Health Bill, 1969—Committee Stage (Resumed).
Question again proposed: "That section 45 stand part of the Bill".
I just want to make a few brief points on this section. First of all, there is mention in it of persons with limited eligibility for services under this Part of the Bill. There is mention of persons insured under the Social Welfare Act, 1952. It seems to me unfortunate that it is insufficiently known that on ceasing to be qualified or to be compulsorily bound to be insured under the Social Welfare Acts, persons can contribute voluntarily and by so doing achieve benefits for themselves. That is a very useful service to a lot of people. If this section were made public, were made known to the people concerned, many of them would benefit. It is more the responsibility of the Minister for Social Welfare to do this and I wish he would do so.
The second point is that I do not think that the benefits which one can obtain by continuing as a voluntary contributor are being made available under this Bill. The only type of benefit you can get is a pension benefit. If that is incorrect, I should like to be informed of it. Whether it is correct or not, however, it occurs to me the Minister might tell us whether he intends to deal with a contingency which arises under the 1952 Social Welfare Act in respect of persons who were insured under that Act, being nonmanual employees, who ceased to be insured at the £1,200 a year limit. The Minister might deal with such persons and with persons who are provided for under subsection (1) (b)—adult persons whose yearly means are more than £1,200 a year.
There are sections which he could operate which are welcomed by my Party and by everybody in the House, sections 52 and 54, in relation to persons whose income is increased to more than £1,200 a year but not by such an amount as leaves available a spendable income which is in excess of the cost of the health services to that person in that year. It seems the Minister has powers under section 52 to extend the benefits to such persons by making an appropriate order as to the charge to be made to them—that it would not be of such an amount that there would be a loss incurred by the person in question.
The position as I understand it is that since 1956, persons who still continue to retain voluntary social welfare insurance, if they had 24 contributions for the previous 12 months, are able to get the middle income benefits. I agree with Senator Alexis FitzGerald that perhaps some people do not know this when they ceased to pay contributions voluntarily, or rather when they did not begin to pay contributions voluntarily. I understand there are Department of Social Welfare booklets available to everybody on this matter.
I suppose it would be true to say that when the information offices are set up by regional health boards there will be more information for people and anything that affects the medical services will be included in the information given through the offices. In regard to the hardship cases mentioned by the Senator, there is provision in the Bill whereby persons who are just about to become disqualified on the £1,200 a year limit who would find difficulty in paying hospital bills, can have the hardship provision applied to them. They may have to contribute something but the officers concerned can decide to give them assistance towards their hospital expenses, the expense of the doctor in the hospital and so forth. I think that, plus the section in the Bill which will enable the middle income group to get drugs which cost more than a certain stated amount per month, will contribute materially towards the general position.
I was just going to press the Minister to give us his view of the equity of subsection (2) of section 45. This is this reference back to Rule I of the Seventh Schedule of the 1952 Act, which permits the calculation of the means of anybody to take into account not only their real means but also the theoretical means deriving from a capital sum which may not even be invested. Subsection (2) not only permits the calculation of means based on the interest on a sum of money which may not be bringing in any interest, but actually supposes that the major portion of such a sum would be bringing in 10 per cent whether it does or not.
The Minister realises, of course, that some savings on the one hand give about four per cent, and Post Office bonds might give you six and a half per cent, but even if it were easy to get 10 per cent from invested capital I should like to hear the Minister's views as to the justice of calculating not on what is actually coming in, but on what theoretically might come in, if the capital sum were invested at 10 per cent. This is so manifestly unjust that I am surprised to see it enshrined in this Act.
With reference to that, I feel that calculations as made under the Social Welfare Acts first of all are reasonable and practicable. Let us assume that a man is looking for the old age pension and that he has a sum of £1,500 in the bank. That may be earning for him only two per cent or two and a half per cent and thereby bringing him in only perhaps £37 10s. per annum at two and a half per cent. In this State there is a limited amount of money which has to be spread as well as possible so as to provide the greatest benefit for those who are most badly in need. A man of 70 years of age or thereabouts, even 68, who had £1,500, with that money he could purchase, if he wished, an annuity which would bring him in approximately 15 per cent instead of investing it, thereby leaving him with a net income of £225 per annum. If you spread out social welfare benefits so as to give substantial benefits to those with considerable assets of their own, that means that there is so much less left for those who are much more badly in need, people with no income whatsoever, people living alone, that very grave injustice would be done to those people.
So, we take a national figure and let the man do what he likes with his money afterwards: if he is being supported by his family, let him bequeath it by will to his family—that is his own affair—or let him if he wishes give his family the use of the money, otherwise you will be faced with all sorts of difficulties because what very many people would do with substantial sums is that they would lend those moneys to others—I come across this frequently in my practice as a solicitor —free of interest in order to get the full benefit of the Social Welfare Acts, and those other people to whom the money is lent might not be in need at all. This is the sort of situation which would happen.
Those are the only people who can get a loan.
I see the point made by Senator Nash in regard to the possibility of buying an annuity, but there will be an objection to that and that is what the man might want to do to make provision for his widow. I mentioned a case on the Second Reading of a man having sold a large house and having moved into a smaller one happened to have £2,000 in the bank in a current account. It was not drawing any interest at all.
Senator Nash might say: "He could have bought an annuity". In fact this £2,000 meant that he was just barely above the £800 maximum as it was then—his actual pension being £650. Now this resulted in his having to pay a very large hospital bill both for his wife and himself at a time when it was by no means easy for him to do it. The hardship clause was invoked and the hospital bill was reduced by a not inconsiderate amount, but it still left him a lot to pay. At the age of 76, which he reached just a few months after this whole incident, he died and all he was able to leave was a house and this couple of thousand pounds.
Senator Nash might say: "Well this is plenty. She could live for the rest of her life, apparently, on this £2,000." In fact, I have heard from that lady that she was given an ex gratia pension of one-eighth of her late husband's 1955 retirement salary. This means she has been given something in the neighbourhood of £200, if I understand her correctly.
Apart entirely from whether the person in question is enabled—or well advised—to buy an annuity or not, I am asking in all equity that the means be assessed upon the actual means and not upon theoretical means which that person could get if the sum of money was invested to the best possible advantage. Unearned income is assessed by the Revenue Commissioners on the actual interest coming in and not on the maximum interest which could be earned if a person were well advised as to how to invest money in stocks and shares. I would like the Minister's views as to the equity of just charging 10 per cent, when possibly the money is not bringing in anything like 10 per cent. I am not criticising the percentage, but the justice of calculating the amounts as if the money was necessarily bringing in 10 per cent, when in fact, it might be bringing in 2½ or 4 per cent. Should the means not be calculated on what is actually coming in, rather than on what might come in if the money were invested in a more profitable manner?
Senator Sheehy Skeffington has already had an explanation of the methods of assessment used. We followed Social Welfare legislation. I have made it clear here and in the Dáil that we are linked with the Department of Social Welfare in so far as this matter is concerned. We do not intend to depart from the general arrangements made in that Department in relation to this particular group of people. It would be possible for me to modify these arrangements, if I chose to, in the regulations which will come before the Dáil and the Seanad at a later date in relation to the middle income group and to those with medical cards.
Would the Minister favour changing it?
I did not particularly study this because, as the House recalls, the Minister for Social Welfare has made a great number of miscellaneous small changes in the means test during the past ten years. Those changes are all for the better. I imagine it would take me at least half an hour to mention each small change which has helped to relieve necessitous persons in one way or another in regard to means tests.
I might refer briefly to non-contributory old age pensions, where there is a similar assessment of interest on capital. I do not believe the Minister for Social Welfare has received many complaints on the lines suggested by Senator Sheehy Skeffington. If he had, he would have made a change. All I can say is that when we are preparing the rules we will be in touch with the Department of Social Welfare. It is possible that at some time in the future changes will be made in social insurance plans. I will mention these points to the Minister. Personally, I feel the Minister for Social Welfare would have made changes if genuine hardship had resulted from the assessments. The first £25 of capital are not assessed. Five per cent is calculated on the next £375 and on capital exceeding the sum of £400 one-tenth of the capital value is taken. I myself have brought pressure to bear, as many Members on both sides of the House have, in regard to the means test provisions in the Social Welfare Acts. In many cases the recommendations made were adopted in the various Social Welfare Acts. I have never had great pressure brought to bear on me. That is as far as I can go on this point at present.
I welcome this assurance by the Minister, because I accept his statement that there have been quite a number of changes in relation to the means test. I particularly like the Minister's undertaking that he will bring this matter to the attention of the Minister for Social Welfare. I do not think it is sufficient to say that there have not been many complaints about injustice in this matter. It is manifestly unjust in itself. I am confident that inside the Cabinet, with his colleagues, the Minister will do his best to see that interest will no longer be assessed on small capital sums, and that it will not be assumed that capital necessarily earns 10 per cent.
I should like to add my voice to that of Senator Sheehy Skeffington in connection with this matter. I understood the Minister to say he felt there was no great volume of complaint against this regulation. Every member of local pension committees throughout the country—or at least in the west of Ireland—has from time to time passed remarks about this. There is no point in assessing a person with an income of 10 per cent or 5 per cent on his capital when that person is actually getting 2 per cent or 2¼ per cent. Most old age pensioners have not the knowledge or the facility to invest their money to their best advantage. Most of them put small amounts into the local bank in order to have something available for burial. We, on local pension committees, have found such people assessed at 5 or 10 per cent on these small amounts. The Minister is a courageous man and if he can change the method of assessment the Minister for Social Welfare might follow on that line.
I feel very uneasy about subsection (1) (b) and (c) of section 45. I would like to draw the attention of the Minister to the fact that when this equation of £1,200 income with £60 valuation was made the Land Commission regarded a 25-acre holding as a viable one. It is doubtful whether a 50-acre holding can now be considered viable. In view of the steep increases in the cost of hospital treatment and medicine in recent years I would like the Minister to take a serious look at the £60 ceiling. In recent legislation on grants for students for higher education the Minister for Education came up with a very workable scale. I should like to see something on those lines brought in to make the method of assessment more flexible. Clearly, the £1,200 limit and the £60 valuation—buildings are even included here although there is no income derived from them—are not high enough. As Minister for Transport and Power last year the Minister took note of this point when he wisely and graciously made a concession to people occupying large mansions as part of their allotments of land from the Land Commission. ESB charges on suitable scales were made. The Minister could possibly follow up that line of thought when dealing with this section. It would certainly help a very wide section of the population and I think they are entitled to this concession.
From subsection (1) (a), (b), (c) and (d) of section 45, it appears to me that if the yearly income of a person is £1,200 or he has a valuation of £60 or less on his farm, he is eligible and his dependants are eligible, but you have the situation where a person with no dependants having an income of £1,200 yearly or a person with no dependants and a valuation of £60 is eligible. I should like to hear the Minister's comment on a person who would have, say, £1,250 and a wife and three or four children, or a person with a valuation of £61, £62 or £65 with dependants. They do not seem to qualify and it appears to me we should have something to meet this in this subsection. Senator McDonald tried to do this but the amendments were ruled out of order because they would be a charge on the Exchequer. However, this was done by the Minister for Local Government in the 1966 Housing Act with regard to eligibility of people with dependants to obtain supplementary grants from local authorities.
In reply to Senators Fitzgerald and McDonald, we will look at the whole of this problem in relation to the means test in the middle income group before we set out regulations in draft form. It could be possible to adjust the income limits to provide that a single person might be regarded as being above the income limit at a certain figure whereas a person with a wife and three children might be within it even though he was slightly above the limit. We will look into this to see how we can set out in a schedule the means whereby allowances would be made for people with a large number of children who are in the fringe area of income and valuation.
However, it is equally true that a person with £1,250 a year or with a valuation of £61 and a large number of children who has an expensive hospital bill to pay can get it under the hardship section, where contributions can be made to persons above the limit if it is going to be a hardship on them to pay. We have two means available: we have the hardship facility, and we will examine this to see if we can spell it out in a more equitable way.
I am grateful to the Minister for his explanation but I should like to point out to him that a number of people might try to pay the bill by instalments, even though it creates hardship. They might not have representations made on their behalf to the county manager and this is why I should like to see something written into the Bill, say, £100 per child.
Details like this would have to be done by regulation.
I find the whole social insurance and social assistance code difficult to grasp. I made a point originally, which was incorrect, based on a statement in a book published by the Institute of Public Administration published in 1964 to the effect that there is no provision for voluntary insurance for benefits other than pensions. I should be quite happy to see this matter dealt with by regulations which is what I had in mind. I have had personal experience of people who declined increases because they calculated that the cost to them in loss of benefit under statutory provisions would be greater than the increase to them.
This seems to me to be wrong and something that could be dealt with in this Act by regulation. I do not like to think of people having to rely on the undue hardship clause. Why should they be called on to disclose all their circumstances to the chief executive officer? A person I have in mind was not prepared to take such a risk. However, what the Minister has said is encouraging and if this matter can be dealt with by regulation I am content.
I wish to remind the Minister of my remarks regarding subsection (1) (b) and the point I made with which he agreed on Second Stage, that the time the income limit of £1,200 was set was 1956. In view of the fall in money values since then, a figure of £1,450 would be required now to keep in line with the original figure. The Minister, at columns 1064 and 1065, volume 67 of the Official Report, agreed with this figure. As the section now stands, it is offering benefit to a smaller number of people than the original regulations and the figure would need to be increased to £1,450 to-day to be at the same standard of living. I am not sure the Minister clarified this other point in some of his remarks but some of us are apprehensive the voluntary contributors under the 1952 Act would be excluded by the way section 45 is worded. Section 4 of the 1952 Act states that voluntary contributors shall be taken as being insured persons for the purpose of the Act. On my reading it would seem voluntary contributors will still be eligible under section 45 subsection (1) (a). Perhaps the Minister would clarify this.
I have made it clear that they do continue to draw health benefit. I have already deal with this question of income limit and made it clear. The figure of £1,200 was still relevant in 1959 in relation to £800 in 1958, but there is the other argument that if you start at the time the White Paper was produced in 1966 there is justification for an increase of £250. This will have to be examined by the Minister for Social Welfare and myself as to what the limit should be. I cannot commit myself at this stage but I appreciate that wages and salaries have increased so much that there may be a case for raising the limit also. However, this is something on which I cannot commit myself now.
I was about to make the same point as Senator Boland but as the Minister has replied to that I see no point in making further reference to it. I should like to refer the Minister to subsection (3) of section 45 which states:
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.
We endeavoured to bring in an amendment to ensure that by that change the ceiling of means of such persons shall not be less than those contained in subsection (1). I would like the Minister's assurance that such will be the case.
I cannot give any guarantee of what I will do under subsection (3) but I do not propose to allow the middle income services to deteriorate. This is a subsection enabling me with the consent of the Minister for Finance to define income limits in other ways, if I think fit to do so and if the Dáil and Seanad agree. In relation to paragraph (b), in the case of a person with less than £1,200 one could have some adjustments in relation to the number of children in the family —one could have some sliding scale limit. That is what is being done. It does not mean that the services will deteriorate and I can guarantee my intention of preventing a general policy of lessening the general impact of the section on the hospital and institutional services provided for the middle income group. I do not think that it has deteriorated in the whole history of the State, and in fact it will improve.
The limit has not deteriorated certainly since World War II except on one occasion when there was a decrease in the old age pension back in the 30s. I think that that was the only occasion on which there was a reduction.
Might I ask the Minister whether he contemplates making regulations from time to time under subsection (3) so that, for example, in 1970 the limit might be £1,200, in 1972 £1,500 and so on? If he is contemplating that, should not the words "from time to time" be in the subsection?
I understand that that is covered by that wonderful Interpretation Act which must have come before the Seanad in many forms, and which enables us to be certain that we do not need to say "from time to time".
It is the Minister's intention?
Question put and agreed to.
SECTION 46.
I move amendment No. 88:
In subsection (1), line 45, to delete all words after "to" and substitute:—
"a Tribunal appointed in the following manner: Chairman appointed by the Minister, one member appointed by the Board and one member appointed by the Public Services Committee of the ICTU".
An Leas-Chathaoirleach
It is suggested that amendments Nos. 88 and 89 could be debated together?
They do not necessarily mean the same thing.
An Leas-Chathaoirleach
Both can be debated now. A decision will then be taken on the question as to whether the words in the Bill stand. If they do, then neither amendment can pass. If the words do not stand the House can then decide which of these forms it would like to adopt. Is that clear?
Section 46 outlines the proposed machinery for an appeal against a decision by an officer of the board regarding eligibility under sections 44 and 45. We consider it most undesirable that in the first instance as outlined in subsection (1) the appeal should be to possibly an officer of the same board. It seems to us some what unjudicial that an officer of a board having made a decision, it is provided that an appeal made against that decision will be dealt with by an officer of the same board. It is our understanding that in appeals machinery of this nature the appeal should lie as it were at another level, because obviously, without casting any aspersions on the integrity of such officers, there is an understandable and human possibility that an officer of the same board might not be disposed to upset the decision made by a colleague.
We have not got quite the same objection against the second subsection, because the stipulation under that subsection is that the appeal may be made to another person nominated by the Minister, by taking the two in conjunction and remembering what the Minister said in speaking in the debate on amendment No. 71 to section 44, when he said that the judgment which would be made by an officer would be a subjective judgment, it seems to us that it is not quite proper that an appeal of such an important nature as postulated under section 46 subsection (1) should he against the subjective judgment possibly of one person to the subjective judgment of yet another person.
For these reasons we would suggest to the Minister that he should give very strong and sympathetic consideration to our amendment or perhaps to the spirit that we think is contained therein. We would suggest that it would be more equitable to have such appeals referred to a tribunal which should, as befits a tribunal of that nature, be widely representative of the interests concerned in the appeal. Quite obviously the Minister has an interest and he should be allowed to appoint the chairman. The board concerned have an interest and obviously should be represented.
We suggest trade union representation, not that we claim that we have any monopoly of interest in this particular field but because this would be in line with similar tribunals and similar appeals machinery particularly contained in the social welfare code. There is provision in the Social Welfare Act, 1952, where a person or persons who are debarred from receiving unemployment assistance or unemployment benefit may appeal to an appeals officer who may be assisted by assessors, one of whom may be and usually is a representative of a trade union. So we would very strongly recommend this amendment to the Minister.
We repeat the point that we are somewhat uneasy that a decision made by one person might be referred by way of appeal to an officer of the same board, and we are also concerned that the subjective judgment of one person may simply be transferred to being the subjective judgment of another person. It will be appreciated, I am sure, by the House and the Minister that these appeals will of necessity involve quite an element of human hardship if not suffering, and we are sure that the Minister will agree with us that such an appeal should get as fair and equitable a hearing as possible and that it should be considered by a representative body such as we suggest in the tribunal referred to in the amendment.
The main purpose of both of these amendments is to take away from section 46 the provision that an appeal can be taken from an officer of a board to another officer of that board who has already given a decision on this eligibility problem. We feel that, as I said in my Second Reading speech, in borderline cases, as Senator Jack Fitzgerald said there is a human element, and it is unlikely that two officers of the same board will disagree in their attitudes. It is quite obvious that if there has been a very wrong decision of course they would not agree, but all cases coming for appeal will be borderline cases and, therefore, I foresee great danger in allowing a person to judge an appeal from a fellow officer who has already given judgment on it.
