be advisable on the occasion of a change in chief executive officers to review certain matters. From that point of view it might well be that the times mentioned in the amendments would be a little too short for convenience. On the other hand, if this were to be stressed unduly we could get into the position, as Senator Jessop said, of tolerating and perhaps encouraging inefficiency. Perhaps if the Minister thought in terms of six months as being a suitable period it would cover cases of review, giving ample time for change in regulations, if necessary. It would be desirable to move the period from two months to six months rather than to start making exceptions: it would be far better if there could be agreement on a period rather than to include in the amendments a long list of excepted cases.
I withdraw the amendment on the understanding that the Minister will look into the matter before the Report Stage.
Amendment, by leave, withdrawn.
Amendment No. 23 not moved.
Question proposed: "That section 12 stand part of the Bill".
I should like to ask the Minister about a difficulty I have in regard to this section. It is of a general kind. Subsection (1) states that there shall be appointed in respect of each board a person who shall be called and shall act as the chief executive officer of the board. Later on, in subsection (4), the Bill states:
A chief executive officer shall hold his office on such terms and conditions and shall perform such duties as the Minister from time to time determines.
Subsection (5) goes on:
There shall be paid by a health board to its chief executive officer such remuneration and allowances as the Minister from time to time determines.
It seems to me this puts the health board in a very undignified position. It may be part of normal local government practice. There is an officer of the board and, as far as I can see from this section, the board do not specify his duties. They do not determine his salary. They merely pay him whatever the Minister says he must be paid and they allow him to do whatever the Minister says he shall do. I am sure the Minister will discuss this with the health boards, but the Bill does not require him to do so. He may also stipulate that the officer shall do what the Minister determines he shall do. I should like clarification on this. What authority will health boards have over their chief executive officers?
The duties of the CEO are clearly expressed in section 16 of the Bill, and matters relating to his suspension or dismissal are clearly indicated in other sections. As far as the wording of section 12 is concerned, it conforms with the general wording of the County Management Acts, and whatever difficulties we have had in regard to county managers, most of them related to matters of discussion in relation to their reserved powers. I do not think there have been any difficulties there in regard to the wording of this Bill which the Senator has quoted. I am not aware that the wording has caused difficulties in relation to county managers and the Senator may be assured there is nothing which will prevent a CEO from administering the health services in his area. It will bear some relationship, though not an exact one, to the way the local government services have been administered by managers.
We are not entering any revolutionary phase in which there will be extraordinary changes. In this Bill we are clearly expressing what the reserved functions shall be and we have stated that all other functions shall be the functions of the regional health board. Then we have a subsection in section 16 which makes it possible to have some adjustment as between the reserved powers of the CEO and those which are held by the regional health board.
Subsection (1), paragraph (c) states:
The Minister may specify classes of officers who may be appointed as deputy chief executive officers and any appointment under this section shall comply with any such specification.
Has the Minister formed his mind yet on how he will frame these specifications?
I do not think this has been determined yet. Quite evidently, in relation to the kind of people who have been administering the health services throughout the country, the picture is clear of the general structure of the whole of local government services administered by local authorities. I do not think it will be difficult for us to arrange this. We know what the workload has been for the officer next below the county manager. We know the functions as between health and other aspects of local government and I therefore do not think it will be difficult to devise these specifications and I do not think the Seanad need to fear that anomalies will be created or that the Minister may make errors.
One may make the analogy that certain difficulties have arisen in the past in the local government services. It is a fact of the local government services that there has been lack of harmony between the administrative officers and the professional officers. On the point the Minister mentions about who is to act as deputy manager, there are some county managers who have preferred to nominate as deputy manager the county engineer and there are others who have not been prepared in any circumstances to nominate a professional officer or anyone other than a purely administrative officer to act as their deputies for any purpose or during any period.
I am sure the Minister is aware that the relationship between administrative and professional officers in the local government services has not been altogether happy. If one reads the Tavistock Report one will find it quite clear that the problem exists—that there is a good deal of lack of comprehension on either side in regard to the functions of the other. Therefore I would hope that the Minister, in laying down any specifications, would not do so in the way I fear he might, because he has said it would be clear as to who is the person next in line below the CEO. This makes one fear that the Minister automatically thinks that when an administrative officer such as a chief executive officer cannot act it would be the administrator immediately under him who would act for him. It would be unwise that any regulations the Minister would make would prevent a CEO who wished to do so from nominating a professional officer as his deputy.
Perhaps, I did not go far enough into this. If we start a discussion on the vexed question of the relationship between the administrator and the professional officer we could spend many hours at it. I have had some experience in this matter both in the Forestry Division and in the Department of Posts and Telegraphs. There has been this rivalry between professionals and administrators, not only in the Civil Service but in the local authorities and, in addition, there has not only been rivalry but frightening managerial difficulties in some of the greatest commercial concerns in the world in this regard. One of the solutions is that from the very beginning the administrative officers should have at least some technical training in what the professional officers are doing and, above all, the professional officers in their training from the beginning should have training in management. That is being given in the case of the post office.
And in the case of university colleges, I can assure the Minister.
Every engineer is now taking a course in the Management Institute. In certain cases where the professional element must predominate, as it must in hospitals where they are actually looking after the hospital, this could be a very complicated discussion as between where the professional must have the job and where the administrator must have the job and the common ground between them and the inter-relationship between the managerial structure of decisions made and, if there are two or three officials working on any matter, what responsibility should be given to the professional in sharing with the administrative side in the making of actual decisions. I hope there will be a proper understanding of all this.
I do not think anything in the Bill prevents this. I have been very interested in this since my appointment as Minister for Health from the standpoint of realising that there is a great deal to be considered in relation to modern management structure once we start changing the boundaries of the health authorities. It will take some time and I could not promise any spectacular results over a period of a year but I should like to hope that we will have a very careful examination of all these matters. I do not think the House need worry that this section could prevent— and I am committing myself in saying this—a proper study of this interrelation between professional men and those who are regarded as administrators in designing the structure of the new health boards administration.
Question put and agreed to.
I move amendment No. 24:
In page 9, subsection (3), line 54, before "as" to insert "appropriate to his office".
In proposing this amendment I am aware that under normal circumstances no official could be asked to carry out duties which were not specifically in his contract but we are entering a period of change and many people will be moving from one authority to another and there will be considerable change in the type of employment, hours and so on and I was hoping that the Minister would insert this phrase "appropriate to his office" so that any officer in this changeover would be sure that he would only be doing work for which he had contracted.
I dealt with this matter very fully in the Dáil and Deputy O'Higgins who had some experience of administration agreed with me that one could not possibly define in legislation or lay down what precisely was appropriate to a person's office. The legal adviser stated that the subsection as it stands, just as in the case of section 10 (1) of the Local Government Act, would not permit inappropriate duties to be assigned to any officer. "Appropriate to the office" is implicit in the legal power to assign duties. I cannot say more than this. I do not think you could define it any closer and I could not accept this amendment.
Amendment, by leave, withdrawn.
I move amendment No. 25:
In subsection (5) (b), page 10, line 10, before "and" to insert "shall participate in".
The conciliation and arbitration scheme for local authority employees will apply to transferred health staff and does not make it mandatory on the city or county manager to participate. In fact, one manager has used his right not to participate in the scheme. This is to ensure that all CEOs will not alone have regard to the scheme but will participate in the scheme so that we will have somebody with whom to negotiate.
Senator Owens, perhaps, has not quite understood the actual position. It is intended that CEOs on the health boards will be joined with the county managers on the official side in the revised conciliation and arbitration scheme which will be coming forward very soon. Naturally each individual CEO could not participate in every conciliation and arbitration proceeding. In other words, CEOs as a body will be joined in the conciliation and arbitration scheme but the implication of the amendment is that all of them would be involved. The Senator can accept my word that in the new scheme they will be involved.
That is not what I intended. I am aware that every CEO could not participate in every meeting of the conciliation and arbitration board; the intention was to prevent the situation, which has arisen, where in the future a particular CEO could say to the unions concerned: "I am not having any part of the scheme." This is what one county manager has done. I will accept the Minister's assurance. I have not yet seen the revised scheme but if he can guarantee me that this will be included as part of the scheme I will accept his assurance.
The only way in which I can deal with this is to give an assurance which I am sure will satisfy everybody on both sides of the House. Under section 12 (4), a CEO shall hold office under such terms and conditions and perform such duties as the Minister may determine and in the belief that conciliation and arbitration schemes must work effectively I would certainly write in as one of the conditions that the CEOs must participate to the extent that they are appointed as part of any scheme in conciliation and arbitration proceedings.
This assurance will strengthen what exists in subsection (5). If we left the subsection as it stands it might well be that the CEOs would only have to have regard to the results of conciliation and arbitration and would, in fact, be able to opt out.
It would be very wise that it should be part of their duties.
I should like to be associated with those remarks because I know that one of the matters which worried the medical organisation was that, while there was this scheme for local authority officers and employees mentioned in section 14, section 13, which covers conditions of employment and so on, mentions nothing about conciliation or arbitration. The organisations were, I know, hoping that the Minister would include a subsection which would clarify the position.
The position is that conciliation and arbitration schemes will require legislation by the Minister for Local Government. The scheme is, I believe, in course of preparation and the main elements of it have been prepared. The local government officials union is aware of the position. It is impossible for me to say exactly what will constitute this legislation but, quite obviously, it will have to apply to health authority employees.
It is quite inevitable. It has already been made absolutely clear that it will apply to the whole local government administration. There will be a complete system of conciliation and arbitration in the local areas, which will apply, for the first time, not only to wages but to conditions of service as well.
Amendment, by leave, withdrawn.
Question proposed: "That section 13 stand part of the Bill".
With regard to subsection (7), I should be interested to know the working conditions and circumstances this is intended to cover.
I gather this subsection applies mostly to temporary dispensary officers. In the ordinary way this section would apply to the appointment of temporary dispensary officers; if a vacancy occurred the most adjacent dispensary officer would be asked to do the work of the officer who had vacated the position. There is nothing of any great significance in it.
It seems to me the onus of finding a locum is placed on the officer. In an industrial concern the onus of finding a replacement would be the function of the chief executive officer or the manager. In the sphere of education teachers have to find their own locums if they have to be away from their posts for any reason. It seems to me it would be more desirable to place the onus in this case on the manager or on the chief executive officer. I know that teachers very often have a hectic time trying to find a stand-in. My fears that the same sort of thing may happen in the health services may be groundless or due to my inexperience in this particular field of activity.
Medical officers will be permitted under this section to find their own substitutes.
The position has been that, if a medical officer becomes ill, for example, the onus of finding a replacement is placed on the county manager or the CEO of the health authority. Part of the recent dispute was occasioned by the fact that medical officers were informally arranging for substitutes, though there was no legal obligation on them to do so. As a protest they ceased to provide substitutes and now it would seem that the onus of finding substitutes is being even more emphatically placed on them.
This does not alter the position. The manager or the chief executive officer can find the substitute. There are circumstances in which the Minister will consent to the officer himself finding the substitute. I think the system has worked fairly well. What the Senator is referring to is arrangements for guaranteed leave. The protest could have taken place irrespective of legislation and irrespective of whether or not the county manager appointed the substitute or the dispensary officer himself. The dispute was occasioned because doctors were not getting the kind of leave opportunities other people were getting.
I was wondering if the onus had been changed.
It remains the same. It is a question of a dual method of doing it. It is part of a long tradition. Arrangements for guaranteed leave are being negotiated, but any arrangements arrived at will not require any change in the legislation. Under certain circumstances a doctor may find his own substitute and get the consent of the chief executive officer, the Minister agreeing to this arrangement. In other cases the chief executive officer may find the substitute. This will not affect any arrangements made for guaranteed leave.
Question put and agreed to.
Question proposed: "That section 14 stand part of the Bill".
What is the effect of this section?
The Local Authorities (Officers and Employees) Acts, 1926 and 1940, require that all offices, the qualifications for which are wholly or in part professional, and other such offices as the Minister may specify, should be filled on recommendations made by the Local Appointments Commissioners unless filled by the transfer of a person from an office with the same or similar duties. Section 14 will not automatically apply the LAC procedure to professional officers and this relates to consultant medical posts to be filled through the Local Appointments Commission. There must be some greater flexibility in relation to these offices, particularly if they have teaching functions in hospitals. The general arrangements have been operated successfully but there obviously must be some modification in this procedure where you have a person appointed to a teaching hospital, or a person appointed to a teaching hospital who may go to another hospital on a sessional basis.
What troubles me slightly about the section, as drafted, is that there is, first of all, a general application of the LAC system to the senior appointments under this Bill and then exceptions can be made. Apparently these exceptions will be made by an order of the Minister after consultation with the commissioners. There is no indication here as to whether this applies to classes of post which the Minister may exempt by order or whether he may exempt individual posts. Is it intended that this should cover both and does the Minister anticipate that in practice it would cover both classes of posts and individual posts?
I think I said this already in the Dáil, the chief executive officers must be appointed by the Local Appointments Commission. Modifications can be made in the case of consultant appointments where you have a consultant who also has a teaching job in a hospital. It is in order to enable the Local Appointments Commission to co-ordinate with the university or teaching body concerned, and with the hospital concerned, that these exceptions are made. There has never been any difficulty, as far as I know, and there will be no difficulty in the future because it is quite evident that if any Minister for Health were suddenly to start making exceptions for reasons that were different from those I have indicated he could be very easily accused of irresponsibility or worse. Therefore, the Senator can be assured that this section of the Bill will be interpreted in a proper manner entirely in relation to the circumstances I have mentioned.
The Minister has said that any future hypothetical Minister for Health who acted irresponsibly could very easily be detected but there is no provision here in connection with any of these orders.
The Local Appointments Commission have to give consent themselves, as an independent body, to any modifications made in these consultant procedures.
The Local Appointments Commission do not issue regular bulletins on their activities.
The Senator agrees that the Local Appointments Commission is an independent body. Then he may be satisfied——
I appreciate that and I am in full agreement with the Minister that it is necessary that in the case of the consultant appointments some arrangement should be made. In the case of the existing health authorities these arrangements have worked extremely smoothly, even though we had on the one hand the Local Appointments Commission system and on the other, the question of teaching posts with all the jealous autonomy of the universities concerned. A successful solution has been worked out in the appointment of persons who can hold joint posts in this regard, but this is a specific case. My worry is that there is nothing specific here in the section as it stands. The section as it stands does not limit these exceptions to consultant posts or analogous posts, and I think the Minister is going too far in saying in section after section that the irresponsible Minister will be detected. It is not good enough for us to pass legislation here and to say we need not put a safeguard here in this section; we need not put a safeguard in the other section, because it will be known. In this section as it stands the Minister is asking the Oireachtas to rely on the Local Appointments Commission to curb an irresponsible Minister. If the Minister wishes to make an exception of a class of consultant, this could be written into section 14. If he has no objection to it being known— and he has no objection—what are the types of exceptions that are being made, it could be written here into section 14 that any exceptions made in this regard could be laid before the House, could be included in the report of the Local Appointments Commission. This is a very general section as it stands with no limitations to consultant posts, and the Legislature is entitled to ask that there should be some forms of reporting in regard to action taken under it.
If the Senator wishes, I am quite willing on Report Stage to put in an amendment that there must be publication of some sort. I have no objection. I do not believe this kind of minute legislation creates either honesty or efficiency in public life. I know there must be some of it but I am not at all agreed that if you write this, that and the other in, making a long list of tiny little regulations, you are going to get honesty.
The Minister seems pessimistic about getting honesty.
We maintain a system in this country which is one of the most honest in the world both as regards the operation of national and local government, and I do not think this is because of pinpointing little regulations. However, I am quite willing to have an amendment put in here, if the House wishes, that modifications in the Local Appointments Commission procedure will be published somewhere.
I am grateful to the Minister for undertaking to do this. May I assure him that I do not think our Civil Service can be criticised at all on the point of honesty but it can be severely criticised on the grounds of secrecy? What I am asking for is that information be available to those who want it. I think the Minister is well aware that we are moving into a situation where the public are not only entitled to fair play but are also entitled to information.
On the grounds of information, I can agree with what the Senator says.
I sympathise with the Minister on this point of minute legislation, and the medical profession are grateful to him for the care and attention he has given their worries as shown by the Health Bill. There is considerable apprehension among the consultants attached to the voluntary hospitals, as the Minister knows, and even the smallest point seems to worry them at times. I thoroughly agree that minute legislation is foolish but we understood that Comhairle na nOspidéal would have as their function negotiation with the Minister and the Local Appointments Commission to work out a system for the appointment of consultants; it would come as a shock to consultants to see an earlier section giving considerable power to the Local Appointments Commission unless the responsible Minister were to step in and keep the system of appointment we hope to maintain.
As the Senator knows, the selection procedures in relation to Comhairle na nOspidéal will not be enacted when the Bill passes but will be the result of negotiations and this will again have to come before the Dáil and Seanad before it is agreed.
I realise that but I was worried that it would appear to take precedence.
Question put and agreed to.
Section 15 agreed to.
I move amendment No. 26:
In subsection (1), page 11, line 31, before "shall" to insert "other than the Eastern Health Board".
Amendments Nos. 26 and 27 may be taken together.
The Minister knows the purpose of these two amendments; he has already dealt with them in the Dáil. I referred in general to that on Second Stage in the Seanad. I think the Minister was misquoted in the report of the debate in the Seanad. According to the report the Minister referred me to section 6 (d). I think the reference was to section 16. Am I correct in stating that? I have not the column of the Official Report before me.
I referred the Senator to section 16 subsection (4) (d).
Yes, but the Official Report has "section 6". I just wanted to point that out to the Minister before I commenced.
The purpose of these amendments is to restore power to the manager of the Eastern Health Board. The eastern health region at the present moment has a population of 912,000. By the time the Bill is enacted and the Act is fully functioning the population will be over one million. The two major functions of the CEO of a health board are with regard to decisions of eligibility, limited eligibility and questions of supervision of staff. Practically all the other functions of a health board are to be dealt with by the members of a health board. Those of us who have been members of the Dublin Health Authority feel that we would prefer to retain the powers managers have at the moment in relation to the new CEO of the Eastern Health Board.
The Minister, in the Dáil—Volume 242, column 1342—promised Deputy Clinton as follows:
I will examine this before Report Stage. Under section 16, the functions reserved to the CEO in subsection (3) cannot be taken away by any decision the board make under subsection (1). However, I agree to examine it before Report Stage to make certain that this is clearly the case. I agree with the Deputies that it should be clearly the case.
The Minister there referred to the three Deputies—Deputies Clinton, Burke, and Dockrell, who had met the Minister on the subject. The Minister continued:
If they feel doubtful about the attitude the eastern regional health board may take when the new members are elected....
and so on. The Minister met the three Deputies concerned and had some sympathy at the time with their point of view. There are three members of the Seanad also on the Dublin Health Authority. Although the CEO is not the manager he is delegated by the manager and, therefore, we can call him the manager. The working of the Dublin Health Authority under the chief executive officer, which is the current managerial system, we found to be quite efficient, excellent and, in many ways, worked out to the benefit of everybody.
If under the new method that the Minister intends to bring in, allowing more authority to members which, in effect, means more responsibility and more work, in an area that will have well over one million population, in a few years time the amount of work involved for members in dealing with day-to-day housekeeping matters will become intolerable and unbearable. It would be more appropriate if it were dealt with by the CEO with his officials. We want to revert to the managerial system that is in existence at the moment.
It will be noticed that in the amendment we apply this only to the eastern region and it is only the eastern region that I am speaking about. In case other Members of the Seanad have any fears about what I am saying, we are asking for this only because we feel that in a region like ours it would be impractical that members would be signing orders and doing various things like that, going in every day, spending hours there, holding meetings, acting on sub-committees. I do not know how many sub-committees we would have to have to deal with the business. This would be quite impractical. I appeal to the Minister again to consider this matter.
The Minister did mention section 16 subsection (4) (e). That subsection, as passed by Dáil Éireann, says:
Such other functions as may be prescribed.
It does not state by whom it is to be prescribed. In a later amendment we seek to have that prescribed by the health board. If that amendment is passed, I think it would satisfy the members of the eastern region.
The Minister has dealt with this at length in the Dáil and I do not propose to delay him any longer here because he knows the arguments for and his own opinions, whether for or against, I leave it to himself to say.
I thought I had made extremely clear in the Dáil what the position was, that I introduced two amendments designed to make the position clear. The basis of section 16 of the Bill, as the House knows, is that the board issues general policy decisions and directions and leaves the CEO and his staff to carry out these decisions. The new subsections that I introduced are designed to make the position even clearer. They indicate that the board can give either general or particular directions in regard to the duties of the chief executive officer and it is possible under this section for the board to delegate to the chief executive officer all the powers that enable him to do the day-to-day business of any board in the country. That means, for example, that if they vote a given sum for the maintenance or improvement of dispensaries, they can delegate to the chief executive officer how he spends the money or they can get a report on the dispensaries and agree that certain dispensaries require priority treatment and then in the rest of the year he carries out the duty of painting and maintaining those dispensaries, which means that no one can get up and have a two hours discussion to the effect that a certain dispensary needs repair much more than another and totally disrupt the business of the board and you can have this, as has been pointed out to me, repeated over and over again until regional health boards become absolutely cluttered with day-to-day business. That might not apply to some of the very small boards but I can assure the House the delegation power is there in the Bill and I moved it with that in view.
Then there is the ultimate residual power, that if real trouble arises in regard to the boards functioning effectively, I can make use of the section of the Bill for further delegation of powers. So, I do not think the Senator need be worried about this at all.
The Minister obviously appreciates our apprehension about this in the eastern area, as has been outlined to him so often in the Dáil and here on Second Reading. Already, the Dublin Health Authority is catering for a population of over one million. We, who are members of it, feel that it functions very efficiently. Quite recently, the Dublin city manager said he felt the Dublin Health Authority was one of the most efficient administrations he had come across in Europe. Obviously, we were very apprehensive lest this efficient system of administration might be changed to the detriment of the health services in general. I think we would be fairly happy with the Minister's assurances in relation to this. We followed the whole discussion in the Dáil quite closely but my interpretation of it was not quite as good as it now is, having heard the Minister's reply to Senator Belton.
On a point of information. In subsection (4) (e) reference is made to such other functions as may be prescribed. Will that be done by order of the Minister on application by the appropriate board?
I take it that these regulations will be laid before both Houses?
Our amendment on section 16 (4) (e) really was on the same lines as these other ones. We were offering the Minister amendments Nos. 26 and 27 or, if he did not like this, we felt perhaps amendment No. 30 might be acceptable to him. If the functions were to be prescribed by some form of regulation, there is no subsection in section 16 to cover this whole thing.
Subsection (1) of section 16 and subsection (2) were amended in a manner which I am convinced will give the Eastern Regional Board power to transfer to the CEO such managerial functions as will enable the board to act objectively, to have a reasonable agenda, to plan in a forward-looking way, to examine matters in an intelligent way and to continue to act intelligently and efficiently. I have given that assurance. If there is any borderline case where something could go wrong, I could delegate further functions to the CEO on the recommendation of the Eastern Health Board, having laid those changes before the Oireachtas under section 16 (4) (e).
Amendment, by leave, withdrawn.
Amendment No. 27 not moved.
Amendments Nos. 28 and 29 might be taken together.
I move amendment No. 28:
In subsection (4) (b) to delete all words after "which" in line 52 and substitute "a person may avail himself of any such service."
This is to change the phraseology of section 16 (4) (b). It is very disturbing to a doctor to discover that the CEO would have power to dictate the extent to which and the manner in which a person shall avail himself of any such medical service. We would hope that the Minister could see his way to amend this to the extent to which a person may avail himself of any such service. Actually, I had understood that there had been consultations between the Minister's officers and the medical organisations on 5th May and that this point had been reached between them. It came rather as a surprise to the organisations that the wording still remains the same. I should be glad if the Minister would look at it again and see his way to amend it.
