This is a drafting amendment. It proposes the introduction of a comma after "Minister" in section 38 to make the interpretation of the section easier and improve the drafting. I am told it is not customary to introduce a comma by itself as an amendment.
Private Business. - Health Bill, 1969: Report Stage (Resumed) and Final Stage.
Government amendment No. 32:
In page 28, line 54, to delete "by the Minister" and substitute "by the Minister,".
Amendment agreed to.
Government amendment No. 33:
In page 32, between lines 25 and 26, to insert the following:
"(3) Before laying the draft of an order under this section before each House of the Oireachtas, the Minister shall consult the Commissioners of Charitable Donations and Bequests for Ireland.".
This is an amendment arising from a point made by Senator Alexis FitzGerald that if the charter of a hospital is to be altered under section 74 we ought to consider the position of the Commissioners of Charitable Donations and Bequests who might have something to say in connection with the change in the function of the hospital or hospitals concerned or in relation to certain bequests normally administered by them which were granted to these hospitals. The amendment is quite evident. The Minister should consult the Commissioners for Charitable Donations and Bequests on all occasions when it is proposed to alter the charter of a hospital.
May I congratulate the Minister on introducing this? Besides the Governors of hospitals there may be other interests involved. I feel the Minister has been very good and kind in acceding to the suggestion of Senator Alexis FitzGerald.
Amendment agreed to.
I move amendment No. 34:
In page 37, line 37, before "terminate" to insert "for good and sufficient reasons stated in writing".
The amendment is self-explanatory. Its purpose is to add after the words in subsection (13) where it states that the Minister may at any time terminate the appointment of a member of the board who is appointed by him, the words, or the equivalent wording to "for good and sufficient reasons stated in writing". The reasons are self-explanatory. I hope the Minister will accept them. The Minister himself in section 11 (2) inserted his own amendment to the effect that where the Minister makes an order under subsection (1) he will notify the persons who have been removed from office as members of the board of the making of the order and of his reasons for the removal. It seems to me the same principle should apply in regard to his own nominees on this board.
I completely agree with this. The Minister may feel his appointee is involved in this but I still think that the same rule should apply here as applied in the case Senator Russell has spoken of. The reason should be given. This is a fair request.
There is a distinction between removal of members of the board where there are not personal reasons for the removal and the removal of members of the board appointed by the Minister, although it has very rarely happened. There are circumstances in which I do not think it would be desirable for the Minister to give his reasons. I have got advice on this and I think I am right in saying that if, for example, somebody appointed by the Minister was becoming a psychiatric case or indisposed——
Supposing it was a different Government——
——it would be much better not to have to give the reason. There are other circumstances which could arise like that and I think it had better be left to the Minister in charge, who very rarely has used this power. It has been in the Nurses Authority Act, 1960 and the Voluntary Health Insurance Act, 1957, all of which have similar provisions. In State company appointments where directors are appointed by the Minister he can dismiss them without stating a reason. That, I think, has been rather rare, but nevertheless there are definite circumstances where he would not like to have to give a reason. I cannot accept the amendment.
Supposing there was a change of Government?
We would all be quite satisfied that the present Minister would certaintly not be guilty of any excess under this section, but, as Senator Belton pointed out, supposing that there was a change of Government and the new Minister did not particularly like the nominees of his predecessor there is nothing to stop him terminating their membership without giving any reason whatsoever. The Minister has quoted a number of reasons why he should not state the reason, and I would accept that, but I think we can also quote plenty of reasons why it should be stated—in fact I do not see why the principle applied in the case of members of the board should not be applied in the case of the Minister's own nominees. It seems to me that it is a good principle. After all, speaking as one who has some experience of what a Minister can do in certain circumstances, I think that anybody who is removed by Ministerial Order is entitled to know why he is being removed. This is only fair and just, and I am rather surprised that the Minister would not accept it, if necessary in his own wording under section 11. I would be quite prepared to accept that.
There is nothing in the Bill which prevents a Minister giving a reason for the dismissal of a person, and I think that the House will appreciate that if a Minister chooses to remove appointees made by the Minister of another Government it would be perfectly obvious that he was doing it perhaps for political reasons. He would not have to tell this to people at all. Looking back on a long experience in what are now five different Departments, although there are exceptions to this there is general continuity of appointment in relation to appointments to boards. A great number of people continue to be appointed until they reach an advanced age.
Certainly in the case of the eight State companies over which I had supervision, I did not remove people when their term of office expired if they were appointed for three or five years. There were two cases of people between 70 and 80 who were not reappointed. On the whole, there is a general tradition of continuity, and again I may say that if a Minister chooses on political grounds, and perhaps rightly, to change appointees because they were incapable of representing his point of view on the board, it would be perfectly obvious to the public why he was doing so. It would be more than evident.
There might be some instances in which the Minister would be entitled to do this if some Ministerial appointees of a previous Government were people who had very definite viewpoints about the health services which they had expressed—entirely party political views. Then the Minister for Health of the day might feel that it would be better balanced by appointing other people, but certainly he would not need to give a reason in those circumstances. Again, this is a pragmatic matter. I think myself that should a Minister decide to remove one of these representatives then the situation would arise which would be one that will be apparent to everybody, unless it is a case of a delicate kind such as I mentioned—somebody who he knows is in such grave trouble that it would be better if he were out of it, or somebody psychologically indisposed, or something of that kind.
The Chair would like to remind Senators that we are on Report Stage and therefore Senators can speak once only. I will allow Senator Alton to speak, because although Senator Russell concluded it may not have been clear to Senator Alton that Senator Russell was concluding.
Then it is clear that Senator Russell can speak again?
We will reach that point when we get there. Meanwhile, Senator Alton.
I am disappointed with the Minister because he had assured me that when the representatives chosen from the medical group were appointed by him they would be given the same status as the county councillors in the health boards, and when we were talking about the regional hospital boards he told me that, being extensions of his Department, he would have to maintain the right to terminate their appointments.
We are very concerned that such good relations which exist between the present Minister and the medical profession might not continue and we might revert to a stage some years ago where we had very severe and unpleasant relations with a former Minister. We are concerned, therefore, that we would have representatives who could speak out their minds and be straightforward about things without running the risk of losing their seats on whichever of our boards they worked. This is very important because we hope that under this Bill there will be a much greater degree of co-operation between the medical profession, the local authorities and the Department of Health. This is the first time in the history of Ireland or England when the medical profession have been given seats on executive boards on the health services.