As to whether Senator J. Fitzgerald's amendment is better than the one put down by Senator Reynolds and myself, I am not sure. While Senator Fitzgerald has quoted precedents in other spheres of life, I can equally quote spheres where one person decides an issue. For instance, an official arbitrator would find himself in the position of having to make a much greater decision. Therefore, the only difference I can see between Senator Fitzgerald's amendment and mine is whether the decision should be made by a board or by an individual person. For my part, I would prefer the individual person but our main object in both amendments is to eradicate the idea that an officer of a board can be appealed to from an officer of the same board.
Miss Bourke
I should like to support the Labour amendment on this point as to a decision on eligibility. The amendment emphasises the concept that what we need in this country is that justice must not only be done but must be seen to be done. Therefore, I would favour a tribunal rather than an individual person where the third member might be selected by the ICTU or some other independent body.
It is time that we followed the English practice in this. Since the Tribunal of Inquiry Act of 1967, they have come out very strongly in favour of independent tribunals in areas which deal with eligibility instead of what we have in our social welfare scheme. This would be a very good time to set up an independent tribunal on this matter and this would not cause any great administrative difficulty. In supporting very strongly this Labour amendment, I am not concerned as to who the third person should be provided it is a member who is independent of the health board.
I, also, wish to support the point of view expressed in connection with these two amendments. The kernel of the matter, as mentioned by Senator Belton, is that an appeal should not be from one officer of a board to another officer of the same board in any circumstances. There is precedent for this kind of provision in the social welfare code but it is not a good precedent to follow. It seems to me that we should not think in terms of the code of establishment that we have at the moment of allowing an appeal from one district justice to another district justice or from one circuit court judge to another circuit court judge rather than going on into a different region.
Whichever one of these amendments might be accepted, or whether the Minister may bring in an amendment in a completely different form, the important thing is to get away from the idea that an appeal should be from an officer of the board to another officer of that board.
Perhaps most Senators will agree that in the course of the years what will happen is that, under a particular health board, precedents will be established and decisions which may have been given will be looked upon as precedents within the area of that board and it will not matter whether it is one officer or another officer of the board who is concerned because once the decisions have been made the precedents will have been established —precedents that the officers of the board will look to when similar cases come before them.
What is needed here is a fresh independent mind completely untrammelled by previous decisions within the particular board. I do not think we will get that under the machinery as suggested in the section. I have an open mind as to whether the appeal should be to one person or should be to a tribunal. There are advantages in both. Where the appeal is to an individual, there is the advantage of speed whereas in the case of a tribunal there might be a certain amount of delay, in the first place in the establishment of the tribunal unless it could be one that would be in more or less permanent session. There is also the probability that an appeal coming before a tribunal would tend to be more lengthy than that coming before an individual so that there are advantages and disadvantages on both sides, but the principle involved is that an appeal should not be from one officer of a board to another officer of the same board.
Senator O'Higgins has made a point that I wish to speak about. This assessing of eligibility will eventually evolve into a matter of precedents and from the way in which the section is worded we will probably find that a junior official would first make the judgment and that the appeal may be to a senior officer, but in the eyes of the public who are the people involved in this, one official is the same as the other and what would be likely to happen is that a member of the public would go to his local representative and start representation all over again.
Apart from the point made by Senator Dunne, this sort of final code of appeal would save a lot of administrative disorder and inefficiency and as pointed out by Senator Bourke, justice would not only be done but would be seen to be done which is the very important object behind this amendment. We are very anxious to hear the Minister's reply and I hope that he will accept the amendment because it would be a break-through in a way of dealing with the public as against officialdom.
I am afraid I could not agree to accept either of those amendments. I have had long experience in this whole business and although it can be said in the Department of Social Welfare that obviously they are not always perfect, that they make mistakes. I am not aware that the present arrangement, whereby in relation to the Department of Social Welfare their deciding officers and appeals officers do their work separately—the appeals officers examine the cases which are appealed from the decisions of the deciding officers—has caused abuse or that it has left out people who are entitled to benefits of one kind or another, nor am I aware of any great injustice done in relation to the provision of medical cards under the present health arrangements.
We have had improvements in regard to the provision of medical cards. We have arranged for a national standard of medical card eligibility which will come before the Dáil and the Seanad. We have made a statutory appeal available in the Bill. The representation of Deputies, Senators and local authorities, county councillors and other persons of the same kind, will continue and there will be no change in that regard.
I could not possibly accept the idea of a tribunal because the whole basis in regard to this Bill is that the regional health boards will not take part in anything relating to eligibility for services or charges for services. That I think is a good thing for reasons which will be perfectly evident to the Seanad, so the members of the health boards could not take part in it.
Suggestions were made that the Congress of Trade Unions should have representation on this tribunal. I see nothing wrong in that. If you have a tribunal obviously you would want to have people representing workers and union members, but the people who put forward this amendment know the reason for this particular kind of assessor, for the appointment of an assessor is largely owing to the fact that many appeals in the social welfare code are based on whether a person is genuinely seeking work and in relation to the seeking of work whether the kind of work that was offered was suitable to the person.
The assessment of means in relation to medical services is quite a different matter and I do not see the need for representation of that kind. As I have said in regard to the middle income group, at present when there is an appeal by them it is done by the appeals officer of the Department of Social Welfare because they operate the social welfare code. We want to maintain uniformity with that code and we will continue to use those officers for that purpose. I have not heard it said that the deciding officers and the appeals officers in that Department have constituted between them some element of injustice or that justice is not seen to be done. Anyone appointed for this purpose is bound to make mistakes and in some cases they could make a mistake in the wrong direction giving someone the right to medical benefit who did not really merit it at all as well as making mistakes on the other side.
I can assure the House in relation to the issue of medical cards that I will make certain that an officer at a lower level will make the decision in the first case and the different appeals made will be made by an officer at a higher level, possibly a chief executive officer. This practice will continue. Those must be people who will genuinely look at each case without so to speak there being any plot between them. In other words, the appeals officers must have a genuine review of the case.
I think once those regional health boards are established and the officers appointed for an entire regional health board, if they start to become overharsh in making those decisions I would very quickly hear about that and if it could be shown by Deputies, Senators or local authority representatives that those particular officers appointed for this purpose were being harsh in their judgments or that the public failed to understand their judgments in particular cases, I would be perfectly prepared at any time to consider some alternative form of administration such as, for example, if I had to do it, having the appeals board in some central place so that the people did not frequently meet what might be called the first deciding officers in regard to medical cards.
We could do that in order to make sure there should be an entire separation, at least physically, between them, but I do not think it is necessary. As I have said, I am quite satisfied there will be no injustice as a result of the decisions we will make in this regard. The present groups of deciding officers and appeals officers who will deal with the middle income group will have two different officials, one at a higher level, dealing with the final appeal for medical cards. I can assure the House that I will always be vigilant to ensure that the arrangements will prove to be satisfactory and indeed I will be the first to hear if they are not.
One of course has no hesitation in accepting the personal assurance of the Minister but with the greatest respect it is appreciated that we are concerned with legislation which may long outlive the present Minister. I must say we are disappointed at his seemingly adamant attitude to our amendment or, as I said earlier, to the spirit in which we put it forward. I make the point again, with particular reference to the social welfare code, that the appeals officers provided for in that code are not in every case, but are in very many cases, assisted by assessors and in certain circumstances these assessors may be trade union representatives. I do not think it is quite accurate, if I understand the Minister right, to say that in the main those appeals would be concerned with whether the particular appellant had been genuinely seeking work.
I have had some experience as an assessor for many years in that connection and we were very often faced with some more complicated problems than that. The Minister knows that when one enters the field of human want there is seemingly no limit to the complexities one may encounter. I can recall not merely dealing with questions as to whether the appellant had looked for work but with questions of means, very often matters affecting trade disputes and many matters of that nature.
I am most anxious that nothing I would say would apparently reflect on the integrity of any officer of any Department but it occurred to me as the Minister spoke that we could never hope to know how many appeals are not in fact made because the people concerned would perhaps take the point of view that some of my fellow-Senators have expressed, that there would not be much use in appealing to two officers of the same Department, and we make the analogy here of officers of the same board.
I repeat my disappointment at the attitude of the Minister. We would make the point that the tripartite representation on the tribunal we suggested is quite common not merely under the social welfare code or something like it, to which I have referred, but it is making its impact more and more through the different stratas of our community.
Senator Bourke has put it better than I have and has said that not alone should something be done but it must appear to be done. There are many facets of social life today but few are more important than the whole field of social welfare and health. It is proper that the Government, the community and the people, through their organisations, should be represented. We have accepted the Minister's expressions of the importance of this Health Bill which contains many desirable improvements. It purports to lay a foundation for still greater improvements in the future. For that reason the Minister should examine the thinking behind this amendment with more sympathy. If we have failed to convince the Minister, I regret to say the Minister has equally failed to convince us that what we are seeking, or something analogous to it, is not very desirable.
Miss Bourke
Might I mention here that we are setting up the mechanics of this scheme and are not imputing any misconduct to existing officers or saying they will act without the fullest integrity in the future. We are providing the machinery and we should do so with greatest care. Is the Minister aware that in England this idea of a deciding officer and an appeals officer is frowned on and not regarded as good machinery?
Since the Tribunal Report of 1957 and the Act of 1958 in England, it has been the practice to set up a tribunal. Has the Minister considered the position? If he did, perhaps he would reconsider this matter for the many good reasons put forward by Senator Dunne and Senator Miss Owens. Perhaps this matter could be left open for the Report Stage. We could set a good precedent here which would not involve much change but would be a type of participation by the public on the question of eligibility. This is necessary in order to show that this is not a bureaucratic machine but one which takes into account, and is seen to take into account, human factors. If this machinery did not work very well the Minister would hear about it and could see that it was improved. I would prefer this machinery instead of the single deciding officer with appeal to a higher officer.
The Minister is possibly not on the right lines when he makes the case that complaints have not been made although the system has been operating in relation to social welfare. Complaints have been made. I accept that the officers do their job properly and quite impartially. That is not an issue here. As Senator Dunne says, it is a question of the machinery and of passing legislation which will probably far outlive the present Oireachtas. The purpose of passing legislation is that it will continue in existence and be amended from time to time. There is not any question of reflecting unfavourably on the officers who do this kind of work now, or on their impartiality. It is merely a question of what is good practice. It does not seem to us to be good practice that there should be a system where an appeal is made from a person's right hand to his left hand, as it were
In reply to the Senators who spoke I want to be frank about this. I do not feel I am entitled to consider this matter in depth. It is a matter for the Minister for Social Welfare and possibly the Minister for Labour to consider. Senator Bourke has raised many issues in relation to this type of arrangement and the making of decisions of this kind. This country is not the same as England. We are a country of three million people with a distinct individualist tradition. The same necessity for such tribunals does not apply here as in England where people have a very different temperament and live under different conditions in a state of comparatively greater affluence because of the growth of industry there over the centuries. I do not think we should compare ourselves with the British.
I would have an open mind in listening to arguments on the concept of tribunals independent of the Department, which, incidentally, would have to be permanent because there are far too many medical card-holders for anything like a part-time tribunal to operate. This covers the whole field of occupational injuries, wet-time insurance, unemployment benefit, health benefit and old age pensions. It covers a vast field in relation to a person's eligibility for a grant or a privilege. This is a big sociological problem and there are two sides to it. The people who want to look for an independent tribunal can be grouped with the people who have a perfect right to advocate the principle of an ombudsman. Nobody would agree to the provision of an ombudsman or changes in the fabric of constitutional arrangements.
The Minister should not assume that.
There could be a case for it in some countries where no Senator would be permitted to investigate. This is a very big matter and I do not propose to make decisions myself about it. I would not compare this country with Great Britain in regard to appeals procedures. Senator Bourke should admit that we are a different country with different attitudes. Civil servants in England might take an inhuman attitude because they are living in a huge, densely populated country where very few people know each other.
Miss Bourke
I was suggesting we might learn a little from the mechanics there.
In England there might be injustice and there might be some purpose in having an independent tribunal. I would prefer to leave the matter as it is. I would have to consult the Minister for Social Welfare and the Government if there was to be any major change in the general concept. Thousands of appeals are decided each year by the appeals officer and deciding officer in the Department of Social Welfare. These decisions are made on a humane basis. In the debates on the Estimate there have not been many serious complaints indicating the necessity to change the system. That is my last word on this. I could not go further in this matter because it covers too big a field.
An Leas-Chathaoirleach
Is amendment No. 88 withdrawn? In order to save amendment 89 I propose to put the question in the following way: the motion is that in line 45 the words "a person being" stand part of the section. Those who are against amendment No. 88 should vote for the motion. Those who are for amendment No. 89 should vote against the motion as put. Is that clear?
Might I suggest that the formula which was proposed originally would probably satisfy everyone? The question is put on the basis that the words proposed to be deleted stand. Those in favour of either amendment 88 or 89, or in favour of both will know what to do. It would be voting against the motion.
An Leas-Chathaoirleach
This is a matter for the House but this would preclude a person from being against amendment No. 88 but in favour of amendment No. 89. Is the House agreeable to vote on the question: "That the words proposed to be deleted stand"?
An Leas-Chathaoirleach
The House apparently is no clearer than it was before. The question is: "That the words proposed to be deleted stand".
Question put.
The Committee divided: Tá, 27; Níl, 19.
Tá
- Ahern, Liam.
- Alton, Bryan G.
- Brennan, John J.
- Brugha, Ruairí.
- Cranitch, Mícheál C.
- Crinion, Brendan.
- Doyle, John.
- Eachthéirn, Cáit Uí.
- Farrell, Joseph.
- Farrell, Peggy.
- Fitzsimons, Patrick.
- Flanagan, Thomas P.
- Gallanagh, Michael.
- Garrett, Jack.
- Hanafin, Desmond.
- Honan, Dermot P.
- Keery, Neville.
- Killilea, Mark.
- McGlinchey, Bernard.
- McGowan, Patrick.
- Nash, John J.
- Norton, Patrick.
- Ó Maoláin, Tomás.
- O'Sullivan, Terry.
- Ryan, Eoin.
- Ryan, Patrick W.
- Walsh, Seán.
Níl
- Belton, Richard.
- Boland, John.
- Bourke, Mary T.W.
- Desmond, Eileen.
- Dooge, James C.I.
- Dunne, James.
- Farrelly, Denis.
- FitzGerald, Alexis.
- Fitzgerald, Jack.
- Horgan, John.
- Kelly, John.
- Lyons, Michael D.
- McDonald, Charles B.
- Malone, Patrick.
- Mannion, John M.
- O'Brien, William.
- O'Higgins, Michael J.
- Owens, Evelyn P.
- Sheehy Skeffington, O.L.
Tellers: Tá, Senators Brennan and J. Farrell; Níl, Senators Dunne and Owens.
Question declared carried.
Amendment declared lost.
Amendment No. 89 not moved.
Section 46 agreed to.
Section 47 agreed to.
SECTION 48.
I move amendment No. 90:
In subsection (1), page 27, line 1, before "where" to insert "subject to the provisions of section 45 subsection (1)" and in line 2 to delete "section" and substitute "Part".
I move this particularly badly-drawn amendment, which is in my name alone, alas, which makes it quite clear who drafted it. When I drafted it originally—if the Seanad would ignore the first-proposed insertion, because I do not understand what I had in mind in suggesting the proposed insertion— I intended to propose the deletion of "section" and substitution of "Part" because I could not understand why the word "section" was in the section, there being no purpose for it in section 48. This seems to me to be a suitable drafting amendment and I would invite the Minister to consider it.
I will consider it, but the subsection is a repetition of a corresponding subsection in the 1953 Health Act and I am not aware that any difficulty has arisen with the operation of the provisions concerned. But just in case there is something in Senator FitzGerald's amendment I will look at it again. The subsection is an exact repeat of the existing provision in the 1953 Act, and my officers tell me that it has never given rise to any sort of difficulty.
I think that the word "section" should not be there, there being no provision for recording under the section and the only provision would be under sections 44 and 45 with regard to declarations under section 47 and therefore the Minister should have either "Part" or "Chapter". However, I will leave it with the Minister.
Amendment, by leave, withdrawn.
Question proposed: "That section 48 stand part of the Bill".
Where a person is recorded, if he does not notify the health authority or the health board of a change in circumstances, in other words, if the income of the home increases for some reason or another, he is under this section leaving himself open to conviction and a fine not exceeding £50. Under the Health Act at the moment you have a situation where—and I presume that there will be a change in this—if somebody gets a medical card and the family grow up and go to work and the income of the household increases and then there is a review of the position with regard to this health card, the moment they find out that the income in the house has increased very substantially from the time he applied for and got a medical card, I hope that in a position like that we would not have the situation where somebody would be liable to be brought to court because he did not notify the local authority that some of his children were working and bringing eight or ten pounds more than when the health card was issued.
I am not aware that there has been any difficulty over these decisions before, and I have never heard of any fine being imposed unfairly.
I am aware that there were not, but there could well be in the future.
I do not believe in this kind of talking. I do not believe that there is any kind of hardship for people, and I am sure that the officers of the health authorities and the county councils have done a splendid job. I have not heard any criticism or complaint over the position being altered in this way.
I have not made any such charge.
I think that the Senator made certain implications there.
Question put and agreed to.
Section 49 agreed to.
SECTION 50.
I move amendment No. 91:
In page 27, before section 50 but in Chapter I to insert the following new section:—
"( ) If a health board are of opinion that the eligibility qualification ‘without undue hardship' in this Chapter operates to the detriment of persons applying for services the board may, by resolution, make rules relaxing the eligibility test applied by regulations or by the Chief Executive Officer, provided that the cost of providing the service to a person (or part of a service) under such rules shall not be a charge on the Exchequer, and provided also that such rules shall not be made without the prior consent of the local rating authority concerned."
This again deals with the problem of undue hardship and with cases, of which I do not think there would be too many, where the health board are aware of the eligibility qualification that is defined and where they might preclude a person or certain categories of persons from availing of a service. It proposes that the committee by resolution could relax the eligibility qualification for undue hardship.
In order to keep ourselves in order, we provide that the cost would not be a charge on the Exchequer, but it would be unfair if they were to make a resolution of this nature without the consent of the local rating authorities, as I think it should be because there would be more than one. The whole charge would have to fall on the rates, and it would be only fair that the rating authority would have a say in such a decision. Again, in expressing the possibility of a problem in relation to undue hardship I assure the Minister that there is no implication, nor am I suggesting that the officers are being too rigid about it. What we are trying to get is more flexibility than they have had before. I do not think that this would be a category or an instance that would arise too often, but I believe that there are or have been some similar type problems in the application of it previously. It would be reasonable, I think, that the individual health board who are proposing to widen the thing in particular circumstances should have to move a resolution amending the regulations with the consent of the local rating authorities who would be bearing the whole charge.
I sympathise with the idea underlying this amendment but I cannot accept it. It would be a matter for the Minister for Health of the day to have regard to undue hardship types that had been brought to his notice not covered by existing regulations, but I cannot accept an amendment of the Bill which will allow health boards to have varying standards of eligibility. This would mean that one regional health board could have a different standard of eligibility to others. It would cause great difficulty, and it would be extremely difficult to avoid all kinds of pressures. It would result, for example, in the standard of eligibility being raised by particular health boards for their own good reasons and it would go against the whole principle involved in the social welfare codes, in the codes relating to disability benefits, national health benefits, old age pensions and so forth. We should set a precedent, and that I think would be entirely wrong.
