Before we take up consideration of this Bill I should like to indicate that I have ruled amendments Nos. 10, 21 and 28 out of order. Nos. 10 and 28 have been ruled out of order because they would involve a charge on public revenue and the reason for ruling No. 21 out of order is because it was not raised in a substantial manner on Committee Stage.
Health Bill, 1969: Report Stage.
In relation to amendment No. 21, I wonder if the Minister and the Leader of the House would agree to recommit the Bill in order to consider it. It has been ruled out of order only because the Chair has decided it was not raised in a substantial manner on Committee Stage.
I am afraid that I could not do that.
Has the Minister any view on the matter?
Do I understand that this would not postpone any final decision on the Bill or that it would not require an extra meeting?
It merely means that when we come to the amendment the Seanad will go into Committee and then go back to Report on completion of the amendment.
Provided it does not lead to a wholesale debate all over again.
Amendment No. 21 will be recommitted in due course.
I move amendment No. 1:
In page 5, line 11, to add to subsection (2) (a) (iii) the following:—
"Such persons shall include at least one person nominated by the public Services Committee of the Irish Congress of Trade Unions."
Similar amendments have been discussed at length already and the reason why I have put this down again is because the Minister agreed on Committee Stage that he would at least have another look at the proposal. We have altered it slightly to cut down on the number of representatives since the Minister made the point that he would, perhaps, have to make the health board too large. We have reduced the number to one and I consider this to be entirely reasonable.
It is not asking very much of the Minister to accept this. I should like to point out that the Minister's decision so far not to accept this has been deeply resented by the staff sides concerned. They believe this to be substantially discriminating against them and there is adequate representation, from other areas of the professional and ancillary grades. They fail to understand the Minister's reason for refusing to accept that at least one member from the staff side should be on the board.
I should also like to point out to the Minister that if he were to accept this, it would bring tremendous goodwill from the staff side to the implementation of all proposals for the new health board. I shall not delay the House by rehashing all the arguments put forward already in favour of this but I should just like to say that these people have a contribution to make at board level and it would be a very valuable gesture from the Government towards the idea of worker participation. There is plenty of precedent for it. I have already given the example of the Dublin Port and Docks and I do not consider it to be too revolutionary to ask that we should have one member on the board.
I had occasion to think a great deal about this problem when I was Minister for Transport and Power. I find that there is a great deal of varying opinion on this even in trade union circles. I shall not quote all the references but perhaps I might refer to "The Distasteful Challenge" by Charles McCarthy in which he put into words rather more effectively than I something that I have been trying to say to the Seanad.
The lack of a proposed management structure can lead to frustration among employees and to their believing that they have no effective contribution to make to the working of an organisation. I would hope to help the new boards to develop a form of management structure which would do more to help to avoid the type of frustration which had manifested itself elsewhere than direct representation on a board without a good management structure might achieve.
I say that as a kind of paraphrase of what had been said in this contribution to social and economic problems of the day by Charles McCarthy, the well-known trade unionist. In present circumstances, unless the health boards have a management structure which enables people who are able to do so to make contributions from the various sections of the staff, they would be lacking in their duty.
This is not an easy thing to do but I do not believe that someone appointed directly to represent the staff interest of 15 different grades of people could make an effective contribution. I believe the thing to do is to let the section go through as it is and then to see whether the health boards, who, apparently, judging by the general views of the Seanad, will consist of a number of people who have this kind of thing in mind, first of all, will develop this kind of management structure that will throw into prominence the kind of people who are able to make a contribution to the work of the board and then, perhaps, in a few years time, when undoubtedly there will be amendments of one kind or another to this Health Act or to the regulations framing the appointment of the health board—I can hardly concede that this could remain absolutely static in that time—the matter could be reconsidered.
The first thing to do is to have the kind of management structure that would make effective what is proposed in this amendment. I honestly do not believe that there is one among the health authorities at the present time and I should like to see them develop. It cannot be done by the Minister because this is a matter of restructuring and a willingness of people who, in respect of the actual position they occupy on the board, could be said initially not to have very much contribution to make.
This kind of thing can be developed and the people who are unable to make provision for the board in the ordinary way in their capacity as individual officers can do it through the board of the consultative council. That would be the first step in what might be a change in practice.