We regard this as an important advance. Ireland and England are the only two countries that did not up to now give doctors seats on such boards and, therefore, we regard this Bill as acceptance of the maturity of medical and professional opinion and we hope to have a long period of working in harmony with the Department of Health and the local authorities. We think an essential for this harmony is that our representatives, even though appointed by the Minister, would have security of tenure and would not be liable to dismissal at a moment's notice by a Minister who might not perhaps be as far-sighted and just as the present Minister. I am anxious that this amendment should go through so that these people would be given security of tenure and a guarantee that they would not be dismissed without good reason and that reason stated in writing.
Senator Alton has enunciated it very clearly. This amounts to a "hire and fire section" without any stated reasons for terminating membership of one of the Minister's own nominees and this is bad in principle. It is accepted in common justice where a man's services are terminated in any code that a reason is given and he has the protection of a trade union. I have had experience of this and I know what it can mean. The Minister and I have given perhaps two extreme examples but in between there could be good and sufficient reason why a member should have an opportunity of hearing his case or seeing it stated in writing and I would ask the Minister to reconsider his decision.
The success of these boards will depend on the amicable and united efforts of the members concerned and they would like to know, even the Minister's nominees, that they have security of tenure even for five years. The Minister is going to be very selective in appointing his nominees and I find it difficult to believe that in a period of a few years they will suddenly suffer from psychiatric or other troubles. I think the Minister is being unreasonable in this and I say this with some temerity because he has been most co-operative and receptive both in the Dáil and the Seanad. I would appeal to him to reconsider his attitude in regard to this and not to be so adamant about a point I regard as being contrary to common justice and fair play.
Is the amendment being pressed?
No.
Amendment put and declared lost.
Amendments Nos. 35 and 37 are related and will be taken together.
I move amendment No. 35:—
In page 38, line 14, after "Minister" to add "and shall be an annual meeting".
The wording of amendment No. 37 is slightly different to the 1960 Act which already allowed 14 days. It is in actual fact practically a facsimile of what came out of the 1960 Act with slight variations. The section goes on to state:
"( ) The Board shall at their first meeting appoint a day of the year not earlier than the 1st day of July nor later than the 21st day of July for the holding of annual meetings and may at any subsequent annual meeting alter the day so appointed.
( ) The Board shall hold an annual meeting in each year and the meeting shall be held on the day which is for the time being appointed for the holding of annual meetings under these rules, unless that day falls on a Sunday or bank holiday, when the meeting shall be held on the next following day which is neither a Sunday nor a bank holiday.
( ) If the first or any other annual meeting of the board is for any reason (including a quorum not being present) not held on the day appointed for the holding thereof under these rules, the secretary of the board shall as soon as may be summon a meeting of the Board for a convenient hour on a day which appears to him to be the earliest convenient date for the purpose, and the meeting held in pursuance of that summons shall be for all purposes an annual meeting held on the date appointed under these rules".
What we are trying to get at here, and this is in conjunction with amendment No. 35, is that we want the health boards to have annual meetings. This was contained in the 1960 Act and we want it brought in here for the regional health boards. It is contained in the First Schedule of the 1960 Health Act. For these two amendments our purpose is that annual meetings would be held and that at these annual meetings there would be rotation of chairmen.
I had thought that amendment No. 38 might have been taken in conjunction with these amendments. There does not seem to be much point in holding annual meetings unless you are going to elect a chairman and vice-chairman because the only business that is normally transacted at an annual meeting of a health board at present, if these amendments are accepted, would be the election of the chairman and vice-chairman.
Amendment No. 38 leaves certain issues not directly related, but if the House wishes——
If that is the case I should wish to speak again.
I think we had better leave it as it is and take No. 38 later.
The fact that annual meetings are held and that a new chairman and vice-chairman are appointed at these meetings is very important from the point of view of having a new person coming into the position of chairman and benefiting from the 12 months' experience. I have seen in the two or three years I have been in the Dublin Health Authority the changes in the attitude, in the knowledge and experience of the several people who were chairmen of the authority. I am thinking particularly of the fantastic increase in experience and interest in the health services which Deputy Richie Ryan had after spending 12 months as chairman of the health authority and realising the intricacies and problems which officials, trying to provide a comprehensive and modern service, come up against.
It is also of interest from the point of view of the general public that if a new chairman is appointed annually the public are more inclined to take an interest in the health board whereas if a chairman were to be appointed for a five-year period he might be very much "old hat" at the end of that period; people might not want to have him come to speak to them, or open some new service they were providing. From this point of view it is bringing the health boards more into the mind of the general public and affording to five members rather than to one the opportunity of learning considerably about all the intricacies of the health service.
For this reason I ask the Minister seriously to consider accepting this amendment. It is more or less a verbatim copy of rules 10 to 14 of the First Schedule to the Health Authority Acts of 1960 with slight modifications to the date within which the annual meeting can be held and there is a reference in Rule 38 to the fact that an officer or servant of the board cannot be chairman or vice-chairman.
We could argue about this for a very long time. It is obvious that there are different points of view about this question of annual meetings and about how often the chairman is replaced. I put in amendment No. 36 which provides for 12 meetings during the year of each health board but not by the regional hospital board or Comhairle na nOspidéal. It will be open to each health board if they so desire to make standing orders providing for the holding of annual meetings.
The board are rather different from a health authority in some senses and each board should be given some discretion in deciding how best to order their affairs. I do not propose to restrict them except by insisting that they meet 12 times each year. Members also have plenty of time to consider how they wish to order their affairs and whether they wish to have their chairman elected annually or otherwise. I prefer a sort of pragmatic touch relying on the intelligence of the board to order their affairs in respect of matters like this and my compromise is amendment No. 36 in which I insure that they meet 12 times each year. It is up to them to decide whether they wish to appoint a new chairman or vice-chairman each year.
There have been occasions in the past history of local authorities where quite evidently chairmen, although most dedicated people, have been allowed to remain in office for too long because no one wanted to offend them by removing them. Incidentally, one can also think of chairmen who have been extremely active right up to a very advanced age and who were better than any other chairmen who might have been appointed to the particular local authority. The situation varies from place to place and we have reached the stage in the modern world with young people taking more interest in these affairs and a lot of the older generation retiring where we ought to leave it to the health board to make their decision as to whether they wish to change their chairman every year. They can do that under the Bill and amendment No. 36 insures that they meet often enough to take a lively interest in their affairs. I could not accept amendments Nos. 35 and 37.
I am afraid that the Minister was discussing not amendments Nos. 35 and 37 but Nos. 36 and 38.
I started to discuss No. 38 wrongly and broke the rules of the House.