I must in all conscience, in consultation with the Minister for Social Welfare, provide for uniform standards of eligibility throughout the country, and I think that when the regulations are put before the Dáil and Seanad it will be seen that they cover all the points relating to the eligibility of people for medical services from all walks of life both in town and country and that the standards would be operated fairly.
I am afraid that I cannot accept the amendment. The result of the amendment would be to ensure that there would not be unvarying standards of eligibility throughout the country. I cannot make exceptions to the rule that a health board should have nothing to do with eligibility for services. I think that the House has already accepted that principle. To depart from it would place an impossible burden on individual members of the health board in an area and would place them in very great difficulty. There would be all kinds of pressures that they would have to face, so I cannot accept the amendment.
I appreciate that the Minister has a problem, but I do not accept what he said about there being no variation in eligibility, because he has fixed the amount of £1,200 or £60 valuation for some people. It is because there could be variations in particular local areas that we thought it would be reasonable to make this request. When speaking about that, the Minister said he could not possibly define undue hardship but, evidently, it is possible to define eligibility. I shall not press that because I know there are problems involved but I do not accept what the Minister has said in reply.
Amendment, by leave, withdrawn.
Section 50 agreed to.
SECTION 51.
I move amendment No. 92:
To add to the section the following new subsection:—
( ) A health board shall make available in-patients services to all mentally handicapped children but the cost of providing such service shall not constitute a charge or potential charge on State funds.
This amendment to deal with the in-patient treatment of mentally retarded children is one towards which I would expect that every Member of the House would have great sympathy. In putting down this amendment I would have liked to have included all mentally retarded people but that might be going extremely far with regard to a charge on the rates.
From the way the amendment is worded it will be seen that there will be no charge on the Exchequer. I had to put it that way because otherwise it would be ruled out, and I have confined the class of persons to mentally retarded children. There are several points about this that should be considered, the first being that recent advances in psychological medicine and in particular psychiatric medicine, have shown that in many cases there is need for in-patient treatment of these children. When we consider autistic children and the schools provided for them in, for instance, St. Loman's Hospital, we should be able to see the need for in-patient treatment.
There are also, of course, mongolian children. The causes of this condition are being found—they are related to chromosomes and genes in the various cells, and that is another reason why in-patient treatment is necessary. But there is yet another and a very cogent reason for this type of treatment. In my opinion, a mentally retarded child who is kept at home with other children who are normal may have an effect on the family because the other children cannot behave as normally as if they were living with a healthy child. They cannot be expected to look on life in the same way as if the whole family were healthy, and the impact on the parents in always having to look at the mentally retarded child must be great so that the parents may, themselves, become affected. Indeed, I have known of cases in which parents developed inferiority complexes because of a mentally retarded child within the family. Therefore, it is my opinion that the Minister should treat this very reasonable request with great sympathy.
I should like to differ very strongly from part of what Senator Belton has said. Although I sympathise with the general intention of the amendment, I would disagree sharply with him when he says that the presence of a mentally retarded child in a family would necessarily have a bad effect on other children or on the parents. Very often the presence of such a child may have a very good effect on the rest of the family by promoting and encouraging tenderness and compassion. Perhaps Senator Belton has not fully considered the fact that very often the presence within the family of such a child can, in practice, greatly benefit the entire family. I should be very reluctant to support an amendment which would seem to carry with it the implication that all such children should be removed from the family for the supposed benefit of the family.
I understand the object of this amendment and it is one with which I have great sympathy, but the Bill does not specifically state that in-patient treatment for children suffering from long-term disabilities and diseases will be provided free. However, I have already made it clear in the Dáil that I intend, subject to the consent of the Minister for Finance, to provide that such treatment will be provided free for children suffering from such conditions following the enactment of the Bill and I have already committed myself publicly in this respect.
Senator Sheehy Skeffington has partly given the right answer in regard to this. We must be very careful about these conditions and there might be certain cases where assistance would be merited but where perpetual in-patient treatment would not be merited. In other words, if we can improve the domiciliary care and arrangements of children suffering from varying degrees of disability, there are some children, who, as Senator Sheehy Skeffington says, derive great benefit from being with their families provided the families do not suffer pain or distress in looking after them, and this relates to the rate of growth in new drugs and treatments and to assist teaching in as far as is possible for these children.
It is an advancing science and I wish to be left free in this respect so that I can ensure that children who really have need of institutional treatment can get it without any hardship attaching to their parents while at the same time we can be discreet about this so as to ensure that we carry out the suggestions of practically every great expert and scientist in the field of mental handicap.
It is important that you try and keep people at home as much as possible and that you provide psychiatric officers and social workers to help the parents to keep the children at home. You can equally provide day treatment in some institutions such as the day treatment provided for by the parents of handicapped children's associations in Dublin where there are day units. I think the House will agree if it is left to the Minister for Health to make the orders for this—my predecessor and I have committed ourselves in regard to including mental handicap and certain other diseases with a psychiatric origin —it will be sufficient.
I am grateful to the Minister. I want to make one or two observations. In the amendment I did not make any reference to eligibility or anything of that nature. I was including everybody in this amendment. However, on the Minister's word and undertaking about examining this and including in those other diseases of long standing and in this regard I am sure he is referring to diabetes and other diseases of that nature. I was not including any type of eligibility in this amendment.
I accept the Minister's undertaking that he will keep this in mind because I think it is one which should be watched very carefully.
Amendment, by leave, withdrawn.
Questioned proposed: "That section 51 stand part of the Bill".
Before we dispose of this section I should like to say how much I am in sympathy with the Minister's aims in this section. I would hope, however, that he would make it a point that the illnesses and disability which will be eligible for long-term treatment will be properly listed, and the list compiled by regulation by himself otherwise I feel that this section could possibly lead to abuse of in-patient treatment and that it might be used for the disposal of patients who would, as Senator Sheehy Skeffington said, be better off kept at home or indeed that we might have health boards enlarging the list of eligible patients just to cover certain eventualities, and to leave it without listing the list of diseases would mean that the rules of eligibility would be very fixed and unvaried from board to board.
They will be listed and cannot be varied from board to board.
It would seem that this is the section that does away with the completely free treatment of children attending national schools irrespective of the means of their parents. Looking at the explanatory memorandum issued with the Bill it says the obligation to be imposed on health boards by section 51 of the Bill is generally similar to the present obligation of health authorities.
This is only for ordinary maladies discovered at school examination in respect of the higher income group and I think they should be able to pay for the treatment of ordinary maladies. They can get voluntary health insurance so far as possible treatment is concerned or they can get arrangements under the hardship clause if they are on the edge of the higher income group, if they have to face up to some difficult financial situation.
I appreciate all that but it seems to be rather a pity in the part of the Bill which is introducing many new services and improvements to some degree that one particular section is taking away a facility which already existed and that is children attending national schools receive free treatment irrespective of the means of their parents. I wonder if it is a wise thing because surely in a comprehensive examination and treatment programme of children one is taking steps to see that the health of the adults of tomorrow is being cared for, generally looked after and provided for. However, I presume the Minister's mind is fairly definitely made up on this.
People in the lower level of the higher income group who are in great difficulty under the hardship clause could get assistance from the health boards for maladies discovered at the school examinations for which hospital treatment or institutional treatment is required. I think that should cover it.
Question put and agreed to.
Sections 52 to 54, inclusive, agreed to.
SECTION 55.
I move amendment No. 93:
In page 28, to add to the section the following new subsection:—
(6) A health board may (with the consent of a Public Assistance Authority) make arrangements for the provision of meals (and payment of bus or rail fares) to persons attending hospitals or clinics for out-patient services, provided that this service shall not require a contribution from the Exchequer.
The reason why we put down this amendment was because it appears to me having provided all those services we have not in the case of outpatient services provided for the means by which they would be able to get there to avail of the services. The Minister may be able to correct me on this but it seems to me you can have a situation where a person who has to travel to avail of the outpatient services may not be in a position to pay the fare required and if that person is delayed it may take him or her a day's journey between coming and going and that person might not be able out of his own means to provide for food on the way. This is the reason why we put down this amendment so that those people would be able to fully avail of the services which the Minister for Health is providing under this section.
I am grossly out of order but just to help people I want to say that the next three amendments are all the same in the sense that they are not necessary. Under section 56 (1) the health board have discretion to provide other means of transport for the conveyance of patients to places within the board's own functional area or to places outside its functional area or from places outside its functional area to places within it. This allows them to pay bus or rail fares for out-patients if they consider it is appropriate and also enables them to provide a meal for patients who have to wait for a long time after they arrive for a test. They can provide a meal in the hospital for those people who require nourishment during a long wait. In other words, it is already covered under section 56 subsection (1) or else it is covered in previous legislation so I can assure the House this amendment is not necessary.
Is the question of meals covered under section 56 (1)?
Yes it is. The legal adviser has indicated to me that this could be part of the administrative arrangements for providing such meal services. If a person attending a hospital arrives at 12 o'clock and has to wait until 3 o'clock for a test it would be possible to provide a meal in the hospital for him or her.
If the person had to wait a long time for a train and wanted a meal would that be covered by section 56?
I am not sure of that. There must be some limit.
This is what we had in mind when we put down this amendment. I am glad the Minister cleared up the point for me. I had examined section 56 in that regard. I thought it only meant the provision of an ambulance or public health transport rather than general transport, which seems to be the more expensive way of doing it. Perhaps the Minister could clear up the point as to whether meals could be obtained at the hospital?
We just cannot do everything. I do not think they could.
Before we leave this section I should like to ask the Minister about the possibility of providing meals for private in-patients and out-patients. We are talking about big regional hospitals and I cannot see how we can build them without providing facilities in them for private as well as public patients.
One of the problems arising is that there are many complicated techniques and operations now, the facilities for which will exist only in big State-owned and State-run complexes. It will not be possible for private hospitals to afford the equipment and services for such work. A state of affairs will develop where the wealthier classes will be the second-class citizens in so far as they will be unable to get the type of hospital services they require in the hospitals to which they would normally go. It would be up to the State institutions to provide such services. Provision must be made in legislation for the future which will permit the State to build and maintain both in-patient and out-patient services for people who wish to have private medical treatment, always assuming they were prepared to pay for it and that by doing so they would make a contribution to the general services income.
This does not arise on this section at all. I could not commit myself to the State's liability to pay for private hospitals. If a person requires intensive care I understand he is better to be associated with accommodation where intensive care can be available to very few people with specialists and consultants as required. A private room in a hospital could be of use to a patient who needs intensive care. Such patients are best associated with a group of consultants and specialists. I could not start a debate on the extent of the State's contribution out of the capital fund for purely private hospitals. In present circumstances, unless there was some special reason for doing it, a purely private hospital would have to be built at cost to the people concerned. I could not engage capital expenditure for this kind of work. It does not arise on the section. This section is concerned with in-patient and out-patient services.
Officials of the Department have informed us that sections 54 and 55 cover the whole issue.
I do not know whether there is confusion about this. One can have private rooms in hospitals built with the aid of State capital. They would be available for those people who were regarded by the hospital as being suitable for them. If that can be done there is no objection to having some private rooms in large hospitals built with State grants. That is different from the question of building private hospitals. This matter is one which would arise for consideration in the general planning procedures and decisions arising from the FitzGerald Report in relation to the two regional hospitals being built in Dublin.
Is it not relevant to section 54?
It was never intended to talk about private hospitals. I wondered could the facilities for private rooms exist in State hospitals?
I should like to ask the Minister for his comments on another point in regard to section 55. Section 55 provides:
(1) For the purposes of this section "out-patient services" means institutional services other than in-patient services provided at, or by persons attached to, a hospital or home and institutional services provided at a laboratory, clinic, health centre or similar premises, but does not include—
(a) the giving of any drug, medicine or other preparation, except where it is administered to the patient direct by a person providing the service or is for psychiatric treatment, or
(b) dental, ophthalmic or aural services.
Paragraph (b) puzzles me. It excludes dental, ophthalmic or aural services. Section 66 states:
(1) A health board shall make dental, ophthalmic and aural treatment and dental, optical and aural appliances available for persons with full eligibility and persons with limited eligibility.
(2) A health board shall make dental, ophthalmic and aural treatment and dental, optical and aural appliances available in respect of defects noticed at an examination under the service mentioned in section 65.
(3) Save as provided for under subsection (4), charges shall not be made for treatment and appliances made available under this section.
I am not quite clear why in subsection (1) of section 55, dental, ophthalmic and aural services are excluded. What exactly is the implication of this exclusion?
It is purely one of drafting, in order to have a perfectly clear section dealing with dental, ophthalmic and aural services. It is included in order to have two sections. One deals with services other than those.
It would be clearer if it were excluded under section 55. There would be no confusion then in anybody's mind. Senator Sheehy Skeffington is quite right in this. The confusion arises by reason of the exclusion of these services in section 55.
I have made it clear now.
The House will not be satisfied with that kind of reply. The Minister's reply will not be incorporated in the Act.
Section 66 deals with dental, ophthalmic and aural services.
From the point of view of drafting, it seems to me that Senator Sheehy Skeffington is right. We are asked to prepare an Act in one section of which we can see certain things are excluded. That is a positive statement which comes first in point of time in section 66. Why do we say that if we do not mean it?
It is a technical way of drafting. I am not very good at arguing about how a draftsman drafts Bills.
I suggest it is the Minister's job to persuade the Seanad at this moment that this is correct.
I will not be drawn. This is based on the 1953 Act and has worked well. There were separate sections in the 1953 Act and there has not been great confusion. I would ask the Seanad to bear with me on this.
I have no objection to section 66 at all and would have no objection to section 55. I think no confusion would arise as between the two sections if paragraph (b) of subsection (1) of section 55 were simply deleted.
Only God knows what is in the mind of draftsmen when drafting, but they seem to work out all right.
At this moment we are entitled to know what is in the mind of the draftsman.
We cannot be satisfied if the Minister says it is a mysterious process which he does not understand but "has worked well" so far. That is like a conjuror saying he will take a rabbit out of a hat, and if his trick works it is very impressive. It may be all done by mirrors. I do not think this is the way to treat the Houses of the Oireachtas, to say: "I do not understand it but it has worked since 1953 and so far nobody has objected; there is a sort of magic involved that brings bad luck to the questioner." I do not think the House should be dealt with in this manner.
I do not mind asking the legal adviser to look at it again but I do not see why we should not have two separate sections, one specifically dealing with dental, ophthalmic or aural services.
There is no objection to that: the objection is to the fact that there is a definite statement in section 55 that out-patient services shall not include these services.
It is only there for the purposes of the section.
I think Senators forget they have non-technical minds: the draftsmen have the expertise.
The clue may be in the final words the Minister said, that this is modified in that it is for the purposes of this section only. Possibly that is the answer to the problem that has been raised.
Amendment, by leave, withdrawn.
Section 55 agreed to.
Section 56 agreed to.
NEW SECTION.
I move amendment No. 94:
In page 28, before section 57 but in Chapter II, to insert the following new section:—
"(1) Where the chief executive officer of a health board is of the opinion that services under this chapter can more expeditiously be provided to a person within that health board area by an adjoining health board he shall, with the consent of the chief executive officer of such adjoining health board, arrange for such services to be provided.
(2) Where, in the opinion of the responsible officer of a health board an emergency exists and services under this chapter can more expeditiously be provided by an adjoining health board he shall forthwith requisition such services as he deems to be urgently necessary.
(3) The cost of providing services under subsection (1) or (2) shall be recouped to the health board which provided such service by the health board which availed of that service."
The Minister referred to the fact that this amendment is covered in section 56 subsection (1), but there is a difference in wording. Section 56 (1) states:
A health board may make arrangements for providing ambulances or other means of transport for the conveyance of patients from places in the board's functional area to places in or outside that area or from places outside the functional area to places in that area.
I want this function to be given to the chief executive officer or his delegated officer, whoever he may be, to enable area boundaries, that is, regional health board boundaries, to be crossed. The first part of Part II does not deal with emergencies. That is dealt with in part 2. In dealing with any emergency the chief executive officer should be given the powers to requisition services from the nearest available health board, whether ambulance, resuscitation or other services, the cost to be recouped to the health board which provided such service by the health board which availed of it. That is the point of my amendment.
I do not think this amendment is necessary. There is adequate power under section 25 (2) where it is stated that two health boards may make and carry out an arrangement for the provision by one of them on behalf of and at the cost to the other of services under the Health Acts, 1947 to 1969. The health boards when they meet can make general arrangements to cover a great number of situations that have been known to arise. If any board does not want to do this and would prefer not only in respect of some particular type of service but in regard to all services to leave it to the chief executive officer they could ask me to prescribe that such functions should be reserved to the chief executive officer under section 16, subsection (4) (e). They can do it by a kind of omnibus arrangement and if they want to go further and leave certain matters in the hands of the chief executive officer they can do this by passing a resolution. I can then confirm such arrangements are being carried out solely at the discretion of the chief executive officer. Therefore, the amendment is not required.
I appreciate what the Minister has said. However, section 25 states that "a health board may, in accordance with such conditions ...". Here again I am faced with this difference between "may" and "shall"; I do not know what "may" means here. There is another point: arrangements must be made beforehand, otherwise they cannot be carried out.
The second part is where an emergency may arise and a responsible officer of a health board has the right to requisition the services of a neighbouring health area board. The recoupment is set out in subsection (3).
I have had a long debate both here and in the Dáil about the difference between the Health Act and the County Management Act in that the functions reserved to the chief executive officer are quite clearly defined as are the functions reserved to the health boards. Many people for purely administrative reasons are going to give chief executive officers more authority than they are getting under this Bill and I went through all of that in section 16 of the Bill. Here the Senator is asking me deliberately to give to a chief executive officer the power and I have made a suggestion that involves intelligent action on the part of the health boards themselves. I said if I thought they were not doing enough devolution in regard to this and that their work was getting cluttered up I would be bound to make use of the section to insist they do their work more effectively by insisting that the chief executive officers have more power in relation to the day-to-day operation of the services. If I do this I am making a decision in advance. I could accept the amendment, but that would be presuming it was generally felt that the chief executive officer should be charged with this matter, but I can assure the Senator that if health boards want some advice from the Department it will be perfectly easy for us to frame a set of regulations that they can pass that will have the effect of doing what the Senator wishes, in other words that if a resolution is passed the board have power to provide emergency services so as to enable patients living in north Roscommon to be sent very rapidly to Sligo instead of to Roscommon Hospital or to Galway Regional Hospital. I think that the House can take it for granted these resolutions can be passed by the board with great ease.
I am very glad. The Minister can well appreciate the point.
If there was to be the least difficulty we would come to their help.
I had in mind cases going from north Dublin County to the Lourdes Hospital, from west Waterford into Cork, from Clare into Galway, and places of that kind.
They can have a standing arrangement. If they want to give the chief executive officer very wide powers they could pass a resolution asking that this could be part of the function of the chief executive officer under section 16, subsection (4) (e).
I still appreciate it, but the two health boards have to get together, and if "may" were altered to "shall" it would cover the whole point.
I will look at it before the Report Stage, but I can assure the House that this can be done very easily.