I have read plenty of articles about this and a great many trade unionists object very much to the concept of having a trade unionist on the board of an enterprise if, in fact, the board have to act in a consultative manner and the trade union representative is not able to act effectively on behalf of his trade union. Equally, there are arguments on the other side. There are other people in the trade union movement who press very strongly for that kind of participation. Others ask for far more consultation for work councils and some others ask for what might be described as a supervisory board which would not have executive authority. It is a complex subject but there is far from being unanimity in relation to the kind of proposal made by the Senator and I quite understand her motives in making it.
We readily accept, as the Minister has said, that this is a very complex problem, that is to say the thinking and indeed the philosophy represented in this amendment, and we also accept that there are naturally several points of view about it. At the same time, it has to be stated here that the policy of worker-staff representation on boards of managements concerned with enterprises, industries and services is the policy of the Irish Congress of Trade Unions notwithstanding what views may or may not be expressed by other people.
I very much regret the Minister has taken this very ultra-conservative view in respect of this question. I believe if we do this in connection with the health boards, and if the same thinking is to apply universally in our community in this whole matter of staff and industrial relations, we will do no more and no less than mark time, and if we mark time in this important sensitive sector of our community we will have only ourselves to blame for undesirable consequences.
I have in another place pointed out that we have certain advantages in this country. We have a relatively large measure of public ownership and State control and it is not too much to say in relation to the health boards to be set up under this Bill when it becomes an Act that there is an analogy with public ownership and State control. The point I should like to make to the Minister is that within those areas, outside, separate and distinct from private enterprise, there exists the opportunity for us in this country, while we have the opportunity, to indulge in a form of social experimentation.
We cannot say—Senator Owens and my other colleagues—that what we propose in this amendment will be the be all and end all of industrial relations but we say it is one step forward on the road to proper worker participation and consultation, and if we are to wait until developments in this particular field take place, I repeat that we may wait too long. The Government, through the Minister for Labour, established a committee of inquiry into industrial relations in the ESB. The Minister chose the chairman and he also nominated two ordinary members of that committee. He assented to the appointment of two assessors and, inter alia, that committee recommended that for the betterment of industrial relations in the ESB there should be worker participation in management and indeed worker representation on the board. Although the Government, so far as I know, have not announced any official attitude to the report of that committee, the mere fact that they were a Government committee, officered and manned, as it were, by Government appointees and nominees, and taking into account the calibre of the membership of the committee the thinking and the philosophy behind that committee must engage the attention of the Government and indeed of every Minister of that Government.
We have in this amendment opened an opportunity to the Government, through the Minister for Health, to take this step forward. It is not a unique step. There are trade union representatives serving on boards, there have been cases in which trade union representatives have served on boards, which boards have at times been in dispute with trade unions, and I am not aware that this has caused any inhibitions or embarrassment. Rather I think one could say that it has often lent strength to that particular board or enterprise.
Because my colleague Senator Owens put forward very ably and competently our arguments in support of this on Committee Stage and I do not wish to detain either the House or the Minister with a rehash of those arguments, I end as I started by saying "Yes, we accept from the Minister that the problem is rather complex" but we differ from the Minister to the extent that unless somebody has the courage to take the first step along the road of proper worker and staff representation then somebody else may well take that step and it may be too late for us in this House or elsewhere to bemoan the consequences.
I find myself in some sympathy with this amendment. I can see the Minister's point very clearly that as a method of contributing to the know-how of management of the board this may not be of very great significance. I think if you applied his arguments to every member of the board, as they will find themselves in this situation in the future, very few of us had any training in management. We have all had to just to sort of jump in at the deep end and do the best we could and hope our colleagues would be indulgent in their views of what we are trying to do.
I think in terms of hospital boards. I serve on a number of those and in some cases the staff are there as of right and in others they are not. In some they are excluded altogether and in some they come merely as observers, to speak when they are spoken to, to answer questions when they arise but not to vote on any questions of decision. I have seen the change take place in one hospital from the point where they were only there on sufferance to the point when they were incorporated as full members. The reason for excluding them in the first case was that they were very similar to those whom the Minister has said he has to take into account in looking at this amendment—that they had, as it were, a kind of vested union interest in the work of the hospital and therefore they should not be in the capacity of managing at the same time, and furthermore they were not trained in any managerial way—their techniques and expertise were different. But when we have got those colleagues in the hospitals on those boards, they can quite often be very valuable in their own way.