The whole purpose of amendments Nos. 35 and 37 is to enable a change of chairman so that we could have these annual general meetings. I do not mean a change of chairman per se but that there could be a re-election of chairman who held office up to the time of the election. However, if the Minister is not prepared to accept Nos. 35 and 37 I do not know what I shall do as regards No. 38.
Under subsection (2) of section 5 any health board can ask me to agree to certain rules and one of the rules, No. 17, is in the Second Schedule and that includes the arrangements for the election of a chairman or a vice-chairman so that they can make rules themselves.
I accept the Minister's word that that is what he has in mind, and, therefore, there is no need to proceed further on amendments Nos. 35 or 37. That is that annual general meetings can be held and business that is normal to be conducted can be conducted at such a meeting. That does not refer in any way to amendment No. 38. It was not my intention in these two amendments to infringe on the regional health boards and since I have a guarantee from the Minister that there is provision within this Bill for annual meetings where normal business can be conducted, I withdraw the amendment.
I made it clear to the House that subsection (2) of section 5 stipulates that any health board may ask the Minister to make an Order providing for specific rules. That surely covers the situation.
Amendment, by leave, withdrawn.
Government amendment No. 36:
In page 38, line 18, after "hold" to insert "at last twelve meetings in each year and".
I have made it clear that as a concession to a point raised by Senator Alexis FitzGerald and others during Committee Stage, I do not think the board should hold a meeting each month as has been suggested because there might be some periods, for example, July or August, when it would not be convenient. As we have directed, the board ought to hold at least 12 meetings in each year and it is up to them to make arrangements for the conduct of their business in so far as it is not specified in the Bill. It seems to me to be a reasonable compromise.
I am in agreement with the Minister because in many local bodies no meetings are held during the month of August but how they would divide 12 into 11 I do not know.
Amendment agreed to.
Amendment No. 37 not moved.
I move amendment No. 38:
In page 38, to delete lines 27 to 33 and substitute:
"17 (1) At every annual meeting of the Board the Board shall elect one of their members (not being a member who is an officer or servant of the Board) to be chairman of the Board and another of their members (not being a member who is an officer or servant of the Board) to be vice-chairman of the Board.
(2) Whenever the office of chairman or vice-chairman of the Board becomes vacant otherwise than by the termination of the ordinary term of office, the Board shall at their next meeting after the vacancy occurs or, in the case of a resignation of office, at the meeting at which the resignation becomes effective, elect one of their members to be chairman or vice-chairman of the Board.
(3) A person elected to be chairman or vice-chairman of the Board shall, unless he sooner resigns the office of chairman or vice-chairman, or sooner ceases to be, or becomes disqualified for being, a member of the Board, hold office as chairman or vice-chairman until his successor has been appointed.
(4) Whenever the chairman or vice-chairman of the Board ceases to be, or becomes disqualified for being, a member of the Board, he shall forthwith cease to be chairman or vice-chairman of the Board."
This of course is cognate to amendments Nos. 35 and 37 and this really is the purpose of bringing this in, that we want an annual election of a chairman and vice-chairman. We want an annual general meeting to be held for the purpose of electing a chairman and vice-chairman. I do not want to go over all the points again. Everybody has seen the amendment and I do not propose to read it out. We want to make quite certain that there will be an annual election of the chairman and vice-chairmen in the regional health boards.
I explained my decision in regard to this. Those people are quite capable of having it made a permanent regulation but I should prefer to leave them to make their own rules.
I accept that.
Amendment, by leave, withdrawn.
Government amendment No. 39.
In page 38, line 32, after "board" to insert the following:—
"by a resolution, for which not less than two-thirds of the members of the board voted and of the intention to propose which not less than seven days notice was given to every person who was a member of the board when the notice was given,".
This amendment arose out of a discussion on what could happen if there was some sudden meeting for some reason to deprive the chairman of his job. The amendment makes it clear that the chairman cannot be removed from his office save by resolution of the board of which not less than two-thirds of the members are present. This should make the position of chairman more certain and it avoids any difficulty which might arise regarding the casting vote of a chairman should the election of his position depend on a simple majority. I will refer the House to Rule 29 and this amendment arises out of a number of points made on Committee Stage.
Amendment agreed to.
Miss Bourke
Might I say on this section——
The Senator's remarks would be more proper on the Fifth Stage of the Bill. The amendment has been passed.
Government amendment No. 40:
In page 38, line 48, before "of" where it first occurs, to insert "or, in his absence, the vice-chairman".
Amendments Nos. 40, 41 and 42 can be discussed together.
I do not think those amendments are particularly essential but nevertheless I agree with some Members of the House who spoke that we should give the vice-chairmen of those boards some very definite functions and spell them out. The vice-chairman is frequently ignored or neglected in legislation. He is a very important man and can become chairman, so those amendments are perfectly evident for that purpose. The purport of those amendments was discussed on Committee Stage and I should like to move a purely minor amendment of a drafting kind to amendment No. 42:
That line 1 be replaced by lines 1 and 8.
This is purely a drafting amendment in amendment No. 42. I presume that the Seanad will agree to those amendments.
Amendment agreed to.
Government amendment No. 41:
In page 38, line 49, after "chairman" to insert "or, in his absence, the vice-chairman".
Amendment agreed to.
Government amendment No. 42:
In page 39, line 1, after "chairman" to insert "or vice-chairman".
Amendment, as amended, agreed to.
I move amendment No. 43:—
In page 39 to delete line 21 and substitute the following:—
"save with the consent of the necessary majority of members present as defined by the standing orders of that Board."
This unfortunately has been worded incorrectly. It is cognate in actual fact to the final amendment, that is Government amendment No. 45. In actual fact the amendment should read:
In page 39 to add line 21.
This should be instead of "delete line 21". I ask the permission of the House that this change be made.
If the House is agreeable to make this amendment to the amendment it can be made.
I move the following amendment to amendment No. 43:
To delete the words "to delete line 21 and substitute" and substitute the words "to add to line 21."
As I said this relates to the last amendment "save with the consent of the necessary majority of the members present as defined by standing orders of the board." This is this famous paragraph 23 which states:
No business shall be transacted at a meeting of the board other than that specified in the summons relating thereto.
The addition to it would make "save with the consent of the necessary majority present as defined by standing orders of the board". As I said this is cognate to the last amendment, which is a Government amendment. The Minister provides the Standing Orders in the last one and if he does this you cannot go through with paragraph 23 because they are not reconcilable. If you are going to introduce Standing Orders this one cannot stand up and therefore in line 29 we have proposed "save with the consent of the necessary majority of members present as defined by the Standing Orders of that Board". I think this is self-explanatory.