I support the amendment. I support, in the first place, what has been said about the position from the point of view of a medical officer. Also, I think it might create administrative difficulties—the manner in which this service is provided could be determined. It would be possible to envisage circumstances where "the manner in which" could be a manner that might be an inappropriate one in the circumstances. The manner of discharging a function might be very difficult for the medical officer concerned who might, therefore, be unwilling to participate in the scheme. We want to encourage medical practitioners to put themselves on the panel to implement the scheme. This wording that the function of the executive officer will be determined in the manner in which officers such as the medical officer will carry out his function is not necessary to the rest of the section. Perhaps, the Minister might consider that it would be an improvement both from the point of view of the doctor himself and also, I think, administratively, if the executive officer was not in a position to determine the manner in which the functions of a medical officer would be carried out under the section?
As far as I know, there has been no trouble about this up to now. Whatever the significance of previous legislation would be and the manner in which a person avails himself of a service—it is purely the question of the administrative arrangements made for that purpose. It does not refer to the treatment or to the decision of the medical officers in regard to this. It purely refers to administrative arrangements such as the place where the doctor operates or the arrangements for gathering together patients, and matters of that kind— the actual physical administration but not the treatment.
Is that not part of the difficulty? It is very hard to draw a borderline between the administration and the manner in which the functions of the medical officer are carried out. In many ways, the best person to say the manner in which they would be carried out would be the medical officer. He might resent—perhaps, "resent" is too strong—dictation from the executive officer in this area. I could think of examples where it might be made difficult, by prescribing a particular manner in carrying out a function, but it would not be administration. For instance, treatment over a long period. The CEO and the medical officer might differ as to the manner in which it would be carried out. I can see difficulties here.
Here, again, I get into trouble with Senators in the Opposition. This question of legislationad infinitum I do not accept. My experience in life is that there has not been a difficulty up to now in which county managers have been accused of interfering with the treatment suggested or applied to patients by medical officers. If there has been trouble, it has been minimal over the years. In 30 years of public life, I cannot remember any big conflicts arising because county managers were interfering with the work of dedicated profesional men in deciding what the treatment should be or how long it should last. I am assured that the legislation does not depart in any way from this to cause any fear in the minds of medical officers. However, in response to this request I shall go over this matter with my officers between now and Report Stage and try to see whether there is anything that could suggest that chief executive officers or regional boards are going to interfere with the doctor's right to prescribe treatment or the length or the manner of the treatment.
Perhaps, the Minister might consult representatives of the medical profession on this point.
The difficulty is that medical officers, obviously like myself skilled in a particular kind of practice, may not be able to understand what is necessary to frame legislation. I would be quite willing to consult medical officers but in the end you have to go on the advice of people in the Department as to what words in a Bill mean. My experience is that officers in a Department generally give accurate advice and if they say words do not mean something it is generally the case and this I can say after 19 years in ministerial and Parliamentary Secretary duties.
I appreciate that the Minister is going to look at the question but I submit again that the extent to which the chief executive officers are given administrative authority to carry out their functions and the manner in which it may be given to them may give rise to some difficulties.
I understand that doctors must be allowed to make their own decisions in regard to their patients without any interference.
I am prepared to accept the Minister's statement and I am grateful that he will look into the matter particularly as there appeared to be some difficulty between officers and the profession at a meeting held in May. In view of the Minister's assurance I am withdrawing the amendment.
Amendment, by leave, withdrawn.
Amendment No. 29 not moved.
I move amendment No. 30:
In subsection (4), page 12, line 4, after "prescribed" to add "by the health board".
This refers to section 16 (4) (e) "such other functions as may be prescribed." This was put in as an adjunct to previous amendments Nos. 26 and 27, as a safeguard.
Having had the previous discussion, the Senator will agree with me that it is good to leave the Minister an ultimate residue of power to prescribe functions.
Having obtained the information and in view of the discussion on the other two amendments, I withdraw this amendment.
For instance, if I saw a very large board such as the southeastern or the eastern board absolutely cluttered up with day-to-day discussion the manager might have to be given more power.
I accept the Minister's statement.
Amendment, by leave, withdrawn.
Amendments Nos. 31 and 32 will be taken together.
I move amendment No. 31:
In page 12, before subsection (5), to insert the following new subsections:—
"( ) Every act or thing done or decision taken or function performed by the chief executive officer shall be done, taken or performed by an order in writing signed by him, and every such order shall be deemed to be made at the time at which it is signed, unless or until the contrary is proved.
( ) Any member of the board shall be entitled on demand to be furnished by the chief executive officer with a copy of any particular order specified by such member.
( ) Every chief executive officer shall keep a register in which shall be entered a copy of every order made by him and shall, at every meeting of the Board, produce for the inspection of the members so much of the register so kept as contains any orders so made since the next previous meeting."
The purpose of putting down this amendment is to seek information because there does not appear to be anything in the Health Act to indicate that the chief executive officer would have to circulate any orders that might be made by him from one meeting to another to the members of a health authority in the same way as county managers circulate orders made by them to members of local authorities. I think it is essential that this should be done. Is it intended that this will be done in the same way or is it intended that the chief executive officer is the health authority from one meeting of a health authority to another, and that any action taken by him between one meeting and another is taken on behalf of the health authority and that the health authority cannot question, or if they can question that they cannot take any action? I should like this information with regard to amendment No. 31.
It has been indicated that we shall take amendments Nos. 31 and 32 together but I think amendment No. 32 is consequential on amendment No. 31 in so far as if those orders are to be circulated to the members of a health authority they can be questioned in the same way by members of a health authority as a manager's orders may be questioned by a local authority. While we do not want something similar to section 4 to be served on chief executive officers in the same way as it can be served on county managers we would like that something would be put into the Bill to ensure that if the chief executive officer does something that a health authority resents or dislikes they will be in a position to say to him: "While we are not going to revoke what you have done we hope you will not repeat this in future."
The Senator can be assured that the amendments he has put down are unnecessary. They were quite evidently under section 19 of the County Management Act, 1940, and he made use of this to apply it to this Bill. These two sections of the County Management Act applied when there was a rigid division under the County Management Act between the executive and reserved functions, the former being executed deliberately by managers' orders and the latter by resolution of the council. Now the position is that reserved functions of chief executive officers are clearly stated in the Bill in subsection (4) of section 16 but it is open to every regional health board to require chief executive officers to publish such orders as they wish and this is absolutely clear. Equally, they can reject orders of the chief executive officers as they desire with the exception of orders where the chief executive officer has absolutely reserved powers, chiefly concerned with remuneration, conditions and appointment of staff, eligibility of service or charges for service.
Can the members of a board request managers to produce orders where managers have reserved functions?
Amendment, by leave, withdrawn.
Amendment No. 32 not moved Section 16 agreed to.
I move amendment No. 33:
In lines 12 and 13 to delete ",or for continuing as an officer,".
The section states:
The qualifications for appointment as an officer, or for continuing as an officer, under a health board shall be approved of or directed by the Minister and, in the case of an office to be filled by selection by the Local Appointments Commissioners, after consultation with the Commissioners.
I feel that the words themselves need explanation of the continuance as an officer when there is the possibility of suspension or removal for specified reasons.
I have been given to understand—I do not know if this is so, if it is I would press my point more strongly— that the reason for the insertion of these words is that a person who holds the appointment may become a married woman and, therefore, that it may be desirable to have her removed. If this is not so I would be glad if the Minister would clarify the point. It is hard to understand on reading the section why the words are necessary in view of the other provisions of the Bill. If this is the reason why they were inserted I would ask, in view of the status of women in this country, which is a matter of some importance, that the words be deleted and that they be deleted in any case because of the fact that they need not be construed in such a way and, therefore, the qualifications for the continuing as an officer are a very wide mandate to give to the Minister. I feel that they are not necessary in view of the other provisions of the Bill. Therefore, I would ask, first of all, for clarification and also if the Minister would consider the deletion of this phrase.
Certain of the qualifications for officers are such that the person must be required to have them not only when a candidate for the office but also during the tenure of office of the person. An example, as the Senator has said, is that the woman must be unmarried and that the person must be in a suitable state of health. That is the reason for the professional qualifications as shown in section 17.
The legal advisers indicated to me, and I mentioned this in the Dáil, that the section could not be used so that a new declaration of qualifications could be made which would have the effect of debarring existing holders of the office from continuing to hold it. I am absolutely certain of this. Any such new declaration of the qualifications could only relate to holders appointed after the date of the new declaration. That is the position and I cannot enter into controversy about women remaining in office after marriage. As the House knows, there is to be a commission on the status of women and this and other problems will be examined at that time.
I still have not got from the Minister the reason why this is necessary. Why is it necessary to insert the phrase "or continuing as an officer" unless it is in some way to discriminate against certain persons who are continuing in office under the old system? I cannot understand the reason for this. Obviously, the qualifications themselves can determine who will become an officer and obviously there can be a certain leeway for somebody who is suffering from ill-health but apart from that the only other qualification that I can see is the fact that somebody who was appointed and properly qualified as an officer subsequently married and this is a discrimination which I would not like to see in the Act and which cannot be pushed aside as a matter for a possible commission to be set up in the future on the status of women. It is a matter that is relevant to this section now.
Of course, amendment No. 34 deals with the question of unmarried women. I am afraid I cannot explain it any more. This is a question of the legal advice I have had.
Does the Minister consider that this phrase is necessary because to me it could have a wider connotation? The Minister has given an undertaking and I appreciate that but the Minister's undertaking is not binding. It is the wording of the Act that is binding upon us. In view of that, would the Minister reconsider whether this phrase is absolutely necessary?
I do not mind having a look at it but I have already given an absolute assurance to the House. I made this absolutely clear twice, once in the Dáil and now again.
The problem is that although the Minister's assurance is accepted in good faith it does not have a validity as far as the interpretation of the section goes.
Of course, this is a question which we could discuss for a long time. Looking back on a long experience of this, I feel that statements by Ministers on Second Stage or Committee Stage of a Bill are at least to some extent like common law precedents. I think they are. Certainly, in my experience as Minister I have introduced a great deal of legislation in the Dáil. I do not think anybody has ever been able to get up and say: "What you said was just blatantly ignored". People might have some political discussion as to what constituted a statement I made in the Dáil, whether I truly observed it, whether it had been observed in legislative practice, but I do think that in the case of a Bill like this the statement of the Minister does have to have some validity and influence.
Is amendment No. 33 withdrawn?
Subject to the Minister, perhaps, considering it.
I do not mind considering it to make quite sure.
Amendment, by leave, withdrawn.
I move amendment No. 34:
To add to the section the following new subsection:—
"( ) The Minister shall not approve or direct any qualification specifying that any woman holding office be either unmarried or a widow."
The Minister has already referred to this amendment. I feel it is frightfully important that this amendment goes into the Bill. The Minister in this Bill has departed in many ways from the local government code but he has not specified any qualifications for officers and this is just giving him the power to do so. Maybe we are just too suspicious about it but what he has said already today does not give me any great hope. This amendment is to anticipate the possibility of his bringing in a qualification that does exist in the local government code already that any woman holder of an office be either unmarried or a widow. To have a piece of legislation of that sort in 1970 puts Ireland somewhere that is certainly not heading towards Europe and the EEC to put it at its minimum. I do not want to involve the Seanad in a lengthy debate on whether women should work when they are married or not. I do not think that is the point. The point is that one does not legislate against their doing something. This is sheer discrimination against at least 50 per cent of the population.
Article 123 of the ILO which deals with this question of the working woman's family responsibilities specifies that it should be a matter of choice. Of course, this is the important thing, that it is a choice and a free choice of the individuals concerned.
Even looking at it from an economic point of view, there is quite a shortage of certain skills in the public sector. There is a shortage of nurses in some areas of the nursing profession. What happens is that nurses must retire on marriage and they are re-employed in a temporary capacity. They used to come in at the minimum of the scale even though they may have been at the maximum of the scale before they took the plunge. They now come in a few points up the scale but this is only after years of negotiation. This is grossly unfair to them. Similar things can happen in the administration field where clerk-typists and clerical officers must resign on marriage. Because of the shortage of secretarial skills in the city clerk-typists are now being kept on, possibly at the minimum, but without their superannuation rights in any case. The loss of skills in the professional field must be fantastic. When a woman doctor chooses to go into the local authority and then has to resign all the skills and knowledge she has acquired are lost. With the extension of the health services envisaged under this Bill it seems a great waste apart from the investment which the country has put into her training.
A point that would help my argument and may, perhaps, help the Minister is that one of the recommendations of the Devlin Report is that the question of married women in the public sector should be investigated. They recommended, in fact, that they should be allowed to stay on if they so wished. I hope the Minister will accept this amendment. Perhaps, Senator Bourke will have something to say on it and probably can say it much better than I can. I want to press this amendment very hard.
I hope the Senator is clear on the point that in declaring the qualifications for particular positions there is nothing in this Bill which prevents me including the right of married women to participate. I do not do it because it has not been the practice, but we are not disqualifying married women. The Senator has thrown this very large stone into the pool and I am afraid that I am not prepared to take it up with her now. It would be most unreasonable if the Minister for Health by accepting this amendment were to initiate an entirely new concept which I agree is being thought about very much, but it would be quite wrong. We could not have the collective responsibility of Government retained unless this was a result of a decision made on behalf of the Civil Service, on behalf of the local authority and resulting from the decision on the whole community. I do not really think that the Senator expects me to do this. The responsibility for Government collective action is extremely important, and one can see absurd results where there has been any departure from it.
The Senator could not expect me to accept this. It must be a collective decision. We have this commission and I am very glad to say that it was through me that Dr. Thekla Beere was made the first woman secretary of a Department. She served me absolutely splendidly. She was magnificent, and I am very glad that she is to be chairman of this commission. We could find no better person. She has much shrewd sense and wonderful human capacities to deal with this matter and to head this commission which will be quite able to handle this question. I simply cannot decide on this question by introducing an amendment to this Bill, and I am sure that the Senator well knows it.
It was because the Minister has shown such an enlightened point of view in administration that I hoped he might be the person to take the plunge into the 70's. One sees, of course, the point that it would be a collective responsibility of the Government, but there is ample time before Report Stage if the Minister is prepared to take it up with the Cabinet to get his colleagues to make a decision, and I would be prepared to leave it to that stage if he could give that undertaking. I, indeed, welcome the appointment of Dr. Thekla Beere as chairman of the commission, but the fact is that at the moment all we have is a chairman. We have no commission. It is at least 18 months since the Taoiseach was talking about setting up the commission and it is at least two months since he said that he was going to appoint it. As this Bill is going through I do not see why we should have to leave it to the commission, because I think that not even the chairman knows what the terms of reference are—at least she did not the last time I heard her being interviewed —and it may take four years before they bring in a report and in the meantime you will have people in the health service resigning on marriage, with all the subsequent problems such as lost skills. I would ask the Minister before Report Stage to raise the matter in the Cabinet seeing his reluctance to take the plunge himself.
I could not, of course, guarantee to get a decision by my colleagues by Report Stage and I think that the Senator knows that very well.
The Senator can always withdraw and re-table on Report independent of the Minister's attitude.
It is quite unreasonable, and the Senator knows it, to get a decision of this kind.
Is the amendment being pressed?
Amendment, by leave, withdrawn.
Question proposed: "That section 17 stand part of the Bill".
I think that we should pause here for a brief period to examine what is a most vital factor in guaranteeing the success of the new Health Act, and that is the qualifications of those who will be called on to operate it. Already the Minister has taken an enlightened but very necessary step in taking power to appoint some CEOs ahead of the coming into operation of the scheme so that they can go abroad and get desirable additional training before taking up duties. I should like to press the Minister a little further on that and to suggest that the success depends more on the second run of the officers, and, indeed, it is going to be the general officer more than even the CEO himself, and, consequently, the Minister's scheme should be extended as a matter of urgency to enable a vast number of our potential officers of the health boards, our serving officers in existing health, to get leave of absence and to go on scholarships or grants to England, the United States or elsewhere to acquire additional qualifications in hospital management and in the various other ancillaries of that.
I am not suggesting that we should make any commitment to these people other than the commitment that the Minister has made in the case of the CEOs, that he will appoint them and will send them abroad, but for the others I think that we could possibly spend even in the region of £50,000 or £100,000. That may seem big money, but yet £100,000 would enable 40 or 50 people to be sent abroad for training and would provide a pool from which the future officers and their subordinates could be selected. Again, this would be a way of discharging the Minister's undoubted commitment to existing officials, because within the various boards of health we have relatively young men who entered probably just after the intermediate certificate and certainly not beyond the leaving certificate.
They are in health and they are started on it and in the old course of business they would work their way right up to the highest positions. Today where we have much greater facilities for advanced education comparable young men to these would aspire to go to the university and plan to get their degrees and later come back to serve in administration or other positions in health or other schemes. The Minister, I think, could ensure that future appointees would have all this additional training by now making very generous opportunities available to serving officers to get degrees that would be suited to certain classes of work in the operation of the health scheme. If he did that, at one stroke he would ensure that the staffs in the future would be trained to the limit of their capacity and the second important result would be that he would do a lot to cut out the division that exists between the clerical and the professional groups within the health service, because we have to face the fact, as Senator Owens said, that we are heading into the 70's and in the 70's the possession of a university degree is going to be comparable to the possession of, say, the intermediate certificate 15 years ago.
We can ensure that the health scheme gets off on the right foot by giving these opportunities. If the Minister does this, he will be more than discharging his commitment to existing officers. He will be providing them with the opportunity they were denied because of financial circumstances five, ten or fifteen years ago. If he sends those people back to get their additional qualifications, they will benefit by the experience and the country will benefit considerably by that experience when those people come back again into the public service. I should like if the Minister would indicate to us a little more of his intentions in this respect.
Senator Quinlan spoke in a very interesting way about this but I think he exaggerated the possibilities whereby everybody who is going to enter the new boards can get some kind of training before the boards begin to operate. I have asked the appropriate officials to give me a general picture of what special training is being made available not only to people working in the health authorities but also to those who administer the hospitals and to various other classes of staff to see what training structure we have and what retraining facilities we have.
As the Senator knows, there are facilities for retraining; there are scholarships available for professional men to go abroad to acquire experience. I wish to make it clear also that it is not essential always to send officers abroad to get training in management. There are some excellent managements in this country.
Although an officer of a health authority could gain good but limited experience in some English health authorities, the system there is totally different from ours and, I am glad to say, is being amended on our lines. In England, the system operates on a principle of three health authorities who co-ordinate together—the hospital service, the public health service and the medical authority—and they have discovered there is a lot of inefficiency, of Parkinsonianism, and they have recommended a complete change with unification of all these authorities.
Only in particular fields or in particular aspects of the service could our people gain by going to England. There are, of course, other countries where they could gain experience and I sympathise wholly with the general import of what the Senator has said. However, this must be done in a practical way. When I was in charge of other Departments, they can say of me that I helped to introduce opportunities for more skill to be acquired through the personnel being enabled to take special courses elsewhere. I cannot do more than that here. I have been appointed Minister for Health only recently and one of the things I have to do is to discuss the question of what we need to have in the way of special management instruction. Chief executive officers may be appointed without any knowledge of health whatsoever, although some of them, quite obviously, will be transferred from existing health authorities. I have equally to consider matters in relation to the number of staff, but I cannot go beyond that. I can assure the Senator that recently I authorised a number of officers in my Department and officers in certain health boards to partake of courses abroad through scholarship schemes. I will continue to do that or abandon it if necessary.
While he has gone some distance on my suggestion, I submit to the Minister that in the industrial field a concern engaged in the spending of something in the order of £80 million to £100 million a year, which is not an unreasonable picture of our health services in the 70's, would regard the spending of a small percentage of that money on training as a prudent investment towards getting the organisation efficient. Therefore, in looking to our health services I should like to see provision whereby we would spend, say, one per cent or two per cent of the total in trying to improve the general efficiency of the operation of the system. After all, it would mean spending £1 million a year for studies within the units on how they could operate more efficiently. It might mean retraining of personnel, in anticipation of personnel needs, by scholarships.
This may seem extravagant but it would be good business straight away to earmark at least £1 million to get an efficient health service. By efficient I mean having the various units investigated, co-ordinated and got up to maximum efficiency, and, above all, I should like to see the administrative personnel trained to the fullest extent possible.
Question put and agreed to.
Section 18 agreed to.
I move amendment No. 35:
In page 12, line 24 after "authority" to add "subject to the following modifications:
(a) a non-pensionable officer shall be deemed to be a pensionable servant,
(b) paragraph (f) of section 10 (1) shall have effect as if the following words were added at the end of the paragraph—‘(other than an absence in consequence of a trade dispute)',
(c) section 13 shall have effect as if ‘(or pensionable servant)' were inserted after ‘pensionable officer' and as if ‘(or servant)' were inserted after ‘officer'
(d) an allowance payable to a servant shall not be reduced without the consent of the Board.
(e) when first employed the qualifying service days in any financial year shall be reckonable as pensionable service, provided arrears of contributions are paid by the servant,
(f) where a servant has more than 300 service days in a year and less than 200 (or 300) service days in another year he may request the Board to transfer the surplus days for which he has contributed to such other years as he specifies in writing.
(g) ‘£250' is substituted for ‘£100' in section 61 (1) (e),
(h) section 66 shall have effect as if ‘(or his trade union)' were inserted after ‘he' where that word occurs,
(i) the cost (if any) of implementing paragraphs (a) to (h) of this section shall not be a charge on the Exchequer."
The section applies the provisions of the 1956 Superannuation Act to transferred people and the purpose of the amendment is to try to eliminate some of the problems which have arisen under the 1956 Act in regard to the transfer of staff. Paragraph (a) of the amendment proposes to treat a non-pensionable officer as a pensionable officer. We spoke of this type of person earlier and we referred principally to long-term, temporary officers.
Paragraph (b) of the amendment is of prime importance in regard to officers of health boards. At the moment, if local authority officers absent themselves through a trade dispute they lose all their previous rights of service. When the 1956 Act was going through we got an assurance about that, but in a dispute with a local authority about 18 months ago the matter was resolved only after long discussion. We do not want to see that kind of thing carried forward into this Act. Paragraph (c) is to remedy what amounts to a class distinction in the Bill which we do not wish to see in legislation. Paragraph (e) is to bring in extra qualifying days if the person affected pays his arrears of contributions. Paragraph (f) is to average out the number of days over the years. This might have the effect of bringing in an extra year's service. Paragraph (g) is to increase the amount from £100 to £250. At the moment if the amount is as low as £110, the relatives of the officer have to go to all the trouble of paying solicitors' fees and so on before they can get any money. Paragraph (h) proposes to allow the trade union to make the appeal on behalf of the officer. The Minister again may say that he does not wish to break the local government code but I hope he will accept some of the proposals in this amendment. The proposal in paragraph (g) to substitute £250 for £100 should not create any problem.
I cannot break the 1956 Act code simply on behalf of myself or the Department of Health. It applies to local authorities and to certain corporate bodies. There is no point in my going into all these things. I simply cannot do it. It is recognised that the Minister for Local Government has the responsibility for changes in legislation of this kind. A great many of them quite evidently apply to the officers and servants in the health authority.
I am afraid I am unable to accept any of these amendments. There is no point in discussing them in detail. A number of them may be right and proper but the interpretation of matters such as what constitutes a wild-cat strike, the pensionable allowance for service and so on, can all be taken up by the new and expanded arbitration and conciliation board which is to be promoted by the Minister for Local Government and which will involve all officers and servants of the health authority. Senator Owens will agree, and, in fact, all members of the House will agree, particularly those on this side of the House, that we have done a very great deal in the last 40 years to improve conditions of service for all the people. There has been an unsatisfactory method of determining these matters because of the system whereby the managers have to get together and agree to certain proposals and there is a very rigid area whereby officers of the local authority hold their services on certain terms and they have an appeal to the Minister. There cannot be any decision in relation to conditions of service determined in a proper way but the new system of conciliation and arbitration should enable a great many of these questions to be properly ventilated.
I will not press the amendment but I may refer to it at a later stage.
Amendment, by leave, withdrawn.
Section 19 agreed to.
I move amendment No. 36:
In subsection (5), page 12, line 39, before "that" to insert "or if requested by the chief executive officer a public local inquiry,".