This amendment No. 94 worries me considerably. One of the basic recommendations of the FitzGerald Report was that a patient could be referred to any hospital in the country from any place in the country, and this was accepted in many discussions we had afterwards both with the Minister and with the Department. I should imagine that the same thing would apply if a person were on the border between two area health boards and wished to have his choice of doctor extended so that his general practitioner might be in another area and not in his own. It should be the right of a person to decide to pick his doctor in the neighbouring area. Therefore I feel that this amendment is taking away from the right of the individual, as it has been outlined earlier, that he would have a choice of doctor even if it were in a different area.
I do not think that this is correct.
Section 54 covers what Senator Alton says.
I am sorry if I am out of order.
The purpose of Dr. Belton's amendment is to insert a new section between section 56 and section 57. It does not relate to section 57, and what Senator Alton is saying does not arise out of this amendment.
My fear arose out of the Ministerial amendment here, No. 94.
It is not a Ministerial amendment.
I am sorry. I thought it was.
If it is not a Ministerial amendment there is no need to fear it.
Section 53 is the section which should satisfy Senator Alton.
Amendment, by leave, withdrawn.
I move amendment No. 95:
In page 28, before section 57 but in Chapter II, to insert the following new section:—
"(1) Where an emergency exists in a county not currently under the jurisdiction of the Oireachtas and contiguous with the North-Western or North-Eastern health board, and a request for services under this chapter is received from the responsible health authority, the responsible officer of the health board shall provide such emergency services.
(2) If recoupment is not received for the provision of services under subsection (1) the cost to the health board concerned shall be met by all health boards through a levy raised on their contributing rating authorities."
This is also, I think quite obviously, from the way it is drafted, referring to the two regions, the North-Western and the North-Eastern Health Boards, enabling them on request from a neighbouring county not under the jurisdiction of the Oireachtas to provide services. These are counties in the Six Counties adjoining counties in the Twenty-six Counties, if you put it that way. The amendment provides that services can be sent across the Border. These emergency services can be sent across the Border at the request of the responsible officer of the particular county in the Six Counties, and the recoupment is also set out here. If recoupment is not received for the provision of the service, the cost to the health board shall be met by all health boards through a levy raised on their contributing rating authorities. I could not legislate for whether the northern counties outside the jurisdiction of the Oireachtas will pay or will not pay, and therefore I have to put in the arrangement for recoupment that is in the amendment.
There is nothing in the Bill which has a residence qualification in it to prevent a person coming from abroad or from one of the counties referred to in the amendment from getting some such treatment as they would be entitled to, and health boards can co-operate with responsible health authorities in those areas, if they so choose, in making such mutual arrangements to provide such emergency services as may be required. There is nothing in this Bill which would prevent that kind of co-operation from taking place.
I think that the ambulance service would be all right too.
This is not the point. I think that the Minister has missed my point here, which is that where an emergency exists in a county not currently under the jurisdiction of the Oireachtas and contact is made with the North-Western or North-Eastern Health Boards, a request for services under this chapter, received from a responsible health authority, can be catered for. In other words, it means that they would have the right to cross the Border to provide this service.
Yes. I am advised that the Bill does not prevent that happening. There is nothing to prevent that kind of arrangement being made.
If there is nothing in the Bill, can it not be incorporated in the Bill?
I do not see any point in putting something into the Bill which is not necessary. We could have enlarged this Bill very much.
As for example by including dental services under Section 55.
I do not see why there is any objection to incorporating it in the Bill.
We have had a great number of examples of amendments put in by Deputies and Senators who wanted to ensure that the Bill covered certain aspects of the health services or certain facilities, and I do not think that this custom of adding amendments to the Bill in order to confirm that something can be done that we know can be done is reasonable. The Senator need have no doubt about this. There is nothing hindering a health authority from making an arrangement of this sort.
I accept that the Minister believes every word he says and that he is quite satisfied that the Bill as it stands would enable these services to be provided, but I think that in order to satisfy himself the Minister would require to go right through this Bill and be able to point to the authority to give the services in case of an emergency, such as is proposed in this amendment, to people across the Border.
There is certainly very great merit in what Senator Belton urges that the position would be made crystal clear by accepting the amendment and putting it into the Bill. It may be there by implication already but if it is only there by implication, it is only there by implication and it could very well be that anything in the nature of expenditure incurred in the provision of this kind of service could be either surcharged to the health authority in question or could be challenged in the courts so that the unfortunate health authority who provided the service would, at that time, be required to quote chapter and verse to show their authority. I do not think it could be accepted by them as sufficient authority to say that it is in the Bill by implication because it is not ruled out. On the other hand, the position would be quite different if it were put into the Bill in a positive form as suggested by Senator Belton.
I wish to take up the point raised by Senator O'Higgins. If a service were provided and a surcharge deemed necessary and if the health board in question were trying to defend their action and said they understood they had permission because it was in the Bill by implication, the answer might be given that they did not have permission because it was not stated in the Bill and it was from the Bill that they got their power and authority.
Surely if the amendment is not damaging—it can hardly be damaging to suggest that we can provide services in an emergency to counties which are not currently included—there is no harm in including them. I would have thought that, unfortunately, the powers of the Oireachtas at present only extend over 26 of our counties and if we are to allow some public servants to provide services in counties other than those 26 counties we may have to write it into the legislation. The situation might also arise that in an emergency an official of the north-eastern or north-western health board might hesitate about providing a service because he would not be sure whether he was entitled to authority and valuable time could well be wasted.
We are starting to play to the gallery about this.
There are not very many there.
I have made a specific statement that this can be done. The word of the Minister on the Committee Stage of a Bill should generally be accepted. English people and others of non-English extraction have come here and have been helped by health boards so it can be done and there is no need to go on with this any further.
Let us be the judge as to whether it is necessary to go on with it. Normally, I am a person who will accept without hesitation the assurance or undertaking given by a Minister in either House of the Oireachtas but we had a debate here only last week arising out of an assurance given by a Minister in this House.
There was no assurance given.
That might be a matter of opinion but I wish to make a point that is not a matter of opinion but of fact. When a particular tribunal sought the views of the Executive they were told that if it was the intention to do a particular thing it would have been written into the terms of reference. The point I wish to make is that if it is the intention of this House that these powers should prevail, they should be written into the Bill in accordance with the opinion expressed by the Executive on the other matter to which I refer.
The second point I wish to make is that it seems to me, in any event, that the Minister has not grasped the essential point of this amendment; that we are not here concerned in this amendment with rendering these services to people who have come across the Border or who have come from England or New Zealand into the jurisdiction here but we are concerned with rendering these services across the Border if such a request is made.
I should just like to mention that there could be a matter of grave urgency if, for example, one of our more warlike Ministers went yodelling into battle in the North and had to be quickly rescued by ambulance. In such case, it would be necessary to know who would pay for the ambulance.
I am sorry but I am not going any further into this.
Amendment put.
The Committee divided: Tá, 19; Níl, 27.
Tá
- Belton, Richard.
- Boland, John.
- Dooge, James C.I.
- Dunne, James.
- Farrelly, Denis.
- FitzGerald, Alexis.
- Fitzgerald, Jack.
- Kelly, John.
- Lyons, Michael D.
- McDonald, Charles B.
- Malone, Patrick.
- Mannion, John M.
- O'Brien, Andy.
- O'Brien, William.
- O'Higgins, Michael J.
- Owens, Evelyn P.
- Reynolds, Patrick J.
- Russell, G.E.
- Sheehy Skeffington, O.L.
Níl
- Ahern, Liam.
- Alton, Bryan G.
- Brennan, John J.
- Brugha, Ruairí.
- Cranitch, Mícheál C.
- Crinion, Brendan.
- Doyle, John.
- Eachthéirn, Cáit Uí.
- Farrell, Joseph.
- Farrell, Peggy.
- Fitzsimons, Patrick.
- Flanagan, Thomas P.
- Gallanagh, Michael.
- Garrett, Jack.
- Hanafin, Desmond.
- Honan, Dermot P.
- Keery, Neville.
- Killilea, Mark.
- McElgunn, Farrell.
- McGlinchey, Bernard.
- McGowan, Patrick.
- Nash, John J.
- Ó Maoláin, Tomás.
- O'Sullivan, Terry.
- Ryan, Eoin.
- Ryan, Patrick W.
- Walsh, Seán.
Tellers: Tá, Senators Boland and McDonald; Níl, Senators Brennan and Joseph Farrell.
Amendment declared lost.
SECTION 57.
Question proposed: "That section 57 stand part of the Bill".
I should like the reassurance of the Minister that where areas adjoin patients will be able to pick doctors of their choice in the adjoining area quite freely and without having to get the permission of the CEO of their own area. This was the mistake I made a moment ago in confusing the amendments but it brought the point home to me. I think where areas adjoin each other as far as the general medical practitioner service is concerned they should be able to pick the doctors of their choice in the adjoining area.
In reply to the Senator, under this Bill it is possible for a person if necessary to cross the border between one health board and another.
Yes. A resolution has to be passed by the health board for this but naturally the whole choice of doctor area has to be enacted to have this arrangement there. There should be the greatest freedom in regard to this matter and it will be more convenient first of all in the breaking down of counting and will make it easy for the choice of doctor. Equally it can be done across the border of two areas adjoining each other.
I should just like to ask for clarification in relation to the service, which is a very good one under section 57, which relates to the making available, without charge, of general practitioner, medical and surgical services for persons with full eligibility. It is in relation to subsection (2) that I would just like to ask a question, in relation to the very good provision that the patient is to get a choice of medical practitioner. This choice is made subject to conditions prescribed in regulations. I should like to ask the Minister what kind of conditions he has in mind and, in practice, how wide the choice of doctor has the patient? What order of magnitude will it be? The Minister has made the point that so far as possible the same quality and standard of service will be available throughout the country. It seems obvious that urban patients will have a wider choice of doctor than rural patients and I was wondering how wide the disparity will be.
We are having negotiations with the Irish Medical Union about the fee for service arrangements. These regulations refer to the final decisions in regard to that. First of all, there will be a limitation as to distance. It would be unreasonable for a patient to seek service from a doctor at a great distance from where he or she lives. It would be unreasonable for a doctor to have an excessive number of patients on his register. Such regulations are obviously needed. Common sense must come into it.
Could the Minister say from how many doctors will the patients be able to choose?
That would depend on the area. In some areas it would relate to the district medical officer services. In other areas there would be many to choose from. The doctors would probably tend to form group practices. Some counties have a surprising number of district medical officers living contentedly in quiet remote villages. Other districts, such as Monaghan, seem to have all the dispensary officers living in five towns. There are other areas where it is difficult to get doctors at all and they are offered attractive remuneration as an inducement to go there. Such an area would be the remote West and places like Belmullet peninsula. In such areas there would be no choice.
Is the Minister satisfied there will be a variety of choice available in different parts of the country? Is he satisfied there will be a sufficient choice of doctor for every potential patient, or are we to take it there will be no choice in some places?
That is the fact. Unless you can attract a private doctor to set up a practice, who is not the district medical officer, and who thinks by earning fees for service he can make a living there will be very little choice of doctor in some areas.
Some patients will have no choice.
In some places there will be no choice.
The Minister explained this on the Second Reading. We all accept the choice of doctor as an excellent idea. We understand what must inevitably occur. Some type of board will have to be nominated to regulate the quality and number of doctors available to a town or community. A newly-qualified person could not be put on to a panel from which patients choose. He must have postgraduate experience.
The Minister has said that there is an inducement scheme already in existence to attract doctors to places like Belmullet, Connemara and the Aran Islands.
There are places nearer than Belmullet where there is no choice of doctor.
If an inducement scheme is not already in existence in such areas it should be brought in. The question of whether the inducement should be cut off when a doctor leaves such an area or not is something the Minister must consider. Perhaps that inducement should be left with doctors so that they may stay five or six years in such an area before leaving.
We can have power to do that under this Bill.
I had an amendment down about that.
Question put and agreed to.
Section 58 agreed to.
SECTION 59.
I move amendment No. 96:
In page 29, before section 59 to insert the following new section:—
"(1) The Minister shall by regulations establish a body, which shall be known as the National Medicine and Drugs Council and is in this section referred to as the Council."
This is an effort to set up a council to examine the whole question of medicines and drugs. The name of the council should be such as to distinguish drugs used as medicine from addictive drugs. The functions of the council are set out. Even if the Minister agrees with the setting up of this council to examine the whole drugs and medicine formulae in the country he may not be able to incorporate it into this Bill. I should like him to incorporate the machinery for such a council in the Bill. It is necessary that standardisation should be brought into the whole medicine-drug business. Advice could be given by a council like this on certain drugs. They could recommend research into certain drugs and advise taking certain drugs off the market.
The National Drugs Advisory Board set up by the Minister for Health in 1966 under the National Drugs Advisory Board Establishment Order makes use of powers which the Minister has under an Act of 1961. It is quite possible for me to extend the functions of this Drug Advisory Board so that any functions not covered but considered desirable could be included. As the Senator knows, the National Drugs Advisory Board already send information to medical practitioners about drugs they consider dangerous, about drugs whose side effects may not be apparent, and every month duplicate copies are sent to practitioners throughout the country.
The National Drugs Advisory Board are in touch with the Dunlop Committee in Great Britain who are able to do a great deal of research we cannot do on these drugs. We hope it will be possible to establish a formulary of drugs once arrangements for the provision of drugs for retail chemists are made. The computer will be able to help in telling us which drugs are used and their cost. We hope to be able to give advice to general practitioners about drugs that would cure a person and which are similar to more expensive drugs under a different name. We do not need this amendment because the National Drugs Advisory Board can always have their powers extended if required.
I am very glad to hear the Minister say this. This is the point I was getting at.
It is now after 6 p.m. Does the House wish to adjourn or to finish this amendment?
I shall only take one minute if the House will allow me. In regard to the establishment of a national formulary of drugs I should like to give the Minister as wide powers as possible. The House would be willing that this extension of powers be given. Therefore, I am withdrawing my amendment.
Amendment, by leave, withdrawn.
Business suspended at 6.5 p.m. and resumed at 7.30 p.m.
Section 59 agreed to.
SECTION 60.
Amendment No. 97 not moved.
Question proposed: "That section 60 stand part of the Bill".
This is a section that was dealt with on the Second Stage when the Minister said that he had made provision for such a thing as home help in certain circumstances where, for instance, a widow or some other person would have to go out to work and somebody would be needed to look after the children. I will not speak too long on this as the Minister has already made some provision.
Paragraph (c) of subsection (1) makes that clear.
I would also hope that the Minister could see his way to accept at least part of the amendment because we very frequently in hospitals see situations arising where we cannot take a patient into hospital until he can arrange that the children be placed in a children's hospital, or for a dependent elderly person to be sent perhaps to a county home or something like this, and as a result the placing of one person in hospital who needs it may result in the placing of two or three people in hospitals who do not need it. This particular section should, if properly worked, result in a diminution of the actual number of patients in the country and as a result would be very valuable. I should very much like to see the change suggested to put "shall" instead of "may" in subsection (1).
There is no amendment, since amendment No. 97 was ruled out of order.
I take it that the Senator may urge on the Minister that he might consider that.
May I speak on the section for a moment?
I should like to urge on the Minister to make it just a shade more compulsory for the health board to make arrangements for maintenance in homes for dependants of people who need hospitalisation, to provide arrangements by which the sick person could be treated.
I have already dealt with this on the Second Stage and on other occasions. I am very anxious to have the home help system operate and grow in strength, and also to have social workers appointed in greater numbers, in order to forward the whole concept of domiciliary care not only from the sociological point of view but that it might, as the Senator says, actually save money for the health authorities and for other good purposes.
Of course this will take some time and one could not make it absolutely mandatory on a health board, because first of all the home helps have to be trained. It is found in other countries that they are not easily available for this kind of domestic work. There are not many people who want to do it so that you have to examine the whole situation and make the necessary inquiries and find how many of the home helps would be part-time and how many full-time, and what voluntary workers would be required. There are already many voluntary workers and community associations of different kinds doing this whom we want to encourage. Voluntary work must continue, because it would be practically impossible to find sufficient number of paid home helps for every purpose.
There are still 8 or 10 per cent of the home helps required in Great Britain that have not yet been found. I hope that we will meet a happier situation here. It must be a flexible arrangement based on an examination by the health boards. I myself as Minister am extremely interested in this whole concept. We also want to ensure that, taking the advice of a number of reports that we have received, where possible the salary of the home help will be paid on the basis that the home help person works under a voluntary association in close co-ordination with the health authority.
We also want to ensure in a country such as our own, where we find that the absence of home help services is always a real problem, as it is found even in much richer countries, that we have some sort of co-ordination between the home help for the aged poor, home help for the mentally-ill people, and in relation to that provision of psychiatric work outside, and domiciliary care for everyone.
It must be co-ordinated and although there is need for some specialists in this field there are some people who would be trained for a number of purposes, for instance, a public nurse, who can very often do the work of a home help officer to a limited extent but the whole thing must be very carefully planned to ensure that we get the very best value for the money spent and to ensure that people suffering from the various kinds of disabilities will be looked after at the lowest possible cost to the community and, at the same time, that they be looked after with the greatest humanity and efficiency.
That is why we could not have the word "shall" used although it may be taken for granted. The regional health boards are very keen on this and do not need much encouragement from me and, certainly, the Dublin Health Authority, with their own particular problems, do not need much encouragement from me. I hope the whole thing will proceed. Nobody in the House need have any doubt that the use of the word "may" will not deter me from encouraging this inevitable development in the health service.
I was one of the people who referred to these two words "shall" and "may" in relation to these two consecutive sections of the Bill. I was very disappointed when this amendment was ruled out of order and I associate myself with what Senator Alton has said about it. On the other hand, now that I have heard the Minister, I am quite happy to leave the matter stand as he says. I accept fully his intention to encourage the development of domiciliary care not only in relation to health but in relation to social workers. This is the best possible way of developing the service and of lightening the burden on the community in general.
However, the Minister has said one thing which to my mind is much easier to talk about than to bring into practice and that is the co-ordination of voluntary effort. This is one of the problems that we all face when we are dealing with a situation such as this. There are many people willing to help on a voluntary basis but in some cases there may be too many of these in one area while in other cases there may be none available. This problem of overlapping and gaps is one of the problems of co-ordination which have to be faced. I hope this will be realised by the health board. I am very glad to hear what the Minister has said and I accept his assurances.
I should like to welcome this section. Again, it is a section to which I referred on Second Stage. It is an extremely important section and I welcome the Minister's comments at this stage of the debate. He has painted a much fuller picture of how he intends the domiciliary services to develop than that painted at the early stage of the debate. I would like to ask a couple of questions with regard to the wording. The Minister's outline of how the service will work is splendid but when I was reading through the Bill initially I noticed, for example, the little heading in the margin "Home help service" giving a very fine picture of the service being completely organised with officers and staff but in the actual section itself the wording becomes much more general.
There is not this type of specific reference and the phrase used is "maintenance at home" which has a much more financial than social welfare ring about it. I would just like to be sure that the Minister believes this section will give full powers to local authorities to develop the domiciliary services with the full ramifications of child care, psychiatric social work and so on that he has just described. In sections (a), (b) and (c) we have raised the question of the specific categories of persons whom it is intended should be assisted at home but, as Senator Alton inferred when talking about hospital cases, it often is the case that illness in the home creates a social problem and, in fact, the part of the problem of maintaining a sick person at home may well be in solving the social problems of other members of the family. I wonder if this sort of approach to the social aspect of illness in the home is covered in this section.