I am afraid we have not seen the full implication of this amendment. It leaves it open to the board with the consent of the specific majority to transact business other than that specified and relating to it. Rule 23 can in fact be amended by the Minister on the request of the health board and I think the desirability of a change such as this should be left to each health board. The amendment as it is presented to the House would mean that two-thirds of a bare quorum, say a quorum is nine, could bring in something, which would be a far-reaching decision, without the adequate notice being given to the other members. If the health board wanted to make some arrangement to discuss matters which are not literally on the agenda, which were not actually on the agenda, they could do that but I certainly could not possibly accept an amendment which would have this effect.
I do not want to have small groups of health boards springing far-reaching decisions by this amendment. It is only the necessary majority of members present which is required and therefore that is the diktat put forward by the quorum, which might only be nine out of a board of 30, and that majority could spring something on the board and make far-reaching decisions without adequate notice to the other members. I hope Rule 23 can be used in an intelligent way not in order that this kind of position could take place but to make any reasonable rules in regard to the way business is transacted which will prevent the springing of far-reaching decisions by what could be a very small number of members of the board. I hope the House will realise the commonsense of what I am saying.
I am terribly disappointed especially when this is the last amendment which we had in on this whole Bill. I expected the Minister to accept it. It arose originally out of the discussion on the Committee Stage. We realised this was a copy of one of the rules in the First Schedule of the 1960 Act. It meant that certain health authorities had operated over the last nine years illegally because they had suspended Standing Orders to discuss matters of importance. It seems to me that if a CEO or some other official of a new health board had been reading the debates on this Bill in the Dáil and in this House he might point out to his board that they were absolutely and utterly restricted to discussing only matters arising on the agenda and no matter how urgent a matter was they had no right to suspend Standing Orders to discuss it.
This is the only reason for entering this particular amendment. We have to apologise that the word was "delete" rather than "add to". I am sure the Minister and his advisers knew what we were getting at. The Minister has pleaded his pragmatism. In fact, I might say now we were trying to be nothing more than pragmatic about this. Bearing in mind the fact that members of a health board were not likely to spring some outlandish decision on the board without due notice, we wanted to allow for a matter of urgency to be discussed if a member had informed his colleagues of it and had the necessary majority to have that discussion take place. This is certainly something which operates in all local authorities at the moment. It has operated in the Dublin Health Authority. Reading the First Schedule of the Act I discovered this was illegal. It was to prevent boards acting illegally we sought to have this rule amended, and we did so completely out of a sense of pragmatism and confidence in the new members of the board, which the Minister has referred to here. I am disappointed that the Minister did not see his way to accepting this amendment.
I would ask the Minister to reconsider his attitude entirely on one point that has been made by Senator Boland. It is of vital importance if this is to work efficiently. It is important to consider it in relation to an emergency situation arising. It would certainly not be the Minister's intention to hamstring the boards in such a situation which he would unintentionally be doing if he leaves this rule unaltered and unamended. None of us can foresee the type of emergency that might arise to make it essential for a board to give urgent consideration to some problem arising in emergency conditions. Unless there is an alteration on the lines suggested in this amendment it would seem that that simply cannot be done. It cannot be done no matter how the standing orders of the board might be drafted. They must be drafted subject to the statutory requirements. If this rule remains unaltered in the legislation which permits the establishment of the boards and permits standing orders to be drafted, it seems to me no matter what is in the standing orders rule 23 must take priority and standing orders must be subject to that. The Minister would be imposing a rigid requirement that in most cases would be unnecessary and in some cases might be disastrous.
Miss Bourke
The Minister in appearing not to favour this amendment stated he feared a minimum quorum obtainable on a health board might spring far-reaching decisions on the rest of the board in their absence. I should like to know where this power of coming to far-reaching decisions could come from? Under various sections things are done with the consent and approval of the Minister. The Minister is informed in advance of any decisions of any consequence which the boards make. Therefore it would be impossible for a small quorum of people to spring far-reaching decisions on the health boards. This amendment is giving certain flexibility under the standing orders which the Minister gives the boards power to draw up. Something could arise at a meeting of a health board which might not be discussed for another month or two. I support this amendment and think the Minister's objection to it is unrealistic in the circumstances.
The worst meetings I have been at were the ones at which the agenda includes that well-known and final item "any other business". Dr. Belton's amendment is a safeguard against this soul-destroying item on any agenda. It is a common item on most local authority meeting agendas. The Minister is being a little pessimistic and certainly seems to take the opposite view to his wishes for the health boards when he assumes that nine out of 32 members will attend and that the nine members will come for the purpose of springing something unforewarned on the meeting. That is unlikely. It is not going to happen. These boards will be very well attended. This is a safeguard to any chairman who will know that at the end of the meeting no one is going to jump up and propose some resolution or discussion on some subject under the heading of "any other business". This is a most dangerous subject as I know, speaking as a chairman of a local authority. I am sure other Senators will agree with me. It is a safeguard which puts it to the commonsense of the members present to refuse to allow discussion or else to allow discussion only on a realistic and sensible subject. I think it is very necessary if the boards are going to operate in the manner in which the Minister and all of us hope they will.
I was listening to Senator Bourke and I find myself in agreement with her up to a point. Surely if Senator Bourke is right that the functions of the health board are subject to the prior consent of the Minister, the kind of ruling suggested would be ultra vires the statute itself. In other words, the health boards may not discuss business and are precluded from discussing anything except the Minister's consent had been given. It is all very well to say that these things do not happen, that you will not get cliques to turn up, but everyone who has been in local government knows that as in the Letterkenny case, all these things can happen with regard to membership and can happen in other places besides Letterkenny. There was one famous case in Letterkenny. Most people know what happened there. I can see no virtue in the amendment in this way. I would foresee a type of emergency which would require it.
It is in dealing with an emergency that we are concerned about.
I would like to know how this would come within the ambit of the health board.
Adverse press publicity which could be quickly refuted.
I do not see how adverse press publicity could be a matter to be discussed by a health board or how it could be a matter for a decision to be taken by the board. I cannot see any real purpose in the amendment, and I think it would probably defeat the section if it were to be amended as suggested by Senator Bourke.
Despite Senator Sheldon and the local government procedure in County Donegal I do not think he has in any way——
I did not mention County Donegal.
He mentioned Letterkenny which I understood to be in County Donegal.