Under this section the Minister may remove a CEO from office following a local inquiry. I accept that a local inquiry in certain circumstances is correct. The Minister rightly said, perhaps, not in reference to this section, that a public local inquiry could militate against the officer himself and certain facts might emanate from a local public inquiry that would not redound to the credit of the person to be removed. We maintain that if the CEO requests a public local inquiry he should be granted it. That is a reasonable and fair suggestion. I know that the Minister would not remove a man lightly but even in a local inquiry the facts might not come out as they should and if the officer to be removed demands a public local inquiry instead of a local inquiry that should be conceded to him. This is self-evident and does not need a lot of explaining.
I am a bit confused myself as to whether or not it is desirable. I think there are two sides to it. One could argue that it would be only in rare circumstances that a CEO threatened with removal would want to have his dirty linen washed in public. One could look at it in that way. On the other hand, a person looking for a public inquiry, assuming he was not being blatantly victimised, could be doing it for the purpose of implicating other people in his misdemeanours and who might to some extent become vaguely involved with him but not really guilty or sufficiently guilty to justify their removal as well as his. All this is a bit mythical. There is the question of whether a CEO might have had a vendetta with the board and seek an inquiry to discredit them although they did not merit discredit and the matter could be quite serious in relation to this question of the mud that might stick to them. The suspension or removal of a CEO would only be for a very serious offence. I do not feel inclined to accept this amendment for these reasons. I can equally see that there is a certain case for it but, on balance, I do not want to accept it.
One of the reasons for tabling this amendment was that we felt that a CEO might take a line completely contrary to that which the health board wished to adopt and he might feel very strongly in principle that what he wanted to do was right and the board might feel he was wrong. He might come in conflict with the Minister in the same way. You might have a situation in which the Minister felt that the CEO was not acting in the best interests while the CEO might be convinced he was. After all, there will only be eight CEOs, who are going to be very important people, and if the general public were to be informed that a CEO had been suspended pending an inquiry or some sort of investigation into his removal, it might very well militate against the CEO's good reputation in his own area. He might want to go before the general public and let them know the reason for the conflict was not that he had misappropriated or misused funds but that in principle he objected to the way in which his board operated or sought to operate or objected to the way in which the Minister was acting or wanted the health board to act. For this reason a CEO would have a right to have his point of view put before the general public. Perhaps, the Minister might think about this in this light before Report Stage.
One can realise the complexity of this Bill and I quite understand why many of these amendments were put down. You could spend three weeks going back over all the Acts that apply in this Bill and still be rather at a loss to know what is happening. I suppose this kind of discussion is valuable. I understand that the Minister could decide to hold such an inquiry in public because of some other section of a Local Government Act. He could decide—it is not obligatory on him. If he decided that the action of the CEO did require airing he could hold a public inquiry under another section of previous legislation. Perhaps, that would satisfy the Senators they do not need to move this amendment.
Amendment, by leave, withdrawn.
Section 20 agreed to.
I move amendment No. 37:
In subsection (5), page 13, line 11, before "and" to insert "unless the Minister otherwise directs".
The purpose of this amendment is to show our concern that as the section stands there is no limitation upon the period for which an officer may be suspended under the section. Yet, during that period, the officer would not be in receipt of any salary. We suggest that this would constitute a hardship not only on the officer himself but on people who would not be guilty of the misconduct leading to the officer's suspension. I refer to his wife and family. We appreciate the complexity and delicacy of the situation visualised under the section but, if the Minister were to accept our amendment, that would at least introduce the necessary human element into this very sensitive area. We are not suggesting anything imperative so far as the Minister is concerned. We are simply asking that in cases of extreme hardship, hardship over and above the requirements of the discipline which led to the suspension in the first instance, it would be open to the Minister to direct that at least some part of the salary would be paid during the period of suspension or during part of that period. This could come about directly on the initiative of the Minister or as a result of representations made by those concerned with the humanitarian aspect. We would strongly urge the Minister to give favourable consideration to this amendment. Our only purpose in tabling it is to avoid creating unnecessary and undue hardship for people not directly involved in the circumstances which led to the suspension.
The Minister for Local Government and I have been thinking along lines similar to these and I shall introduce on Report Stage an amendment which will make it possible to pay whatever remuneration a suspended officer may be in receipt of to whatever point the chief executive officer, in consultation with the Minister for Health, considers desirable. That will clarify the situation.
I am very grateful to the Minister.
It will not always be done, of course; it will be a matter for the chief executive officer to decide whether the suspended officer should be paid in full or in part.
Amendment, by leave, withdrawn.
It is suggested that amendments Nos. 38 and 39 should be discussed together.
I move amendment No. 38:
In page 13 to add to subsection (5) a new paragraph as, follows:—
"( ) a decision either on the termination of such suspension or the removal of such suspended officer shall be taken within three months of the notification of the suspension to the Minister by the chief executive officer, as provided within the procedures set out in section 22 and section 23."
I should like to ask the Minister to fix a time limit to a suspension of an officer or servant so that the officer or servant would not be in the position of waiting for a decision for a very long period. The element of remuneration also enters in. The Minister should put a time limit to the duration of the suspension.
I am afraid I could not possibly agree to either of these amendments. I made the position absolutely clear in the Dáil. There can be no time limit. There might be a question of prosecution or court proceedings and the officer or servant might be prejudiced if there were a time limit fixed. Again, the officer or servant might be ill. This is the kind of suggestion that does not work out in practice and I could not possibly agree to accept either of these amendments.
Amendment, by leave, withdrawn.
Amendment No. 39 not moved.
Question proposed: "That section 21 stand part of the Bill".
When one speaks of officers is the reference to members of the administrative staff or to matrons, surgeons, physicians, home assistance officers, and so forth?
It could possibly happen that the officer to be suspended could be the chairman of the board.
An officer cannot be chairman of the board.
He might be a member of the board.
It would be a rather embarrassing situation if the chief executive officer were to suspend a member of the board.
It certainly would be embarrassing. It could happen, but it would be most unlikely.
Question put and agreed to.
I move amendment No. 40:
In subsection (2), page 13, line 22, before "shall" to insert "or pensionable servant".
Again, this is an attempt to remove what we regard as discrimination against pensionable servants. The section deals with the removal of officers and servants and subsection (2) relates to permanent officers but excludes pensionable servants. A permanent officer can be removed only by direction of the Minister or by a committee set up under section 23. This amendment seeks to give the pensionable servant the same rights from the point of view of removal as the permanent officer is given under the Bill.
I cannot, as Minister for Health, alter the relationship between a servant of the board and an officer of the board. A servant is normally employed to do a certain amount of work in return for which he receives a certain sum of money and other benefits established either by legislation or by the policy of the body by whom he is employed. There is a definite distinction made. The Senator may argue that the distinction is wrong. To some extent it is outdated and there should be a further drawing up of a fresh list to mark the distinction, but I cannot do this under the existing code. It would have to be done by conciliation and arbitration. As the Senator knows, this is a matter of very great interest to people all over the country and the Minister for Labour has introduced into legislation a fair code of employment, giving greater security of employment to workers of various classes. I think everybody will agree that it is a strange thing that, although building workers have had pretty secure employment over considerable periods, their pay arrangements sometimes date for only 24 hours. That is not due to any failure of the trade unions to effect a change. It is a question of the whole reconsideration of the employment code. I do not think I can initiate here what could be done in relation to the public service as a whole.
I do not concede that the new conciliation and arbitration scheme will enable the alteration of legislation. We might be able to negotiate conditions which we have not been able to do up to now but we shall hardly be able to negotiate a whole new superannuation code.
However, I may be embarrassing the Minister and I am prepared to withdraw the amendment.
Amendment, by leave, withdrawn.
I move amendment No. 41:
In subsection (3), page 13, line 29, after "office" to add ": absence in consequence of a trade dispute not to be considered as a reason for removal from office under this section."
Perhaps, the Minister would clarify this: it has been indicated to me that this section could be interpreted that if you had an official strike—we will not talk about unofficial ones—this clause could be used against the officers and be treated as removal from office or absenting oneself from office. If the Minister assures me that is not so, I shall not press it.
The Senator does not need to move this amendment. If we accepted this amendment it might lead to embarrassment of the trade union movement because it would completely tie the hands of the Minister, that is, where a person absents himself from duty for an unwarranted and patently unofficial strike. Subsection (3) of section 22 is not specifically intended to cover the situation that would arise as a result of a trade dispute.
Amendment, by leave, withdrawn.
I move amendment No. 42:
To add to the section the following new subsection:—
"( ) A person shall not be removed from being an officer or servant before the reasons for his removal have been specified to him in writing and he or his trade union or appropriate organisation has been given an opportunity to reply to such reasons."
The spirit and fact of this amendment, we would suggest, is in line with enlightened industrial relations whereby we seek to remove from people in authority the right unilaterally to suspend employees. We have also been concerned in these situations which have presented themselves to us that the reasons for these actions by people in authority have not been sufficiently spelled out. In recent years, as the Minister will be aware, we are progressing towards a situation between management and labour whereby the conditions of employment, including regulations covering suspension and other such disciplinary action, are covered in written agreements. What we seek to provide in this section is that the person or persons concerned would have specified to him or them in writing the reasons for such action on the part of those in authority. Therefore, two things may be achieved: the person or persons directly concerned will know why this action has been taken against them or is proposed to be taken against them and they will have the right to enter an appeal and make representations. We want this right to be conceded to the trade unions or appropriate organisations. I am sure the Minister will appreciate, as I have said, that this is in line with what one might call not alone enlightened but commonsense industrial relations procedure.
I will put an amendment in which will follow the general import of what the Senator has said. It seems to me that in this modern age we should do this.
Amendment, by leave, withdrawn.
I move amendment No. 43:
To add to the section a new subsection as follows:—
"( ) An officer or servant removed in accordance with this section shall have a right of appeal to the Minister."
This amendment is proposed mainly for the temporary official who if he is removed from office has no right of appeal to the Minister.
Again, this is a question of being able to understand the complexity of this legislation. Where a person is removed for absenting himself from duty without leave and without reasonable excuse the Minister is the person who removes the officer ultimately and, naturally, the officer can make an appeal. If he is available, if he can be found, he can make an appeal to the Minister. Where an officer is going to be removed or should be removed because of misconduct there is in section 23 of the Bill a provision for an appeal to the Minister so it does not seem to me necessary to have this.
What about section 1, in which the temporary officials can be removed without reference to——
I understand that temporary staff have no permanent status in the health authority, so section 22 would not apply to them. It applies to the permanent staff.
If this section only applies to the permanent staff why is the distinction made between an officer that can be removed by the chief executive officer and in subsection (2) "a permanent officer shall not be removed"? Why is the distinction made? We have a very considerable number of temporary medical officers of 18 to 20 years service.
A temporary officer has no right of appeal to the Minister against dismissal. He accepts the position as a temporary officer. I cannot alter the code in the manner the Senator suggests.
Is the code so rigid that a temporary officer, no matter how many years service, cannot appeal to the Minister if he is dismissed?
That is right. That is the case.
Is there no way this can be dealt with? It does not seem very fair.
I do not think I could consider it without its being considered generally speaking. It is a question of the total code. I have not had many complaints in regard to this matter.
The Minister may not have complaints because of the existence of this code. Is it that they know of the existence of this code, and therefore they do not bother to appeal?
As I have said, I cannot alter the code unilaterally. As far as I know, those matters have been constantly examined in the Department of Local Government. Particularly now that industrial relations are becoming more intensively discussed and that the worker's interest is more understood and accepted, all these things are discussed fairly continuously. I do not think the House may feel that the Minister for Local Government could be in arrears of what would be regarded as reasonable public opinion on these questions. There are bound to be discussions in the course of the next few years on these matters where it is felt that people suffer under a disability compared with other people.
I am sorry to persist with this but surely there must be some method by which the CEO can be, perhaps, restrained from dismissing without consulting the Department in case of long-term temporary officers?
There, again, it is a question that we could argue about for a long time—the value of legislation in regard to all this. As the Senator probably knows, even although the county manager has this power without reference to the Minister, there is no question, representations can be made to the Minister about this and the Minister can write and say: "Would you not consider this in relation to a temporary officer's position?" An ounce of sympathy and informal understanding is worth a ton of legislation, as the Senator knows. It is, perhaps, one of the unusual features of this country and the temperament of the people. It can result, also, in a great deal of inefficiency. It can result in people being excused because of their weakness and being allowed to remain inefficient. It can also result in hurt to their family. Over-sympathy can result in hurt to families as well as in inefficiency. On the whole, I think it is a good thing that we have a sympathetic attitude. This way, in which we have informal understanding and are not out of touch with county managers, is just as good as trying to put it into the Bill, or nearly as good.
Amendment, by leave, withdrawn.
Section 22 agreed to.
I move amendment No. 44:
In page 13, subsection (2) (b) (ii), in line 52, to delete "the chief executive officer of".
The purpose of this amendment is that the Minister should select from the panel of persons nominated by the health board representatives on the committee which will decide whether or not a permanent officer of the health board should be relieved from duty. We feel that this is a matter where power should be left with the health board to nominate the panel from which the Minister will make his selection rather than with the chief executive officer who, so to speak, is the person initiating the action against the permanent officer.
I am afraid I could not possibly accept this amendment. It cuts right across the concept established in the Bill of the chief executive officer dealing with all functions relating to control and supervision of staff. The regional health boards have no function in this respect whatsoever. It is the chief executive officer and trade union and other official organisations representing the staff between whom conditions and remuneration and service are discussed. Quite evidently, under those circumstances, the chief executive officer must be allowed to nominate the persons who serve on the panels which will be appointed when there is a question of the removal of officers under section 23. Quite evidently, we could not give the health board this particular capacity and not give it other functions in relation to the remuneration of staff. I can see some difficult situations arising with the regional health board if it were given this power. They might find it extremely tricky, for the first time, to start to interfere with this and to appoint a committee representing the staff side under the chief executive officer. It might be very embarrassing for them. They might get themselves into great personal difficulties over this.
Amendment, by leave, withdrawn.
Question proposed: "That section 23 stand part of the Bill".
Before the section is cleared, I wonder could I suggest that the Minister might consider that the half of this committee which are selected by the Minister from a panel of persons nominated "by such organisation (or organisations) as is (or are) in the opinion of the Minister, representative of the class of officer to which the person belongs", should be selected at the beginning of a health board's life and should remain in existence during the life of the health board? It would obviate the difficulty of picking a panel in certain cases and it would mean that you would have a panel whose views would be completely neutral from the very beginning of the health board's life to the end.
I think the Senator is quite right in this. The Bill provides arrangements whereby the panel can be formed at the beginning of the lifetime of the health board. I quite agree with him that not only for reasons of humanity but also of good administration, people should know who the panel will be and it should not be self-constituted by the chief executive officer at a time when there may be a lot of perturbation in the minds of everybody concerning a particular person, and people might feel that the people appointed were prejudiced in one way or other. If appointed at the very beginning, there can be no feeling of prejudice when a particular officer comes up for examination. I quite agree.
While I agree with that procedure, should not there be provision for any member of the panel to resign temporarily if he feels he has some personal commitment or personal relations in the matter?
It is possible for a particular person who did not want to appear for some reason not to be selected from the total panel.
Question put and agreed to.
Section 24 agreed to.
Amendment No. 45 has already been ruled out of order as involving a charge on the public revenue.
Due to the word "inducement"?
The Chair is silent on reasons.
Amendment No. 45 not moved.
Section 25 agreed to.
Section 26 agreed to.
Question proposed: "That section 27 stand part of the Bill."
May I ask a question with regard to the working of section 27? It is a general question that I referred to on Second Stage. I wonder, in detail, will the system of audit by the local government auditor be precisely the same system as applies in the health authorities and local government service at the moment because I have heard complaints from time to time that this type of audit as at present established is, in fact, in many ways a stifling system, an out-dated system, which can restrict desirable initiative and freedoms in some cases by the officials of the authorities?
At a time when a new Health Act is being introduced, would it be possible —I appreciate there are always difficulties—rather than incorporatingin toto the existing audit arrangements, to introduce some flexibility? Particularly in a health area, where it is a human problem dealing with individuals, often in an emergency situation, it is desirable that there should be a certain amount of flexibility. I have heard of cases in a local authority where, at a week-end, for example, there were a number of breakdowns regarding ambulances and, for some reason, there was not a battery in the stores or something of this kind and an officer was faced with the problem of whether he could just get a battery and put it into an ambulance. Faced with this thought of the local government auditor looking over his shoulder, it was a real dilemma, a real problem. This is the sort of situation which I think needs flexible treatment. I would just be interested in the Minister's comment on this. Even if nothing can be done at this stage, I hope this is another aspect of local government administration which we will shortly see reformed and developed. I would refer again to the approach of my old friends, the Devlin group, looking into this situation generally.
The Minister for Local Government is examining the whole structure of this audit system. I cannot anticipate what he would like to do about it. As the Senator knows, as far as the battery and ambulance are concerned, I am not sure of the exact instance but the CEO and the county manager can give delegations of authority for miscellaneous purchases for emergency purposes so that a person need never be surcharged. When these occasional circumstances arise that look very peculiar—appalling, indeed—I think it may be that the existing legislation has not been properly followed by someone and, for that reason, the battery could not be obtained for the ambulance. Anyway, all of this code is being examined and it needs modernisation. When I was first Parliamentary Secretary in 1944 the then Minister for Local Government, Mr. Seán MacEntee, gave me, as one of my first duties to get my teeth into understanding the work of the ministry, the work of clearing up the audits of arrears in all the local authorities: some were seven years in arrears. We got it done in two years. It gave me a lot of experience of the audit system.
I want to draw the Minister's attention to subsection (2) of section 27 where there is a reference to "(including any enactment passed after the passing of this Act)". Is all this necessary? There is a general provision about subsequent enactments to any enactment referred to in this Bill. We have four enactments referred to by name here and yet, again, there is, in this, special provision about enactments passed after the passing of this Act. Perhaps, this was in before the Minister's amendment?
This is going backwards. Every section goes forward.
No—"(including any enactment passed after the passing of this Act)".
For the sake of tidying it up, the Minister might look at it.
I should like to go in for consultation before I started tidying-up of that kind. I could not say when we will consolidate the health law. It would depend on the work load on the draftsman.
You would spend a year on it.
Question put and agreed to.
Sections 28 and 29 agreed to.
Question proposed: "That section 30 stand part of the Bill".
This is part of the complex situation I do not understand. The phraseology in this section seems very rigid: "A health board shall not, save with the Minister's consent, incur expenditure for any service or purpose within any period in excess of such sum as maybe specified..." One wonders whether a small amount of discretion would not be given for the transfer from one type of service to another.
If I had the opportunity, I would have worded the section differently. Take the rather negative statement made in subsection (2) (b):
If at any time the chief executive officer of a health board is of opinion that a decision or proposed decision of the board would incur expenditure by the board in contravention of this section, he shall so inform the board and the Minister.
That, of course, is the disciplinary section. I understand that if there was an emergency in the region of a health board, it really would be in practice a matter of telephoning to get the thing looked after.
I hope there is no telephone strike.
I think it is important that we should have proper budgetary control. Again, it is a question of commonsense. I do not think the health service will be impeded by insisting on proper budgetary control over the ordinary service. I guarantee that this will not limit the application of money for emergency services—sickness, outbreaks of disease or emergency due to flooding or anything else, it will not happen.
At the beginning, in subsection (1), it says:
A health board shall not, save with the Minister's consent, incur expenditure for any service or purpose...
Then, at the end, in subsection (2) (b), it says that, if expenditure has been incurred, the Minister shall be so informed. I do not follow this reasoning or this wording. Am I correct in my deduction?
This is a matter for the CEO—warning the board that they are breaking the rule without the Minister's consent. It is purely a disciplinary expression.
Would it not seem that there should be a built-in flexibility in the budgeting and that it would be up to the health board to use any over and above expenditure? This idea of having to ring back to headquarters in Dublin on every item of expenditure going over and above what is here seems outmoded administration. Surely every concept of modern administration allows delegation of authority?
I think the regional health boards will have a sum for contingencies already. There is nothing objectionable to having an amount down for contingencies. I do not think the Senator need worry about the applicability of this section to the financing of health boards.
Question put and agreed to.
A number of amendments are cognate in principle. It is suggested that amendments Nos. 46, 47, 48, 50, 51, 52 and 53 be debated together, with separate decisions if necessary.
Government amendment No. 46:
In page 16, subsection (2) (b), line 23, after "Minister" to insert "after consultation with the Minister for Local Government and".
These amendments arise from discussion in the Dáil on the provision in the Bill for the allocation of local contributions between contributing local authorities. Section 31 (3) provides that this will be determined by regulations made by the Minister for Local Government. The point was made during the debate that it would be preferable to follow the precedent of the Health Act, 1960, in relation to health authorities and allow contributing authorities to agree on the proportion of contribution of each constituent part of a health board and, in the absence of agreement, to allow the proportion to be determined by an arbitration appointed by the Minister.
These measures are designed to make these changes. If members of various local councils concerned with a particular health board agree on the basis of allocation, this can come into effect with the consent of the Minister for Local Government. If they do not agree a person would be appointed to make a determination of the allocation of expenses. There must be, in the event of agreement or determination, a provisional allocation specified by the Minister, subject to adjustment after agreement or determination is made. This is the purpose of amendment No. 46. The Minister for Local Government must be consulted on the level of the supplementary grants that will be given under section 31 (2) (b). Amendments Nos. 50 and 52 are consequential on the preceding amendment. All this was debated in the Dáil and those who read the Official Report will know the purpose.
Amendments Nos. 46 and 47 are ministerial amendments. It is an extraordinary thing but amendment No. 48 corresponds practically word for word with amendment No. 47—the latter is a ministerial amendment and amendment No. 48 stands in my name. I do not know how this occurred; we must have copied from the same exercise book. However, I congratulate the Minister on making these changes. As a member of the Dublin Health Authority on its inception in 1960 I know that it took about six months to negotiate an arrangement but an arrangement was mutually arrived at and it has worked for more than nine years in a very satisfactory manner. This was 85 per cent based on a services-rendered basis and it has worked excellently. The Minister is wise in stating that, if a board can get together and agree among themselves, they should be allowed to do this instead of forcing methods of contribution upon them. I welcome what the Minister has done and I am grateful to him.
Amendment agreed to.
I should point out to the House that if amendment No. 47 is agreed amendment No. 48 may not be moved.
Government amendment No. 47:
In page 16, to delete subsection (3) and substitute the following:
"(3) The expenditure of a health board established by this Act which is not met by grants under subsection (2) and other receipts shall be contributed by the local authorities required under this Act to appoint members to the board in such proportions as those authorities may agree upon with the consent of the Minister or, failing such agreement being made within a period of six months (or such longer period as may be approved of by the Minister) after the day of the establishment of the health board, in such proportions as may be determined by a person appointed for that purpose by the Minister.
(4) An agreement or determination under subsection (3) shall have effect as from the establishment of the health board to which it relates.
(5) (a) An agreement under subsection (3) may be varied—
(i) by agreement between the local authorities concerned made with the consent of the Minister, or
(ii) by a person whom the Minister, acting at the request of one of the local authorities concerned, appoints to review the agreement.
(b) A determination under subsection (3) may be varied—
(i) by agreement between the local authorities concerned made with the consent of the Minister, or
(ii) by a person whom the Minister, acting either at the request of one of the local authorities concerned or on his own initiative, appoints to review the determination.
(6) The making of an agreement under subsection (3) or a request under subsection (5) by a local authority shall be a reserved function for the purpose of the County Management Acts, 1940 to 1955, or the Acts relating to the management of county boroughs, as may be appropriate.
(7) (a) Pending the making of an agreement or determination under subsection (3), the expenditure of a health board which is not met by grants under subsection (2) and other receipts shall be met, in such proportions as may be specified by the Minister, by the local authorities required under this Act to appoint members to the board.
(b) The specification proportions under paragraph (a) shall be subject to the relevant agreement or determination pursuant to subsection (3) when that agreement or determination has been made, and appropriate adjustments shall be made accordingly."
Amendment agreed to.
Amendment No. 48 not moved.
Is it in order for me to move that business be suspended at this stage?
Is it not possible to dispose of amendment No. 49?
I do not think so, if the Minister has no objection.
I am quite willing, but I should prefer if the House were to resume at 5 p.m. However, I understand 5.30 p.m. has been agreed to.
It is a matter for the House to control its own time of meeting.