Yes, it could be used for that purpose. The whole question has to be examined very carefully. There may be people in the community who would like home nursing and who can afford to pay for it. There are others who cannot afford to pay and there may be some who can afford to pay a little towards it but there are women, for instance, who are ill and living alone, who absolutely refuse to go into any kind of private home but who might be willing to pay somebody to come in each day. A service that can cover every kind of person in the community will have to be very carefully worked out and it will not be easy to get home help people.
I am sure the Minister is already considering this but this is another good reason why it is important that the home assistance service should be linked with the health service.
That has been dealt with already.
People in home assistance have a great deal of experience in making arrangements of this kind.
Surely, but that has been dealt with already in an earlier part of the Bill.
Question put and agreed to.
SECTION 61.
Amendment No. 98 not moved.
SECTION 62.
Question proposed: "That section 62 stand part of the Bill".
It says in this section that special treatment could only be given up to six weeks but in a later section there is provision for care up to six months. I think the Minister knows exactly to what I am referring.
The Senator may be slightly wrong. The only other reference to a different period in relation to children or young people is in section 65 where there is a reference to examination for children under the age of six years.
Question put and agreed to.
SECTION 63.
Amendment No. 99 not moved.
Section 63 agreed to.
Section 64 agreed to.
SECTION 65.
Amendment No. 100 not moved.
I move amendment No. 101:
In subsection (1), line 28, to delete "treatment" and substitute "advisory".
There are two reasons for this. The first one is that it would not be possible to implement this service unless practically every doctor in the country was prepared to do it. That is the main reason. The second one is that it is really an extension of the Health Bill to extend treatment to a group of children whose parents would be outside the eligibility limit. Personally I am not so keen on this reason because I feel every child in the country is entitled to this service, but as a practical measure it would be better if the advisory service were used rather than a treatment service. In the former arrangement the child would be eligible to go to his own practitioner. I ask the Minister to look at this, but from the practical point of view the amendment would be a good thing.
Of course the Senator is quite right because those children will have to be referred to the general practitioner and through him to the consultant but this is again in the provisions in the 1953 Act and it has been interpreted now for a great many years in this way. The reason we include the other treatment in the subsection is to permit welfare officers and nurses in child welfare clinics to give absolutely minor treatment for minor ailments which might be ancillary to the health service. The Senator can take my word that this has never been abused. A child might have a simple boil which could be treated immediately. We can rely on the medical fraternity to assist here. However, as I have said, this has never been abused. The vast majority have been referred to medical practitioners.
I think the Minister does not require any urging in this and I was going to urge him not to accept this amendment. It is not that I do not apprreciate the point of view expressed by Senator Alton but at the same time I think the wording of the subsection as it stands is valuable. Firstly, it is mandatory as it stands and secondly, what is aimed at is treatment service rather than advisory service. An advisory service in a certain context can be extremely valuable but an advisory service in the context in which it would apply here in this section of the Bill might indeed prove to be very nebulous, although possibly that is not the right word, but certainly ineffective in that what might be required as a matter of urgency, maybe small cases such as the Minister referred to, would be actual treatment and it is valuable that a treatment service should remain in the Bill.
In view of the Minister's assurance I withdraw the amendment.
Amendment, by leave, withdrawn.
Government amendment No. 102:
In page 30, lines 33 and 34, to delete "provides elementary education but".
This is an amendment of a minor kind merely to provide the possibility of having pilot schemes of examination for post-primary schoolchildren. The study group on the child health services recommended there should be a limited school health examination provided for in post-primary schools but they felt such a service, quite rightly, should not be introduced until the pre-school and school health services are working properly. The House will have seen a statement I issued on the plan we have which is to build up the pre-school and national school services and it will pose a very big challenge to the health boards for the next five years.
It will be operated in stages. We will have to appoint more assistant county medical officers. We are having them all trained in child health and paediatrics and we will certainly have to increase the staff in various places and encourage growth in the number of paediatricians throughout the country. There is a great deal of administrative work to do in this. There is the arrangement for child record cards, all of which has to be prepared so that the amendment simply will have the effect of permitting post-primary examinations but it will be done on a pilot basis to begin with because the whole objective is to try to find as many practitioners as possible to make this possible for pre-school children and then to have a more selective type of examination in national schools. All the expert advice we can get suggests that this is the right course. No doubt we could benefit perhaps by a fairly extensive post-primary school examination but nevertheless the priorities are there so that is why I wanted to mention that in connection with that amendment.
Amendment agreed to.
Question proposed: "That section 65, as amended, stand part of the Bill".
Would the Minister just explain subsection (5) of this section?
I understand that this subsection means we must confine the child health service examination to clinics and that the child health service would be performed by general practitioners, that we cannot permit health boards to have children examined everywhere. In other words, we must ensure that this is done on a proper basis through general practitioner child welfare clinics.
Could I mention at this stage a difficulty which has often occurred to me in relation to the service as a whole which we are providing for in this Bill and which was provided in previous Acts. We have provided in sections 61 to 65 for a continuous method of supervising the individual from birth up to the time of leaving school, whether it is a national school or some other type of school, and in previous sections we have instructed the health board to make provision for the care of adult persons and their dependants, whether they are in the fully eligible or partly eligible classes. There is a gap here between the school leaving age and the time when a person becomes an adult which I do not know how to explain. I should like the Minister to help me on this. This person may be still dependent. Although there are many boys and girls of 17 and 18 years who are dependent on their parents, they are listed as adults, although they are still schoolchildren. Which category do they come into?
When they are over 16 they are considered to be adults. If they are eligible they are able to avail of all services and get everything free. If they are in part eligible they get hospital care and may have to pay ten shillings per day. If they have long-term disabilities they can be looked after.
If that is the definition of adults, it answers my question. It solves the problem.
This may be the same drafting point mentioned earlier in relation to subsection (5) of section 65 which states:
Nothing in this section shall be construed as authorising a health board to provide any general domiciliary service or any services such as are mentioned in section 51, 55 or 66.
Section 66 deals with dental and aural treatment. Subsection (2) provides:
A health board shall make dental, ophthalmic and aural treatment and dental, optical and aural appliances available in respect of defects noticed at an examination under the service mentioned in section 65.
Presumably the reason for the exclusion in subsection (5) of section 65 is the drafting advice which the Minister referred to earlier when this point was raised on another matter by Senator Sheehy Skeffington. Section 65 imposes a mandatory obligation on a health board to make available examination and treatment services free of charge. In other words, so long as the treatment is carried out under section 55 it is free of charge. If the treatment happens to be dental treatment which is provided for under section 66 does the exclusion of that by means of subsection (5) of section 65 exclude free treatment in the case of children? If they come under section 66 rather than under section 65 does it mean the treatment can be charged for instead of being free of charge?
It can be free of charge under section 66. Subsection (5) is nothing but a drafting section to keep section 65 tidy. It refers to the child health services. Children cannot go to hospital for a child health examination. The control of this operation should be confined to the health clinic and the private dispensaries of health offices. The idea is to have a first examination by a medical officer and a public health nurse and then to have the person referred for treatment to the general practitioner who normally looks after him. The person who examined the child could recommend to the general practitioner that a consultant should see the patient. This is only a tidying-up section to prevent the arrangements for the child health and the school health examination being authorised in a way which relates to other sections of the Bill. It does not prevent anybody who needs it from getting free dental service.
I will raise the point on the next section. I want to ensure that if the treatment is being supplied under section 65 by reason of subsection (5) of that section, a child will not find himself pushed into a situation where a charge may be permitted under section 66. It should perhaps be dealt with in connection with section 66 rather than 65.
I will look at it again to ensure there is not any difficulty of the kind mentioned by the Senator.
Question put and agreed to.
SECTION 66.
Amendment No. 103 has been ruled out of order.
Question proposed: "That section 66 stand part of the Bill".
This amendment stood in my name and was ruled out of order. I brought it in because of various reports I had heard, especially of dental and aural services. There have been complaints all over the country under the present system. It seems to me that the services under this section are not being properly dealt with at all. It is important that children's teeth should be looked after. Older people should get dentures after extractions. This has been a bone of contention. There are not sufficient dentists in certain parts of the country. An effort should be made to ensure that each health board carry out their duties under this section. We wished to empower the Minister to get the work done himself and to recoup himself from the health boards who should provide these services, but the amendment was ruled out of order. The service has been deficient under present legislation. It has been widely criticised. It should be brought up to date under new legislation. This service has been badly neglected.
Since this point was earlier made by Senators Sheehy Skeffington and O'Higgins I have been studying section 55 and section 66 and, though I do not share the admirable faith the Leader of the House has in the Parliamentary draftsmen as to the extent of their wisdom and the extent to which they can be relied on, generally they have a point. If they exclude from one section particular categories of services or persons and have a special section to deal with them, there are generally reasons for that.
On exact study of section 66 as I read it—I am wide open to correction —there seems to me to be four differences between the position of persons looking for or entitled to dental, ophthalmic or aural services, if they had been included under section 55 and their position as they are included under section 66. It would seem reasonable to say that the definition of out-patient services in section 55 does not include appliances and appliances are included in section 66.
A famous man once said that services cannot be counted as productive because they perish in the very instant of their performance—a sensation one has very strongly when some Ministers, other than the present Minister, are looking after a Bill before this House. The natural meaning of in-patient services under section 55 and the earlier section in that Part of the Bill would include appliances. There is provision for appliances in section 66 which would not fall within the natural ambit of section 55. That is a positive advantage of having them separately treated, but a closer examination would make it necessary to observe there are certain negative consequences of separate treatment. Parliamentary draftsmen generally do not draft things in the void but act in accordance with instructions given.
Section 66 seems to include in-patient and out-patient services; under section 55 persons other than persons with full eligibility may not be charged for out-patient services but they may be charged under section 66, subsection (4). If they had been included in section 55 they would not have been charged, but being included in section 66 they can be charged, or so I read the section. Section 55 obliges the health board to make available out-patient services in respect of diseases or disabilities of children of a permanent or long-term nature. I am unaware of any reason why such diseases or disabilities which require dental, ophthalmic or aural treatment should receive separate treatment as they do receive separate treatment under section 66. Under this section there is no provision for these unless they fall within the categories of full or limited eligibility and they would be entitled to these services if they had not been excluded in section 55.
There is another point that it becomes possible' by having them under different sections to make different provision for the charges. There is a more important point that can easily be remedied if it has validity and which I feel is nothing other than a piece of draftsmanship that can be improved. The section that deals with the provision of ambulances falls under Part II dealing with hospital in-patient and out-patient services and does not appear under the Part dealing with general medical services, in the Part dealing with mothers and children or under the other health services in Part V. There will be auditors concerned to establish whether people have been properly incurring expenditure in relation to ambulances and it is possible to argue that by placing it under this Part it limits the availability of the ambulance service to in-patient and out-patient services and possibly, ultra vires, to incur expenditure on such ambulance services in relation to the other health services contemplated to be made available under this Bill.
If my view about the ambulance service is correct it should be moved to Chapter VI or out of this part of the Act altogether into Part 5, but at any rate it should not be left in any doubt that the ambulance services are to be available for mothers and children, for people in need of general medical practitioner and surgical services and for those needing dental, ophthalmic and aural services. I am sure this is not intended but I feel it possible that it could be legally construed as having been excluded.
I think the Minister has agreed to look into the point which I raised on the last section in relation to this so I shall not repeat it.
I do not understand one word of what Senator FitzGerald has said and I shall have to read the Senate debate and look into it between now and Report Stage. Most of this legislation is based on extension of the 1947 and 1953 Health Acts and there is little in it to show that the changes that have been made are the kind of changes that would result in some of the frightful things that Senator FitzGerald has said would happen. In other words, the 1947 and 1953 Acts are the framework under which these services can be given. I do not think the Senator has anything to worry about, but I will look into it between now and Report Stage and if it requires amendment we will do so
In regard to Senator Belton's remarks about the dental services, he is absolutely right. The dental service is inadequate and will continue to be inadequate. There are a number of priorities in the health services that will have to be looked at, such as the fluoridation of water and its effect on children. We have had an initial study and it is most gratifying to read about the studies being made regarding the amount of caries in children up to the age of two years. It has been less successful in the case of older children who do not face the earlier part of their lives drinking fluoridated water. As I have said, the dental service is not satisfactory; we have not enough dentists: they are difficult to find but the number is slowly increasing. Whatever deficiencies exist are being diminished and there is nothing in the section that prevents the service being improved in the way we would all wish.
As regards ophthalmic and aural services, except for delays that occur they are not too bad for the lower income group. We are going to provide, as soon as the Health Bill comes into operation, services for the middle income group on the basis of contributions towards hearing aids. There will also be contributions towards spectacles, the sum being paid for spectacles or aural aids being limited to a certain amount. We hope to improve these services and they are capable of improvement. There is a certain delay in certain types of ophthalmic services because, for example, there is a waiting list at the Royal Eye and Ear Hospital in Dublin but nevertheless they are not bad. I have not had time at the moment to look into the dental service in detail but I do not regard it as an absolute priority in relation to the whole health services. It takes an immense amount of time to examine but I am hoping that it will improve.
I am thankful to the Minister. I know that one can only do the possible. As regards ophthalmic services I do not know exactly how they are today but a couple of years ago in St. Michael's Hospital, Dún Laoghaire, the waiting list was fantastic.
There are still considerable delays.
I must say the Minister certainly has been frank in speaking about the dental services but nevertheless I think that this is too important a service, and has been neglected too long, to shelve it altogether. I should like to see the new health authorities getting away from appointing dental officers as the local health authorities have been dealing with schools perhaps and medical cardholders.
A system whereby the ordinary private practitioner would be paid so much per three-hour session, perhaps, would produce faster and better results. As well as that it would be giving a patient a choice of dental doctor. I think that we should preserve this. In my own experience we have had rather considerable waiting lists in my own county until last year when we gave medical cardholders and children a choice of going to whatever practitioner they wanted. In the system of council dental officers visiting national schools heretofore, extractions were made in an ordinary chair under the most primitive conditions. This practice should be stopped and all dental treatment should be carried out in clinics. All towns should be equipped with a dental clinic attached to a central clinic. I do not think it is sufficient to say that the priorities are such that we must forget the dental services. It surely is to be hoped that at least nursing and expectant mothers will remain on top of the priority list.
One other point that annoys me is that children who are referred to the Dental Hospital in Dublin for treatment to have appliances have to undergo a very long delay. The administration of this service must be improved. We find that when the children are sent up they may have to wait for up to five hours and when they eventually get the appliances the children have grown out of them. There is no point in supplying service unless you can make sure that the appliances, which I under stand are rather costly, are efficient and effective. If we have a limited amount of money to spend on this service it is up to the Minister to ensure that it is utilised to the very best advantage. Those of us on local authorities know that in this coming year the amount of money being spent on the fluoridation of water schemes has increased steeply, and there is no point in spending this unless we follow up with a extensively improved dental service.
I do not want to be a bore, particularly as I feel that the Minister expresses very well the whole feeling of the House in response to my remarks. If I could just take two points quietly perhaps that could make the Minister not have to depend on the Official Report. Looking at section 55, referring to dental ophthalmic or aural services, you will find that persons looking for such services with limited eligibility must get them free of charge. If you look at section 66 you will find that they can be charged. The Minister, under subsection (4) of section 66 may, with the consent of the Minister for Finance, make regulations providing for the imposition in specified circumstances of charges for services under this section for persons who are not persons with full eligibility or for specified classes of such persons, the implication being that he may make charges for a person with limited eligibility.
I have already explained we believe that in the case of the middle income group they can make some contribution towards ophthalmic or aural services that are provided for them.
Senator Alexis FitzGerald's remarks would be equally appropriate as between sections 55 and 66 and I think the Minister has agreed to look into them.
I will look into it. I could not do more.
A second point, if I may repeat it, is one which for some reason I cannot understand. I am sure that there is a reason for it but it should be understood by the House—that children with permanent diseases and disabilities of a permanent or long drawn nature find that they are outside the categories of entitlement under the other subsection and can get provision under section 55 but cannot get such provision under section 66.
I have already mentioned that we have provision in respect of disabilities of a long-term nature.
But not if they are dental, ophthalmic or aural.
I am afraid that we have not provided for that. A child, for example, who is permanently deaf and in addition is a mental defective, which is a usual consequence of the deafness, would be free for institutional treatment. I will look into it.
Question put and agreed to.
SECTION 67.
Question proposed: "That section 67 stand part of the Bill".
In relation to this point I have a letter from one of the residential centres for mentally-handicapped children pointing out that while section 67 allows a health board to make available training and training facilities for disabled persons there is no obligation placed on the health boards to actually make employment available for those persons after their training, and the feeling apparently of this association was that the health board, after training people, should continue in these sheltered workshops a form of employment for people that they have so trained.
The note states that "section 66 obliges health boards to provide a service for the training of disabled persons and permits the health board to provide workshops, et cetera, for this purpose, but the Bill makes no reference to what we consider should be an obligation on health boards, and that is to provide facilities including premises for the employment of disabled persons in a sheltered environment.
I have been visiting some of these wonderful institutions and I agree that they should be encouraged as much as possible, but the position is that the health boards can provide for sheltered employment for this type of training if they decide to implement it, but they cannot provide financial help for people once they go into outside employment. They can have social workers who will visit the factories to explain to the managers what kind of treatment they should get, to encourage factories wherever such people are employed— and they are mostly employed on a limited basis—and to give an indication of the kind of care that should be exercised in looking after them, but I think that if there was to be anything of the kind suggested by the Senator I would be entering into the field of the Minister for Labour. There is nothing in the Bill for initiating outside employment or providing for it. It simply deals with sheltered employment and training for outside employment. Sometimes these unfortunate people—many of them are very courageous and work very successfully—but some of them have to come back to sheltered employment. They do not succeed, and some have to be institutionalised because they simply breakdown and are found to be unsuitable for work. I am afraid that I cannot say anything more about that.
I think that that is fair enough. What they were most concerned about was the type of person who could have work in a sheltered environment, and they felt that the health board ought to be obliged to make employment available in a case like that. Perhaps the Minister would talk with the Minister for Labour about this, and they will think about this problem in the course of time between now and the implementation of the Bill.
Yes. It occurred to me that, possibly, the health board might be empowered but not obliged to deal with a situation involving a person who is quite disabled to the extent of being unable to earn a living but happens to have inherited a large house and whose wife is willing to work on it and take in paying guests but who has not got and who cannot get any finance to equip the house for the purpose. I do not know if it is appropriate that the health board should be given such power but I mention the case particularly when finances are readily available through Bord Fáilte to hoteliers. I do not expect the Minister to say anything about that comment at this stage.
Question put and agreed to.
SECTION 68.
I move amendment No. 104:
In page 31, to add the following new subsection to the section:—
(3) Notwithstanding anything contained in this Act a health board may operate the provisions of subsection (1) in advance of the repeal of section 50, subsection (7) of the Health Act, 1953, provided that the additional expenditure involved (if any) shall not be a charge on the Exchequer.