He mentioned practices which could not be confined to County Donegal. I do not think that what Senator Sheldon said alters in any way what the previous Senators said in regard to this amendment. I do not think that there is any doubt whatsoever that if the Minister leaves the Bill as it stands now in fact the health boards, when they come to operate, will have on their agenda "other business". They will have a deal of discussion under "other business" and they might even follow some universities in not only having "other business" at the end but in having "chairman's business" No. 2 on the agenda, so that you can have unnotified discussion at both the beginning and the end of the agenda. What this amendment seeks to do is to control in some fashion discussion of a matter of which notice has not been given.
I think it is far better that this should be controlled under the standing orders, because there is no doubt whatsoever that the health boards will require from time to time to discuss certain matters. If they are not permitted to do it under their standing orders, as they would not be if we are to allow the regulations stand and refuse this amendment, they will use their own devices. They will, in fact, go month after month there, when there will be blanket items on the agenda just in case anything should arise at the last moment.
I think that it is far preferable that we should adopt an amendment such as we have here, making it a regulation so that the standing orders would have to provide for a certain majority—the very fact that we mention a majority prescribed in standing orders in this amendment indicates that it would have to be greater than a simple majority— if this amendment were adopted then we would be in the position of guaranteeing that only serious matters, only matters of true emergency nature, which a substantial number of members of the board present agreed were worthy of discussion, could be discussed.
If we reject the amendment I am very much afraid that we would find ourselves in a position that in case a real emergency were to arise the board would have to put down an omnibus agenda item—if we like to be pedantic we should use the word "agendum"—under which these matters could arise and there would be no means of preventing other matters arising once that had been done. This is the trouble.
If we rule out an amendment of this sort we are not ruling out discussions of any type, we are not ruling out people raising without notice, we are in fact almost ruling it in, because boards, in order to provide against a genuine emergency, will have to have an item "chairman's business", "chief executive officer's report", or "other business". They will have to put an item on the agenda in case something comes up. Once an item is in the whole thing will be wide open. It is far better to put in a control suggested here under standing orders and have this measure of ensuring by adopting it that standing orders will allow matters to be raised without notice under prescribed conditions and with the consent of the prescribed majority. Then, in fact, we will confine these discussions on points without notice to matters of real importance.
On this amendment which we have put down everything that I would like to say has been said. Senator Russell said that you can get over this business by putting down an item "any other business". As he said this, of course, leaves the thing too wide open for discussion. Our amendment allows the suspension of standing orders by a certain majority, and, as I said, in the last amendment of the Minister, he has provided for standing orders being suspended, but section 23 will over-rule that unless you accept our amendment. This is in every local body, every body that I know. Every body I know has standing orders, and this is recognised by the Minister himself in the last amendment here, amendment 45, and all I want is to allow the suspension of standing orders with a certain majority of the board and to cut out this idea of an omnibus item "any other business "which, of course, makes a farce of the whole proceedings.
I have explained the position, and I would just like to add that there is nothing to prevent other business being discussed under this Bill. I cannot prevent other business being discussed. This is a question of decisions being taken by a small number. The other point I have not mentioned is that it would be recommended to all health boards that they pass a sort of omnibus resolution giving the chief executive officer power to deal with an emergency of any kind. If they want to discuss an emergency they can under "any other business", and there certainly would be discussion under "any other business" and I could not prevent that. They can have omnibus powers given to the chief executive officer and can say to him "Go ahead with your omnibus powers" if there is a flood of smallpox or very serious conditions in a certain area of the health board. My point is that there is plenty of provision for dealing with an emergency.
Too much, probably.
Amendment, as amended, put.
The Seanad divided: Tá, 16; Níl, 25.
Tá
- Belton, Richard.
- Boland, John.
- Bourke, Mary T.W.
- Butler, Pierce.
- Dooge, James C.I.
- Dunne, James.
- Farrelly, Denis.
- FitzGerald, Alexis.
- Fitzgerald, Jack.
- McDonald, Charles B.
- Malone, Patrick.
- O'Brien, Andy.
- O'Brien, William.
- O'Higgins, Michael J.
- Owens, Evelyn P.
- Russell, G.E.
Níl
- Alton, Bryan G.
- Brennan, John J.
- Brugha, Ruairí.
- Cranitch, Mícheál C.
- Crinion, Brendan.
- Doyle, John.
- Eachthéirn, Cáit Uí.
- Farrell, Peggy.
- Fitzsimons, Patrick.
- Norton, Patrick.!
- Ó Maoláin, Tomás.
- O'Sullivan, Terry.
- Ryan, Eoin.
- Flanagan, Thomas P.
- Gallanagh, Michael.
- Garrett, Jack.
- Hanafin, Desmond.
- Honan, Dermot P.
- Keery, Neville.
- McElgunn, Farrell.
- McGlinchey, Bernard.
- Nash, John J.
- Ryan, Patrick W.
- Sheldon, W.A.W.
- Walsh, Seán.
Tellers: Tá, Senators J. Boland and McDonald; Níl, Senators Brennan and Fitzsimons.
Amendment, as amended, declared lost.
Government amendment No. 44:
In page 39, after Rule 29, to insert the following new Rule:—
"(30) A member of the board who has—
(a) any interest in any company or concern with which the board proposes to make any contract, or
(b) any interest in any contract which the board proposes to make,
shall disclose to the board the fact of the interest and the nature thereof, and shall take no part in any deliberation or decision of the board relating to the contract, and any such disclosure shall be recorded in the minutes of the board."
The purpose of this amendment is obvious. A very valid point was made by Senator Alexis FitzGerald during Committee Stage and we have now inserted this Rule, No. 30. I would hope that these health boards under Standing Orders would make such arrangements but it is just as well to enshrine these amendments in the Bill. This is a great improvement and I am glad to introduce the amendment at this stage.
Amendment agreed to.
Government amendment No. 45:
In page 40, before Rule 30, to insert the following new Rule:—
"( ) A health board may make standing orders for the regulation of its proceedings, other than proceedings the regulation of which is provided for by or under statute (including this Act), and may amend or revoke such standing orders.".
This, again, arises out of an undertaking that I gave on Committee Stage. The amendment makes it clear that health boards will have power to make standing orders governing their procedure. I should like to introduce another minor drafting amendment. Apparently, it is better at this stage that it be "the board" rather than "a health board" so that it conforms with the rest of the rules.
We do not wish to start a debate on this because we have already had a very helpful debate on it. One of the things one learns after many years of pressing Bills through the Dáil is that the position with regard to these rules is that a health board may do anything in the way of standing orders that is not specifically forbidden in the Bill but I am putting this in to make sure that they can make the standing orders for miscellaneous matters in regard to times of meetings and so on. I have put this in at the request of the people who raised the matter.