The time of 5.30 p.m. was suggested to me.
I should like to facilitate the Minister in this regard. If every Senator were here I would ask them to facilitate the Minister, but it is unfortunate that they are not all here and I cannot take it upon myself to change the time. The Minister and the Leader of the House will understand the position.
Business suspended at 1 p.m. and resumed at 5.30 p.m.
I move amendment No. 49:
In page 16, before subsection (4) to insert the following new subsection:
"( ) A person in making a determination under this section in relation to a health board established by this Act shall have regard to—
(a) the opinions of the Commissioners of Valuation as to the fairness and equity of distribution of valuation between different local authorities,
(b) the amount of rates in proportion to the total rates payable to a local authority written off as noncollectable by each such local authority,
(c) the amount of rates waived by each local authority under the Local Government (Relief of Rates) Act 1969,
(d) any evidence as to the average income of the ratepayers paying rates to each local authority made available to him by the Central Statistics Office,
(e) any formula the Minister for Local Government may publish for the guidance of the person making such determination for the more equitable distribution of the burden of rates between local authorities."
We had some hestitancy in putting down this amendment in so far as we wondered whether it would have, if adopted, the effect of preventing agreement being reached by the health authorities in relation to the distribution of the expenditure which, we agree with the Minister, is a desirable thing, in so far as any local authority looking at sections of this kind might be tempted to think that, if they disagreed and then relied on determination by a person guided by these principles, they might do better with the application of these principles. On balance we decided that it was right to put down the amendment for the House to consider it and the Minister's mind to be directed to it.
As I said on Second Reading, and it has been emphasised by almost everyone on this side of the House, the one part of this Bill that we are unhappy about is the financing of it. In so far as health expenditure will be falling on the rates, to that extent it will represent regressive taxation, that is to say it will be paid by people irrespective of the income they enjoy. I felt it well to address the House and to direct the Minister's attention to a point that I do not think can be over-emphasised, and that is that in a developing area such as the city of Dublin, for example, where the demand for accommodation is in excess of the supply, rates always represent in effect a tax on accommodation. Whatever contractual arrangements the tenant may have with his landlord or whatever his statutory rights, in effect the burden of rates in a society of this kind finally falls upon the tenant. He pays it in accordance with the accommodation he has, its cost to him in the market.
It seems a bad principle that, where it is proposed to extend the health services in this admirable way, the people will to an undisclosed degree pay in extra rent for the cost of these additional health services. It is probably a good economic proposition to say that a reverse situation exists in, say, the undeveloped areas of the country and that the effect of increasing rates is to encourage what no one in this House wishes to encourage: emigration from these areas.
The object of this amendment is to achieve within the context of the existing valuation system a fair distribution of the burden to ensure that, as far as possible within existing legislation and before there is a revised system of valuation, as much fairness as possible will be achieved, that the poorer the county the less that county will have to pay.
I should like to say to the Minister that there has been very useful work done on this whole question of valuation and if the attention of the experts were directed to the question of where the burden lies heaviest it would be found that an excessive burden is falling on certain counties. I made the point in this House before that at the time of the valuation of land in Ireland the areas of land near the sea which have the benefit of natural fertiliser were on the whole valued more highly than the areas further inland. There is evidence, too, of the burden of rates to be found in the established figures for the amount of rates which the poorer counties, counties like Mayo, simply cannot collect every year and there is further evidence in that there is a waiver of rates in the Local Government (Rates) (No. 2) Bill which is proceeding through this House. One of the reasons which made my colleagues and I come down in favour of this proposal was that it might encourage local authorities to actually implement schemes for waiver of rates if the effect of doing so might be to achieve a determination in their favour in the distribution of the burden of expense between the different local authorities forming a particular region.
Senator FitzGerald has raised very interesting issues but I do not want to initiate a debate on the general question of the rates because we could spend a great deal of time at that, as was spent on the Second Stage of the Bill. Of course, this whole question has been under study by a rating committee in the Department of Local Government. Rates bear heavily on certain classes of persons—everybody admits that— people with permanent unchanged incomes and on certain poor persons. If you take some statistics they show the relative fairness in the application of rates. I think that I am right in saying that since 1958 industrial earnings of the people have gone up at about the same level as the increase in total rates in Dublin Corporation, but then again industrial earnings do not apply to all sections of the community. Those Senators who read the various reports will know that rates as a total percentage of all expenditure have been declining steadily in the last ten years. In fact, for the whole country the State pays 75 per cent of all health expenditure including the proportion of the agricultural grant that has to be raised to meet the health proportion of county council expenditure which it is correct to include in it. That, again, does not cover many of the smaller towns. If you look at the last table prepared, which I think dates back to 1967/68, of rates per head of population in various counties, you will find for example that in County Mayo where they have a huge rate, the rate per head of the population compares favourably with that in some other western counties such as Sligo or Leitrim.
A number of factors of that kind are there, and then there are other difficulties that have arisen as has been admitted on both sides of the House. The House knows that we have passed an Act enabling rates to be paid by instalment. There is too the very complicated psychological impact of rates, that element of it that if you drove a medium sized car two years ago 10,000 miles you would be paying £65 in petrol tax and that would correspond to a rate figure for a house of £65, which being paid in two half-yearly instalments imposes a psychological as well as a financial burden on the person concerned, whereas if it could be paid by instalments or by a system of fixing stamps on a book it would tend to be easier as a burden. There is that element of it. There is the arrangement now being made whereby local authorities can raise an aditional rate for the remission of rates on persons in needy positions.
Having said all that, it is true that this problem has not yet been solved. As Senator FitzGerald knows, it is a complex problem because for example social welfare services are increasing and that contributes towards the payment of rates in certain instances. We also had the case two or three years ago where we did give some remission in income tax for people living on very small unearned incomes. It was no great remission but it helped. Study of this rates position is continuous.
The Senator has proposed an interesting amendment with which I have some sympathy, and I think that the people who decide allocations of rates should perhaps make a greater study than they do at the moment of all the elements that go towards a fair allocation of rates. The only thing is that there are a number of matters that the Senator has not included in his statement as an element, for example, expenditure payable out of rates in the past few years which would have an effect on the allocation of the rates. There is the obvious method of division in the Dublin Health Authority on a services rendered basis, and there are recent statistics on county incomes published by the Economic Research Unit. Senators will be interested to read that particular volume. I advise them to get it. Unfortunately it deals with incomes per head 1960 and 1965 and the increases that took place relative to different counties. It places the counties of Ireland in order of income per head—agricultural income and other income—and in various ways it is a most interesting document. I am not aware how far it is accurate and whether there are errors in it which might be cumulative and which would affect the whole field, though they might to some extent cancel each other out. I am not aware whether the Statistics Office could say that you could, using some general factor, increase the income per head from 1965 to 1969 and make it applicable to rates to be struck, for instance, next year. Nevertheless this is the kind of documentation which should be considered. I think that it is an advance in thought on rates, a subject on which thoughts have been expressed on both sides of the House and I am sure that Senators on my side would equally feel that this kind of treatment of the subject is valuable.
I will consider, perhaps, putting in a clause whereby by regulation studies of relevant variations could be taken into account. How much use this will be I would not like to say, because Senator Alexis FitzGerald appears to have made a study of rates and if he has he knows that it is a far from simple matter. He knows that you hear experts on valuation based on the letting value of property by a willing seller to a willing buyer expressing views that this has become irrelevant in certain circumstances and that in other circumstances it is relevant. It is a highly complex business and we are still investigating it.
Very complex. I do not know it.
The Senator being a very humble man is admitting that he is unable himself to frame any definite statements on the whole question of valuation. Then there is the great difficulty of re-valuation which I cannot go into now. I think that if I put in regulations under which the people who make these decisions will have to have regard to certain matters it will give them at least a guideline upon which to go—not absolute but some kind of guideline. I will of course have to consult the Minister for Local Government on this, but I will propose to introduce regulations as to the matters to which the people concerned will have to have regard in this.
I am most grateful to the Minister for his reception of this amendment. I did not attempt to set out all the sorts of matters that the person making this determination should have regard to. The Minister has used in his reply the very word I failed to use when I moved the amendment, the title of "guidelines". That was in fact the object of the amendment. A very interesting statutory example of that, if I might direct the Minister's attention to it, is in the Restrictive Trade Practices Act, 1953. A list is given which does not exhaust the definition of what is a restrictive trade practice by examples of what would be restrictive trading practices. It is the same sort of idea.
Amendment, by leave, withdrawn.
Government amendment No. 50:
In page 16, to delete subsection (5) lines 34 to 37.
Amendment agreed to.
Amendment No. 51 not moved.
Government amendment No. 52:
In page 16, to delete subsection (7) lines 46 to 51.
Amendment agreed to.
Amendment No. 53 not moved.
Question proposed: "That section 31, as amended, stand part of the Bill."
As much as I should like to facilitate the Minister in this arduous work he has to do—I know he wants to get the Bill as soon as possible—in principle we must oppose the section as a whole in that it imposes too great an onus on the ratepayers. We feel that it is not a correct way of financing the health services. We think there is another way that would be more equitable, some sort of contributory insurance scheme, and on this basis we intend to oppose the section.
I will not go into all the arguments that were made in the Dáil because to reiterate what was said in the Dáil, all the cross-talk that occurred there about methods of financing the health services, would not be of any avail here: it has been heard by many people and read by many people and I do not think repetition here would get us anywhere. I will, however, repeat that as a party we are opposing the section on account of the method of financing. We do not feel that financing through rates is the correct method; we feel that financing through an insurance scheme is the correct wav.
I do not think I should start a debate on this. We had it in the Dáil on a considerable scale on the Second Stage and indeed on the Committee Stage. I feel that, though the Dáil will meet on February 4th, it is incumbent on me to mention to the House that the Minister for Finance has agreed to provide a further supplementary sum over and above what would correspond with the total proportion of additional contributions by the State—the amount was 55 per cent last year, excluding the agricultural grant—an additional sum which would have the effect that the increase in respect of rates for health will be only very modest.
I am not permitted, naturally, to indicate a budgetary amount before the Budget takes place, so I use the word "modest"—only a modest increase will occur and therefore nothing extra will impinge really severely on the ratepayers. As I have said, it would not be right to disclose Budget statements. I daresay Fine Gael will still feel the same. In addition, there is an amendment coming forward about a contributory scheme. We have been going into this: my party also are interested in a contributory insurance scheme. It has immense complications.
There are three classes to be considered. First of all there are the farmers, and there are arguments against levying any further contributions from farmers, even from those above the medical card limit, on grounds that would be very quickly expressed by many people in both the Fine Gael and Fianna Fáil Parties. Then there are the self-employed persons whose contributions would have to be levied by some machinery organised by the Revenue Commissioners. This alone would be extremely complex. Then there are the social welfare people, and if you exclude those people who have medical cards from making contributions it would involve enormous difficulty. You could hardly allow an additional stamp and then refund the money to the medical card holders who paid for that stamp.
One could say that employers could pay health contribution for those in the social welfare group, who hold medical cards, and that people in the middle income group would pay the contributions themselves. That again involves considerations of a most difficult kind. I find myself also beset with another problem. We know very little in this or in any other country about the incidence of taxation, about how many in the middle income group are paying what proportion of taxation of all kinds. I say to members of my own party who ask us to consider it that I just wonder how popular this insurance contribution scheme would be. I wonder how many people would begin to say: "It is not really insurance. It is just another way of collecting taxes and rates from me". I wonder how many would feel it is equitable.
Despite these difficulties, the Government are examining this scheme. I am not sure it should not be examined in the general context of the total sum value of incomes. I am not sure whether it should not be levied solely for health purposes. That is my honest opinion and it is not stated with any political forethought or simply to establish a political point. It is very interesting that at the Ard Fheis of our party there were people thinking on this basis. Therefore, it is not any longer a party political issue and therefore I do not need to point out the anomalies that exist in the Fine Gael scheme. Therefore, Fine Gael should admit that there are variations in their scheme and a certain lack of consistency of approach.
I do not need to go into that. They present a scheme which we might not, were we on the other side of the House, have been able to present. I still am not able to announce that a contributory scheme has been approved by the Government because of the difficulties it would involve, particularly the psychological difficulties. I stated earlier that there is not only the financial effect of taxation, that there is the psychological effect involving the payability of taxes, the feeling of whether the tax is fair in a particular instance. This is very important now when we are taking 30 per cent of total income values in taxation and rates, which means that we have joined the high level tax group of the advanced democracies which are also the most prosperous democracies. It is something which would make the old Victorians wince in the matter of extremely high taxation and rates.
We have reached a phase of thought in this which is very interesting. There is this psychological impact, and to my mind nothing would be worse than to introduce a contributory insurance scheme which would be intensely resented by a great number of people although the Government of the day thought it extremely equitable. Now, that is what I really feel about it. The matter is still under consideration and it may have to remain under consideration for some time.
There is also the question of its introduction and all I can say is, and I do not think there is any reason why I should not say this, that the collection of taxes from the self-employed community would involve changes in the method of collection by the commissioners for revenue and would involve also the climax of certain administrative changes in the use of the computer that are now taking place and it could not possibly be introduced economically for quite a considerable time while these gradual changes in the use of technical methods are being introduced.
I am being absolutely fair to both sides about this. I do not think I should say anything more about that. I have told the House, first of all, that there will be an extra sum in the Budget and through which the increase in the health rates will only be modest, and secondly, that the contribution scheme has been thought of in a sympathetic way, by myself, my party and the Government. We have already a great deal of data on it, and we are continuing to examine it but I cannot announce approval of it yet.
The Minister has been very explicit, very kind and gracious in his reply to me. I welcome the supplementary grant the Minister for Finance has promised. The Minister mentioned keeping the rate levy for health down to a few pennies.
I did not say a few pennies, I said a modest amount.
Well, a modest amount. There are a few aspects of this which I should like the Minister to consider. He did say that some type of contribution scheme is being examined, that certain complexities were involved and that it would not be workable for about four or five years and therefore if we let this remain the way it is we will still have the demand on the rates. The supplementary grant will reduce this year—I think the Minister was referring to this year——
The coming year, 1970-71.
Yes, the coming year. The grant will be in relation to the estimates for the coming year. There is one point which has not yet been mentioned here, although it may have been mentioned in the Dáil, and that is that the implementation of this Bill when it has been enacted will, within its first year of enactment, increase the cost to the ratepayers by approximately 50 or 60 per cent. That is my view; it may not be everybody's point of view. When you come to consider the various concessions being made and which have to be paid for by the health boards—possibly the fee for service for doctors, possibly taking out the income of dependants, all of which I agree with—then in regard to the actual cost of running the finances of the country, which are now running at the rate of about £51 million— I am open to correction on that—then within two years it will be running at the rate of about £85 millions to £90 millions. At that stage the impact on the rates will be so great that there is sure to be an outcry. While the Minister has said that he is examining a type of insurance contribution, that is so far away that it not material to the examination of this Bill. Although the Minister has been very frank I am afraid I must still press the amendment.
The Senator can press for the rejection of the section but he has got the question of the increased costs of the services recommended in the White Paper—I think he said £60 million to £80 million—completely wrong. The cost in improvements or extensions of services as estimated back in January, 1966, was £4,265,000. Some of these estimates have proved to be incorrect because of changes that have taken place. Some of the services have already been established and I would say that on a rising basis over the next three years, not including any inflationary element, the extra cost would be between £1 million and £3 million. We are carrying out the policy stated in the White Paper, that the cost of the further extensions of the services should not be met in any proportion by the rates, which means that the taxpayer would have to pay the cost of the fee for service arrangements and not the ratepayer. If we provide long-term disability benefits for children in hospital regardless of the income of the parents that extra cost will be met by the taxpayer and not the ratepayer.
As I said, this promise is going to be kept and the extension of services, such as the new system of child health examination which I announced the other day, will be paid for by the taxpayer. The Senator is being extremely pessimistic and perhaps he is being pessimistic because of the fearful effect of inflation. However, we cannot have a debate on that; it takes place in other countries but it has been particularly pronounced here in the last two or three years. Inflation affects costs and to some extent it also increases the buoyancy of taxation. At least we have that one relief, that it increases the buoyancy of taxation. I do not think the House should divide on the basis of this frightening estimate of increased costs resulting from improvements in the services. Some of these services will be of very great value but they will not cost a great deal.
At present the cost of providing the middle income group with the hardship allowance is costing the State £100,000 to £120,000. If during the next four years we were to say that they would never pay more than £X per month for drugs it would not cost us a great deal but it would be of great help particularly to those in the group affected, as Senators will appreciate.
The cost of establishing a national standard for medical card holders is a very valuable improvement. It will help many families and it will not cost the taxpayer a great deal. I think the Senator is very, very pessimistic about this. I have been very careful to say I am not including any possible inflationary effect on the general economic situation, but I think the Senator has exaggerated.
May I repeat what I have already said twice here: people have asked for improved health and improved social welfare services. If we have a real increase in the volume of gross national product in ten years of 50 per cent, completely eliminating the inflationary cost, and a real increase in the volume of health expenditure, completely eliminating the extra cost of salaries, wages, materials, hospitals and so on, of 100 per cent this is a very great social advance. We may ask for more. It will involve a redistribution of incomes for the purpose of ensuring health services particularly to those in need of them and on whom such services bear heavily in time of illness.
I should like to assure the Minister and the House that opposition to this section and to the method of financing is not based either on the figures given by way of illustration by Senator Belton or on any suggested limitation of health services in the future. The difference of opinion, which the Minister clearly appreciated in his earlier remarks to be a valid difference of opinion, as to the best method of financing the health services is in fact the only point at issue at this moment. It is welcome to hear from the Minister that further financial support will be made available during the next financial year. However, those of us who are worried about the unsuitability of the present method of financing feel that this financial prop is a prop being put in to support an already tottering structure and, while it is welcome in order to prevent any intensification of the danger of the collapse of the structure, nevertheless what is needed here is, in our view, a complete overhaul. We have given our views on this particular subject. They were never put forward as a final scheme. They could never have been put forward as a final scheme by a party in opposition, but we believe this is the direction in which we should move and in this section of this Bill there is no move in that direction. We are so strongly convinced that this is the proper direction that we believe a move in this direction should have been incorporated in this new health charter. For that reason, we must relucantly oppose the section, not on the question of what increases are to come and the justification for them but merely on the precise method of their payment.
The Minister has been typically gracious. On the other hand, he has also been a typical advocate of the Government's policy in relation to the financing of the health services. We must be grateful to him for the two assurances he has given: first, the Minister for Finance will make an extra subvention over and above the 55 per cent given in the last few years and, secondly, the Fianna Fáil Party has eventually come to realise that there may be some merit in the Fine Gael proposal that the health services should be financed on a contributory basis. Because the assurances are so vague, however, they do not allay our fears and they do not convince us that we should not oppose this section and oppose it vigorously.
We are opposed in principle to placing approximately half the cost of the health services on the rates. While the Minister may say that, because of the extra subvention the Minister for Finance intends to give in the next Budget, only a very modest increase will fall upon the rates, to me personally and, I am sure, to many of my colleagues this is the typically vague sort of remark thrown out some months before the Budget is introduced. For that reason this is something we cannot accept. The rates in County Dublin will suffer an increase of 4/- in the coming year to meet the cost of health services. How much of that 4/- must be mitigated so that we may describe the increase as a modest increase? I should imagine at least 3/6d; 3/6d would amount to about £150,000 of additional subvention for County Dublin alone. I cannot visualise the Minister for Finance giving that additional subvention under the present system, the system which will be continued under section 31.
The Minister has shown a great deal of interest in the scheme put forward by us and for that we should be grateful to him. To suggest that it might be an inequitable scheme because it would place an additional burden upon the middle income group does not seem to me to be a fair or realistic approach.
The Minister did not say that.
The ratepayers are financing the health services to a great degree and, in the main, the ratepayers are the people who do not benefit because they are the people earning over £1,200 a year. Any scheme which results in those who are better off having to finance the health services for the benefit of those who are less well off could not be any more unfair or unjust than the present system, bearing in mind the cost of the health services at the moment. The new administrative set-up will undoubtedly bring about increased costs. Some of the better provisions in the Bill—there are many of them—will undoubtedly cost a great deal more than the health services are costing at the moment. The salaries and wages of officials will increase. The health services generally will cost more.
Senator Belton estimated the possible increase in the cost of the health services over the next two years. The Minister was not inclined to accept his figure, but it seems to me, bearing in mind that section 31 intends to continue the present system of financing, the ratepayers will, in five years time, be paying at least two-thirds more through the rates for health services, perhaps improved health services, than they are paying today. On both sides of the House we know the intolerable burden the rates constitute today. I do not think the Minister and his colleagues envisage salaries and wages increasing by two-thirds in the next five years.
I do not think the Minister, who has a better grasp of the future of the health services than most of us here, would categorically deny that the cost of the health services to the ratepayer will increase by less than two-thirds in the next five years. If he did he might very well be presented with a set of figures in 1975 which would prove him wrong as, indeed, figures can now be presented in this House which prove some of the statements of his predecessors to be very wrong and to be grossly underestimated. Therefore, on behalf of the ratepayers and the electors of this country, on behalf of our party with a carefully documented policy, I say that while bearing in mind the many good sections in this Bill we cannot accept the provisions of section 31.
The opposition to this section is a follow-up of the tactics used in the dissolution of local bodies recently and it would seem that they have less reason behind them. In one section they are calling for the inclusion of dissolved members and then in another one they are telling us that if these men are reinstated they will do the same thing next year because they feel this thing is wrong. Will they tell me simply how it would benefit the poorer section of the community to have this amount taken from the rates and put back on these very same people in direct taxation? Big businesses here in the city of Dublin have premises with £3,000 and £4,000 valuations as against the £30 valuation of the private house and are, therefore, paying £3,000 or £4,000 for every £30 paid by the private house owner. The big business man will be smoking his packet of cigarettes, drinking his pint of beer or using his gallon of petrol as an individual and paying at the same rate as the ordinary person. There is a definite protection being voiced here by the Fine Gael Party in favour of the richer classes, the business people of the city and I believe that is what is behind their comments. I cannot understand Labour's attitude because their supporters have most to gain by the retention of a certain amount of the health charges on the rates. I cannot understand the argument that taking this money off the rates will benefit the people. I should like some of them to tell us how exactly the community will benefit by this change.
To the dismay of the Minister I have to say something on this subject. The alternative to rates is not direct taxation merely; it is direct taxation and indirect taxation. Direct taxation protects and ought to protect progressively the incomes of the people. As their incomes get larger they should pay proportionately more and they do pay proportionately more; some may think insufficiently more in proportion but direct taxation is the form of legislation which protects. In the case of indirect taxation you can abstain from buying a drink, you can abstain from buying cigarettes, you can abstain from doing things to some degree. However, in relation to rates, you are in premises and it is not easy to be hopping around to new premises. To suggest that those who are opposing this section are in some way in favour of rich people is grotesquely unfair particularly in the context of the fact that I have said here a few times that the valuation system is inequitable and should be reduced in favour of the people who need to have the inequities of the system altered.
Would the Senator's party advocate revaluation of the country?
I do not know what the expressed views of my party are on the subject but I have advocated it here.
Do not let us get started on a discussion on valuation.
The Committee divided: Tá, 24; Níl, 14.
- Ahern, Liam.
- Alton, Bryan G.
- Bourke, Mary T.W.
- Brennan, John J.
- Crinion, Brendan.
- Eachthéirn, Cáit Uí.
- Farrell, Joseph.
- Fitzsimons, Patrick.
- Flanagan, Thomas P.
- Gallanagh, Michael.
- Garrett, Jack.
- Hanafin, Desmond.
- Honan, Dermot P.
- Jessop, W.J.E.
- Keery, Neville.
- McElgunn, Farrell.
- McGlinchey, Bernard.
- Nash, John J.
- Norton, Patrick.
- Ó Maoláin, Tomás.
- Ryan, Patrick W.
- Sheehy Skeffington, O.L.
- Sheldon, W.A.W.
- Walsh, Seán.
- Belton, Richard.
- Boland, John.
- Dooge, James C.I.
- Dunne, James.
- Farrelly, Denis.
- FitzGerald, Alexis.
- Fitzgerald, Jack.
- Horgan, John.