There is another function we must remember and that is the function of the channel of communication—that a member like this, working and serving on a board, will be expected, I suppose, to transmit to his colleagues the difficulties of the board, the reasons why all the things they want to get for their services cannot be given straight away and that they must exercise some degree of reasonableness about this. This could be very important and certainly medical people working in a hospital get a lot of information from their colleagues who serve on the board which they could not get merely by having letters written to them or discussing the thing with the secretary of the board who might not clearly understand their point of view. As I say, I can see the Minister's difficulty but I think I have sympathy with the amendment for those various reasons.
Briefly, just to reiterate the point made by Senator Dunne about trade union policy on the matter, as the Minister pointed out there are quite rightly differences of opinion within the trade union movement although it is official Congress policy, but particularly in relation to this amendment. This amendment, in fact, first started at the last annual general meeting of the Irish Congress of Trade Unions. It was adopted specifically in relation to this Health Bill.
The Minister is anxious to experiment with management techniques and re-structuring. I would suggest respectfully that the Minister might find his experimenting and re-structuring easier if he accepted this amendment. The Minister would then have this additional line of communication which would be important at the experimental stage. To a degree the Minister accepts it, because he did suggest that we might have this representation in the future. This is promising us cake tomorrow but no cake today. I want my cake now and not in the 80s. I appeal to the Minister to accept what is really a very minimum request.
Amendment put.
The Seanad divided: Tá, 15; Níl, 22.
Tá
- Belton, Richard.
- Boland, John.
- Bourke, Mary T.W.
- Butler, Pierce.
- Dooge, James C.I.
- Dunne, James.
- Farrelly, Denis.
- Fitzgerald, Jack.
- Horgan, John.
- Jessop, W.J.E.
- Kelly, John.
- O'Higgins, Michael J.
- Owens, Evelyn P.
- Russell, G.E.
- Sheehy Skeffington, O.L.
Níl
- Ahern, Liam.
- Alton, Bryan G.
- Brennan, John J.
- Brugha, Ruairí.
- Cranitch, Mícheál C.
- Doyle, John.
- Eachthéirn, Cáit Uí.
- Farrell, Peggy.
- Fitzsimons, Patrick.
- Flanagan, Thomas P.
- Gallanagh, Michael.
- Garrett, Jack.
- Hanafin, Desmond.
- Honan, Dermot P.
- Keery, Neville.
- McGlinchey, Bernard.
- McGowan, Patrick.
- Nash, John J.
- Norton, Patrick.
- Ó Maoláin, Tomás.
- O'Sullivan, Terry.
- Walsh, Seán.
Tellers: Tá, Senator Dunne and Senator J. Fitzgerald; Níl, Senator Fitzsimons and Senator Keery.
Amendment declared lost.
I move amendment No. 2:
In page 5, line 15, after "board" to add "by not less than 25%".
The wording of the amendment is substantially the same as the amendment moved by Senator Bourke and Senator Belton on the Committee Stage. I have no desire to be repetitive on this matter or to hold up the passage of the Bill through the Seanad, but I have taken advantage of the Minister's statement in replying to Senator Belton when he said "all I can say is that if I felt it would help me to get a consensus to express a particular percentage, I will look at it between now and the Report Stage. I cannot say more than that".
I should like to suggest to the Minister that a consensus acceptable to the House might be if representatives of local authorities comprising the various health boards were to have 60 per cent of the total membership of the board, 30 per cent filled by the medical and other interests, and the Minister's nominees ten per cent. I would suggest that in a board of say 30 members the representatives of the local authorities would have 18 members, the medical, dental, nursing and other representatives would have nine, and the Minister would have three nominees.
As regards my personal views, I am very much in favour of the existing arrangement. I should like to be clear on that, and in moving this amendment I might say that it is for me a substantial come down from what I regard as the very effective and proven working arrangement on the present health boards. I have served on the Limerick Health Board for nine years, and although the membership of 23 was dominated by the Minister's party during the nine years, I can say without fear of contradiction that the board as a whole have worked together with an amazing degree of unity and endeavour to do their best for the people in their area. They are now faced with becoming members of a board in which their representation will be reduced from 23 to a little more than 50 per cent, if I understand the Minister's intention from what he said on the Committee Stage.