Section 68 is a very good section and we believe that many local health authorities might feel like putting this section into operation on the passing of the Act between now and April of 1971 and it is for that reason that we have put down this amendment so that such local authorities would be given the opportunity of putting the section into operation.
Senator Fitzgerald's concept is one with which we can all sympathise but the amendment is not necessary. This could be done under the present home assistance service so if the Senator wishes to see this done he should encourage local authorities to vote larger sums for some assistance to cover this in the interval and that would be levied exclusively on the rates. That is the position.
Amendment, by leave, withdrawn.
Section 68 agreed to.
SECTION 69.
Question proposed: "That section 69 stand part of the Bill."
With regard to this section I should like to ask the Minister if it is envisaged that the cervical cancer smear test will be covered. Perhaps he is aware that the existing facilities in certain areas for this test are completely inadequate. I understand that this particular form of cancer is one which can be cured if diagnosed at an early stage. I also ask the Minister if publicity about the availability of the services will be made available.
The answer is that it can be made available. I was talking the other day in the offices of my Department about this problem to the Chief Medical Officer and we are engaged in seeing whether the service can be extended. It must be done with the greatest care. Smears must be taken in a very expert way and not all practitioners are trained to do this. We have had some very valuable reports from Great Britain on which an analysis was made. The reports showed that while good was being done, a very high percentage of the people who were having the cervical smear were people who were not afraid and who went along because they wanted to be sure they were healthy while quite a percentage of those who should have gone did not go and later were found to have cancer of the neck of the womb.
This must be done in an intelligent way. Tests are being carried out in Galway very successfully and tests are also being done in St. Kevin's but these must be done in an intelligent way and on the basis of advice received from expert consultants.
I could not agree more with the Minister when he says that they must be done in an intelligent way. I would have thought that would go without saying. I appreciate the information that the Minister has given.
I take it that what is proposed here is voluntary tests. Perhaps the Minister will have a look at the wording which seems to be somewhat ambiguous in stating that a health authority may make arrangements for carrying out tests on persons. I should imagine that what is intended is that the health board may make facilities available for carrying out tests or some such wording.
A lot of this discussion stems from the fact that we have not consolidated the Health Acts. I hope that some day we will do that. Section 4 of the 1953 Act makes it clear that people can only voluntarily submit themselves for this kind of examination. That has not been repealed and therefore it covers the situation.
Section 69 covers all kinds of smear tests and not only cervical cancer smear tests, and I was hoping that the Minister would assure us that before the introduction of widespread tests for many conditions there would be consultation with the professions.
There certainly will and the Senator need have no doubt about this. I have read enough copies of the Medical Journal to know the care that must be exercised in connection with this.
Section 69 seems to be the last section of the last Part dealing with the services provided in this Act and so far there seems to be no provision for domiciliary visits by consultants at the request of general practitioners to patients in their own homes. This service is a very essential one and I was wondering if such a service was covered by the Bill or if it was envisaged?
Section 55 covers that and I am very keen on the extension of the out-patient expert diagnostic service.
Does this state it must be in the health service clinic or a similar place? I do not think home is included in this.
It is all places attached to it.
Hospital or home assistance?
I can assure the Senator the service can be provided at home.
It does not make it very clear. It is clinic, health service of similar premises.
What it means is the service of a consultant who is normally working in a hospital, a home or an institution and he can visit a person in his home. There is nothing to stop them visiting people in their homes I can assure the Senator. I will look into it to make quite sure.
I think it is most important to make sure because it is a service which has not been used very much in this country and is one which is very well worthwhile examining.
I think one of the most important aspects of the FitzGerald Report was that it said that there should be a better diagnostic service in clinics and homes.
Question put and agreed to.
SECTION 70.
Government amendment No. 105:
In page 31, between lines 30 and 31, to insert the following new section:
( ) (1) The Minister may make arrangements for the dissemination of information and advice on matters relating to health and health services.
(2) A health board shall make arrangements for the dissemination of information and advice on matters relating to health and health services.
I was pressed in the Dáil to exercise greater influence in providing for the dissemination of information in matters relating to health and health services. This amendment will make the provision of this service obligatory on the health boards. This can be covered by Ministerial regulations under section 70 of the Bill. Senator Jessop referred to this matter on the Second Stage of the Bill. A number of Deputies in the Dáil also referred to it. I think it is obviously necessary to disseminate more. We can have an information office in every town if we wish but at least we should ensure that in every area there will be one very good centre and in some fairly large county towns there will be somebody who can spell out for everybody all the services they are entitled to and who can give them any information they require with regard to the health services in the country. That is the purpose of this amendment. I can make arrangements for this but I imagine the health boards who will be encouraged by what has been said in the Dáil and here in the Seanad will wish to make their own arrangements.
This is a very welcome amendment from the Minister. It states that the Minister may make arrangements for the dissemination of information and advice on matters relating to health and health services. The Minister mentions information centres. I should like to draw his attention to other communication media like newspapers, radio and television. Section 69 which we have just passed provides for preventive measures and this section will also provide for preventive measures. Mass radiography is a preventive measure. I agree with the Minister that specialised centres are very good in regard to providing this information but I think we could also use other media for this. We hear a lot of talk at the moment about cancer and heart disease and one gets information about heart disease everywhere. However, if such things were emphasised through the various media they would have a greater impact.
The whole publicity arrangements in my Department are under review. I recommended that this be done. A good deal has already been done and the house can be assured that we have got to do more preventive work in the Department. I intend to go ahead with this to the extent that the Minister for Finance allows me to do it.
I should like to thank the Minister for having brought in this amendment. I have read the terms of it very carefully and I think they cover the question very well. I should like to underline one remark of the Minister, that is that the information available should be good. This is very important. Health education has been inflated to an enormous extent in other countries. There are professorships in health education in universities and there are courses on it, but too much emphasis on this makes people neurotic and they get worried and therefore it does at least some harm.
The Minister is quite right in not having those centres in every town in the country because it would not be a good thing. It would not be possible either to get enough officers to staff such a number of centres at any time in the foreseeable future and therefore it is much better to have a few good centres which will give this information.
Senator Belton mentioned the mass X-ray service which was instituted to deal with the problem of tuberculosis. It was the first screening operation in this country and in any other. It has worked very well over the years. Fortunately the number of cases of tuberculosis being discovered by this means in this country and in others is now so small that the question of whether it is an economic proposition to continue its operation in the foreseeable future is arising. Already in Britain, they have decided they will wind up this service in a given period of years. I am sure this question will arise here too and when it comes up I hope the Minister and the officers of his Department will have given thought to what will happen next, particularly in relation to the people engaged in this service. Those people have been working on this problem for more than 20 years. and have enormous experience of these questions of health education and epidemiology. They have experience of assembling the information. Their expertise should not be wasted. They should be kept as a team to carry on such work in some other capacity and some other aspect of health education such as is provided for in some sections of this Bill.
The Minister's amendment underlines the distinction which has been spoken of earlier today between "may" and "shall". It is discretionary to the Minister to disseminate information. The word "may" is used in that case. The word "shall" is used in relation to the health boards. Why is it put in that form?
It is a case where we use the word "shall" to place an obligation on the health boards to provide for the dissemination of information. If I want to, I can insist on the dissemination of information. It is all part of the old "may" and "shall" business.
I should like to welcome the initiative the Minister is taking on this matter of information. I am glad to hear the whole matter is under revision. There are many other services like education and housing where there is a similar information problem.
We cannot go into all that.
I appreciate that. I suggest when these services are being developed for health reasons it might be an ecomony to develop them in conjunction with other information services, particularly using the public library as a possible basis for these information services.
I wish to congratulate the Minister on this amendment which will be of great assistance to the public, and will be much appreciated.
I agree with that Dublin Health Authority became concerned at the fall in the number of mothers bringing their children for diphtheria vaccination. We authorised a publicity campaign. I was reading a report recently from the chief medical officer saying how spectacularly the number of children coming for vaccination had increased after this campaign started.
Amendment agreed to.
I move amendment No. 106:
To add to the section the following new subsection:—
"( ) Regulations made under this section (with the consent of the Minister for Social Welfare) may provide for the collection of charges through social insurance contributions in lieu of charges which may otherwise be made under this Part and the Minister may apportion the income from such social insurance contributions between the several health boards having regard to such factors as:—
(a) the estimated number of insured persons residing in the functional area of a health board,
(b) the number of in-patient incidents,
(c) the number of out-patient incidents,
(d) the number of other prescribed incidents."
The Minister has already referred to this amendment when speaking on section 34. We did not appreciate we were dropping so large a brick then.
This was dealt with at great length.
I welcome the information that the Government are investigating a contributory scheme for health services. The Minister pointed out that there were administrative difficulties particularly in regard to the farmers and the self-employed. If the Minister accepts the amendment he may appreciate this even more. We have been careful to say the Minister "may" bring in regulations. There is nothing compulsory about it. It would enable the Minister, if he so wished, to experiment with a pilot scheme. He has already said the Government were investigating the possibility of this. It would rule out people with full eligibility. It would probably only apply to people with limited eligibility. From time to time we in the trade union movement carried out a survey as to the receipts from the 10/- a day hospital charge in particular areas. At that stage it would appear that something like twopence per week on the social welfare stamp would cover what the health authority received as receipts from these charges. It may be more now. It could be threepence a week extra. It will have the advantage that many people would gladly opt to pay threepence a week rather than go through the process of applying for a medical card, having an inquiry, and having a means test. I will not elaborate on parts (a) to (d) of the amendment. They are only a suggested method by which the Minister and his officials could distribute the income from this added contribution. I would ask the Minister to consider it. It gives him power to experiment.
One could not start a contributory scheme applying only to people coming under the Social Welfare Acts and who are in the middle income group. It certainly would have to be done by way of a special Bill. I am certain of that. The officers of my Department and of the Department of Social Welfare are not taking a conservative, rejecting attitude because of their fear of having to produce legislation in this Bill. I am convinced it would require a special Bill. Even if it were done in a limited way under the social welfare code there is the question of examination now being made by the Minister for Social Welfare of having pay-related social insurance contributions. It would affect that examination. I have gone into this in considerable detail. I hope we do not need to have a long discussion on this tonight. This matter is still under consideration and I outlined frankly to the House the considerable difficulty of establishing a contributory insurance scheme. I have taken note of what has been said by members of my own Party and by members of other Parties, including the Fine Gael Party.
Suggestions have been made about a social insurance scheme without a means test. Most of the schemes presented to me involved a means test because certain people are to be excluded from this kind of scheme. I showed that I was sympathetic but said that at the moment the difficulties seemed overwhelming. It could not be part of this Health Bill. I would have to refuse the amendment for that reason alone. It must be done in a special Bill.
I accept that there might be administrative difficulties but I do not accept that such a scheme would be impossible to implement. I withdraw the amendment.
Amendment, by leave, withdrawn
Section 70, as amended, agreed to
Sections 71 to 73, inclusive, agreed to.
SECTION 74.
An Leas-Chathaoirleach
Amendment No. 107 has been ruled out of order.
I move amendment No. 108:
In page 32, before section 74, to insert the following new section:—
"The Minister shall, after consultation with An Bord Altranais, Comhairle na nOspidéal, a body to be established representing the chief executive officers of the health boards and representative organisations of those engaged in the nursing professions, define the method whereby negotiations will take place between such organisations or bodies."
This has been brought in in an endeavour to have some method of settling disputes which might arise as regards conditions of employment as between nurses and the various boards to be established under this Bill. Roughly, it is trying to set up a negotiating machinery between these various bodies and I think it is only fair to say that the nurses must enter at some stage into this. This amendment was put down to give them some say in the negotiating machinery.
In reply to the Senator I would agree with him there would have to be something of this kind if I felt the general arrangements for the negotiations taking place between such organisations as the Irish Nurses Organisation and the health authorities were not only inadequate but not to be changed. There is going to be an expanded scheme of conciliation and arbitration which is now being negotiated and the scheme will include arrangements for the nursing profession to enter into negotiations on this matter. I suppose most Members of the House must know the basis of all that has been going on to end the peculiar arrangements that existed before which worked fairly well but which have proved ineffective in that in some cases the Minister for Health would tell managers if they increased salaries by a given amount he would not oppose it; in some cases some of the managers agreed to do it and others did not agree and are going through the Managers' Association. Now we are going to have for the Minister for Local Government an agreed scheme of conciliation and arbitration, agreed by all the organisations which look after the interests of workers of health boards and which will certainly include the Irish Nurses Organisation.
I am very grateful to the Minister. That is the point we wanted to bring out, to have a simple method, instead of a complicated one, to deal with the matter. In view of the Minister's assurance I shall withdraw my amendment.
Amendment, by leave, withdrawn.
I move amendment No. 109:
In page 32, before section 74, to insert the following new section:—
"Section 65 of the Nurses Act, 1950, is hereby amended by the addition of the following subsections:—
(4) The Board shall furnish to the Minister advice on the facilities for post-graduate training of nurses, and shall take into account submissions made to it by a person or persons or organisations engaged in, or representative of, the nursing profession, and the relevant paragraphs of the Report of the Consultative Council on the General Hospital Services (1968).
This arises out of various meetings some Fine Gael members had with the Irish Nurses Organisation. To my mind, the relevant paragraphs referred to are on page 86 of the Outline Of The Future Hospital System, commonly known as the FitzGerald Report, which states:
Facilities for post-graduate training should be developed. Post-graduate training should encompass practical and theoretical aspects of nursing including administration. Nurses should be selected for post-graduate training on application for training in any of the courses of the curriculum by a selection committee. Successful candidates should derive an incremental salary benefit.
7.17. A wider range of promotion opportunities, modelled on the recommendations of the Salmon Report should be provided for nurses.
7.18. All nursing posts, including and above the level of staff nurse, should be permanent and pensionable.
There is no necessity for me to read all this as I am sure the Minister has read the relevant page himself. I should like to ask him to consider this amendment in conjunction with what is on page 86 of the Outline Of The Future Hospital System.
Subsection (5) states that the board shall furnish to the Minister advice on the recruitment and training of pupil nurses. This is something on which the Irish Nurses Organisation do not seem to dwell too much but I think the treatment and conditions in which pupil nurses work should be examined in full. In many hospitals, and especially in voluntary hospitals, those pupil nurses do not get the treatment that perhaps girls working in an office or a factory would receive. I think the amendment I suggest should take that into consideration and that all this advice I have suggested here should be furnished to the Minister.
I agree that what Senator Belton has suggested in this amendment is excellent but I am absolutely advised that section 65 of the Nurses Act, 1950, imposes an obligation on An Bord Altranais to advise the Minister on any matter relating to nursing on which he requests advice and it authorises the board to give the Minister such reports relating to nursing as he may think fit. We have been in touch with the board in regard to the establishment of a faculty of nursing for post-graduate education as well as on a number of matters, for example, in relation to the question of nurse/patient ratio, not with the idea of working the nurses too hard but with a view to enabling them to work more effectively and to see whether better organisation would ensure more effective work and perhaps in some cases diminish the need for the number of nurses being employed in particular hospitals.
All the arrangments for the recruitment and training of student nurses come under the authority of An Bord Altranais and I can ask them to give me any report and I shall listen to any proposals they make to me. Regarding the terms and conditions of work, this arises in connection with the operation of the Irish Nurses Organisation and I think Senator Belton would agree with me that on the whole the voluntary hospitals are following reasonably well the lines of improvement in conditions for nurses that have been made effective through the work of the health boards. I have not had time to go into all these matters but I can assure the House that the nursing profession is one that needs to be fostered and helped. I was very glad to see an improvement in the conditions for nurses in a number of different ways, reduced hours of work, special increments for certain types of work and so on. I was very glad that up to a certain moment —I think it has changed now—nurses with final pay awards were being paid fractionally more than nurses in England, if one subtracted the amount deducted for living-in expenses.
That does not mean that I think we have got to the end with regard to the payment of nurses, but we have been making progress and the House can be assured that everything that needs to be done can be done under existing legislation. Section 65 of the Nurses Act, 1950, will go just as far as the amendment goes. It covers all the arrangements, but like so many other sections in this Act this section depends first of all on the activity of An Bord Altranais and equally on the interest of the Minister. You cannot enforce all the things that the Senator wants to do. It depends on the initiative of the Minister and the activity of the board ultimately.
I am very appreciative of the Minister's sympathy but there are a few points that arise. One is the conditions attached to married women or widows re-entering into the service. That is one; and the suggestion here of the State enrolled nurses and the State registered nurses is a thing that might be examined in this context too. I believe that there is some distinction but I do not know where it operates.
I have had no demand for State enrolled nurses, and An Bord Altranais thinks that we do not need to have them here.
There is a feeling in the Dublin Health Authority that the time might come——
The time might come, but shortages of nurses can only be seen in certain limited pockets and not over the country as a whole.
We have had this discussion with the Health Authority over the State enrolled nurses.
I wanted to refer to the second part of this. These are amendments which we would not have put in if there was a section in the Bill dealing with nurses, but there is not, and therefore there was no opportunity of putting this point of view to the Minister. The second part of the amendment refers to the pupil nurses. There is a feeling amongst many of us that the conditions under which pupil nurses are expected to serve the first year or two are quite deplorable and out of keeping with present day working standards. One of the things that I personally feel very strongly about is that there are certain of the voluntary hospitals which still demand a fee, and in some cases quite a large fee, for the privilege of working as student nurses in a particular hospital. It seems to me that this is something which has gone out in almost every occupation. Anybody who goes into the nursing profession, let us face it, has to have either a vocation or something very near it, and to be asked to pay a fee of up to £200 seems to me to be dreadful in the 70s. Perhaps the Minister would speak about this.
It is the voluntary hospitals that do this.
I could not interfere with that, and I see no reason I should do so, because they are able to get applicants. I have told the House that drop outs of nursing students are very low here compared with England, in which there can be as much as from 24 to 38 per cent. Here it is very low. There is bound to be a drop out rate. I am not saying that there cannot be improvements in all these matters in relation to pupil nurses, but the position is much better here than in Britain I am glad to say.
I am glad that Senator Boland has referred to this question, which I was about to raise myself. Although the Minister has said that this is a matter for attention by the voluntary hospitals, this question of fees for nurses, I think, is one for the attention of the Minister, of his Department and of the Government if necessary. Senator Boland has pointed out that the time is long gone where girls should be compelled to pay a fee if they want to get trained in what are described as the snobbish hospitals in this city. Their parents are obliged to pay an exhorbitant fee, and they are obliged then to give slave service for a year after they are finished. Granted that conditions have recently been improved due to the intervention of An Bord Altranais and to the Minister's good offices, the conditions and pay are still very far from satisfactory. I would suggest very strongly to the Minister that whether this is considered to be a matter for the voluntary hospitals or not, the time has come when some attention should be paid to this matter, because we are losing good quality girls who have to go to the hospital service in England, and afterwards losing them from there to the hospital services in the United States and Canada—many of the best girls we have in this country. They are highly intelligent, well-educated girls. I had experience in one hospital in England and was amazed at the educational standard of the girls I found there, 90 per cent of whom were Irish. They could not afford to pay the fees that were demanded here in these hospitals in Dublin and had to go to England. I suggest that something must be done to deal with these hospitals.
The second thing I should like to bring to the Minister's attention is that I have been looking at what I thought was going to be a white elephant in Elm Park for the last 15 or 20 years. I do not know what impeded its completion and what impeded its opening. If it does not open soon the situation will be catastrophic in this city with every doctor around the country waiting for beds, and here is a big hospital lying idle in Elm Park.