- Kelly, John.
- Lyons, Michael D.
- O'Brien, Andy.
- O'Higgins, Michael J.
- Owens, Evelyn P.
- Reynolds, Patrick J.
Tellers: Tá, Senators Brennan and Joseph Farrell; Níl, Senators J. Boland and Reynolds.
Question declared carried.
Section 32 agreed to.
I move amendment No. 54:
In page 17, before subsection (2) to insert a new subsection as follows:—
"( ) (a) If immediately before the commencement of this section Eugene O'Keeffe was Chief Executive Officer of the Dublin Health Authority, he shall become by virtue of this subsection Chief Executive Officer of the Eastern Health Board.
(b) If immediately before the commencement of this section James Joseph Nolan was Assistant Chief Executive Officer of the Dublin Health Authority, he shall become by virtue of this subsection Assistant Chief Executive Officer of the Eastern Health Board.
(c) If immediately before the commencement of this section Randal Neal Lamb was Secretary of the Dublin Health Authority, he shall become by virtue of this subsection Secretary of the Eastern Health Board."
This amendment came before the Minister already in the Dáil and he was to a great extent sympathetic with the idea but he felt that local government procedure or some procedure would preclude him—the Minister can correct me if I am wrong in this— from doing what is in the amendment, that is, to provide that if immediately before the commencement of this section Eugene O'Keeffe was chief executive officer of the Dublin Health Authority, he shall become by virtue of this subsection chief executive officer of the Eastern Health Board. The Minister felt that there was a stumbling block there, although he was sympathetic with the idea. He did concede, however, that whatever position Mr. O'Keeffe got within the new Eastern Health Board, the two following gentlemen, Mr. Nolan and Mr. Lamb would rank immediately after that in the way they rank in the Dublin Health Authority at the moment.
When I was speaking on section 4 I adverted to the fact that I wondered what the functions of the new health boards would be in the interim between their establishment in the autumn of 1970 and the spring of 1971 when they would come into operation, and the Minister said that they would be working with the current health authorities. They would be examining the methods of the current health authorities and they would be examining the method of estimating for the year 1971/72.
It seems to me, therefore, that it is extremely logical that, in an area like the Eastern Region Health Board area, which will be dealing with the health of well over one million people by the time they come properly into operation, the three gentlemen mentioned in this amendment would be of inestimable value in that transition period. Not alone that, but, if they were appointed in the autumn of 1970 to the positions suggested in this amendment, the transition period would not contain so many rocks to perish upon. I know it is the Minister's intention that this should commence smoothly and run smoothly and be an effective method of administering health throughout the country.
The objection has been raised that names have never been mentioned before. I shall not enumerate the Acts but in various Acts people were mentioned by name. When the managerial system was set up, various people were mentioned by name. That procedure is not inconsistent that people should be mentioned by name.
Although not officially the manager of the Dublin Health Authority, Mr. O'Keeffe has been CEO of the Dublin Health Authority and, furthermore, he is the only CEO of a health authority in the country. Consider the experience these three gentlemen have gained in the formation of the Dublin Health Authority in 1960 when various divergent bodies had to be assembled —the Rathdown Board of Assistance, the Balrothery Board of Assistance, and various other bodies: I think there was a total of seven bodies in all which they had to agglomerate and bring into one unit to get them functioning. They have experience of commencement of an organisation like this. They have experience of initiating an organisation like this. Another factor is the great work which is on record that they have done since the establishment of the health authority.
This is not in any degree a political viewpoint. As a matter of fact, there could inadvertently have been appended to this amendment the name of Senator Seán Walsh who is in entire agreement with it.
It is not a political amendment.
I am sure the Minister appreciates that completely. Every side, I think, appreciates the work of these three gentlemen and every side would like to see them in charge of the new body, namely, the Eastern Region Health Board, for the various reasons I have enumerated.
I feel the Minister should re-think on this. In speaking, he has shown sympathy with this idea but he has not conceded that this should be incorporated in the Bill. We are seeking that it be incorporated in the Bill.
I should like to support this amendment. Senator Belton and Senator Walsh can testify to the success of the Dublin Health Authority and the efficiency of the officers mentioned in this amendment. My knowledge in regard to this matter goes farther back. The Dublin Health Authority, even more than the other health authorities, are precursors of what has been proposed in this Bill. The discussions on the amalgamation of the health services of all types in Dublin city and county go back some 15 years to a period when I myself was chairman of Dublin County Council and at that time took a deep interest in what was proposed and in the discussions concerning the form the new health authority might take. I should like to join the present members of the health authority in urging that this amendment be accepted.
The Dublin Health Authority were an anticipation of what is being applied to the whole country in the Health Bill now before us in the same way that the management system was first introduced in the city of Cork and then introduced in the cities and then adopted for all the counties. So, too, we have had the same sort of development here in regard to regional health services. The Dublin Health Authority was a pilot scheme. Right from the very beginning, it was clear what was to be the position. Mr. O'Keeffe is, in effect, the CEO of the Dublin Health Authority. His position is unique. No analogy can validly be drawn between his position and any other. I do not think the Minister need fear that any analogy will be drawn in the future on the basis of Mr. O'Keeffe's position in order to press further concessions on him.
In law, Mr. O'Keeffe was, on his first appointment, to administer the unified health services of Dublin city and county: he was delegated to do so as an assistant city and county manager. However, it was quite clear, during the years he acted in this position, that he was not acting just as an assistant city and county manager. It was not that he, as one of the three assistant city and county managers, had been delegated to health and that he might, at another time, be delegated to deal with other duties. In the mid-1950's, Mr. O'Keeffe's position carried a higher salary.
When advertised, the position carried a higher salary because it was accepted that whoever was appointed to the position of senior assistant city and county manager would, in fact, be given the health services. It was not that he was selected from among the managers to administer the unified health services of Dublin city and county. He was designated to the particular post which carried this. Therefore, it was natural in 1960 that Mr. O'Keeffe was urged to resign, to break his link with Dublin Corporation, to resign in fact from what was his post as deputy assistant city and county manager in order to devote his entire time to the Dublin Health Authority and this he has done since then. From the first stages of unification of the health services in Dublin city and county it was quite clear that this was of a pattern, at no time was there a break.
All this Bill does is to add a small area to the area of the Dublin Health Authority and to change the name of the Dublin Health Authority to the Eastern Health Board. The position is that the men who have been named in this amendment have been administering 85 per cent of what will be the new eastern region and it is on that basis that the amendment is put. It is on that basis that the argument is made that there can be no true analogy between the position in the eastern region relative to the existing Dublin Health Authority and any other new region and any other existing health authority. The various appointments made to the Dublin Health Authority after 1960 were a true anticipation of what will be done under this Bill when it becomes law for the remainder of the country.
The men concerned should not be penalised because of the fact that they have been part of the pilot experiment; they should not be penalised for the fact that by their work in the Dublin Health Authority they have made a success of this type of organisation— so much of a success that it is now to be followed throughout the remainder of the country. The Minister may well have had some fears in the early days of these discussions that if he gave into what is urged in this amendment he would be deluged by a number of applications from people who thought their case was similar. I am given to understand that the Minister has now received from the appropriate representative professional organisation in Mr. O'Keeffe's case an assurance that in their opinion no analogy exists between the case of Mr. O'Keeffe and any other, that no other case can be considered as even remotely analogous to the one we are discussing under this amendment. It is not merely that those of us here have knowledge of this—in my own case of how Dublin Health Authority started and in the case of other Members of the Seanad of how it has worked since then—but the colleagues of Mr. O'Keeffe see that if this plea is ignored a real injustice will be done to the man who has in effect been a chief executive officer before the Minister got round to creating such a post in the present Bill.
Speaking as vice-chairman of the Dublin Health Authority I would ask the Minister to consider accepting this amendment and have the people concerned—Mr. O'Keeffe, Mr. Nolan and Mr. Lamb—appointed to posts in the new Eastern Health Board similar to those occupied by them at present. When the Dublin Health Authority were formed in 1960 Mr. O'Keeffe was asked to resign from his post of deputy assistant county and city manager on taking up duty as chief executive officer in the Dublin Health Authority. Apart from differences which members of the health authority may have in striking the rate from time to time we are all unanimous that Mr. O'Keeffe has played an important role in making such a success of this authority, and the same can be said in the case of Mr. Nolan and Mr. Lamb.
The Dublin Health Authority were set up in 1960 and have been very successful since then. The formation of the new Eastern Health Board can be said to follow in the footsteps of the Dublin Health Authority and indeed can be described as an extension of the Dublin Health Authority. As Senator Dooge has already mentioned, the health authority are catering for 85 per cent of the territory with which the new Eastern Health Board will be concerned. If the people are to reap the benefits which it is intended they should have it is important that these three men should be appointed to the posts. It was only when I was elected to the health authority in 1967 that I became involved in these matters and I realised and appreciated the work these men performed. Therefore, I would ask the Minister to consider this amendment and have the men appointed to the various posts.
I should like to support this proposal. I am not quite clear about the propriety of introducing particular names into a Bill like this but if it is proper——
——but if it is proper I should like to support the amendment. I am not a member of the Dublin Health Authority or of the county council nor am I a member of the corporation, but negotiations have been going on for some time which will relate the local authority hospitals of this area to the function of teaching. In that respect we have had conversations and negotiations with these three gentlemen, particularly in regard to pathology, and I have been struck by the extremely competent grasp they have of the requirements of teaching bodies in an area such as a hospital. This is a complex matter and one does not very often get somebody who can grasp this type of matter straight away but we have had no difficulty in regard to pathology and I think in other aspects of teaching they are experienced.
I may as well shorten the discussion by saying I am absolutely adamant in regard to this matter. I intend to have the post of chief executive officer thrown open to the Local Appointments Commission throughout the country and in respect of every office of this kind. Moreover, it would set a precedent and could even affect areas such as Cork, Limerick and Waterford and there could even be senior county managers on regional organs claiming some right to be appointed.
I am glad to hear the great compliments paid to Mr. O'Keeffe, Mr. Lamb and Mr. Nolan. Mr. O'Keeffe's position is quite clear. He can apply to the Local Appointments Commission for the position of chief executive officer of the Eastern Health Board automatically with no worsening of his financial position. Mr. Lamb, who I understand is a most efficient officer, will be immediately next under him. I am sorry, Mr. Nolan will be immediately subordinate to Mr. O'Keeffe as deputy chief executive officer without change of salary and Mr. Lamb will be subordinate to Mr. Nolan.
I simply cannot agree to what has been proposed. I wish to have all these appointments open. I wish to give an opportunity to people throughout the country to apply for the positions. I am aware of Mr. O'Keeffe's great contribution to the work of the Dublin Health Authority and the more I hear about his attainments and his efficiency, his dedication and his sense of humanity, all of which have been spoken of in the Dáil and here, the more likely it appears to me that he would receive the appointment as chief executive officer. I do not think Senators can have it both ways. I am absolutely definite about this. I am afraid it does create precedents for me in other directions and I just do not intend to accept the amendment. I think it is a very good thing to have these posts thrown open on the occasion of the changes that are taking place and the establishment of new boards. I very much regret that I cannot accept the amendment.
I am very disappointed to hear the Minister's reaction to this amendment. Apart from section 31, I was in general agreement with many of the sections in this Bill. After hearing a lengthy discussion in Dáil Éireann, after subsequent meetings and discussions which he had with various members and ex-members of the health authority and after the representations which, I believe, he had from colleagues of the officials concerned, I felt the Minister would have understood the position. It does not seem to me that it would place the Minister in a particularly difficult position. The 1955 Act gives him a precedent in that it actually named persons for particular posts. I understand that in the case of the 1940 Act the positions of county secretaries were more or less occupied by the people who it was expected would become county managers. It was envisaged that the Local Appointments Commission would hold a formal interview to interview county secretaries and, if they were found to be suitable, to automatically appoint them as the new or first county managers. In the case of county secretaries not being interested in the position of first county manager, the secretary of the board of health which was being taken into the new county administrative area would then get the next opportunity of being interviewed by the Local Appointments Commissioners.
It seems to me that, as county secretaries in 1939-40 were afforded the first opportunity or first option of being interviewed for the post of county manager, so too should Mr. O'Keeffe be afforded first opportunity and his other subordinate officers in the same way be afforded the same opportunity of being interviewed for the equivalent posts in the new health board. In regard to having their names written into the Act, the precedent exists in the 1955 Management Act.
However, the remarks of the Minister in regard to the efficiency and dedication of these officers will be appreciated by the three members of the health authority who are also Members of this House. We hope and fairly confidently expect that we will see them in equivalent posts in the health board. I would again ask the Minister to have a look at this process which was adopted in 1940 of giving to the county secretaries at that time the first option on the position of county manager and seeing whether this same sort of privilege could not be afforded to these three gentlemen.
I should like to support that. I know what is in the Minister's mind. He is trying to be fair in that he wants to leave the appointments of the CEOs to all health boards open to competition, but his fairness may be running away with him in this regard. As has been mentioned by Senator Boland and others, precedents exist. There is a precedent for naming people but there is also a precedent for putting certain people into certain posts. I do not know which Act it was but when the managers were set up the secretaries were appointed as managers. That was not open to competition. Maybe the Minister for Local Government at the time, whoever he was, had not the fair outlook which the present Minister has, but I would again appeal to him because this is a singular situation.
This is a situation that does not exist anywhere else. The Minister need not fear having the finger pointed at him that he has been favouring any particular person. He need never fear that. Neither need he fear that he has not acted responsibly. Mr. O'Keeffe's position is unique in that there is no other such position in the whole country. It has been pointed out by Senator Dooge that those people whom the Minister fears might object would not do so. There is documentary evidence that that danger does not exist. They would welcome the idea of Mr. O'Keeffe being appointed to the position of CEO of the Eastern Health Board. The Minister was categorical a moment ago that he would not change his view but perhaps drops of water may erode the stone slightly. I hope so. I make another appeal to him.
I am afraid I am quite adamant about it. These very high positions will be thrown open to competition. The more anybody praises those three officers the more I feel that they will have a good chance of participating in this service. Senators cannot have it both ways.
Particularly should he be asked only to qualify for 20 per cent. He is being appointed to the other 80 per cent already.
What would the position of Mr. O'Keeffe be if he did not obtain the position in open competition?
I have already explained that. He is automatically being made deputy chief executive officer of the Eastern Health Board.
What would the position be if Mr. O'Keeffe decided not to apply and go through what he might consider to be the indignity of competing with other officers?
I would hardly think it would be an indignity for Mr. O'Keeffe to apply for this position. I could not accept that it would be an indignity for him.
Presuming for the moment that Mr. O'Keeffe did consider it an indignity to apply?
I said he would become deputy chief executive officer. If he chose to retire, well then he would retire.
And if he retired? If Mr. O'Keeffe just did not apply for the position of CEO what then would be his position in regard to compensation, bearing in mind that as assistant city and county manager and as senior assistant county manager he received a salary which is one-eighth greater than the other assistant city and county manager and that he could not revert to this position at present?
His salary would not be changed and there would be no worsening of his position in regard to his salary. He would become deputy chief executive officer and, therefore, presumably his superannuation rights would remain the same as they were before.
While the Chair appreciates that individuals are named in this amendment, at the same time it would be well not to go into too much detail about pensions, allowances and so on.
Only three options could arise. One is that he would become chief executive officer. The second is that he may apply for that position and may not be appointed to it, and the third is that he may not apply for it at all. We have gone into fairly great detail into the first two possibilities, and in all fairness and bearing in mind that there are individuals named it would be well to establish what would happen in the case of the third eventuality. The question would be whether he would be allowed to revert to his position as deputy city and county manager, which in my opinion he cannot do, and I wonder whether the Minister could clarify this and state whether if he cannot do this there would be any equivalent position for him in the local government or the health service.
I have explained it in a letter to the City and County Managers Association. Mr. O'Keeffe knows about this, and I do not think there is any need to debate it. I think that this debate to an extent has, perhaps, made it clear to the people who will be on the local appointments commission board that Mr. O'Keeffe is a very able man, but I think that if the debate continues any longer it might adversely affect his position. Perhaps, indeed, Mr. O'Keeffe himself would probably not wish the matter to be further discussed, because it might tend to make the local appointments commission board feel that they were being influenced unduly by Senators or Deputies. I think that further discussion of this point should not be pursued.
I will withdraw the amendment with the consent of the other Senators whose names are appended to it.
Amendment, by leave, withdrawn.
Government amendment No. 55:
In page 17, to delete subsection (2) (d) lines 25 to 28 and substitute the following:—
"(d) the transfer of the holder of any health office under the dissolved body to an office under the relevant health board which, in the opinion of the Minister, is similar to that health office,
(e) the transfer, with the consent of the Minister for Social Welfare, of the holder of any public assistance office under the dissolved body to an office under the relevant health board or a relevant local authority which, in the opinion of that Minister, is similar to that public assistance office."
I am very glad to bring this amendment before the Seanad, which arises out of the discussion in the Dáil regarding the future administration of home assistance. Under section 82 of the Bill the responsibility for this will remain with the local authorities, but I did announce in the Dáil on 20th December that it was intended to arrange for the local authorities to delegate under section 24 of the Bill to the health boards responsibility for the day-to-day administration of this service. The case was made on all sides of the House that the administration of home assistance was so closely linked with the health service—the emergence of people from hospital back to their homes, for example, being linked with allowances and the ability to earn income—that it was extremely important that the administration should remain united with home assistance. Under section 33, subsection (2) (b), of the Bill as it stands home assistance officers must be transferred to the relevant local authority, and in order to make the administration of the service completely comprehensive it should be possible to transfer the home assistance officers to the health boards instead of to the local authorities. This is the main purpose of the amendment. The amendment will also make it clear that in the case of health officers the decision on the office to which such person will be transferred will rest with the Minister for Health; in the case of public assistance officers it will rest with the Minister for Social Welfare. The House is aware that there are certain cases where medical officers are almost entirely or to a very great degree engaged in housing matters, and the Bill provides flexible arrangements in connection with their duties, so I am very glad to bring this amendment before the Seanad.
Amendment agreed to.
Section 33, as amended, agreed to.
Question proposed: "That section 34 stand part of the Bill".
I should be obliged if the Minister clarified the position for me because I am probably being more than usually obtuse. Section 45 of the Health Act, 1953, is being repealed, so I take it that section 34 is a sort of a transitory provision. It is the timing of it that leaves me baffled, because section 34 proposes to amend section 45 of the 1953 Act and this particular section is down in the Schedule to be repealed. I am not quite sure what machinery there is under which all this is to happen and the order in which this is to happen, but I take it that this is purely transitory.
It is a transitory provision of the Bill. It deals with the separation of the mental health boards as in Carlow and Tipperary. This does not prevent patients being sent to a mental hospital outside the health board area where that is convenient as in the case of Meath who send some patients to Mullingar, and that will continue. It does not prevent these other health boards or committees, if they choose, having visiting committees to a mental hospital. They can still continue to do it if they think that these committees are useful. I myself would wish that many of those committees would do some more useful work than they have done, but this is an entirely personal opinion, and if they want those committees they can have them. This is entirely transitory.
I do not think it was the substantive subject matter that Senator Sheldon was worried about but the procedure. I think it is a general matter of clarification. It would appear that the Minister is to make an order under an Act which is to be repealed under the Schedule of this Act.
The order will be made before the repeal takes effect.
Will this section come into effect before the Schedule does, because I think it will have to in order to have this implemented?
The section will be used before the repeal in the Schedule takes place.
Question put and agreed to.
Government amendment No. 56:
In page 18, subsection (1), line 36, after "than" to insert "as".
This is purely a drafting amendment.
Amendment agreed to.
I move amendment No. 57:
In page 18, subsection (1), after paragraph (b) to add the following new paragraph:—
"( ) but before designating the real property to be transferred to a health board, the authority shall first consult the housing authority for the area in which the property is located to permit the housing authority to consider if the property is suitable (or needed) for housing purposes."
This amendment relates to land, not buildings, that would be taken over by the new health board, and we are concerned that in a number of institutions there is land available at the present time, perhaps, being used for the production of vegetables, fruit and that kind of thing that might be very useful to local authorities for housing. We are concerned that the local authority would be consulted before the land would be taken over. I realise that a local authority cannot dispose of land without the consent of the Department of Local Government, but we are worried that in this particular case the land can be just taken over by the health authority, taken out of the hands of the local authority, and that that land might be quite useful for building and for the provision of houses. I should like to hear the Minister on that.
I am advised the amendment is not necessary. The only property which would arise for transfer to the health board would be accommodation that was partly used for health services beforehand, and no county council will pass over other property without good reason. The manager would be acting also for the general housing authority. The proposed amendment would add nothing to the section as it stands.
Senator Jack Fitzgerald raised an interesting point, but hospitals and district nursing homes very rarely have additional land except what would be regarded as amenity land. There is land around mental hospitals but the Senator need not have any doubt that if a local authority wish to use such surplus land it can be done without the amendment.
Mental hospital farms, for example?
Amendment, by leave, withdrawn.
Section 35, as amended, agreed to.
I move amendment No. 58:
In subsection 1, page 20, line 11, before "his" to insert "and conditions of service".
I read through the Bill without finding reference to the conditions of service that will exist for officers and servants of local authorities who may be transferred. I am sure the Minister does not have any evil intentions in this respect: indeed he gave a guarantee in the Dáil that there would not be any worsening of the situation. I am not satisfied that this is the proper part of the Bill to have this amendment inserted but I think it is necessary it should be spelled out in some part of the Bill. Officers being transferred feel very strongly that their existing conditions of service should be transferred with them. I am talking mainly here about annual and sick leave and I should like to hear the Minister on the subject. He has been very adamant in his suggestion that nobody will suffer a worsening of conditions but, as he is aware, people are inclined to be a bit subjective on these matters. We had a lot of trouble when the staff were transferred to the Dublin Health Authority some time ago. The negotiations were protracted and difficult and they led to a lot of bad staff relations.
This is a changing position. The whole question of the grading structure under the regional health boards will be examined in the near future and there will be adequate consultation with the organisations representing staffs. There is, for instance, provision for paying the costs of an officer who has to move as a result of any changes that take place. The Senator knows that local authority and Civil Service staffs have a built-in obligation to be transferred in certain circumstances. That is the case in countries with the most advanced social legislation and the greatest possible protection for those in employment.
All I can say is that there is no question of an officer's position being worsened or of their sickness or leave privileges being altered to their detriment. They may be required to move: nurses and doctors must be transferred to health boards and their duties may become redundant. Clerical officers and others may not want to be moved but they can be switched with other health workers who might like to be moved. A joint consultative council will be considering these matters. I think there should be a certain flexibility in regard to the whole of this. These people have a right of appeal to the Minister for Local Government in the case of local government officers and to me in the case of health officers. I do not think the Senator need have any doubt about this matter.
Very often a person feels his position has been worsened though his salary, his remuneration, remains the same and all the conditions of service remain the same. It is very often a subjective matter. I think it is best left to a joint consultative council. Not every individual is likely to be satisfied by what will taken place but, as I have said, there is an appeal to the Minister and if the consultative council look at this in a human and practical way these transfers can be effected without any hardship being imposed.
I thank the Minister for his statement and I do not propose to press the amendment. I should like, however, to give an example. In different local authority areas you have different conditions as regards leave. For instance, church holidays are not worked in some areas but they are in others. If you transfer a man who worked in an area where church holidays were not worked to a regional health board in an area where they are worked, you impose a relative hardship. That is what happened in regard to the Dublin Health Authority. The five-day week was not observed then. However, I accept the Minister's assurance that nobody would be worse off on transfer.
Amendment, by leave, withdrawn.
I move amendment No. 59:
In page 20 to add to subsection (1) the following:—
"Nothing in this section or in regulations made thereunder shall operate to terminate or affect in any way any rights which a person referred to in this subsection had on the 1st day of October, 1969."
I have been reading the section in relation to the transfer of officers and it has occurred to me that no guarantee has been given that there would not be a lowering of remuneration or a loss to an official on transfer. It might be said this is implied, but when we are considering matters of this nature it should be specifically stated that a person would not suffer. The wording in this section is identical with that in section 40 (14) in relation to consultants and we ought to give the same guarantee to other staffs transferred to the health boards. It may be thought this is not necessary but if it were found to be necessary and if it were acceptable in the case of consultants, I cannot see why it is not necessary in the case of other officers.