Amendment, as amended, agreed to.
Bill, as amended, received for final consideration.
Question proposed: "That the Bill do now pass".
I do not wish to take up the time of the House but there are some points that I would like to clear up. Firstly, I must say that the Minister has a very good Bill and one which will give him the power to bring us into line with Europe and the Seventies. The medical profession has been very pleased with the amount of consultation that took place before the Bill was drafted and it opens many areas in consultation between the Department and the profession.
The proposals for the larger units by the health boards and regional hospital boards will make an enormous difference to the future. What a pity we did not take the advice given to us in 1928 and again in 1936 when these hospitals were originally proposed.
There is no doubt that the fee per service and choice of doctor systems will be a remarkable improvement on the dispensary doctor system even though that system was very good. However, I would point out to the Minister that when he is implementing this there is grave danger that the choice of doctor will break down very badly if, at a very early stage, there is not a full implementation of outpatient services, domiciliary visits, home nursing and so on. I am sorry that in many of his pronouncements the Minister did not touch on the question of the finance that will have to be provided to back this Bill.
An Leas-Chathaoirleach
I must warn the Senator that he is not entitled to discuss what the Minister did not say or do. On the Fifth Stage he is only entitled to discuss what is in the Bill.
Finance must be provided for a health service and may I suggest to the Minister that with health rapidly replacing education in other countries as the major employer, there will be a tremendous financial problem with regard to the introduction of a public health service to this country. With our low per capita income I cannot see how it can be done without placing an intolerable burden on the tax-paying public. I would suggest to the Minister that he might consider that the services be broken up into hospitalisation services which would not last more than one month— that is, acute illness not lasting more than one month in hospital. This is one of the largest expenses that we face and is one that could be covered by some form of contribution or insurance factor while the remaining services—the Cinderella services, psychiatric and so on—could take advantage of the money saved. In this way there might be some reduction on rates and taxes.
An Leas-Chathaoirleach
Might I again point out to the Senator that he is not entitled to discuss matters of financing the health services other than those mentioned in the Bill.
By regulation?
An Leas-Chathaoirleach
I doubt if the Minister with all his ingenuity could make regulations governing insurance of certain matters.
That would have to be done in a separate Bill.
Perhaps I can cover the fact by saying that we would hope the Minister would introduce, as he has done in the other Ministries he has held, some crisp and businesslike machinery to cover the administration of the hospital services because in many services there could be greater efficiency and economy.
I have no doubt that cutting down the number of physicians, surgeons, laboratory staff and clerical administrative staff may appear to be economy and the Minister must correct this error. There are hospitals in this country whose efficiency could be doubled by increasing the staff. For example, the biggest hospitals in Dublin are taking twice as long to produce tests as they did ten years ago and they are keeping patients in hospital for twice as long due to lack of staff. Another example is that 2½ years ago we were asked at the Mater Hospital to provide accident services. We decided that we would like to have a radiologist, a biochemist and a technician on the premises all the time so that we could have a 24-hour service.
This was thought to be very good and agreement was reached. We put three newly built rooms at their disposal and now 2½ years later we still cannot get those people living-in 24 hours. Agreement has not been reached and when emergency cases come we have to send taxis out to bring in the people. This is not a good service and it is an example of poor staff. For the future as well I do not think the rural services can be implemented properly unless there is a change in the approach to remuneration of doctors. This is a point I do not like to bring up because we are supposed to be dedicated to healing but I make no apology for it now. The day of medical mystique is over and we only ask now to be remunerated commensurate with our capacity to provide a vital service in a proper and efficient manner.
The Minister knows that many young doctors come back here to this country every year but leave immediately or shortly afterwards because they will not stand the conditions of service. In Wexford, one of the most thriving counties, 14 doctors set up practice in the last ten years, of which seven have gone away. Wexford has now three fewer doctors than ten years ago and its population has increased considerably. This is because of conditions of service.
We are very pleased the Minister is introducing fee-per-service and we think this is a step in the right direction but it brings no joy to our doctors to think that domiciliary business is going to be increased to repair the main fuse at the expense of a TV set. It brings no joy to them either to realise that the value of American services has been worked out by the rather unusual method of deciding what a doctor should earn in the eyes of officialdom and dividing his estimated number of visits per year into that and that is the value of his fee-per-service. This is a bad approach and this will keep doctors away, the service will run down and I do not think this is the right approach.
It is the same way in the hospitals; unless our young men are encouraged to come back the service will not improve. We want them to go more into hospitals and we do not want them to go into private practice. The hospitals need them but it is no good bringing a youngster back who does good work and then because he cannot get a living wage in the hospital he has to go out into private practice and he is lost to the hospital. The hospitals are getting better value but they are still not getting the service from the younger doctors they should get. We do not want to bring them up to a proper standard of efficiency and patient turnover and all the things which make a hospital great and then find we have not a sufficient number of doctors. This can only be done if there is a proper, almost wholetime hospital service, limited private practice and a proper reasonable scale of fees for whose employed in them.
Comhairle na nOispidéal represent quite a break-through and I hope this will work in great harmony with the Department and do an enormous amount to give a decent distribution of specialist services throughout the country. I hope the Minister, the Department and the Local Appointments Commission between them work out a formula which allows the selection of doctors to different appointments but on a system which combines the best features of the Local Appointments Commission, and this system has many features, but still allows for the flexibility of certain particular work which is necessary when you are appointing medical personnel.
During the Committee Stage of the Bill the Minister assured me that domiciliary visits were covered under section 55. The more I look at that section the more I feel it covers only institutional work. While I am sure that somewhere in the Bill the Minister has power—he seems to have powers in most things—to permit and encourage domiciliary visits I think this is one of the key points in the future. If the Minister wants to keep patients out of hospital, and I feel this must be one of the most important things in the future because we just cannot afford to keep 7.2 beds per thousand in this country, the third highest ratio in the world, we want to get away from that and the only thing to do is is to encourage good domiciliary service and to make sure that local practitioners use it.
There are two last points I want to make. Medical education in the hospitals has been in an extraordinary position for years. As far as the undergraduate is concerned, the university course supplies this. The facilities are there, they will supply the staff but they cannot supply the classrooms, the desks, the blackboards, the cleaners, the lights, the personnel to look after it. When you ask them for this money they say the Department of Education will not give it because it is a hospital and the Department of Health say they cannot do it because it is Department of Education work.