The population served by the Limerick health board will go up roughly 100 per cent and the area will be something like 2½ times the size of the existing area. I am sure the Minister would agree that if, as we all hope, these boards are to be effective it is essential that public representatives have adequate membership on the boards. I do not visualise, as was suggested by some speakers on the Committee Stage, a clash of interests between the public representatives on the one side and the medical and other representatives and the Minister's nominees on the other. What I am trying to suggest is that the public representatives should have adequate representation in view of the fact that they will be constantly in touch with the public.
All of us who have served on a county council or city council, or in the Dáil or in the Seanad, will understand that a public man is continually at the service of his constituents, and if adequate representation is not given to the local representatives I can see difficulties arising in the new boards. I would therefore like to suggest to the Minister as a compromise to consider this amendment. I would suggest that it is a fair compromise and one that I think might be accepted for the reasons I suggested at the outset of my contribution.
My reason for appending my name to this amendment is contained in the Committee Stage debate on the Bill at column 1096, Vol. 67, in which, as Senator Russell has quoted, the Minister said: "I will look at it between now and the Report Stage." I found that that was sufficient reason for this being put down on the Report Stage. I am not repeating what I said on the Committee Stage, I am just giving that reason. What I said on the Committee Stage still pertains, and the Minister, I am quite sure, heard me on Committee Stage and knows my reasons for supporting this.
I did look at this matter since the Seanad last met and I cannot find any way of providing for any change in the proposals that are in the Bill. By having less than 25 per cent, which is a majority of ten per cent, it does not make much change in the size of any of the boards; I do not think it would mean anything or would be significant.
I am very keen on the view that these boards should work together and I still refuse to believe that there will be a local authority versus professional clash on more than a very small number of occasions in the lifetime of a health board. I imagine that an occasion on which the local authority element could be in conflict to a degree of 100 per cent with the professional element would perhaps be on the question of the proposed budget to be sent to the Minister for Finance, and I am not sure that it would happen even in such a case.
I do not want the professional element to feel there is any deliberate reason for having a specific and considerable majority of local authority people. I want these people to work together and, as the State pays 75 per cent of the entire health costs of the country, I think that giving the local authority representatives a majority is quite sufficient in the circumstances. As the years go by, I believe the professional and local authority groups will tend to work together; frequently there will be divisions of opinion with members of the local authority and professional groups in the case of a vote.
I do not believe in the whole concept of having to ensure a very considerable majority of local authority representatives. I think that quite a considerable number of professional men will tend to think not only in their professional capacity but also in relation to what they regard as good for the regional health board as a whole. Some of them might feel that either too much was being spent and that there should be a more modest budget and, on the other hand, others might feel that not enough was being spent and that there should be a more liberal budget. I do not see any division of opinion on which there would be a double grouping between the professional and local authority groups. I am afraid on reviewing this matter I cannot accept this amendment.
The Minister has, to some extent, repeated my own arguments in saying he cannot accept there would be any cleavage of interest between the public representatives and medical and other members of the board. A point I made to which the Minister did not refer was that I regarded as inadequate the Minister's present numbers in regard to local authority representatives. I cited the instance of the Limerick Health Board where 23 members represent the city and the county of Limerick; under the new set-up the Limerick Health Authority will become the Mid-Western Health Authority, comprising Limerick City and County, County Clare and North Tipperary. The local authority members' representation will be reduced to probably 14 plus two. As a public representative with many years experience in the working of local authority business and dealings with constituents, I regard this as inadequate.
The Minister's point with regard to the question of division does not arise; the local representatives and the medical and other representatives will work well together but I would point out to the Minister a fact of which I am sure he is aware—that the existing health boards have worked excellently together and I am sure the Minister would agree with me that they have done very fine and selfless work in the period of nine or ten years. They have proved themselves, and if I were to give a personal opinion I would stick to the existing system, enlarge them where necessary or set up new boards. The medical and other interests could be represented on consultative committees, which we have at the moment, and which are largely inoperative.
I am sorry the Minister will not accept the amendment; I do not intend to press it to a division but I would appeal to the Minister when it comes to nominating a majority—I do not ask for a substantial majority and I think that the figures I suggested, 60, 30, and 10, would not be regarded as substantial—to take into consideration the point I am emphasising, that the public representatives will have adequate representation and to ensure this the Minister would have to give them an adequate majority.
Amendment, by leave, withdrawn.