I should like also to direct the Minister's attention to the point that if there is going to be a continuation of the hospital building programme, and if great regional hospitals are going to continue to be built, the sooner we get out of our heads the sort of thing that is going up at the moment as being 21st century hospital buildings the sooner we will realise that we are far behind modern hospital development in other parts of the world. I suggest to the Minister that before any further plans for hospital buildings or extensions are approved by his Department he should take into consideration what is happening in Canada, Sweden, Germany and the United States.
An Leas-Chathaoirleach
The Senator is wandering far, geographically as well as relevantly, from the Bill.
Perhaps so, but I have not spoken in the whole length of the debate.
An Leas-Chathaoirleach
And that is why some latitude has been allowed.
Perhaps I could be allowed a little further latitude to finish this, that I should like the Minister to take a look at those hospitals with particular reference to the point which he made himself, that is the amount of work which nurses can be expected to do in future. Automated hospitals are now being built in those countries, and if the Minister could provide them then our nurses, instead of devoting a lot of their days to kitchen work, domestic work and skivvying, will be able——
——to do the work that they were trained for. I think that we should take a deep interest in that, and I recommend it strongly to him.
I am delighted that our amendment has brought out such wise remarks from the leader of the House.
I can assure Senator Ó Maoláin that I have encouraged officers of my Department to explore further techniques in the construction of modern hospitals. We have a good deal of information which can be taken into account if there are new big hospitals to be built and I will encourage as much as possible new features and modern developments.
Amendment, by leave, withdrawn.
I move amendment No. 110:
In subsection (1), line 19, before "on" to insert "with the consent of the Commissioners of Charitable Donations and Bequests and, in any circumstances where the Attorney General shall so direct, with the approval of the Court".
First of all I should like to make a point that is important in principle with regard to people who having accumulated a fortune devoted it to a charitable project of their choice and determined by their views and their arrangements what in fact is to be done with that money. It seems to me worth recalling an observation of John Stuart Mill with regard to the execution of a will that it is the most remarkable tribute to the human spirit to think that with regard to a man long since dead people now living are bound by his wishes as he expressed them with regard to property he left to a charity or for any other purpose.
This is the sort of principle which lies behind the law relating to charities in Ireland, and I am sure indeed that we all know that the origins of the hospital system we have are due to the dedicated work of the minority in Ireland. It should be said that it was from their work that there sprang the voluntary hospital system. I appreciate the work of members of the Roman Catholic Church or whatever name you want to describe the religion I profess, but modern hospital research has brought out this point, that one of the most neglected features of our history was that the dissolution of the monasteries in fact produced a reaction and an extremely sharp voluntary exercise by religious Christians who did not accept the discipline of the Catholic Church.
I take it that many of the voluntary hospitals that we have here are in fact due to their charity, and as I understand it the law in regard to this matter is concerned not to interfere, but another Act of Parliament has provided for procedures devised to seeing that the charitable intentions of the founders are realised. It has been said in one case that there is a very important jurisdiction conferred on the Commissioners of Charitable Donations to look after charities which are not working.
I am quite happy with the amendment as drafted by the Minister's advisers. The amendment is to ensure that no amendment is made to the charter of any hospital without reference to the appropriate person or persons whose duty it is to see the realisation of the purposes of the charitable person who established the hospital.
In relation to that, I can only say that I am aware of a very large benefaction of an educational and cultural character made in recent times and which led to an Act of Parliament. That bequest would never have come to this country if there had been any possibility whatsoever that power could have been taken by Parliament or anybody else which would have altered that bequest in any way. The bequest was made because it was possible to give advice that the courts of the country would see that the precise intention of the benefactor would, at all times, be realised. One of the provisions of the document dealing with that was that nobody else could come along with a large sum of money, add it to the particular benefaction or change its character in any way. There is a very important principle involved in this. It is a subsidiary point.
Without knowing more than I do, I should not like to think that the Minister would be given power, by order, on the application of the governing body of a hospital to amend a charter. Many members of Parliament are, like myself, members of the corporation of the National University of Ireland and I know that if a power were given in an Act to a Minister to amend the application of the Governing Body, the rights of the corporators might be denied.
I have doubt as to whether Parliament by a section such as this can delegate power to a Minister to amend a private Act or, if it does so, that it is constitutionally correct. My under standing of a private Act is that it is to be construed as a contract between the members of the corporation and I cannot see how the rights arising from that contract can be amended by a Minister even under delegated power and I should like to know whether such a power has been given to any Minister under any other Act. I anticipate being told that similar power was given under the National Health Act in England where, because they say they have an unwritten constitution, they get over the fact that they have not any. Where there is an unwritten constitution it is possible to do anything that Parliament decides.
I am sorry to trouble the House and the Minister with this kind of address when so much has been done in regard to health legislation but it seems to me to be important that I do so on a point of principle.
We could have a very long debate on this. As the House knows, up to now private Acts had to be initiated outside the Dáil and submitted for changes in the constitutional charter board of a private kind and a number of such Acts have been passed in the Dáil and Seanad in relation to property or to changes in the function of private organisations where it is considered desirable.
The only purpose of this amendment is that the Minister, where it is considered desirable, and on the application of a governing body of a hospital, may amend the charter on private Act relating to that hospital. The governing body could request the Minister of the day to make such a change and the Minister, if he agrees will file the necessary order, but there would still be a debate in the Dáil and Seanad and the order would have exactly the same treatment as other Private Bills have had. The treatment of Private Bills has been excellent and the Seanad has been particularly good in the way it has dealt with Private Bills. I am not taking any more power in this. It is simply a different way of doing it. Instead of having to introduce the Private Bill from outside the Minister may press the order on the advice and with the consent of the governing body.
In so far as the Commission for Charitable Donations and Bequests is concerned, it may be taken for granted that if there was any question in relation to some kind of bequest which had previously been given to an organisation and which no longer could be given and its character was changed without the Commissioners for Charitable Donations and Bequests making use of whatever powers they had, one would have to use one's commonsense.
Senator FitzGerald may visualise a situation where the amendment of the charter of a hospital would be of such a fundamental nature that the hospital would no longer continue to attract the type of activity which attracted the bequests in the first instance but, nevertheless, it would not be realistic to change a charter of a Private Act relating to a hospital code save with the consent of the Commissioners because in the majority of cases the amount of the benefaction in relation to the total expenditure of the hospital would not be very large. It would be such that the governing body themselves would be already notified about it.
I do not know very much about this in detail but if, for example, a hospital says it provides only for dying persons and the board of the hospital believed this to be completely outdated, nothing could be more outdated in the modern world than a hospital to which only dying persons could be admitted. Very good work is being done in such institutions so that other persons could be admitted or other classes of persons. I do not know what the Commissioners might do about an annual gift being made from a fund for that hospital. I would imagine they would be entitled to say whether the person would object to assistance coming from this bequest to help people in necessitous circumstances but not necessarily those who are dying. It might assist other classes of persons.
All I can say is I am perfectly certain that the legal authorities working on behalf of a governing body would look into all this and that they would consult the Commissioners for Charitable Donations and Bequests if they felt it was right to do so but I think it would be quite wrong to insist only that the Commissioners should give their consent before a charter was amended or changed. I do not think that is reasonable.
Finally, I should like to say again that a system whereby the Minister can introduce a draft for amending a charter or a Private Act relating to that hospital will come before the Dáil and the Senate and I think the Dáil and the Seanad have shown great responsibility in this matter. I do not think it is necessary that such amendment should be brought before the courts. I do not think anything has happened in the past in relation to those Private Bills which would suggest a change of this kind. Most Senators and Deputies have given great attention to those Private Bills. They have been quite inexhaustible in their patience in bringing them through the Houses, Deputies and Senators on both sides of the Houses have been very helpful in this and those matters have been conducted properly and with all due regard to the human circumstances which are affected by such charters.
Would the Minister consider accepting it in the form "on the application of the governing body of the hospital and after consultation with the Commissioners for Charitable Donations and Bequests"?
I will certainly look into that in order to see if what Senator Alexis FitzGerald has in mind can be properly considered. We will certainly look into that. I can see his point.
I am certainly grateful for the concession of the Minister. It has already been stated to day that we are legislating for a period when every Member of this House may be dead. While we can rely on the commonsense and civilised reaction of the Minister we cannot rely on the commonsense and civilised reaction of his successors, or many of them. I would press a little further than Senator O'Higgins. I would invite the Minister, between now and the Report Stage, if he has an opportunity of doing so, to consult with the Attorney-General on this because I think it is of very great importance. We want to encourage people with money—there are people with money who want to do good things with it—to dedicate their money to good purposes of their own selection. We want to be able to tell them with confidence that it will only be a judicially concerned body which will be able to alter that purpose. The point I am concerned about is that people like Senator O'Higgins and others will be able with absolute confidence to say: "This is there in our civilised laws to protect your good purpose."
I can consult with the Attorney-General but in the ordinary way he would have seen this Bill. I will consult with him to make quite sure that he has taken due cognisance of the matters mentioned by Senator Alexis FitzGerald.
Amendment, by leave, withdrawn.
Section 74 agreed to.
SECTION 75.
Question proposed: "That section 75 stand part of the Bill".
What is meant by "appropriate premises"?
This is a rather gruesome section to have to put in. Because of very tragic circumstances which have arisen where in certain places difficulties have been found as to where a body should be put, this is simply to ensure that the Minister can make provision that bodies can be put in appropriate places, wherever they might be.
At the moment there are only certain premises to which you can bring a body. I take it they are not necessarily the "appropriate premises" within the meaning of this.
Question put and agreed to.
Section 76 agreed to.
NEW SECTION.
Amendments Nos. 111 and 121 may be discussed together.
I move amendment No. 111:
In page 33, before section 77, to insert the following new section:
(1) The Minister may make regulations for the control of the use of a substance to which this section applies.
(2) Regulations under this section may provide for the prohibition of the use of a substance to which the regulations relate, except by persons or classes of persons specified in the regulations and in circumstances and under conditions specified in the regulations.
(3) An agricultural employer who contravenes or attempts to contravene a regulation under this section or who allows another person to contravene such a regulation shall be guilty of an offence.
(4) Every person guilty of an offence under this section shall be liable—
(a) on summary conviction thereof to a fine not exceeding one hundred pounds or to imprisonment for any term not exceeding six months, or to both such fine and such imprisonment; or
(b) on conviction thereof on indictment, to a fine not exceeding five hundred pounds or to imprisonment for any term not exceeding five years, or to both such fine and such imprisonment,
and the court by which the person was convicted may order the forfeiture, and the disposal in such manner as the court thinks fit, of the substance in respect of which the offence was committed.
(5) This section applies to any poisonous substance (being a substance listed in the Fourth Schedule to this Act) used in agriculture to which persons working in agriculture may be exposed or which may be handled or inhaled by such persons.
(6) The Minister may, by order, amend the Fourth Schedule.
The purpose of this amendment is to control the use of agricultural substances and sprays. First of all, I should like to say it is not because I am a lover of controls that I put down this amendment. I should like to emphasise that the purpose of the amendment is to protect ordinary people who use those sprays and, as many Senators here know, at the moment they are very widely used by the agricultural community. Indeed, very often they can be used in a rather careless and haphazard way.
We consider they are certainly a hazard to health equally as much as some of the drugs which are controlled under this Bill. I should like to point out that they are controlled in England and in the Six Counties and that the list of substances mentioned in amendment No. 121 is a list of the substances which are controlled in the Six Counties. I should also like to point out that acceptance of this amendment would enable Ireland to ratify the ILO Convention on this point, which is something they cannot do at the moment. On looking at section 77, it would have the added advantage of making it a worthwhile section because at the moment it does not appear to me to be a very useful section. Indeed one would think at the time in which section 11 of the Rats and Mice Destruction Act, 1919 was introduced there were much more important things to be done than the introduction of an Act of that kind. I hope the Minister will accept this amendment.
The Senator apparently did not read what I said in the Dáil where similar amendments were moved by Deputy Tully. The position is we are formulating a Drugs and Poisons Bill, in which section 15 of the 1961 Act is due for amendment. We are consulting with the Minister for Agriculture and Fisheries about exactly what the Senator was speaking about, the question of the use of poisonous substances, the method of their distribution and so forth. It is simply a different code. I simply could not take what was being put by the Senator into this Bill. The new Poisons Bill is being drafted and I hope it will be ready some time this year. It will cover some of the points made by the Senator.
At the same time I should like to tell the House that under section 14 of the existing Poisons Act, 1961, draft regulations are provided for in relation to the sale, supply, labelling, storage, containers and transport of a great many of the kind of substances which have been scheduled by Senator Jack Fitzgerald. We can get that far by making use of the existing Act.
In regard to the use of those things, we intend to take care of that situation in the new Drugs and Poisons Bill which is a very wide sweeping and extremely complex Bill and we simply could not bring in just one section of that Bill into this Bill. As I said it is a very complex one which I found very hard to understand when reading through it for the Government. I would ask the Senator to withdraw the amendment on the understanding which I gave to Deputy Tully. All the matters he speaks of he will be able to debate fully when this Drugs and Poisons Bill comes before the Seanad.
Which Minister will be responsible for the new Bill?
I will be responsible in consultation with the Minister for Agriculture and Fisheries.
We will have another day on that.
I think the Minister for Agriculture and Fisheries has given consent already to those powers being enacted. I do not think we have any major differences of opinion in regard to the operation of this Bill. He realises the necessity for it but he is joining with me in regard to certain aspects of it and the matter of administration.
I withdraw the amendment.
Amendment, by leave, withdrawn.
SECTION 77.
Question proposed: "That section 77 stand part of the Bill".
This is purely a technical point. Is the Minister satisfied that a tree, for example, would be regarded as land within the meaning of this?
I am not sure of that now.
Cut one and you will know.
The point I have in mind is if we are dealing with land where there is no gate or door. The provision is then that the notice will be fixed to a prominent part of the land. I imagine the draftsman did visualise a tree or something of that sort. I want to ensure that that is feasible. I would have worded it: "shall display the notice on a gate, door or prominent part of the land".
I will look and see whether a tree is a prominent part of land.
The Minister has many tasks.
Question put and agreed to.
Sections 78 to 81, inclusive, agreed to.
SECTION 82.
Amendments Nos. 112 and 113 not moved.
Question proposed: "That section 82 stand part of the Bill".
This is a section dealing with public assistance. I know the Minister was under great pressure in the Dáil about this section. It has been stated somewhere that it will be administered by the health boards and that it will not be administered by the local authorities. There is a large consensus of opinion that this should be brought completely within the ambit of this Bill in the sense that it should be part of the Bill and qualify for grants within the Bill. The Minister, however, has not acceded to that request at any time. I wonder would the Minister reconsider this. I accept he is utterly correct in that it should be administered by the health boards because there would be duplication of effort if it were to be administered by the local authorities who are dealing with similar problems and similar investigations. I would ask the Minister if he could, by any chance, reconsider the point that it be brought completely within the ambit of this Bill.
I explained to the House that the Minister for Social Welfare is examining the whole social welfare code, including home assistance, and he may come up with some proposals in regard to the method by which home assistance is paid and authorised. I must leave the position as it is at present. The cost of home assistance is raised from the rates and then, the amount being known, the payment of it can be made through a health board. I cannot go any further than that at present.
I appreciate that. Is there a likelihood in the future of a change in this order because it seems to me there is some relationship between public assistance and all other assistance which is given. There is a connection between them all. There is a multiplicity of effort all along the line.
The Government have made no decision on it yet. It will take a long time to examine the full implications of the Devlin Report. The Report says the Departments of Social Welfare and Health should be amalgamated. I am not saying they will be. I do not know what the decision will be. There is an indication that many people feel there should be more coordination between the Department of Social Welfare and the Department of Health. That could be effected in various ways. I am all for more coordination at all times. I can only say I can do no more than what is in the Bill at the present. If we intend to allow public assistance to be administered by the health boards that would be done through section 24.
Question put and agreed to.
SECTION 83.
Question proposed: "That section 83 stand part of the Bill".
I object strongly to a provision such as is included in section 83. We have had discussions already about legislation by regulations, and about amending legislation by Ministerial regulations, and we have here in section 83 of the Bill an omnibus provision to enable the Minister to amend by regulation any statute, order or regulation in force at the passing of this Act and relating to any matter or thing dealt with or affected by this Act, and make any adaptation or modifications which appear to be necessary to enable such statute, order or regulation to have effect in conformity with this Act.
I would not feel so strongly about the matter if the amendment or modification which the Minister was being authorised to make were to be limited to orders or regulations in force, but it is going a bit far that the Houses of the Oireachtas should solemnly hand over to the Minister in a section like this authority to amend legislation without coming back and having it discussed in the ordinary way by amending legislation in the House. I do not mean to be discourteous to the Minister in saying that it is the job of the Minister and his advisers in the preparation of this Bill to make such amendments as are necessary in existing statutes.
I understand that this section has a historic use, that has well been defined by precedent. It is for minor purposes, to enable adaptations or modifications that may appear necessary, to enable such statutory orders or regulations to have effect in conformity with this Act. It occurred in the 1947 Act in exactly the same terms and also in the 1960 Act, and I think I am right in saying there has not been a complaint that the Minister has exceeded his power in making use of this section in any way that would flount the wishes of the Oireachtas or would be dictatorial in attitude. It is one of these sections that has to be put in to avoid amending legislation and other various complications that might arise. I do not think it is being misused and I do not think any of the older Members of the House can recall a Minister of the day misusing his power.
Could we have him up? That is the trouble.
I do not think the Senator need worry.
The Minister has made several references throughout this Bill to various Acts that were passed many years ago, but the fact that they were passed years ago does not mean that we cannot take a new look at them. It does not follow that because they were passed some years ago they are valid or logical today. I am not suggesting—nobody has been suggesting— that this Minister will do something wrong and that has never been a suggestion from this side of the House, but it seems, and in this respect I agree with Senator O'Higgins, while I accept the Minister's assurance that it refers only to modifications, under section 83 it could refer to anything. It does not suggest that it is merely referring to minor points. It could nearly invalidate all we have done up to this.
I am only suggesting that it is a reading that could be taken. I know the Minister does not intend that and I accept his assurance. He mentioned minor points, some modifications, but all these facts should be brought out in a Bill of this nature and should not be left as they are at the moment:
It must be in conformity with the Act.
Surely what is amended to have effect in conformity with the Act is a matter of opinion? The Minister might take one view and the Senators might take another.
The Minister could be challenged in the courts if he misused this section. He would be in an appalling spot if he dragged out the section which had been used only for minor things to alter the whole ambit of the health scheme, to confer disability allowances on people or to take away power from the health boards and so on. It seems inconceivable in the modern world that a Minister could give reckless use to this section. Surely the House will agree with me on that?
He would be in trouble with the Select Committee on Statutory Instruments.
Question put and agreed to.
Section 84 agreed to.
FIRST SCHEDULE.
Amendments Nos. 114 and 115 not moved.
Government amendment No. 116:
In page 35, column (3) opposite the reference in column (2) to the Health Act, 1947 before "102" to insert "99,".
This amendment is consequential on the section of the Bill about dissemination of information. It is to repeal section 99 of the Health Act, 1947, which will be replaced by a new section. It is consequential on amendment No. 105.