The FitzGerald Report has suggested a standing committee through the Department of Education and the Department of Health on this matter and I think this will be a most valuable step forward because in the future medical education in the hospitals, for which the regional hospital boards will be responsible, will not be confined to under-graduates. Education where doctors are concerned is a continuing process and the regional hospital boards will be responsible for this. I hope the Minister will make sure when he is outlining the functions of the regional hospital boards, that medical education, the provision of facilities, equipment, the wherewithal for conferences and all this will be properly looked after. At the present moment it is not possible in our hospital to give a visiting lecturer or a visiting group a meal without having to pay for it from private means. This must all be changed.
Lastly, I could not leave this without asking the Minister to take a more positive approach towards the problem of our nursing profession. I feel every nurse in this country, whether she works in a private hospital, a public hospital or is a public health nurse, no matter what job she does, she does a job which is invaluable to the State because if girls are going to work in private nursing or even in private hospitals, patients who require nursing care will have to go to institutions which are a burden on the State financially to get nursing care. Therefore any nurse helps to keep patients out of hospital.
Those girls should be allowed to change from any branch in the service, public health, public hospital, private hospital, private nursing, in and out as the need arises or their circumstances permit, so that they can go in or out without losing anything on the salary or promotion scale. If you did this you would have the whole nursing profession welded together and you would have it as one unit of great value to the country. Furthermore, you would then be in a position to give pensions to all nurses who did a certain number of years service in nursing, regardless of what type of work they did. This to my mind is essential if we are to keep nurses in this country. It is all very well to talk about adequate remuneration, promotion, expectation of jobs and all the rest of it unless you can keep those girls here, give them freedom of movement in and out of the different branches. If you do not, you will not keep them and you are not going to be able to save the tremendous load of patients going into hospitals to get institutional nursing.
I did not realise on this Stage one could go into depth in saying what might have been said on the Second Stage of a Bill.
An Leas-Chathaoirleach
Nor should the Senator think he can do it now.
I do not propose to do so. First of all, our greatest disappointment is the method of financing of this Bill. The Minister knew at the outset of course that we could make an issue of it and I am quite sure he was not disappointed when we did make that issue. After having said that there are points I want to make. There is one point I will take issue with Senator Alton on. I rather feel he is laying too much emphasis on the hospitalisation of patients. The general practitioner is the corner-stone of medicine. The fact that there is to be more co-operation between general practitioners, hospitals and consultants is very welcome. The extension of domiciliary nursing services and aid is also excellent. It was supposed to have been there before but did not exist to any great extent. This will save bed occupancy. We had amendments about nurses and one was ruled out of order. We tried to provide certain increases for nurses but the amendment was ruled out of order because it involved a charge on central funds. We had two other amendments which we discussed in detail. I am not sure what Senator Alton's attitude was——
An Leas-Chathaoirleach
I must point out that amendments that are not accepted are out of order on the Fifth Stage. We must keep to what is in the Bill at the moment.
We were disappointed that certain amendments were not accepted by the Minister. The general reception we got as an Opposition was very good. I would like to compliment the Minister on the way he received us and even on the way he received us when we differed in opinion. I thank the Minister for the concessions he made to us at the various stages. This has been a long, a difficult Bill for him. The Minister was present at all times; he had no lieutenant to take his place. I compliment him on the responsible manner which he has shown. This is an example to other people.
I wish to reiterate the remarks made by the previous speakers. I would like to associate with the thanks to the Minister in dealing with this Bill. As a new member of the House the whole manner in which this Bill has been dealt with has been very instructive and useful to me. I have learned more than I ever expected to from the way in which the Minister dealt with the Bill.
If I expressed some doubts it is only because I accept that everything in the Health Bill is not as we would wish. I have some doubts about the concept of regionalisation. Between now and 1971 when the Bill becomes operative I hope there will be time for a full debate on this concept of regionalisation from an administrative point of view. We have everything to gain and nothing to lose from such a debate and from consultation. We welcome this Bill not necessarily because it contains everything we want but as a breakthrough in social legislation. We are pleased at the concept of free choice of doctor which is included in this Bill. We are not completely happy that everything is in it. I would like to have it on record that we welcome the Bill for what it attempts to achieve.
Miss Bourke
In welcoming this Bill which has now been put through Committee Stage and Report Stage, I should like to say that I have been struck forcibly at this later stage by the contrast in composition of the health boards and the regional boards which are being set up under it. At the Committee Stage the Minister explained why he felt we must retain the power to appoint the chairman and vice-chairman and to terminate the appointment of the chairman and vice-chairman of these regional boards.
I still think it would have been an opportunity for true regionalisation which is what this Bill purports to do but which it falls short of. The Bill leaves a great deal of discretionary power in the hands of the Minister. It is a Bill which must be in the form of a skeleton Act to be implemented by delegated legislation. It goes as far as I would like any Bill to go in this direction. The Minister has reassured the House even if the particular amendment was not accepted, and I believe these reassurances will be carried on by his successor.
With reference to the section which relates to the provision of consultants I would like to say that at the Committee Stage I said I felt these provisions might lead to two types of consultants. One would be the consultant to the local health board hospital and the other the consultant to the voluntary hospital. The reason for this may not be clear here. It seems the consultant to the health board hospital will come under the CEO as his administrative officer whereas the voluntary consultant will continue to come under the authority of the voluntary hospital.
Realistically, it is not hard to see how this would be difficult for many consultants to accept. If this is so I would feel this might perpetrate a division and an idea in the minds of the people that the consultants to the voluntary hospitals were better than the consultants to the health board hospitals. Consultants might wish to belong to the voluntary hospitals because they would not be under the control of the CEO. I do not know whether I can ask for clarification on the Fifth Reading. I may be under a misapprehension but I am not satisfied with the Minister's remarks on this subject. I regret we have not seen fit to initiate the type of reforms and structures in this Bill which I would like to see in relation to eligibility. We have not seen fit to set up an independent tribunal instead of officers of a board——
An Leas-Chathaoirleach
The Senator is now trespassing beyond the proper bounds of the Fifth Stage.
Miss Bourke
We have retained the system of repeal from one officer to another on the health board. The arguments put forward in favour of an independent tribunal were valid. The Minister's argument that this would involve new thinking and consultation with other departments is not valid. One can imagine we could have been braver than we have been.
Apart from these remarks, especially on the point of clarification regarding consultants, I welcome this Bill as a substantial piece of social legislation which I hope will improve health services in this country.
I should like to thank all the Members of the House for the way they received this Bill. The debate has been extremely constructive. In so far as I am concerned I do not think all the complaints are deserved. I welcome them but regard them as exaggerated. I want to be quite frank.