The Senator has in mind the guarantee to consultants. That is a special case because it includes consultants in voluntary hospitals over whom I had no authority. This is aquid pro quo to the control under section 40 (1) (b).
I can appreciate that but does the Minister not think the same guarantee should be written into the Bill in the case of other officers who will be transferred?
To accept the amendment would be to give the officers rights over and above what they have. I cannot accept the amendment which is similar to that with which I have dealt. I cannot give way to the Senator.
Amendment, by leave, withdrawn.
Question proposed: "That section 36 stand part of the Bill".
I should like to draw to the Minister's attention that transfers under this section may be within a much wider area than was envisaged. Let me take an extreme case. In the eastern region there could be a transfer from Louth to Waterford. That will not happen, but there could be transfers from Mullingar to Portarlington or from Wexford to Waterford. This could create a problem of changing house or perhaps about a lowering of the value of their practices and other problems like that. I wonder would the Minister consider introducing a clause which would enable compensation to be paid to officers who might suffer from, if nothing else, transferring their household goods from one place to another. I understand that in the Federated Voluntary Hospitals Act paragraph (6) of the Second Schedule covers matters like this. It might be useful in this regard.
In regard to transferred officers, I have agreed in principle for the reimbursement of expenses necessarily incurred in connection with transfer in order to take up duties with health boards. This is a matter that can be taken up by the joint consultative council. In regard to compensation for disturbance I am afraid I cannot deal with this because the officers in the local authorities and the Civil Service accept transfers as part of their service regulation and this is long standing and accepted. Statutory compensation for disturbance in future changes of this kind simply cannot be entertained; we would be breaking the whole of the Civil Service and local authority code. When Senator Alton speaks about consultants whose private practice might be reduced, well, that is an entirely different matter and it would have to arise in connection with negotiations which would take place with the Medical Association. As the Senator knows, I have just been having negotiations with them over certain reductions in private incomes suffered by surgeons because of a reduction in their private practice as a result of the extension of the middle income scheme. It does not arise on this section or on the Bill at all; it is a separate matter.
Does the Minister not think that if under the new regional hospital arrangements a surgeon who has an established practice in Wexford has to transfer to Waterford that the transfer would not cause him a loss in private practice and that he would be entitled to some compensation?
Section 13 (4) enables a health board to pay to an officer or servant such remuneration or allowances as the CEO determines from time to time. Under that section there can be variations in relation to the allowances to take account of such matters as a transfer of consultants who may have a private practice and who as a result of reorganisation of the service move from an area with a very good private practice to an area in which there is very little private practice. There can be negotiations with the Medical Association representing this officer or officers for such allowances as are desirable.
I am sorry, I did not catch the reference.
Question put and agreed to.
Amendment No. 60 not moved.
Question proposed: "That section 37 stand part of the Bill".
On Second Reading I advocated the abolition of private rooms in local authority hospitals and I referred to the abuses which I found to exist in County Donegal. I spoke from my experience as a member of the Donegal County Council for ten years, and living a short distance from the county hospital I have been the recipient of many complaints down the years. Last week-end theIrish Medical Times dealt with my speech and I am somewhat perplexed by some of the statements that have appeared in that paper. If I may I would like to read from it as follows:
A speech in the Senate last week alleging that under the present medical service private patients received priority over——
Before the Senator goes on I should like to be quite clear about what he is attempting to do.
I want to discuss private beds in local authority hospitals and I want to discuss——
In relation to the system that will operate when this Bill has been enacted?
If the Senator would keep to that and if he wishes to go outside the Bill if he would make his references as brief as possible——
I feel that I have to read this.
under the present medical service private patients received priority over medical card holders, has brought an angry retaliation from Local Authority Hospitals consultants around the country who have described it as "ill-informed" and "completely inaccurate".
Several consultants denounced what they said was an unwarranted attack upon one of the most basic principles of the profession, adding that it was one of the hazards of a democracy that some public representatives felt themselves called upon to play to the gallery.
Speaking on the Health Bill debate, Sen. Bernard McGlinchey of Donegal called for the abolition of private beds in Local Authority hospitals.
He was quoted in the papers as saying that in his own county a medical card holder wishing to avail himself of clinical service was placed on a waiting list for two, three or four months, whereas an appointment could be arranged within one week for a person wishing to pay a specialist in a private capacity.
Senator McGlinchey went on to say that physicians, surgeons and gynaecologists should not have the benefit of a room built by the rate-payers and taxpayers to house their private patients.
According to reports he also claimed that the County Physician in Donegal had said in a court of law under oath: "One generally treats one's private patients oneself. One generally treats one's public patients through one's house surgeons".
Mr. William de Wvtt, Orthopaedic Surgeon for the NorthEastern Health Region, said that Sen. McGlinchey did not adequately inform himself before speaking in the Senate.
There were no private beds in Local Authority hospitals, only amenity beds in separate wards.
An amenity bed was one that was used for public patients who for one reason or another could not be treated in a ward with other patients they might be dying, noisy, or upset by other patients.
If amenity beds were not required for this purpose they were allocated to other people such as nuns, brothers, priests or members of the hospital staff. A large number of nuns, such as the Poor Clares and the Little Sisters of the Poor were medical card holders.
If they were not required by either of the two first categories they might be used for private patients.
"There is no question of private patients being treated before public patients," Mr. de Wytt said. "If a private patient comes in, there may be no private bed for him and he may have to go into a public ward."
Dealing with a comment by Sen. McGlinchey, Mr. de Wytt said that the vast majority of Local Authority consultants were forbidden to treat patients outside of a Local Authority hospital and that, unless there were exceptional circumstances they would be up before the County Manager if they tried to treat them in private hospitals.
On a point of order. From what is the Senator quoting?
I have already read that article.
I must say I am somewhat perplexed by this article and I think that, under the section, I am entitled to some explanation. I understood it was part of the terms of appointment of many of our consultants to local authority hospitals that they would have an allocation of private rooms and, when the county hospital opened in Letterkenny ten years ago, four rooms were allocated to each of three specialists—the county surgeon, the county physician and the county gynaecologist. At that time there was a limit on what each one of them could charge a private patient and that limit was £25. Seven or eight years ago the county manager increased the limit to £30 despite the fact that Donegal County Council unanimously requested him not to do so A year or two later he abolished the limit altogether, again despite the fact that the Donegal County Council unanimously requested him not to do so, and the situation obtains today in which any of these specialists can charge what he likes and I know they charge anything from £60 to £70 to private patients in this local authority hospital.
As I say, this was opposed, and opposed bitterly. Neverthless, that situation obtains today. One would get the impression from Mr. de Wytt that this is not so but the situation is so in Donegal and I am quite certain a similar situation is to be found in other areas. At that time Donegal County Council discussed many of the abuses that existed in the hospital and the county manager gave a detailed statement outlining that to which the general public were entitled in this local authority hospital. One of the points he made was that, if a person was a private patient of one consultant and he required the services of a second consultant, he was only obliged to pay the specialist whose patient he happened to be. This was published in the local papers on Friday. In the hospital at the time there was a patient of the county surgeon. She had been there for two months. She was also being treated by the county physician The county physician called on her almost every day but, on the Friday on which this information was published, the county physician did not call and from that day to the day the woman left the hospital, two months later, the county physician did not cross her door because he knew that she knew, as a result of the county manager's statement, that he could not charge her. Despite the fact that that patient was very ill and had to be removed to a Dublin hospital two months later the county physician did not see his way to continue the treatment he had begun with her. If theIrish Medical Times, or the Medical Council, or the Minister, or his officials would like to examine that charge I shall be glad to provide the name of the person concerned. This is only one of many abuses that I have found in this institution. In this article we are told there are no private beds, only amenity beds. I should like to read——
It certainly is pertinent to the section on local authority hospitals.
The Chair is worried about the line the Senator is following. Nevertheless, I have been reluctant to intervene of my own volition because the Senator is entitled to discuss on this occasion the manner in which hospitals are to be administered after the Bill is passed. The Senator is not manifestly out of order, but he is certainly skirting it.
Surely this applies to sections 54 and 55.
If he is seeking to prevent a recurrence under this Bill he would be in order.
But that would arise on sections 54 and 55.
I might as well finish if I can keep skirting it.
It is very interesting material.
That does not necessarily make it relevant.
We are told in this article that there are no private beds and that amenity beds are used, first of all, for public patients and then by nuns, priests and brothers. Apparently no Protestants are allowed at all. I should like now to quote from a meeting of the visiting committee.
I trust this quotation will not be as long as the last one.
This will be short. "The visiting committee meeting of the county hospital held in the county hospital, Letterkenny, on 9th December, 1969. It was noted that the total number of patient days and private patient days of the consultants for the three months September to November, 1969, were as follows...." Before I read that I want to go back a little. The £30 limit was abolished, but that was not enough. The county manager then came up with another proposition and the proposition was that weeks could go by in which the specialists would have no private patients so they would have to do something about it. A specialist was entitled to four private patients and, if he struck a week in which he had none, they were losing money. What did they do? They opened it right up and they allowed the specialist patient days, four patient days for every day of the year. In other words, each specialist was entitled to have four patients in the hospital for 365 days or 1,460 patient days so that, if the four private rooms were full in any week and four more private patients wanted to come in, they could be stuck into the public wards and the situation then was, and still is, that a specialist could have eight to ten private patients in the hospital at the one time under this change of the manager's some years ago.
The report of the visiting committee says that in the month of September there were 303 private patient days; in October, 212; and in November, 188. It was noted also that the private patient days of each consultant from 1st April, 1969 to 30th November, 1969 were as follows: the county surgeon 817, the county physician 845; and the county obstetrician-gynaecologist, 420, which is just half the number, and I should like to point out that at no time have I ever heard any complaints about the county obstetrician. This should prove conclusively that the article written in theIrish Medical Times is completely wrong and that these people are either under a misapprehension or are deliberately attempting to misrepresent the facts.
One of the abuses which can occur as a result of private beds—and has been the subject of distress in Donegal —is that public patients who are not ready to go home are removed from the county hospital and put in St. Joseph's Home in Stranorlar, which is a county home. While it is today a very fine hospital, it, unfortunately, still bears the stigma of a county home and many people are distressed to find that their relatives are removed to this place, allowed to die in this place, and a false impression is often given.
I wrote to the county manager pointing out that a man was being removed from the county hospital in Letterkenny who was very seriously ill, that his sister, his only relative, who was living nearby was in poor circumstances, and did not want him removed to another town because she felt she could not travel to see him. The manager replied to me that the county physician had instructed it. I later sought permission to have this man transferred to the local mental hospital where, in fact, he died, and his sister was full of praise for the treatment accorded to him there.
The point I want to make is this, that if in time private beds were abolished from local authority hospitals abuses of this kind would not occur. We have now reached a stage where psychiatric nurses are in the higher income group and this will create——
The Senator has gone over the line quite definitely at this point. As long as his remarks can be related to the provision and maintenance of hospitals and the use of them after they have been provided, they will be relevant.
In conclusion, I naturally do not expect the Minister to carry out what I am suggesting at this stage.
Surely this is a Second Reading speech?
I might say, indeed, I got quite a number of letters since I made my speech; I got a solicitor's letter, but that is neither here nor there. Some of them were from County Leitrim; I do not know why but they were. I would hope that the Minister would at some stage initiate discussions to this end. If a specialist is worth £10,000 a year, then pay him £10,000 a year but, for goodness sake, leave the local authority hospitals open to everyone. If this is done we shall have a much fairer medical service. However, I would be happy if the Minister would give me an assurance that if there are any complaints in the future they will be thoroughly examined and, if the complaints are justified, that appropriate action will be taken.
In view of the very compelling points and illustrations given by Senator McGlinchey and in view of his appeal to the Minister that the Minister might at least agree to look into this whole question of private beds and their proportion to public beds in public hospitals, I should like to hear the Minister before we come to a decision on the section.
This is an immensely complex business. I could not possibly give a dissertation on it. It relates to the availability of consultants in certain specialities who are willing to go to a given place, a given area, and on any other conditions except that they will have private patients. It relates to the fact that you might have to pay a surgeon or a consultant in an area a salary in return for his not having some private patients that would be so high it would wreck the entire structure of the health services in relation to the payment of other people who are doing good work. I could not possibly comment on this most complicated business except to say that in relation to anything that Senator McGlinchey has said there will be a regional health board comprising, Leitrim, Sligo and Donegal. There will be a change in the whole administrative area. There will be a county advisory committee for Donegal and I imagine that the time to have a review of the services to see if they require any improvement would be after the passing of the Bill and the inauguration of these new authorities.
I might add I have had very few complaints in my Department that the people of the medical card group do not receive treatment because those who are able to pay for services are able to get services in a prior order. It would be up to Senator McGlinchey to examine this position in Donegal for himself because it certainly has not reached me in the form that would require any kind of inquiry. The choice of doctor system to be inaugurated will give an increased emphasis to the importance of those with medical cards.
Under the FitzGerald Report it is hoped that doctors will have a greater part to play in hospital administration, particularly the smaller hospitals, where they will have a greater right of entry. The whole emphasis of the FitzGerald Report is on better out-patient diagnostic services, on consultants who will be ambulant and who will travel through the country and consultants who will work on a far more extended basis than before both for voluntary hospitals and for county hospitals and bring more advanced care and attention to the medical card group and also to the middle income group. I would hope with all these changes taking place we can look forward to a better health service, but I cannot comment on Senator McGlinchey's observations in the course of this Bill.
Since the Minister makes the case, and probably a sound one, for the provision of beds in public hospitals for private patients, could we ask him what proportion of private beds he would consider reasonable and adequate, because I share the fears of Senator McGlinchey that a system of money privilege may grow up and that if too big a proportion of private beds is provided it may well be that the public patients may be kept waiting longer than they ought to. What kind of proportion of private beds would the Minister consider reasonable in regard to hospitals?
That would be very difficult to answer. It would depend on the disciplines in the hospital and on other things. I am afraid I have not nearly enough experience as Minister for Health to be able to answer it.
Could the Minister not give the order of magnitude?
Does the Minister agree that a specialist should claim that he treats his private patients himself and that his public patients will be treated through his houseman?
I do have to be careful about this. If Senator McGlinchey chooses to raise this issue in the Seanad, I, unfortunately, must be very careful about this. If the Senator has a complaint it must either be made formally through his health authority or the Senator must make use of whatever legislation exists—I could not give it all here—to have his complaint examined. It would be most improper for me to comment. No doubt the Senator feels very sincerely what he states. So far as I am concerned it would have to come to me in a particularly designated way, as it does under the legislation that exists. I am sure the Senator will understand that position.
Would the Minister not be prepared to have inquiries made? I mentioned exactly the same thing when speaking on the Appropriation Bill. I said on that occasion, for God's sake to employ medical men, physicians, surgeons of the highest order and pay them a full inclusive salary, no matter what that salary may be, rather than have them charging fees to private patients, for this reason: if a physician or surgeon is paid even in the region of £15,000 the amount of his salary will be spread over the entire community under his control and it will be paid by people who are fortunate enough to escape sickness and serious illness, equally by all. On the other hand, when a family is stricken by very serious illness and a patient is kept for a long time in a county hospital or other hospital subject to charges by the hospital and subject to a very high bill—I would say an extravagant bill—from a physician or surgeon, even if the patient lives, the family must also pay the normal share through the normal channels, in addition to paying this extraordinary sum at a time when they are least able to pay it. Should the unfortunate patient die they will have to pay the funeral expenses and they are really a very serious matter.
The Minister might give us an indication that he is prepared to look into this matter and, even though it may appear to be wrong in the beginning to give surgeons and physicians and gynaecologists a very handsome salary, I am quite satisfied that in the end it will be an economy and that justice will be done.
I am afraid I would have to look into all this very carefully. For example, I would have to take into the whole examination the fact that there are 375,000 people who insure with the Voluntary Health Insurance Board and, of those, over 31 per cent consist of people who have already medical entitlement. For these people the fees arranged by the Voluntary Health Insurance Board are kept very carefully under control and as far as I know they are not excessive. I would have to take into account that group of people. But I imagine this sort of problem will come under examination in the next years and when we have the regional hospital boards appointed who are able to look over the hospital and consultant service structure over a very big area and when we also have Comhairle na nOspidéal in charge of recommendations for appointments of consultants throughout the country, this matter will gradually come to be studied. Quite evidently, it would be a very long term business to make any substantial changes.
It may be said that if you pay a surgeon £15,000 a year his work will be spread over a considerable area but, unfortunately, in connection with health and local government and even the Civil Service, we have to avoid creating distortions in the payment of professional men and administrators. If we make breaches in this, then there are readjustments of one kind and another.
This is a matter that it is very difficult to discuss on the occasion of this Bill. I take what has been said as an indication of the fact that we should take care to see that the private practice of a consultant would not in any way interfere with his obligation to do his work for which he is paid by the local authority. That is absolutely accepted.
Again, I cannot comment on what Senator McGlinchey has said because if an actual complaint came to my notice and I had to conduct some kind of inquiry I would be the person who would ultimately make the decision Therefore, I have to be absolutely silent about what Senator McGlinchey said and I am sure he appreciates that
Certainly, I do but this complaint that one generally treats one's private patients one self——
The Senator is now about to say for the second time something that was considered out of order the first time.
This was not a sweeping statement of mine. This was something said under oath in a court of law by the county physician.
It may have been relevant in court but it is not here.
Question put and agreed to.
Sections 38 and 39 agreed to.
There is an amendment, 60a, on the Order Paper. Is that moved?
I have not got amend ment No. 60a.
It appears on the Order Paper for today. The amendment is:
In subsection (1) (b) (i), page 22, line 9, before "as" to insert "including general practitioner staff"
On behalf of Senator Jessop I move amendment No. 60a:
In subsection (1) (b) (i), page 22, line 9, before "as" to insert "including general practitioner staff".
The purpose of this amendment is to request the Minister that he might in this section indicate very positively a fact that we all expect to take place in the future, that is, that the general practitioners of an area will be more and more integrated into their local hospitals and we would hope that this would take place in all grades of hospitals from the most specialised down to the district hospital level. Senator Professor Jessop is particularly interested in this point because of a relationship between the Trinity Medical School and the training of general practitioners. They have a scheme at the present moment for the training of general practitioners by a system of almost apprenticeship throughout the city and it is for this reason that he was particularly anxious that this amendment would be accepted by the Minister.
I had better explain the position. The purpose of Comhairle na nOspidéal is to regulate the appointment of consultants and senior registrars; people who are specialists and who do the most important specialist work, to ensure that we have the best kind of consultant staff in the country, that we avoid unnecessary proliferation of specialist staff as between voluntary hospitals and county hospitals, that we enter the modern age of medicine where there are so many specialities and sub-specialities and ensure that, when a specialist is appointed, he will do the most effective work in relation to teaching; his consultancy work; inpatient work and out-patient work. In relation to the size of the country, it is desperately important that this be on an integrated basis.
Comhairle na nOspidéal was not meant to deal with general practitioner staff. General practitioner staff will be under the day-to-day administration of the regional health boards. To the extent that they would take a greater part in hospital services, that is, that they might in the future have greater privileges in regard to bringing patients to small district hospitals and of having the right to visit patients in county hospitals, in some of which they already have these rights, this would be a matter for the hospital boards and the regional health boards.
We have had quite a number of discussions with the medical association on the whole concept of Comhairle na nOspidéal. It really is confined to consultant and senior registrar staff.
I think Senator Jessop was anxious to get the Minister's assertion of the principle somewhere and he felt that this was a good place.
Amendment, by leave, withdrawn.
I move amendment No. 61:
In page 22 to delete subsection (1) (b) (vi), lines 26 and 27.
The subparagraph amounts to what is creeping in more and more into legislation now—a blank cheque, a catch-all phrase at the end of a series or list of functions or powers of a body in case something has been left out. This is the type of delegation Parliament does not want to give to the Executive. If we look at the other sub-paragraphs of this paragraph (b), in relation to the functions of this council, we shall see that it has wide functions:
The functions of the Council shall be—
(i) to regulate the number and type of appointments of consultant medical staffs and such other officers or staffs as may be prescribed, in hospitals engaged in the provision of services under this Act;
(ii) to specify qualifications for appointments referred to in sub-paragraph (i), subject to any general requirements determined by the Minister;
(iii) to advise the Minister or any body established under this Act on matters relating to the organisation and operation of hospital services;
(iv) to prepare and publish reports relating to hospital services;
(v) to perform any functions which may be prescribed after consultation with the Council and with such bodies engaged in medical education as appear to the Minister to be appropriate, in relation to the selection of persons for appointments referred to in subparagraph (i)...
Then we have the blank cheque—(vi) to perform such other functions in relation to hospital services as may be prescribed. There is no limit to what this could mean—any functions of any nature as may be prescribed. With a phrase like this, there is a very strong onus on the Minister to explain why it is necessary to put in such a blank cheque and, if it is not absolutely necessary, then we, as a Parliament, are failing in our duty of controlling delegation. We set up the framework and the Minister implements this by regulation. If we delegate too wide a power so that we cannot control the way this power is implemented by regulation, we are failing in our duty as a Parliament.
There is an increasing tendency to slip into this type of subparagraph. I am sure the Minister will not view it as though we were curtailing in any way the proper functions of the council. The object is to eliminate terminology which is so wide as to be meaningless—a catch-all blank cheque. Therefore, I would ask the Minister to delete this subparagraph as being unnecessary to the rest of section 40 which is adequate for the purposes for which it is introduced.
Comhairle na nOspidéal is a very new body. It will have a very new function. It is usual to put this sub-paragraph into a section dealing with the function of a body such as this. Obviously, it could arise only from a proposal made by Comhairle na nOspidéal. Again, this is a question of taking a pragmatic, commonsense point of view. How on earth could the Minister compel a body of a very novel type, appointed as a result of prolonged negotiations with the consultant world? This will be a body of extremely independent, very brilliant people. They must recognise that, if ever we are to pay for our health services, there must be further integration and co-operation between the voluntary hospital world and the local authority hospital world. They must recognise that there is a necessity to do this because of the growth of specialities. As the Senator possibly knows, there are now specialists who deal with the heart condition of babies up to the age of four and no further— to give one example of a sub-speciality. The provision of these kinds of consultant services—where a person will work, what his duties will be, how many can be appointed—all of that is a most expert business. The idea that any sort of function would be put in, which would be against the public interest, is inconceivable in a body of this kind. Moreover, the regulations governing the allocation of functions of this council will come before the Oireachtas in approved form. The Oireachtas will have to consider the general ambit of functions and the system of administration of this Comhairle na nOispidéal.
To begin with, Comhairle na nOispidéal will not make any appointments itself. Any appointments made will have to be made by the Local Appointments Commission but, subject to clauses that have already been dealt with, it will also provide for changes where teaching bodies are involved, where university appointments are being considered: there are passages in the Bill which clarify that position. The Local Appointments Commission already modified its procedure in these kinds of cases.
All that being the case, I do not think Senator Bourke need worry about this. It will be one of the most interesting bodies in this country. It is applying the State body principle to the medical world for the first time in a most interesting way. The men who compose Comhairle na nOspideál will have to be extremely dedicated and objective. There will have to be very close co-operation with me, as Minister for Health. I shall have a certain number of appointments on the board. I think it will be all to the good of the community. We will have the opportunity of appointing really good consultants in this country and of encouraging people who have gone away to come back to this country if we integrate the medical services as far as we can. I cannot conceive that something frightful would be done in the form of providing some additional function that is not stated in the section.
I would agree with the Minister: I welcome the setting-up of this council. It is an interesting body, a welcome innovation, and so on— I am not quibbling about that. In paragraph (b) are set out the functions of this body and the qualifications— and you can have specialist qualifications if you wish. There is increasing specialisation in the various fields of medicine and I think it is necessary.