Government amendment No. 3:
In page 7, between lines 12 and 13, to insert the following new section:—
(1) A health board may, with the consent of the Minister, pay an allowance to its chairman in respect of expenses (other than expenses referred to in section 9) incurred by him in relation to the business of the board.
(2) A health board may, with the consent of the Minister, pay an allowance to its vice-chairman in respect of expenses (other than expenses referred to in section 9) incurred by him in relation to the business of the board.
(3) The amount of an allowance under this section and the nature of the expenses in respect of which it may be paid shall be such as may be approved by the Minister.
An Leas-Chathaoirleach
Amendment No. 3, which is a Government amendment, involves a charge on State funds. Accordingly, it cannot be adopted on Report Stage and it is necessary to recommit this amendment and to deal with it in Committee.
Bill recommitted in respect of amendment No. 3.
I do not think this will take very much time. I undertook on Committee Stage that I would consider introducing an amendment to provide for making some allowances to members of a board, including the chairman and vice-chairman. I consider in the present instance the allowance should be restricted to the chairman and the vice-chairman because of their extra duties in consulting with the chief executive officer on various matters, in preparing the agenda and in discussions and correspondence relating to meetings of the board and other miscellaneous matters.
If we paid an allowance to members of the board I would be creating a precedent for vocational education committees, county committees of agriculture and corporate bodies under the aegis of my own Department, as well as corporate bodies of other Departments, and that would be going too far.
The proposed allowance I would suggest would be in the nature of an allowance to cover the inevitable expenses of entertainment which the chairman or vice-chairman would have to meet. It is also true to say that the chairman will be meeting on a number of occasions special committees of the board and this will add to his costs. This is really what was in the minds of most Senators and the Minister for Local Government is thinking on the same lines. He has no objection to my putting forward this amendment although it does not absolutely commit him because health boards will be doing a great deal of work in their first years. I have pleasure in commending this amendment.
I agree with what the Minister has said. On Committee Stage on an amendment by Senator Desmond, which embraced more than that, I said I had sympathy with part of the amendment. Paragraph (a) suggests that the health board may make an allowance to the chairman of the board and to the chairman of committees established under sections 7 and 8. I could agree with part of it but not the whole and I think the Minister has met what was in my mind at that stage.
For that reason I welcome the Minister's amendment and I think he is quite wise. In my capacity as a member of the Dublin Health Authority and a past chairman I knew of a case of a person who was a chairman—unfortunately he is now deceased—who was of little means. In the course of his duties as chairman he had to buy wreaths, do a certain amount of entertaining, et cetera, out of his own resources and as a result he was very badly hit financially. I think the Minister is wise in opening up to any competent person of little means the chance to be chairman or vice-chairman of one of these boards.
I should like to thank the Minister for having gone so far in meeting the amendment put down by the Labour Party on Committee Stage. However, it is a pity that this allowance cannot be extended to members because, as Senator Belton has mentioned with regard to chairmen being inhibited because of the expense they may incur as a result of being appointed, the same situation applies to wage-earners who are members of a local authority: if they get time off they lose a day's pay and their expenses are not covered. As a result of this, you can have, perhaps, the best public representative on that local authority debarred economically because he cannot afford to sit on those committees. While I am grateful to the Minister for going so far I hope he will take into consideration some similar payment or compensation to members. This would be a valuable asset to those who find it economically impossible to sit on those committees at the moment.
I, also, should like to join with other Senators in welcoming this amendment. Fine Gael had an amendment on Committee Stage which was more or less along these lines, so we are naturally pleased that the Minister has had the good sense to introduce this.
I realise the Minister's difficulty in relation to the ordinary members of the health board but this is a step in the right direction, and it is a very important step. To the best of my knowledge, nobody serves as a member of a local authority, and I doubt that anybody would serve as a member of the health board, with the idea of getting any financial gain or reward. This amendment will mean that the chairman will be able to devote all his talents and energies to making the activities of the board really important within their own administrative area.
I should like to compliment the Minister on this amendment. It is a great step forward. I have been advocating something like this for local authorities for some years back. It is a step that I welcome very much and it is one which is long over due.
Amendment agreed to.
Amendment reported and agreed to.
Government amendment No. 4:
In page 8, between lines 22 and 23, to insert the following:—
"(2) Where the Minister makes an order under subsection (1), he shall 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."