I have been to the Seanad before with Bills of an intensely controversial nature on which there was inevitably a Party battle between my side of the House and the other side of the House on matters of very great importance. It so happens that we have had a considerable measure of agreement that this Health Bill is a good Bill and that even if it is not perfect it has good features, that we are making progress in the development of the health services. I say therefore that the discussion has been a very helpful and constructive one, and I have been able to accept a great number of amendments or to introduce amendments based on suggestions made by the Opposition—to do this in a constructive way.
It does, I think, rather give proof of the fact that the public in general do believe that our health services have been progressively getting better that we were able to have a debate in such a very constructive way. Nevertheless I do want to thank everybody for their courtesy to me and for the way the debate has been taken. I hope that we will have many debates of this kind, and I hope that even if we have to have really corrosive criticism of Government policy we still could conduct a debate on the highest possible basis of discussion.
Having said that, I just want to mention one or two of the things that arose during the examination of the Bill. A number of people have pointed out that when the Eastern Health Board is appointed the sole representative on the Eastern Health Board, if there is no change in the present position, of Dublin Corporation will be Mr. Garvin, the Commissioner, and he will have only one vote. I want to say that I am going to discuss with the Minister for Local Government the question of providing adequate representation for Dublin Corporation on the board when the Eastern Health Board is formed. I cannot do anything about it till then, for very obvious reasons. I am not going to arouse new controversy on that question, about which there are very divided opinions.
We hold very strongly to our own opinion on this matter, but I will listen to the representations made by the various Senators in regard to this and will draw the attention of the Minister for Local Government to this difficulty of the position of the Commissioner, and will consult with him as to whether he could not make some alternative arrangement of whatever kind he thinks desirable which I can approve which can give greater numerical representation for Dublin Corporation if, at the same time, we still have the present position of the suspension of Dublin Corporation. That is the most that I can do in regard to that.
There were some other matters that were raised during the debate. Senator Belton asked me in relation to section 43 whether my attention had been drawn to a memorandum prepared by the chief psychiatrist of the Dublin Health Authority which related to the procedures for admission to and transfer from the Dundrum Central Mental Hospital. It would be quite impossible to include any legislative changes that may be required in mental illness legislation in this Bill, and we are going to have a separate Bill dealing with a number of recommendations made by the Commission on Mental Illness which will include the procedures for admission to and transfer from Dundrum Central Mental Hospital.
Again I think I said that I would look at the question of whether there was anything sinister in having two separate sections in the Bill, one dealing with dental, ophthalmic and aural services in section 66, and another section dealing with other services, section 55. This is simply regarded as necessary to classify the services in this way. Then the Seanad, I think, will be amused to hear that the legal adviser has been consulted on the question whether the word "land" includes a tree standing on it, and it does.
Fructus naturalis.
In order to reassure the medical profession, Senator Alton asked me to look at Rule 13 of the Second Schedule with a view to introducing an amendment to prevent the Minister for Health from removing from a board any persons appointed by him on nomination under section 4, subsection (2) (c). These are the first appointments of professional members which will be made by me, but I will not select them. They will be made by a preliminary procedure in which the medical associations concerned will be asked to nominate their selection to me and I will then make them. I have examined the question of whether I could introduce a suitable amendment to make it quite sure that they cannot be dismissed at any time by me since I actually appoint them.
An amendment would have to cover all sorts of situations such as the procedures to be followed if a medical member of the board nominated in this way and appointed by me was removed from the register of medical practitioners or had been found guilty of unethical professional practice. This is unlikely to happen, but nevertheless as the board will last for two years until the elections take place in June, 1972, and if I undertook that I would not remove from the board a person nominated under section 4 subsection (2) (c) save in the type of circumstances I have mentioned, the medical profession should accept this.
I do not want to say anything more about the rules. I have done my best and have adopted a number of suggestions put forward for changes, but I could not change any more of them. I am still fascinated by the thought that these boards can do an awful lot as long as it is quite clear that they are not actually disobeying the clear indication given—that they can do a lot of arrangement in their own procedure without necessarily themselves having to be expressed in actual words in the Bill.
These are the only points that I thought I should mention arising from the previous debate. Then as far as Senator Alton is concerned he has made a very helpful, constructive speech. I agree with him that an extension of domiciliary visits and domiciliary care is an essential contribution to the growth of the health services. I am not going to say anything more about a contributory insurance scheme because that does not arise in connection with this Bill. We do intend to develop work study and consultancy. There is a special unit being created in my Department to help hospitals to improve their efficiency and make life easier for the staffs so that they can do perhaps more work efficiently and with less strain. This is a very difficult job because there are so many of the hospitals ancient in construction and the amount of work study that can be done effectively is limited, but we are going to do that, and we have at the moment undertaken a study of nursepatient ratio to see if there is any way whereby we can make use of the wonderful nurses we have more effectively and without placing any unnecessary burden upon them. I agree with him that we must try to reduce the amount of time people spend in hospital, and we will have to reorganise the service so that there would be a shorter time for diagnosis.
We will have to consider, perhaps, changing the system, and the medical profession are well aware of this, from the position whereby consultants on a certain basis depend for their income on the number of days patients are kept in bed and they ought to be on a better basis which will inevitably lead to more economy. We will have to develop the mechanical equipment of our hospitals and help to speed up the time for diagnosis. Obviously there can be improvements in accountancy procedures in some hospitals. Things like the development of pathological facilities must be considered on the basis that the pathological analysis is used in the most economic way. Obviously we must develop the out-patient service on a greater scale in order to try to get people out of hospital.
Senator Alton referred to the pay of doctors; it does not arise on this Bill, but I would remind him and the House that quite fairly liberal status increases of pay have been awarded to district medical officers. I have not got the increased percentage since 1964 with me—I think Senator Alton should be aware of that. In regard to medical education I intend to have a permanent Standing Committee of officers of my Department and officers of the Department of Education in order that we can have much closer co-ordination than heretofore on the whole question of medical education. I think I have answered the main points raised by Senator Alton as a person experienced in hospital and medical work.
I thank Senator Belton for his observations and also Senator Owens and Senator Bourke. I think I did accept a good number of amendments. Much of the discussion here was based on the question of how much liberty you would give to people, how much discipline there must be in the operation of a health authority. I think the final result is a reasonable one that will be accepted by the country at large. Within the next five years it is inevitable that amendments will have to be made; you could not possibly alter the whole pattern of health administration and do it perfectly the first time. This Bill will allow us to make a reasonably good start and I look forward to bringing in regulations for the setting up of individual health boards, regional hospital boards and Comhairle na hOspidéal about next June.
Question put and agreed to.