What I am pointing out is the danger that we as a Parliament will allow a clause such as this and I shall reread it again because the more one reads it the more one realises it is so wide as to be meaningless. There is no control and no matter what regulation is made under it we cannot say that it has gone beyond what the parent Act has prescribed. It says "to perform such other functions in relation to hospital services as may be prescribed". That is unlimited power. I do not say that this council which will be set up and which will be composed, we hope, of eminent men in close liaison with the Minister will abuse this power; but in principle we cannot allow a clause of this nature to go forward because it is our function as Parliament to control the delegation of legislation and we are denying ourselves our own power and denuding ourselves of any control.
It does not matter that the regulations come back in draft form because they cannot fail to comply with this blank cheque. I do not insinuate that there would be improper or unusual functions but I am saying that in principle this paragraph (vi) is not necessary to the section, that the Minister has not shown how the section, apart from this, is in any way defective or would curtail the functions of the council being set up. I strongly oppose the wording of the section and its continuance as an improper delegation of power to this council which we as Parliament should not do. It amounts to a blank cheque.
I am sorry I must resist the amendment. Comhairle na nOspidéal might suddenly be able to do something of great importance for the community. I do not know what kind of thing—I have been so immersed in the major part of this Bill that I have not had time to think of all the details—but Comhairle na nOspidéal might for instance set up an institute——
They could do that under (v).
They might or they might not.
That is the point I am trying to make. You are giving yourself a blank cheque.
I do not call this a blank cheque in the circumstances and in view of the character and nature of the body being set up.
What is the control over it?
If anything occurred against the public interest, knowing the character of this body I am perfectly satisfied that it would arouse the ire of the medical profession, the county councils and everybody else and it would get the Minister into terrible trouble if this body should suddenly do something grossly offensive to the public interest.
What happensipso facto is irrelevant.
It seems to me the Minister is asking for something we should be very reluctant to give any Minister. During the years in the Select Committee on Statutory Instruments we have found various other Ministers making orders referring to the power given to them under certain sections of the Act and using such phrases as "and by such other power him so enabling". This is the kind of phrase that allows the Minister in relation to this new body to do exactly as he wants. The Minister tells us it will be all right; the consultants will look after you, they will not do anything that is not in the public interest. I am not so sure; they might well do something in the interests primarily of the consultants. I should like to feel that the Minister knows where he is going and does not ask for more power than he actually needs. He has told us that the functions of Comhairle na nOspidéal will not be to deal with general practitioners but he has a clause here that will permit him to prescribe they should so deal. Anything he says can be reversed under this clause. He says in defence of this that he does not really know what he may have to do, that this is a very complicated Bill and he must have total power. I think we should give him a total "no" to that request.
I am a pragmatist, not a legalist and perhaps I suffer from a lack of legal knowledge. Whatever the deficiencies of the Government may have been, I do not know of any frightful scandal which has arisen because of the introduction of this small section enabling certain things to be done, at least in the case of specialist bodies. It seems to me there is sufficient vigilance among the people to prevent this kind of abuse. If the Senator wants me to agree to exclude this section the implication is that there is not in this country the kind of vigilance that would prevent abuses of this sort. I believe there is and that it would not be in the interest of any Government to misuse this subsection. What does the Senator suggest might happen? Does he suggest that people might have inferior medical services, might have to pay too much for the medical services, that there would be corruption in appointments or something of that kind?
It is not the vigilance of the public about which we are concerned, it is the vigilance of Parliament. We are talking about the balance of power between Parliament and the Executive in setting up the terms of reference under the Act. It is not that we envisage something terrible being done with this power but that we, as Parliament, should not give this type of power because we are giving unlimited power under the wording of this Act and in principle, because of our functions as Parliament and our control over legislation, we must not allow this type of clause to slip through. The Minister has not shown in any way that it is necessary for the functions of the council. I appreciate that it is a new body and that he cannot foresee every eventuality but the wording of the clauses are very wide. I am reluctant to press this to a vote although I feel very strongly about it but I would ask the Minister to consider this and I shall re-introduce it on Report Stage.
Anyone with experience in local administration, whether in connection with health or housing, will invariably come up with situations where you go to the county manager perhaps to arrange for some woman to be moved to hospital, even to London. Somebody takes out the Health Act, reads over the relevant section and they tell you it is specified what the county manager can do and, unless you can get amended legislation, the manager can do nothing. It is not infrequent in housing legislation that a marginal case is looked at and an official comes along and says that under subsection X of section Y of the Housing Act, 1960, this cannot be done.
There are cases of great urgency that can never be dealt with because the Acts are much too tight and legislation has been made so tightly it leaves no options. I have seen cases of great hardship being perpetrated because the legislation was so tightly worded that the people who administered the Acts in the service of the public need were not permitted to go outside the Acts. I think everybody who has had experience in the administration of Acts will admit this. If Comhairle na nOspidéal were required in an emergency to do a particular thing and we had them completely hamstrung by writing into the Act complete limitations we might well be defeating the purpose of the Health Act entirely. I agree with what the Minister says that everybody is fairly vigilant nowadays and they will at least be subject to budgetary control. This is the most effective kind of control. One can evade an Act one way or another but one cannot escape budgetary control.
I have no doubt that with such a body this clause is necessary. Comhairle na nOspidéal is a completely new concept. It will be breaking fresh ground. It will get into the most involved things in the future. I will give the House one example. In the kidney transplant area Ireland is now in a European set-up with headquarters in Amsterdam. Comhairle na nOspidéal will be responsible for the consultants involved in kidney transplants. We do not know what this kind of work will mean in this country. One could not predict tonight what the needs of this body will be in two years time or in five years time. To have it hamstrung so that the Minister cannot say at the request of the body that we should follow certain lines of investigation or see could some specialist functions be dealt with in a different way because there is a clause that will not allow it and to have to go back for amending legislation would be terribly foolish. As a member of the consultative council I can say that originally we thought that it should be kept as a narrow body just dealing with consultant services. The more we discussed it the more we realised that, unless this body could take a broad view of a problem, it would be totally inadequate and worthless.
This would seem to negate the first paragraph of subsection (1) (b) "to regulate the number and type of appointments to consultant medical staffs and such other officers and staffs as may be prescribed and specified." This is the function of the council. If we give a blank cheque to perform such other functions we are setting up a council which isprima facie and in all the other things basically to set up the qualifications of the consultant staffs and to regulate them and to provide for specialists such as the Minister mentioned: somebody who specialised in heart conditions of children under the age of four. In the last subsection we are broadening it to “any other functions in relation to hospital services as may be prescribed”. This is an unlimited blank cheque. I would prefer the Minister to list 20 other specific functions of the council than to have that phrase go forward as it is because I do not think it is the function of Parliament to give power of such an unspecified, general and uncontrolled nature as this.
The Senator is most charmingly obstinate and I cannot go further.
May I give the Minister assistance? Until Senator Alton had spoken I was to be given the agreeable pleasure of showing the independence of a committed party member to a group of Independents. In this matter I am wholly with the Minister. It may be possible that Senator Bourke may be able to persuade the Minister, on reflection, to adopt some other wording here which would give the ultimate control to Parliament on this but launching any body of this kind it is not possible for anyone in this House or any of the Minister's advisers or any of the medical people who are making representations to him to tell him what will be the position in regard to medicine and the health services in five to ten years time. To limit the powers of this body seems to me to be quite wrong, and for a theoretical reason. It seems to exact too high a price in terms of the quality of the health services.
I am glad to have the assistance of Senator Alexis FitzGerald who, I know, has written many articles of association where there are extra clauses put in in company operation.
I would still like to introduce this on Report Stage.
The Senator is entitled to do that.
Amendment, by leave, withdrawn.
Government amendment No. 62.
In page 22, between lines 27 and 28, to insert the following paragraphs:
"(c) Before making a decision in pursuance of paragraph (b) (i) in relation to an appointment, the duties in relation to which involve the teaching of clinical medicine or the conduct of medical research under the direction of one or more than one college, the Council shall consult each such college.
(d) A function in relation to the selection of a person for an appointment, the holder of which is a full-time or whole-time professor in a college, shall not be prescribed under paragraph (b) (v) save with the consent of that college.
(e) In this subsection ‘college' means a college which awards a qualifying diploma mentioned in the Second Schedule to the Medical Practitioners Act, 1927, or a college of a university which awards such a diploma.".
This amendment arises from consultation with the authorities of University College and Trinity College in relation to teaching appointments in the Dublin hospitals. The teaching authorities are naturally anxious that their position should be safeguarded and agree that the proposals in the amendment will meet their requirements. Comhairle na nOspidéal should obviously consult both the teaching authorities before regulating the number and type of teaching appointments. An chomhairle cannot be given functions on the selection of consultants who are full-time or whole-time professors except with the relevant teaching body. This is quite evidently an essential amendment. It has been commended and agreed to by the teaching authorities of the two colleges.
I have been asked by Senator Jessop to ask the Minister if he would delete the words "in relation to an appointment" in the first paragraph of this amendment. I cannot quite fit in what Senator Jessop was trying to get at but I understood that he did not wish it to apply to a single appointment. He was anxious that the amendment should cover numbers of appointments of staff as well as particular appointments. He wanted Comhairle na nOspideál as far as possible to be responsible for the numbers that would be required as well as the type of appointments. I cannot just see how he meant to do it although it seemed clear at the time.
We all understand that sensation.
I cannot see either. I shall have to look at that before Report Stage because, if a person is mainly engaged in clinical medicine, Comhairle na nOspideál would have a very definite interest in his appointment.
It is the phrase "in relation to an appointment". He wanted it to be in relation to numbers and types of appointments.
Perhaps Senator Jessop had not quite appreciated the fact that Comhairle na nOspideál is moving in two stages: the first stage, when it will not make any appointments; and there is a second stage, if we can reach agreement with the medical profession, when not only will it recommend that an appointment should be made but it will also make the appointment. There is a consultation procedure that will have to come before the Oireachtas. I am afraid I shall have to consider this. I shall get in contact with Senator Jessop.
I would be most grateful to the Minister.
Amendment agreed to.
I move amendment No. 63:
In page 22, to add to subsection (1) (c) the following:—
"Before any such regulation is made relating to the appointment of members to the Council the Minister shall consult with the University medical teaching schools, the voluntary hospitals, the Board of Health Hospitals, the College of Surgeons and the College of Physicians of Ireland."
The Minister has gone some way towards meeting the purpose of this amendment which was that the university medical schools and other medical bodies be consulted in the regulations. Apart from the university teaching schools, there are also the voluntary hospitals and the Board of Health hospitals and the College of Surgeons and the College of Physicians in Ireland who ought to be consulted by the Minister in drawing up regulations under the section. As he said, this is a very new body and I hope, as he does, that it will be composed of the most eminent men but there is a legitimate interest in these bodies in being actually consulted. The Minister will undoubtedly reply that he will be, or, perhaps, already has been, in consultation with those bodies but I feel it should be made clear under the Act that there is a duty of consultation upon the Minister with these bodies who have a concern and a specialised knowledge of which he can avail and, therefore, although I see that the Government amendment is going part of the way I would be grateful if the Minister would consider going further and consult the voluntary hospitals and the local authority hospitals as to qualifications.
The position is that as Minister I am very deeply involved in this. Comhairle na nOspidéal has to be most carefully formed and I must be left with a discretion of choosing who the bodies will be. The furthest I can go is to put in on Report Stage an amendment that would guarantee that there would be consultation with bodies considered appropriate but I simply cannot list all the bodies. If I listed all the bodies some body is certain to be left out. There could be bodies that I would not wish to consult because there were alternative bodies. This is a most delicate matter. I am quite willing to put in an amendment on Report Stage saying that there will be consultation with bodies considered appropriate by the Minister. That together with amendment 62 should, I think, meet what the Senator wishes.
Amendment, by leave, withdrawn.
I move amendment No. 64:
In page 23, to delete subsection (4) (a) and substitute the following paragraph:—
"( ) The Regional Hospital Boards shall from time to time appoint from amongst the members of those bodies established under this section, a chairman and a vice-chairman."
This amendment relates to subsection (4) (a) of section 40. The idea of the section as it stands is to allow the Minister from time to time to appoint from amongst the members of the body established as the regional health board a chairman and vice-chairman, and I have introduced an amendment that the members shall themselves appoint their chairman and vice-chairman. I think that this is important. These regional hospital boards are going to have wide powers. They will, I hope, be very responsible bodies quite capable of choosing a chairman and a vice-chairman from their own members in a democratic way rather than at the nomination of the Minister. It would be better for the self-esteem and integrity of these regional boards that they should appoint their own chairmen and vice-chairmen, and from the point of view of this visualised from the outside with the specialised knowledge of the composition of the board it would look better if they are chosen by members of the board in the normal procedure in relation to boards. Therefore, I would hope that the Minister would be prepared to accept this amendment.
Senator Bourke should be made chairman of a new society for the decentralisation or devolution of everything. I must say that she expresses herself very admirably, but I am afraid that she has not understood, and, perhaps, has not read, what I said in the Dáil about this. This is something which is decentralising the work of my Department to a very considerable extent. It is an interesting form of decentralisation. There are going to be three regional hospital boards and the object of these boards is to plan the hospital service for the entire area. Again, because of the growth of specialisation and because of the great cost involved in that part of the FitzGerald Report which recommended better diagnostic services and because of the growth of special para-medical equipment of every kind, which is extremely expensive, the general position is that everything is getting more and more expensive and that all the equipment must be fully utilised if we want to be able to afford it. The same applies to consultants.
Then there is the question of the linking of the actual hospitals themselves in the regional hospital areas and making sure that we do not have an excessive number of patients coming to Dublin, for example, for certain speciality types of treatment that can be attended to in Galway, Cork, Waterford or Drogheda. This is an immensely complex business. The regional hospital boards are being set up for this purpose. They are also being set up so that they can actually employ certain types of consultants who could not appropriately be employed by any one regional health board because they would be specialists of a kind who would be moving around and whose expenses would be recouped by the regional health boards in relation to their services to them.
It would mean that the Hospital Commission staff will be transferred to these regional hospital boards. It will mean that I will have to examine the whole of the staffing position of my Department because my staff will have to be associated in helping those boards and planning the hospital requirements of the future. It is a decentralisation process. I am absolutely insistent on the right to appoint the professional staffs of these regional hospital boards and their chairmen and vice-chairmen, and I could not possibly yield on that. It would rather be as if, when I was Minister for Transport and Power, I had the right to appoint the chairman of the ESB or CIE or Bord na Móna or Bord Fáilte. Nobody in any party contested my right to appoint those chairmen. The same thing must take place here, and I hope that the House will fully understand the position. The State is responsible for a huge amount of expenditure, because the cost of the hospital services runs between £30 million and £40 million a year, and I must have the right to make these appointments. I am absolutely adamant about it.
I want to speak from a purely personal point of view on this. As someone who has a little knowledge of the health administration in the country personally I am inclined to support the Minister to a very great degree in this. I mentioned on Second Reading that the suggestion had been made that it was wrong for the Minister to retain the power of making these appointments, but to me it seems that these regional boards are going to be the boards that will be deciding upon whether the future health services of this country are going to be economic and up to modern ideas or not, and in this context it is important that they would work closely with the central authority, which will be the Department of Health, and that they would be conversant with the ideas of that Department and closely in touch with the Minister. I am not, as the House and the Minister may have gathtered, a great advocate of ministerial appointees, but I think that in this particular case it would be right to consider favourably the idea of the Minister appointing the chairman and the vice-chairman. I would ask Senator Miss Bourke to think about it in this light. As someone who has some experience of local administration, I realise the great difficulties which are encountered in it.
Is the amendment withdrawn?
In view of the explanation offered by the Minister, I will withdraw it.
Amendment, by leave, withdrawn.
I move amendment No. 65:
In subsection (4) (a), page 23, line 13, after "vice-chairman" to add "of that body".
I move it simply because this amendment as proposed by Senator Belton and Senator Reynolds is desirable to clarify the meaning of the subsection in question.
The amendment can be accepted.
Amendment agreed to.
I move amendment No. 66:
In page 23, to delete subsection (4) (b) (iii).
In view of what the Minister said about the appointment of chairman and vice-chairman, I do not suppose that he will agree to give up the right to terminate the appointment.
I would hope that in future it will be possible to get more autonomy, but I can quite understand the position that this is an extension of a Departmental function and that this amendment might not be appropriate at this time, so I will withdraw the amendment.
Amendment, by leave, withdrawn.
Government amendment No. 67:
In page 23, subsection (8), line 46, to delete "provision" and substitute "provisions".
This is a drafting amendment.
Amendment agreed to.
Amendments Nos. 68 and 69 may be discussed together.
I move amendment No. 68:
In subsection (9) (a), line 60, to delete "sections 12, 13, 15 and 16" and substitute "sections 12, 13, 15, 16, 21 and 22".
The point of the amendment is to draw attention to something which I feel may not have been intended. In section 40 (1) (a) the Minister proposes to withdraw from the CEO of the regional hospital board certain designated functions which the CEO of a health board would have. This amendment is proposed mainly so that the power of the hospital board would remain rather with the board than with the CEO. A consultant in a voluntary hospital over the years has been used to working under a board and it is felt that the changeover, which would mean that he would be working under a CEO instead of a board, would be rather traumatising. The functions of the area health boards have been removed and there is reference to this in sections 12, 13, 15 and 16, but sections 21 and 22 have outlined very serious functions in regard to the CEO—suspensions and dismissals of officers. We feel sure the Minister must have intended that these are functions which in the case of a regional hospital board would remain with the board and not with the CEO. Therefore, we should like to add sections 21 and 22 to the other sections I have mentioned.
I support this amendment which is in line with my later one. I mentioned the situation on Second Reading. As the section stands, one of the implications is that it would lead to two types of consultants, one to the health boards and the other to the voluntary hospitals, because the section as it stands would leave consultants in the voluntary hospitals to be paid by the boards and their tenure of office under the particular hospitals or groups of hospitals, whereas in the case of consultants to the regional health boards, sections 21 and 22, as regards removals or suspensions, would apply.
I can see this, as a possible practical reality, creating a reluctance on the part of consultants to fit into a scheme in which they would be under the control of a CEO, whereas if they went into the voluntary hospitals they would be on the same terms as heretofore. This might perpetrate what is already a possible danger in our system, the tendency to regard voluntary hospitals as being superior to others. This is in many cases unjustified but it is at times the attitude people take. If consultants are frightened off—as the Minister knows, they are very easily frightened off—by the prospect of the CEO having these powers directed against them, it might mean they would be frightened away from the local authority hospitals.
I am prepared to accept this amendment because I think it is reasonable. Amendment No. 68 would cover the position.
Amendment agreed to.
Amendment No. 69 not moved.
I move amendment No. 70:
In page 24 to add to the section the following subsection:—
"( ) A body established under this section may accept a gift of money, land or other property on such trusts and conditions as may be specified by the person making the gift but shall not accept a gift if any conditions attached to the acceptance thereof are inconsistent with the body's functions".
This amendment speaks for itself. It seems to be sensible to give power to Comhairle na nOspidéal to take gifts of money, land or other property, in the same way as the regional boards are authorised to accept such gifts. Without statutory authority they would not have that power.
The principle of the amendment could be accepted and an official amendment brought in on Report Stage.
I was interested to see the amendment because we had a recent example of it in the Industrial Development Bill in which there was a similar section which made it possible for the Industrial Development Authority to receive gifts. However, I am still not clear on the specific examples that might arise in which someone might wish to make a gift to a body of this kind and I should like to ask the proposers of the amendment if, when they put it down, they had any specific examples in mind. I am personally interested.
People might make an office available or a gift of money for a specific purpose. If I might lapse into frivolity for a moment after such a lengthy debate, the best example I can give is when George Bernard Shaw offered to give part of some Carlow property to the State and we had to introduce an amendment of the law on local government because it could not be done without it unless solicitors like Senator Alexis FitzGerald made amazing sums of money out of it Shaw was anxious that we should do it.
Shaw wrote to Mr de Valera and stated:
My beloved wife who died three months ago was a great admirer of yours and always considered you the second greatest living Irishman.
This is entirely out of order, of course and I shall be obliged if the Cathaoir leach forgives me.
Amendment, by leave, withdrawn
Question proposed: "That section 40, as amended, stand part of the Bill".
There are two points in the section which are of concern mainly because, as the Minister knows, this is the most complicated section in the Bill as far as doctors are concerned. It is the section which tries to wed three hospital regions with eight area health boards and at the same time to wed the voluntary hospital system with the local authority system.
Is there provision for divorce?
We have not got to the actual wedding yet. Subsection (9) (b) is the one which chiefly concerns me. We discussed this earlier in the day. Section 14 is the section which sets out that under the Local Authorities (Officers and Employees) Acts, the Local Appointments Commissioners are the body which do the appointing of officers. The day-to-day working of the regional hospitals will be done by the health boards whereas the overall organisation will be by the regional hospital boards.
I am concerned about a consultant who may be working in Dublin and Navan, or in Dublin and Dundalk, in a voluntary hospital and in a local hospital. Under the new system is there any possibility of confusion arising in regard to his appointment? One could be done through Comhairle na nOspidéal and the Commission and the other directly by the Local Appointments Commission. The point I am trying to make is: if a consultant is working in the two types of hospital is there any possibility that trouble could arise over his appointment in the voluntary hospital being under the new system which will be worked out, through Comhairle na nOspidéal, while his appointment to the local authority hospital would be under the old system, by the Local Appointments Commission. We would have a dual way of appointing a man to a single appointment.
The Senator has raised a very interesting point and I must say that I have to get it straight in my own mind first of all. Obviously we cannot depart from the local appointments arrangement for appointment, modified as it is in the case of people who work in voluntary hospitals and people who work in teaching hospitals. There is a modified procedure which is accepted by everybody and under that it would be possible for a specialist to be appointed and who would work mainly, say, in local authority hospitals and do some sessions in the voluntary hospitals. But if he was appointed at the moment in a voluntary hospital, if it was a sole appointment, Comhairle na nOspidéal would write to the voluntary hospital and say "We think in relation to the provision of service in a particular area that you should ask the regional hospital board to appoint a person who would be appointed by the voluntary hospital board and who would, by arrangement with the regional hospital board, do sessions in a local authority hospital". You can have appointments made in both ways now. I cannot be more explicit than that. A flexible system will be devised.
That satisfies me. I was afraid that the subsection might cause trouble. My next point is rather similar. Once again the set-up will be that the regional hospital board will be directly responsible for the region but the hospital in Waterford, for example, will be run by the area health board. This is understandable. This presents a consultant with a problem. He may be working under two different set-ups; he may be working under an area health board, if he has to do sessions in Waterford, and working under the voluntary hospitals system if he is working in Dublin. That would be directly under the regional hospital board. Does the Minister consider that it might be wiser to have the hospitals which are to be run by the area health boards actually looked after by management committees which could include the county councillors on the area health boards and the CEO in the area? This would obviate the problem of the consultant being under a board in Dublin and, if he was in a local authority hospital, under a CEO. He would then be under a management committee which could include the CEO of the area.
The Senator has put a 64-mark question to me. I actually have to think of the final details of this before I bring the draft regulations for the functions and set-up of regional hospital boards before the House. I have had to acquire a vast amount of information in a comparatively short time. There are very many hospitals and very many consultants and I have read lists and lists of their functions and I am slowly trying to absorb the significance of all this. I could not answer the Senator. It might be a good thing if we set up such committees related to the day-to-day administration and——
And they could include the CEO and the county councillors.
Those committees might be able to tie in with the regional hospital boards. This is a management problem which is very complex because it relates to both types of hospital. I could not spell it out in detail but we are thinking very actively on these lines.
The Minister earlier on said that rule 13, by which he has the power to remove people appointed by him to the regional hospital boards, would not apply to professional people. If the Minister is taking medical people who are virtually elected by their own confreres it would be rather unfair if he were able to remove them.
I could not relinquish power to remove members of the regional hospital boards. It has some correspondence to some State companies. The Minister has power to remove people who are mainly in a consultative capacity or managerial capacity and I could not relinquish that power. It would only be used under the most exceptional circumstances.
This is a board on which people will be appointed after nomination by representative bodies and having received the nominations of these people we would not like the Minister to be able to remove them.
Again we are getting into this area where you have to be pragmatic. How many people have been removed from these boards? Ministers in all Governments have generally selected people who, if not always effective, were at least respectable. There have been very few removals even in such bodies as the Nursing Board. I do not think there has been any trouble there but the Minister still has power to remove members even though these people are nominated through him largely. I do not think I could change this and I do not think it will cause trouble.