This is really too obvious to say more than a word about. I agreed on Committee Stage that the reasons for removing the officer concerned would be stated quite clearly and this is the amendment as suggested on Committee Stage. I hope that the amendment will not often have to be utilised in practice. Even after a public inquiry, the Minister will have to give a clear reason as to why the person is being removed.
Again, I am in agreement with the Minister on this. This amendment arose, I imagine, out of the Minister's reply to an amendment of mine, No. 19. The Minister is again honouring what he stated on Committee Stage. It is a good sign when we have a Minister who is prepared to uphold statements made on the Committee Stage of a Bill. I congratulate the Minister on this amendment.
I welcome this amendment. It is a good example of the way in which the Minister is prepared to meet the wishes of the House. It is very important that when members or a member of the board are being removed that justice should be seen to be done and that the reasons for the removal should be stated. That is the purport of this amendment. It is an amendment which is good and useful but I cannot help expressing regret that when a chief executive officer finds reason for refusing the granting of a blue card to an applicant, that he, too, should not be under an obligation to state the reasons that led him to that decision.
Amendment agreed to.
Amendments Nos. 5 and 6 will be discussed together, with separate decisions if necessary.
Miss Bourke
I move amendment No. 5:
In page 9, line 44, to add after "board" the following:—
"Within a period of six months after such temporary appointment has been made, the appropriate procedure shall be set in motion for the filling of the permanent appointment to the office of chief executive officer either under subsections (6), (7) or (8) of this section."
I move amendment No. 5 for the reasons that I stated on Committee Stage. Temporary appointments are quite prevalent in rural areas of this country and are bad for the person in office as well as for the health board in whose jurisdiction the temporary member resides. On Committee Stage, the Minister indicated that there might be administrative difficulties in giving a shorter period—a period of two or three months—and it is for that reason that independently I have increased the period to six months.
I notice that Senator Belton has also increased it to a like period and I cannot see that there can be any administrative difficulties which will hamper the setting in motion of procedure for a permanent appointment as it is. I ask the Minister if he is aware of the prevalence of temporary appointments in rural areas and, particularly, in that part of Ireland from which I come, County Mayo, and if he is aware of the lack of security of tenure on the part of the person holding a temporary appointment. That is something that ought to be discussed on this Bill. Therefore, I would ask the Minister to accept one or other of these amendments.
I presume that the reason why amendments Nos. 5 and 6 are being taken together is because their wording is practically the same. On Committee Stage I had an amendment down on behalf of Fine Gael setting the limit at two months while Senator Bourke in her amendment suggested a limit of three months but towards the end of that stage Senator Dooge suggested that the Minister might agree to our amendments if we extended them to six months. The purpose behind these two amendments is to ensure that the appointment must be made within six months. It may take some time after that to get a permanent holder.
That is the purpose of the two amendments. I am sure I am interpreting Senator Bourke on this. The Minister said on Committee Stage that he would think it over before Report Stage. He said he had a great deal of sympathy with everything said here but then he went on to list certain difficulties and he did not compromise himself in any way. However, he said he had a great deal of sympathy with this. The emphasis I would lay here again is not to appoint that person within that period but to ensure that the machinery to be used to appoint a permanent officer should be set up within that period of six months.
I should like to support the two previous speakers on this matter very simply for the same reason that I think appointments which are left too long in abeyance and filled by temporary people tend to bring neither service to the country or to the individual. I realise there are difficulties in getting people sometimes but I think six months should be quite long enough.
I did not mention the fact that there is a section of an older Act which will apply to the health boards. I refer to the Local Authorities (Officers and Employees) Act, 1926, section 6 subsection (2) which reads:
Whenever a local authority does not, within three months after an office to which this Act applies becomes vacant or, in the case of a new office, is created, either request the Commissioners to recommend to them a person for appointment to such office or make an appointment (other than a temporary appointment) to such office under and in accordance with the provision of this Act dispensing with such request, the Minister may on behalf of such local authority request the Commissioners to recomment to such local authority a person for appointment to such office.
This means that the Minister on the recommendation of the health board, or indeed acting on his own behalf, can try and speed up this procedure if there appears to be undue delay. I think this covers the views I expressed. There is so much referring back to previous Acts that I did not appreciate the information given.