Amendment agreed to.
First Schedule, as amended, agreed to.
SECOND SCHEDULE.
I move amendment No. 117:—
To add to Rule 9, page 37, the following paragraph:—
"(3) A person shall not be disqualified from membership of a health board merely because he has received assistance under the Public Assistance Act, 1939, within twelve months prior to (or at any time after) his election to the Council, or Corporation, which appointed him to the board."
This amendment proposes to add in a new Rule on page 37. The reason is that at the present time any elected representative or member of a council or corporation if he has received public assistance within 12 months prior to election or at any time while he is a member can be disqualified. We contend that this provision is absolutely unnecessary and we wish to have it ruled out as a possibility for the health boards. We think that any elected representative or anyone in a public position who has had the misfortune to rely on public assistance is perhaps in a poor enough position without having the added worry of being concerned that he will be removed from his position.
I cannot find it has ever happened and I imagine the Minister does not intend it should happen, but it is unnecessary that this provision should be there. Any person in that position would be very concerned and worried that this regulation could be enforced and he would be removed from his position. I ask the Minister to consider seriously this amendment or at least to deal with it sympathetically. We are concerned that people going through the mill of public assistance should not have the added burden of concern about being removed from a public position with all that that implies.
I would agree with the Senator but my difficulty is that there is nothing in the Health Bill which disqualifies a person from being a member of a health board because he has received assistance under the Public Assistance Act, 1939. Under existing legislation a person who has received such assistance within 12 months prior to election or at any time after election is debarred from being a member of a local authority. This is a matter for the Minister for Local Government and I would encourage him when next he is dealing with the kind of legislation which would include such provisions to deal with this matter.
Perhaps the Minister could deal with this by regulation under section 83.
I cannot deal with it. I cannot interfere with the local government code.
Surely if he is disqualified from being a member of the local authority, and the local authority have elected him to the health board, then he would be disqualified from membership of the health board because he would not be one of the elected people on the health board. If what the Minister is saying is correct I am surprised that it was not ruled out of order as being outside the scope of the Bill.
I do not think that he could remain a member of the health board after being disqualified as a member of the local authority, because he is elected as a member of the local authority. I sympathise with what Senator Miss Owens has said, but I really could not. I would be invading the codes of the Minister for Local Government in regard to the privileges of members of local authorities and the rules in regard to their election.
Can I take it that the Minister will use his good offices with the Minister for Local Government to get this regulation removed from the local government code?
Amendment, by leave, withdrawn.
I move amendment No. 118:
In page 39, lines 20 and 21, to delete Rule 23.
This refers to paragraph 23 of the Second Schedule which states that no business shall be conducted at a meeting of the board other than that specified in the summons relating thereto. The next amendment, in the names of Labour Members, says in the second part of it that a health board may make standing orders for the regulation of their proceedings. In other words, it is enabling each board to provide standing orders for themselves. I take it that that is what it means. If this is so, then paragraph 23 of the Second Schedule may not be allowed to remain in, because it prevents the suspension of standing orders to deal with any other business. I think that it is extremely rigid.
I would not mind looking into it. On the other hand it is in the First Schedule to the Health Authorities Act, 1960, which governs the operation of the rules under which the Dublin Health Authority operate. I think that nothing is worse than for members present at a board like this of an executive character to spring decisions in regard to a topic on the agenda without proper notice to those present.
I deal with certain boards, the Dublin Health Authority and Dún Laoghaire Corporation, and their standing orders are so tight and hide-bound that they do not allow topics to be brought up, especially Dún Laoghaire Corporation, whenever it does not pertain in some way to the business of the Borough. I think that outside that the chairman never allows the suspension of standing orders and it will not be voted on. The Minister might have a look at this again, because I feel that there are occasions on which the suspension of standing orders should be allowed and paragraph 23 would preclude that.
I will look into it and see if it is necessary to have this power to suspend standing orders, though I very much doubt it.
If the agenda included an item "other business", that, I think, would cover the point that Senator Belton is making.
I suppose it might cover the point but I will look into it.
Is this not a copy of the Schedule which was in the 1960 Health Authorities Act?
Then this would indicate to me, because I know that the Dublin Health Authority regularly suspend standing orders, that perhaps we were working completely illegally during the past nine years.
Maybe it is not necessary but I will look into it.
I should like the Minister to look into it because the second part of the Labour amendment cannot be accepted if this is allowed in.
Of course the next amendment is rather a different matter.
The second part of it does provide for entitlement of a board to establish their own standing orders.
I did actually propose to accept that kind of amendment, but I will have to look into what the Senator has said.
I propose to accept the Labour amendment, which is reasonable. I propose to look into it, and introduce an amendment accepting the principle for the Report Stage.
If the Minister is prepared to accept the principle of the next amendment, then surely paragraph 23 is completely surperfluous?
I accept the principle of amendment No. 120 in the names of Senator Owens and Senator Desmond.
The Minister accepts the sense of Senator Belton's amendment and the principle of Senator Miss Owen's amendment.
Amendment, by leave, withdrawn.
With permission, I withdraw amendment No. 119, but I should like to thank Senator Belton for eliciting from the Minister, in anticipation, what he has said. I welcome the Minister's remarks that he is prepared to look between now and Report Stage at the principle involved in amendment No. 120. I accept that very gratefully and look forward to the Report Stage.
Amendments Nos. 119 and 120 not moved.
Question proposed: "That the Second Schedule, as amended, be the Second Schedule to the Bill".
The object of the points I tried to make in regard to the Second Schedule is to invite the Minister to reconsider his attitude to amendment No. 12 which I put down to section 5, in which I think I was supported by other Members on this side of the House, that it is very desirable with regard to the points that I think I can make with regard to the Schedule that he should take power to amend the rules if they are found to be in any way deficient.
Perhaps before I make any point with regard to this I should declare my awareness of the words of the late Justice Gavan Duffy referring to the "jungle" of local government law. I am well aware that the law behind all this and many other Acts of Parliament may repair the deficiencies which appear in these rules. With that degree of humility, at least, I propose to address myself to the task that if the point I have to make in regard to Rule 1 is right, then it does seem that there is no provision in the rule as drafted which would give sufficient time to the council of the county to appoint the members of the board, in so far as there is no restriction under section 4 on the time before any meeting when it can establish a particular board.
Accordingly you could make an order establishing a board perhaps two days before the meeting of the council held next after it is established, which could be quite insufficient time for the members to do their job of considering who in fact should be the person appointed. It seems to me that there ought to be some provision somewhere which would give sufficient time for the persons to elect the first members of the board to do it, as there is in relation to subsequent elections, when there are these provisions, that there be a first-quarterly meeting, or whatever it may be, held after the quinquennial election of members of that council.
My second point will be met by the Minister's attitude to the amendment which has been tabled and, in particular, amendment No. 120 which gives the board power to make standing orders for the regulations and proceedings. This appears to be a striking defect in the rules. For example, Rule 11 states:
Where a member of the board who was appointed by the council of a county has not, for a consecutive period of six months, attended a meeting of the board, his membership of the board shall thereupon terminate and the council shall, at its next meeting after the expiration of that period, appoint one of its members to fill the vacancy.
This is a strange provision when there is no rule determining how often the health board should meet, so it might be possible to find the whole board out of office, theoretically at least, because they were not obliged to meet more often than once in six months.
It seems to me that to disqualify a member for being absent for six months might be to deprive the board of a very valuable member if his absence were entirely justifiable. Perhaps this can be dealt with by the amendment which the Minister has indicated he is prepared to introduce at Report Stage, but there are many reasons why members of a board might not be able to attend for consecutive periods of six months. A member might be away in another country on the business of the board. In such cases there should be provision for absence.
Again, in these rules, there does not seem to be provision for what might happen if there was not a quorum. In such case would the business be spent or should a rule be provided in the standing orders for the adjournment of the meeting convened for that time and day to another time and day?
Rule 17 would seem to indicate that it is contemplated that there are to be members of the board who will, in fact, also be officers and servants of the board. It may well be that this very elaborate and difficult code of local government provides for this sort of situation but I would have expected to find some provision in these rules for the remuneration of officers. I would also have expected to find some provision for what would be the position in the case of a vote.
Indeed, I would also have expected to have found some provision in the rules for what would be the position in the case of any member whose interest is involved in a matter under consideration by the board. It is desirable that there be complete answers to these questions but if there is not a statutory requirement with regard to this there ought to be a rule and I do not think this is the sort of rule which should be left to the board to make. It should be made by statute and if, as originally drafted, it is not a good rule, the Minister should have power to amend it. Under Rule 19, there is provision for the chairman to call a meeting of the board but what happens if there is no chairman present or if the chairman refuses to call a meeting?
There is no provision for that. The vice-chairman, as far as I construe it, simply presides and is not the chairman for the purpose of convening a meeting. The Minister rightly talks about the desirability to modernise the health services but there is a great deal to be said for modernising the rules relative to the procedure of boards.
I do not like Rule 21 in so far as the place where the board are accustomed to meet might be burned down or might be occupied by people who think it ought to be preserved for purposes other than the health board. This rule could inhibit the meeting and should be made more clear.
Rule 22, which deals with a summons to attend the meeting being left or delivered by post at the usual place of abode, is certainly not a good arrangement. There ought to be provision for a person going on holidays or elsewhere whereby he could send a notice to the secretary saying that he may be found during the next month at such a place especially since the meeting may be held within three days of its being convened.
I am also worried about Rule 27 which has an old-fashioned ring about it. It is not a good system whereby an executive body could be put in the position of being recorded as voting for or against something. Members of this House can sometimes say "no" without having to go into the more elaborate business of being on record as having said "no". It is not a good system to provide for the recording of how people vote unless, of course, a full vote—a division—is called for and that, of course, should go on record.
I think it was Rule 4 or an amendment to Rule 4 that I thought it desirable to have amended because there did not seem to be anything in those rules to prevent a certain kind of people, who ought not to be responsible for deciding matters of great importance, from being members of a health board. I imagine I will find the answer to this is that it is to be found in existing legislation, that is to say, there is no rule here preventing a bankrupt being a member of a health board, or a person who was convicted of an indictable offence or a similar sort of disability. There is provision for giving notice for the meetings but I do not think this is sufficiently expressed.
It should be made clear whether it is to be inclusive or exclusive of the day served and of the day on which it is given, and I think the rules should say when it is to be deemed served. Is it to be deemed served when posted or is it to be deemed served 24 hours, 48 hours or whatever number of hours after it is served? I think there ought to be a rule there. I do not think it should be left to the body to decide the minimum number of meetings. There ought to be a rule providing for the minimum number of meetings in any year and then they can have as many other meetings as they like but I think they should be burdened with the duty of meeting on a minimum number of days, whatever number it might be thought to be by those who know more about those matters than I do.
What happens if there is a quorum at the start of the meeting and if everyone goes out for a drink and one is left behind? Can this one person decide on all matters? There should be a rule telling us the position on that. There ought to be a rule entitling the board to appoint a sub-committee and to delegate their powers for particular purposes if this were deemed by them proper and wise. In the case of Rule 29, should this include the words "or on his termination under Rule 17"? The chairman or vice-chairman, where the board have under consideration a proposal for the termination of his appointment, should not have a casting vote on such a question. It does not seem rational that he should have it in such circumstances. He should not have it on a question of his own election as chairman or vice-chairman. I request the Minister to reconsider his attitude to my amendment proposing that he should take power to amend the rules.
When this whole Schedule was written into the original Bill it was envisaged that the Minister would appoint the chairman and vice-chairman. The Minister very wisely agreed subsequently to allow the board to appoint their own chairman or vice-chairman. This Schedule was originally copied from the 1960 Health Authority Act. That Act provided for the holding of an annual meeting by the health authorities in question at which they would appoint their chairmen. This was excluded from the first writing of the Schedule. At that time the Minister was to appoint the chairman. The Minister has changed his mind on that and we now have the situation where the chairman, after being elected, holds office for the full life of the health board, which is a fiveyear period. I do not know whether this is necessarily a good thing. The members rather like to see annual elections of chairmen and different members taking the position of chairman for a year. It is a post which helps to educate members on the complexities of the health services. Rule 17 (2) (c) states:
(c) the board terminates his appointment as chairman or vice-chairman.
I envisage this happening. It could have happened in the operation of the Dublin Health Authority in the last few years. Let us take an example of Party A and Party B. A meeting could occur at which few members from Party B were present. Party B might actually be the party with the majority of members. A chairman could be a member of Party B but because of the fact that at that meeting there would be a majority of members present from Party A they could apparently terminate the appointment of the chairman and appoint their own chairman. At the following meeting the Party B members could come in and terminate the appointment of that new chairman and re-appoint the original chairman. This "ducks and drakes" procedure of the chairman being appointed and having appointments terminated according as to who was at a particular meeting on a particular night could exist. The Minister might write into this Schedule provisions like those in the 1960 Act to allow health boards to hold annual meetings and to appoint a chairman for a year. Such a chairman would definitely hold office for a whole year.
I cannot agree with Senator Alexis FitzGerald on Rule 27. Very important decisions will be taken by health boards. Sometimes decisions will be taken after quite an amount of controversy and discussion. It would be correct that any member voting for or against a proposal should feel strongly enough about his vote and will not object to having his vote recorded on the roll book of the health board. A person must realise he has taken on certain obligations when he decides to serve on a health board. He must be prepared to make decisions one way or the other. His vote should be recorded. There was a suggestion that these names should not be recorded at all. That is not a suggestion with which I should like to agree. I ask the Minister to have a look at the suggestion of appointing a chairman for a period of a year.
There are just two points I wish to deal with. I should like to know what happens in the event of local authorities, such as county councils or city councils, having their lives extended as has happened twice in the last 20 years. Will the life of a health board be automatically extended in such circumstances? The Minister's own nominees are appointed for only five years. At Rule 1 the Minister talks about quinquennial elections. We have had elections at seven year intervals on two occasions in the last 20 years. I should like to know the answer to this question.
Rule 13 is one on which I have very strong views. It reads as follows:
The Minister may at any time terminate the appointment of a member of the board who was appointed by him.
That clause should include the words "for stated reasons". It is unfair that a man who has given three or four years' service to a board should have his office terminated without reason. I have had experience of this myself as chairman of a certain organisation where a Minister used these powers to terminate a man's term of office without giving any reason whatsoever. I have retained vividly the memory of what I regard as unfair and unjustified action. A man is entitled to know why his appointment is being terminated. It may be that the Minister might not like his political affiliations. Some reason should be given before a man's membership is terminated.
I wish to refer to Rule 20 which reads as follows:
If the chairman of the board refuses to call a meeting of the board after a requisition for that purpose, signed by three members of the board, has been presented to him, any three members of the board may forthwith call a meeting and if the chairman (without so refusing) does not, within seven days after the presentation of the requisition, call a meeting of the board, any three members of the board may, on the expiration of those seven days, call a meeting of the board.
Is three a sufficient number? Consider the number of members we will have on this board. Would three members be sufficient? Supposing three members had a grievance, they could call meetings at any time they liked. It is more unlikely that one-fifth or one-sixth of the total membership of the board entitled to call special meetings would all have grievances but there might be three members with bees in their bonnets who called meetings every month or every week. Are three sufficient?
I cannot deal with all these points. We went largely on the 1960 Act. The rules of that Act worked well. We followed also the 1939 Act on public assistance. The same rules worked well in that. I take a pragmatic view of these matters. I do not think everything can be provided for in legislation.
On the question as to whether three people are sufficient I must say that in relation to the Cork Health Authority, which have 40 members, I have not had any complaints that three were an insufficient number to call a special meeting. A fresh meeting of a health board can be called under Rule 19. I will examine whether this previous legislation provided that members of a health board who have an interest in some particular matter being discussed should be advised to withdraw or not to vote.
I agree with the Senator who said there was no harm in recording votes particularly in matters relating to decisions on surcharges. I understand the arrangements for disqualifying bankrupt persons are satisfactory. No one need have any doubts about that.
Rule 17 deals with the election of a chairman and vice-chairman. It is a matter for the regional health board to decide on the duration of the chairman's appointment.
They must have standing orders for that.
The Senator should look at Rule 17. They can make their own rules about that. I do not think that a snap meeting to appoint a chairman based on a particular political party majority being available is likely to occur but at Rule 23 rules can be made. Rule 23 covers that. There is no danger about it. The life of a health board can be extended if it so happens that a local authority's life is extended. In any event the Minister can reappoint his own representatives on that board.
I will look into the question about the extension of the life of a local authority between now and the Report Stage. In regard to all other matters mentioned by Senator Alexis FitzGerald and other Senators, I will look into them also between now and the Report Stage. I do not propose to write detailed rules into this document. Speaking pragmatically, the Dublin Health Authority, the Cork Health Authority and the Limerick Health Authority have operated successfully. Gross deficiencies in the rules have not been brought to my attention in matters relating to the Health Act, 1960. I do not propose to underline every little situation which might exist. I promise the House I will read the reports of the proceedings as presented between now and the Report Stage. If there is anything that requires attention I will deal with it by amendments at the Report Stage.
The Minister refers to Rule 23. Prior to that the Minister said he would look at Rule 23 in conjunction with the Labour Party suggestion that each health authority should be allowed to provide their own standing orders. In replying, the Minister stated that that is covered by Rule 23. The Minister made some remark like that. I asked for the deletion of Rule 23.
That is true. I will have to look at it. I do not really need to do this. If it is essential to put an extra rule in to make it certain that a chairman or vice-chairman cannot be appointed as a result of a meeting taking place without due notice being given to the members, I will put it in. I do not believe it is necessary. If I have to repeal Rule 23 I will look at it on another basis.
There is another point about the board holding meetings which I should like to mention. The whole thing is a little vague as to who would actually call the meetings. Rule 19 says the chairman may call a meeting. Rule 16 (3) says the board shall hold such other meetings as are necessary. The mechanics are not actually spelt out. The part of the 1960 Act which laid down that meetings were to be held monthly has been excluded. The mechanics of calling a meeting have not been laid down here. The Minister might look at the Schedule to the 1960 Act with regard to this point. It would be a good thing if the boards were obliged to hold a meeting at least once a month.
This is all a question of whether the boards should decide how many meetings should be held in a year or whether the Minister should exercise essential discipline by requiring a minimum number of meetings to be held. It depends on how responsible the members of the boards will be. I hope the members of the boards will be very responsible.
If there are minimum requirements the officials send out notices for the meetings automatically each month. If it is left vague people will not know who should send out the notices requiring the meetings to be called.
The boards themselves can make regulations about when meetings will be called. I presume this will be done responsibly.
If you have standing orders that will be quite all right.
I am beginning to think the Dublin Health Authority have been living on the edge of illegality during the last nine years, after hearing all this criticism of the Second Schedule.
They operated very successfully. I have not heard from many Senators who were members of the Dublin Health Authority that they had great difficulty.
Question put and agreed to.
Third Schedule agreed to.
Title agreed to.
Bill reported with amendments.
Report Stage ordered for Tuesday, 10th February, 1970.
What is the last time for putting in amendments?
We will accept them on Monday morning at the latest. Strictly speaking we should have them on Friday but in the circumstances we will accept them until Monday morning.
The Seanad adjourned at 10.40 p.m. until 3 p.m. on Tuesday, 10th February, 1970.