Question put and agreed to.
Question proposed: "That section 41 stand part of the Bill".
Just a short query: under subsection (2) (a) there is reference to the transfer of property, rights and liabilities of the commission to a body established under this Act. What body?
The regional hospital boards.
We had expected the answer to be Comhairle na nOspidéal.
It might be to either really. The Hospitals Commission staff will be transferred and there will be the question of rights, liabilities and so on. My idea at the moment is to make use of this Act in relation to the regional hospital boards because the Hospitals Commission has more to do with arrangements for improvements to hospitals, and so forth, but it might be both. I should not like to be pressed as to what exactly is meant.
That is the reason for the vagueness then?
Question put and agreed to.
Question proposed: "That section 42 stand part of the Bill".
How long after the implementation of the Bill does the Minister envisage it will be before the Hospitals Commission is dissolved?
Within a couple of months.
Question put and agreed to.
Question proposed: "That section 43 stand part of the Bill".
With regard to subsection (c) it seems to me there is a tripartite interest in the Central Mental Hospital. It is owned by the Board of Works and its function is now being transferred to the Eastern Health Board. The Minister assured me on the Second Stage that the charge would be a county-at-large charge.
I have a document here. I know the Minister has not seen it.
Would the Senator say what it is?
It comes from the Dublin Health Authority.
The Department of Justice naturally has an interest because they send people from the courts to the Central Mental Hospital. I know the Board of Works has an interest.
This may involve a certain amount of investigation and provided I am allowed to speak about it on the Report Stage that would suit me. Meanwhile I will send a copy to the Minister. That may shorten the proceedings.
I should like the Senator to send me a copy because it would be appalling if we had to introduce an amending Bill dealing with some appalling situation of which we had not been made aware. The Department of Justice saw this section of the Bill and agreed with it.
The chief psychiatrist of the Dublin Health Authority does not entirely agree with it. In fact, he feels there is some interference.
The Senator has not told me what it is all about.
It is a bit complicated. The Minister would have to read the document.
If the Senator sends me a copy I will see if it affects the provisions of the Bill.
Will I be allowed to raise the matter on the Report Stage?
By way of amendment, yes.
I welcome the fact that this institution is now called the Central Mental Hospital and not the Criminal Lunatic Asylum. The phrase "criminal lunatics" is obviously a contradiction in terms. About 20 years ago the Irish Association of Civil Liberty prevailed upon the then Government to appoint for the first time a visiting committee to this hospital. I understand that committee is still functioning and I should like an assurance from the Minister that it will continue to function under the new administration.
The Bill is fairly flexible in that regard. The Eastern Health Board can appoint a committee to visit the Central Mental Hospital.
The Minister tells me it can be done. It is extremely important that it should be done. For a long time this hospital was without any visiting committee. The late Miss Helen Chevenix was one of the first on the visiting committee and the work she and her colleagues did was very important. It is a matter of prime importance that the Minister should ensure that a visiting committee is appointed.
The Senator can be assured, I think, that there will be a visiting committee.
Very briefly, what Senator Belton was getting at is that the chief psychiatrist of the Dublin Health Authority feels that the legislation governing the entry and exit of patients is outdated. It goes back to the Act of 1845. It is very difficult to get a patient in and even more difficult to get a patient out. It is impossible to move a patient from there to another psychiatric hospital in Dublin. He seems to think it would be very difficult to integrate the hospital, as it now stands, into the development in Dublin city. He hopes that someone will have a look at the various enactments governing entry and exit to Dundrum Central Mental Hospital and produce a consolidating measure bringing the legislation up to date to enable him to operate the hospital within the scope of modern mental health services.
I do not think we need go into this at the moment. I have promised to give the Minister this document.
There were proposals in the report on medical illness for legislative changes there. I am sure these will have to be incorporated in other changes that will take place. We need to take a new look at many of these things.
There should be a new look at this particular legislation and, if legislation is necessary, it should be introduced before this particular provision is implemented or simultaneously with it.
I will have a look at it to see what can be done.
Question put and agreed to.
I move amendment No. 71:
In page 25, before section 44 to insert the following new section:—
"(1) In this Part ‘undue hardship' has the meaning assigned to it in regulations made by the Minister.
(2) In this Part ‘hardship' has the meaning assigned to it in regulations made by the Minister."
What we are anxious to do here is to get rid of the phrase "undue hardship" and "hardship" which we feel in 1970 is a bit of an anachronism. It originated, I believe, in the Poor Law (Ireland) Act, 1838, and it has been brought forward in legislation since then. I thought we had found a way of doing away with it altogether under amendment No. 74 which we felt might get past the Cathaoirleach. However, it has been ruled out of order and I must settle for second best in this amendment.
The application and interpretation of the phrase "undue hardship" is causing great problems between the management side and the elected representatives. The management side naturally are inclined to take a very rigid interpretation of "undue hardship" because, as Senator Keery reminded us this morning, they are very conscious of an auditor breathing down their necks and naturally concerned that a surcharge might arise. What happens seems to be that when a manager rules a case out the applicant will go along to his public representative who then has to make representations. Then you have this argument going on.
As there does not seem to be any possibility of doing away with the phrase "undue hardship" altogether, at least if it were defined in a regulation, then it would be the responsibility of Parliament. The regulation could then come before both Houses and be discussed. This would cut out a lot of the problem in administering this section.
The Senator makes her point very well. However, I suppose everybody is aware that under section 46 there will be an appeal from an officer's decision in regard to what constitutes undue hardship in a particular case. I do not know how I could assign a meaning to "undue hardship" other than the meaning which any sensible officer making his subjective judgment would give to this phrase.
I think it would be undesirable to eliminate the word "undue". It would make the position of the officer concerned extremely difficult. It would be unwise to try to write something in the form of a ministerial regulation because there are so many complicated and different circumstances that could arise in family life. There might be a household where there apparently are means but where everything is in an absolutely appalling state due to lack of thrift by the head of the household or the drunkenness of the head of the household. On the basis of the actual income coming into the House you might not give them the rights under the middle-income group and then the officer has to consider this humanly, just how far he should go. You do not want to encourage drunkenness and lack of thrift and yet these people must have their hospital and other services paid for and so on. People who have been concerned about this problem in local authorities would know far more about this than even I would—those who serve in local authorities and who perhaps receive more appeals than Deputies do. I honestly think the hunch, the subjective judgment of the officer concerned, is really better, and I say that having the utmost sympathy for what Senator Owens has in mind.
I appreciate the Minister's problem and I must say I would not normally advocate more regulations under the Bill, but I did have a problem and thought this is how we could get around it. If between now and the Report Stage the Minister has time to discuss it further with the representatives of local authorities he will find they are having difficulty in this regard. That is how it came to me. The previous chairman of the health authority told me that they had great problems over the interpretation of "undue hardship". I do not want to press the amendment because it is a difficult matter from everyone's point of view.
In the course of the Second Stage debate I made a suggestion which I thought might help in matters of this kind and perhaps in practice it might meet some of the points that Senator Owens has been making. I think it would be a help, without having any definition in the Bill, if from time to time the health boards published anonymous case histories on how decisions were made in practice, so that gradually in the minds of the public representatives and in the minds of the community guidelines would emerge. I would hope to welcome later on an amendment which the Minister is proposing in regard to information services. I would think this is the sort of better information services any health board could provide by publishing actual anonymous case histories which would help to make the working of the Act, in covering cases of undue hardship, clear to public representatives and the community at large.
I think Senator Keery's idea is very good. I do not think I need to enforce this. A health board, those who are interested in social welfare and the many people who are involved in voluntary welfare work throughout the country might find it interesting to have some case histories prepared which would help to even up the whole situation. I am reminded of the fact that "hardship" for medicines is a bit unevenly interpreted, and that is perhaps one of the things Senator Owens is thinking of. However, when only the income of the spouse and the husband is counted that will be a help and when there is a national standard without any variation between one place and another in regard to means, that will also help. Then, when during the course of the next few years we provide drugs for the middle-income group on the basis of anything above a certain amount per month which will be paid for by the health authorities, that will eliminate some other inconsistencies of attitudes. In any case I could not write a regulation of this kind.
I think the Minister would have a certain amount of difficulty in writing the regulations, but he has just referred to variations in different areas in regard to medicines. The same can apply to the medical cards. In one area people might be disallowed a medical card because the income was £10 a week, whereas in another area it might be £12 a week and they would have a medical card.
That is in the Bill We are providing national standards.
This has been happening under existing legislation.
Up to now there have been certain differences.
In a certain case you will make representations to the staff officer of the health authority and, as all members of local authorities will know, it depends on the type of individual you are dealing with as to how he will interpret the words "undue hardship". If you are fortunate enough to have somebody who is kindly disposed his interpretation of it might not be so rigid, but if you are not so fortunate then somebody might interpret it very rigidly. This is the type of thing we want to eliminate. We would like something to be written into the Bill but if this cannot be done then it should be done by regulation.
There will be national standards under this Bill for the medical cards and they will come before the Dáil. There will be the same principle in regard to means for different classes of the community. These standards will apply all over the country and there will be no more £10 in one place and £12 in another. I might add, it is a most unenviable task for me. I do not particularly enjoy the prospect of bringing these draft regulations before the Dáil and Seanad because I do not believe I am going to please anybody.
This question of assessing means has always been a problem and, as the Minister pointed out, there were different circumstances in different houses. While one family might have had an income of £X and another family an income of £X plus 3, very often one would find that the family with £X plus 3 were worse off than the people with £X.
The difficulty I have always found in the assessment of means and dealing with cases in a humanitarian way is that there is wide discrepancy amongst the people making the decisions as to who should get what. I should like to see attached to every county council a trained almoner who would be a person specially trained in this field and who would be the final decision-maker, because persons who are charged with a heavy load of administrative work invariably have not time to give particular consideration to a particular case. I am just giving this to the Minister as a thought. If a specially trained almoner were available in each deciding area many of these problems would be obviated.
Amendment, by leave, withdrawn.
I move amendment No. 72:
In Part IV, page 25, before section 44 to insert the following new section:—
"( ) Any charge under this Part for a service which is attributable to a traffic accident shall be levied by a health board on the insurer concerned and, subject to regulations may, in default of payments, be recovered as a simple contract debt in any Court of competent jurisdiction."
This amendment deals with traffic accidents. People are brought into local hospitals as a result of traffic accidents and very often are kept there for very long periods. In many cases they are there at the expense of the ratepayer and the taxpayer and there does not seem to be any way in which the expenses can be recovered. By our putting down the amendment, we thought the Minister would consider doing something about that. It is unfortunate that a great deal of time and a great number of hospital beds are taken up with patients who are there as a result of traffic accidents.
We propose to make regulations under section 70 of the Bill. This was explained in the Dáil on 3rd December—columns 317 to 318. I do not think I need to take up the time of the House in explaining it.
Was this in reply to Deputy Ryan?
Deputy Ryan brought this up in the Dáil.
Yes. So, it will be provided for and we propose to take account of this.
I did not read Deputy Ryan.
We have a catholic view. We read everybody.
Amendment, by leave, withdrawn.
Amendments Nos. 73 and 74 not moved.
I move amendment No. 75:
In subsection (3), page 25, line 37, to delete "may" and substitute "shall".
Subsection (3) says "the Minister may with the consent of the Minister for Finance ...". We wish to change "may" to "shall". I am still wondering if it does not cover the Labour amendment No. 71.
Yes. This is the wonderful case of "may" and "shall" about which the draftsmen—very honourable people—have built up a sort of legend.
If it means the same thing, I am willing to accept it.
I will think it over. I am afraid the draftsmen have rather captivated me. I am beginning to be afraid of "may" and "shall".
I am afraid I only know the English language.
Will the Minister look into it?
Amendment, by leave, withdrawn.
Amendment No. 76 has already been discussed with amendment No. 10 and a decision has been taken.
Amendments Nos. 76 and 77 not moved.
Question proposed: "That section 44 stand part of the Bill".
I should just like to ask one question on subsection (7) in relation to the fact that the chief executive officer shall have discretionary powers to admit a person to eligibility or to exclude him. I should just like to ask the Minister whether in the case where a person is thus excluded from full eligibility there is any obligation on the chief executive officer to say why, to give reasons, to show upon what he has based his decision?
There is not any obligation on the chief executive officer to say why, in fact. This is a kind of subjective opinion. The same reasoning makes it possible for him to use his subjective judgment in these very complicated hardship cases where he would exclude a person from a medical card group for service. Equally, it is very hard to ask the chief executive officer to say why he was excluded.
In view of the fact that in some cases one gets the impression that this type of power is used, basing itself upon incomplete evidence, that the person involved does not know on what evidence he has been rejected and sometimes even third party evidence is taken into account without the knowledge of the person involved, it seems to me, in common justice, right that there should be some indication from the chief executive officer as to how he reached his decision. In all fairness this should be a common practice.
It might create difficulties. There is a pretty good, what might be described as, ombudsman service in this country for people, between Deputies, county councillors and private people.
Some people are more influential than others.
Some people who perhaps suffer because of the inevitable creaks that occur in this and every other country, have a pretty good method of defence. I say this with 30 years experience in the Dáil. I really do think they have. I do not think we need to go much further than we have gone in this Bill to ensure that they have justice. I trust the people generally agree with me on this matter. I certainly think I am right and that people agree with me, on the whole.
I think there are Senators who would agree with me that there is often an impression that the medical card is given to some and withheld from others without very clear reasons being evident to the general public. Some people do not understand how it is that character A manages to get a card while character B is refused a card.
Of course, it may be due to some kind of knowledge that the officer has—as I have said, fairly private knowledge.
Yes, and it may be, obviously, that mistakes would be made in regard to this. The creation of a given national standard will eliminate favouritism to the extent that it exists, and I do not know how far it exists.
I would just make a small point on this. The Minister asked a general question about the feelings of the House on this matter and, whilst I certainly agree with him that local representatives and public representatives generally do a very good job in generating steam whenever there are cases of injustice or apparent injustice, I occasionally have a worry that the generation of the steam and the raising of the voice in the council chamber, or wherever it may be, is not necessarily followed through sufficiently. There may not be proper legal or administrative machinery to tackle the position, to right the injustice or, perhaps, lead to the publication of that case in a way which would prevent a situation, of the kind being criticised, arising again. I have mentioned it in other debates. I, for one, certainly feel that a commissioner for administrative justice might well be a useful office to have established. Again, I look forward to a discussion on this point, whenever consideration of the Devlin Report arises.
We cannot start discussing the ombudsman on this Bill. We would be in awful trouble.
The Minister asked a general question. I feel I would like to put my views on record. I know that many people on this side of the House do not agree with this point.
In the meantime, we on this side of the House will continue to act as ombudsman. I would ask the Minister whether the ideas set out in subsection (3) of section 44 are radically different from the Labour Party amendment No. 71. I was hoping this might emerge in the discussion. I do not see a great lot extra provided in their amendment that was not in subsection (3) except that "a class or classes" could be vague. Perhaps the Minister might clarify this. I was rather scathing about this phrase "undue hardship" on Second Reading. At least it is an improvement. The expression "from his own resources or other legal means" presumed "his own resources" were legal in the first place but that was not always legal. I said last night that what might be "undue hardship" to the Minister might not be to me but it might be to someone in the public gallery. Subsequently, I discovered that the Fine Gael Chief Whip was sitting there and took a very dim view of the remark. What really is the intention of subsection (3)? How specific does he intend the Minister for Health to be? How binding does he intend those regulations by various health boards?
Heretofore, this is something that is not widely known, unfortunately, at election times—some of us might feel —members of health authorities were entitled to issue for one month a temporary general medical services card pending investigation by the medical officer. They were supposed to do this only in the event of dire emergency. I asked Senator Belton, as a member of the Dublin Health Authority, if he ever issued one of those cards and he tells me: "No, I have not".
I bet. It did happen that members issued these cards. I understand that, often, quite a number of them were issued at a particular time. It is not written into this Bill that this right will be continued. I do not know whether the provision is being carried on in the existing legislation. I hope it is not because I think it was generally abused.
I should prefer the Minister to cut it out.
That is why you are here and not in the Dáil.
I would say that very few have been issued by a public representative.
It is a point of contention. Everybody thinks everybody else is doing it.
I never heard of it in my county.
I would not propose to put this particular facility in the regulations: there is a national standard for this. There are arrangements for local authorities to provide assistance for people in need, temporarily.
There is a provision in some Act where a local authority may issue such a card.
Will the Minister continue this as far as new members of health boards are concerned?
I think this is most unlikely.
May I support the Minister? I think it should be cut out completely.
It is a temptation to abuse.
I am certain that the rights of members of health boards to help people to make appeals in regard to this are quite sufficient.
Could the Minister give us some definition of subsection (3) as opposed to the intent of the Labour Party amendment No. 71?
It would be very difficult. We have to prepare these standards. I do not suppose, in the initial stages, anyway, there would be a very great difference in the application of the standards in relation to the numbers of people. Thirty one per cent of the entire population is now eligible for these services. There will be a certain change through the means of the husband being only counted in the family so far as their right to a medical card is concerned. It would be very dishonest of me to promise a very big change in the total numbers of people who will be entitled to medical cards.
How wide a class or specific?
One could say in advance that there will be categories of people receiving social welfare assistance who definitely and automatically will be included. Then there will have to be some arrangements for income standards in relation to the numbers in the family, and so on. I could not go further into it. I should prefer the Senator to wait for the regulations which will come before the Dáil and the Seanad.
I should not like the position to be so vague that there should be disputes every day and that public representatives would be besieged. At the same time, I should not like them to be so strict that people would be moved out by 2/6d.
There will still be the hardship clause.
I do not see the difference between the Labour amendment and subsection (3).
I imagine there will be some trouble, inevitably, when the regulations come before the Oireachtas. People will have to adopt a standard that conforms with what is generally being done in all the different counties, with their varying standards. No matter how perfect we may be in this matter, I do not think everybody will be content. I think there will be a period when people will be wondering. I shall do my best to provide something satisfactory.
At that stage, the mythical ombudsman of Senator Keery and the practical ombudsman of Fine Gael will help to solve the problem.
Question put and agreed to.
Amendments Nos. 78 to 84, inclusive, have been ruled out of order. Amendment No. 85 was discussed with amendment No. 10 and I take it, therefore, that amendment No. 85 is not moved. Amendments Nos. 86 and 87 have also been ruled out of order.
Amendments Nos. 78 to 87, inclusive, not moved.
Question proposed: "That section 45 stand part of the Bill."
Several Senators tried to put down amendments in relation to the means test, maximum or minimum whichever way you look at it. I was tempted to do the same but I realised that it would be putting a charge on the Exchequer. However, I am hoping that this sum of £1,200 a year will be increased appreciably by the Minister under the powers given to him by subsection (3) of section 45 which says:
The Minister may, with the consent of the Minister for Finance, by regulations substitute for subsections (1) and (2) other provisions defining in such manner as he thinks fit categories of persons with limited eligibility.
It is obvious that he could, with the consent of the Minister for Finance, raise this £1,200 to the figure which I think he himself on Second Stage said would be nearer to present reality. If one takes this £1,200 as representing what it represented in January 1966 when it was first introduced, that sum would be something like £1,450 or £1,470. Nevertheless, it is disappointing that the Minister has not put down an amendment to this effect because in order to change it now he has to get the consent of the Minister for Finance. I think that in all equity this Bill should start the means test at £1,450 a year and only over and above that if the Minister wanted to change it should he have to go to the Minister for Finance.
Therefore, the first point I wish to make is that £1,200 a year which may have seemed all right as a top figure when the means test was being applied in 1966 is now clearly unjust. I should like to hear some defence by the Minister of his retention of this outmoded figure. The second point I wish to make is to express my disappointment that the Minister has not revised subsection (2). I mentioned this on Second Stage and it is clear we are applying in our means test a quite unjust test which is that in estimating means, a little capital sum in excess of life savings of £400 is counted as if it was necessarily bringing in 10 per cent. I should like to hear the Minister justify that. He made no reference to it in his reply on Second Stage. It goes back to 1952 and is enshrined in this measure again. How can we justify this concept that any piece of life savings in excess of £400, sometimes representing a lifetime of toil, will be considered for the purpose of a means test as if it brought in 10 per cent? This is manifestly unjust and I think this second subsection must be redefined and, if necessary, a new schedule drawn up.
I should like to hear the Minister's promise to look into this between now and Report Stage because it is clearly unjust to have this concept still in the measure before us when it has been shown to be so unjustified. The Minister cannot say: "I do not care whether a little capital sum is bringing in 10 per cent or not. I am going to treat it as if it did". This is a clear injustice and should be remedied.
I hope the day is not too far distant when we abolish the means test altogether. I join with Senator Sheehy Skeffington in his appeal to the Minister. As a result of the recent salary increases, many psychiatric nurses now find themselves in the higher income group. I do not think this was ever envisaged and I believe that people in this category cannot afford to be in the higher income group. Many of them have not realised they are in this category but when they discover it there will be considerable unrest and efforts will be made to have the figure increased. I hope the Minister can see his way to do something in this matter.
Listening to Senator McGlinchey, I was amused by his statement that people cannot afford to be in the higher income group. I know what he meant by that. The position is that in regard to the middle income means test regulations can be made at any time by the Minister under this Bill; it does not require a separate Bill. Regulations can be made and laid before the Houses of the Oireachtas. Obviously, the time will come when there will have to be a revision of this figure. It requires not only the consent of the Minister for Finance but it relates to the Minister for Social Welfare and also to the Minister for Local Government.
In this instance statistics have some significance. If you take the 1958 figure of £800 and apply the cost of living increase since then, the sum of £1,200 was still valid in 1969. Quite rightly some Senators and Deputies say that it was increased to £1,200 in 1966 and they work out the cost of living since then and raise it to £1,450. I suppose there is a certain amount of consistency in both views. I can only say that it is true that this Government have had regard to changes in the cost of living in relation to applicants for social welfare benefits of various kinds. Social welfare payments have increased enormously, far more than the cost of living although, of course, nobody is ever satisfied in this regard. I cannot commit myself to saying when such a change will take place. I think it is inevitable; I think the Minister for Social Welfare is aware of the fact that there must be a modification of this £1,200. I shall be very pleased to come before the Oireachtas as soon as the Government take any decision in regard to this, based on an examination by myself, the Minister for Social Welfare, the Minister for Local Government and the Minister for Finance. I cannot say when this increase will take place and I am not going to make promises I cannot fulfil.
Does the Minister say he really thinks it fair to act as if these poor people were getting 10 per cent interest on their life savings?
We will be able to look into this question of the middle income group and I think it possible to devise some system in relation to the number of dependants and so on.
I am sorry to persist, but rule 1 of the Seventh Schedule of the 1952 Act, which is what we are asked to refer back to in subsection (2), says that the first £25 will go scot-free but that after that the next £375 will be counted as if it were bringing in 5 per cent. Can the Minister not stop there and say any sum in excess of the first £25 might be estimated to bring in 5 per cent? That in itself in many cases would be in excess of reality but to pass on and say that anything in excess of this initial £400 shall be counted as if it were bringing in 10 per cent is manifestly unjust.
It will be possible to introduce the regulations even before the Health Bill comes into operation. I cannot promise the House that it will be done. I will not make a promise that I cannot keep.
The Minister is, in fact, by the context of this Bill asking us to base ourselves on rule 1 of the Seventh Schedule of the 1952 Act and he says we really cannot be so precipative in 1970 as to alter all at once the 1952 Act. I believe that he does not have to refer back to this ancient Schedule. I believe that it is possible in 1970 to behave as if 1952 was quite a long time ago. I believe that since 1952 we have had time enough to recognise that this is an unjust concept and must be changed now, not at some vague future date.
The Senator can look at subsection (3) which enables this to be done.
This is only a vague enabling power which may take another 18 years to implement.
I am afraid I cannot say any more about it. I can appreciate the desire on all sides of the House that we provide better health services and that we take account of the changes that have taken place in the cost of living, the increases in the cost of living that have taken place for the middle income group in the meantime. We have made some progress every year in our social services and I hope we will take full account of what everybody in the House feels in this matter.
Progress reported; Committee to sit again.