I think having six months might in some cases indicate that such a delay was tolerable. The difficulty of ensuring efficiency by legislation could mean that to some extent this might induce the health boards to fill the vacancies but I can see equally that as delays went on they might say: "Well, we have six months". I would prefer not to accept this amendment but the Seanad will be aware of the clause in the Local Authorities (Officers and Employees) Act, 1926, which enables the Minister to request the Local Appointments Commission to recommend such a local authority person for appointment. This means the Minister has a statutory power of entering into the position three months after the position becomes vacant. He is not obliged to do this but he may.
One of the important parts of both of those amendments is the word "shall" is used in the second line of each of them. I know we are getting a lot of talk about "may" and "shall" but surely it is clear that "may" is allowing the Minister whereas "shall" is obliging him. All I can say is it is very amusing to hear the Minister say that a six months period might be too long. I understood him on Committee Stage to say that one of his main reasons for opposing this was that a two-month period would be too short. I consider that what the Minister has read out of the 1926 Act does to some extent allay our fears but again there is no obligation on the Minister. We sought that the Minister would be obliged to set this machinery in motion within the period in question.
Miss Bourke
I am not completely satisfied that the earlier Act referred to by the Minister meets the point. It is only an enabling power at the discretion of the Minister if he wishes to make a recommendation to the health board to fill the temporary appointment. If that power has existed for so long it does not appear to have been used. We have a prevalence of temporary appointments of this nature in this country so this power is not obviously being used and there ought to be a limit. I do not think it would have the effect the Minister suggests of stating that six months is an ideal period before one starts the process in motion for filling a temporary appointment. It is the outside limit for setting up legislation and we should take that outside limit and not leave it in the vague manner it is in. As I said looking on our past record it is a rather sad one in matters of this kind.
Amendment, by leave, withdrawn.
Amendment No. 6 not moved.
I move amendment No. 7:
In page 11, lines 52 and 53, to delete "and the manner in which".
I raised this matter on Committee Stage and I would like to raise it again today. The main reason is the actual wording of this section. I am quite prepared to take the Minister's word that "and the manner in which" which is the phrase to be deleted applies to the administrative manner, that it does not interfere with medical services or the medical manner, but the Medical Association feel that this is a very dangerous clause to leave in in such a wide manner and for this reason I would like the Minister to reconsider it again. We are particularly anxious that he would do so because as I mentioned on the Committee Stage the discussions between the Association and the officials of the Department on 5th May, 1967, reached apparent agreement on this point that this type of phraseology would not be used. I am sure it would not be beyond the powers of the parliamentary draftsman to find some way of giving the chief executive officer all the powers from the administrative point of view and yet making it very clear that those powers did not interfere with the medical manner. I would very much like the Minister to reconsider this point.
Miss Bourke
This amendment is again for the reasons which were put forward on Committee Stage, on this point that it is the function of the chief executive officer to carry out the administrative duties allotted to him in this area and that the wording, the extent to which a person will avail of services, is an administrative matter and properly within the terms of reference of the CEO, but the other wording "and the manner in which" is wider than that and I would submit, although it would be rare that there would be a clash between the CEO and the medical officers on this board, it could occur. I would like to give possible examples which could give rise for difficulties. For example I suggest if an old person receiving treatment was told by the medical officer that he wished to assign him or her to a geriatric home the executive officer could say "No, the manner in which this person will be treated will be in a mental home".
That is within the terms of this Act. It could happen. A CEO might decide that the manner in which the person would be treated should be in a particular hospital whereas the doctor would prefer the person to be treated in a different one. I am not a medical practitioner but I feel the wording could cut across what is within the professional area and not the administrative area. In supporting Senator Alton, I emphasise that the wording "the extent to which" adequately covers any administrative functions which the CEO would seek to exercise. It does not in any way hamper the scheme which we are setting up.
This is a question of interpretation. I take a pragmatic view of a lot of this. If a CEO started to give a point of view about the manner in which a patient should be treated there would be a flaming row from the Medical Association. The whole thing is inconceivable.
Miss Bourke
He could point to his authority in the Act.
I do not believe in these refinements when one applies the principles of commonsense. We already changed section 16 (4) (b) as introduced. It read "extent in which and manner". We felt it did not make the position sufficiently clear. Now we have used the wording derived from the City and County Management Act, 1955, which has been in operation for 14 years. Section 1 (a) refers to individual health functions, meaning functions with respect to decisions whether a particular person should be able to avail of a particular service, including a service for the payment of grants or allowances made available under the Health Acts of 1947 and 1954 and the Mental Treatment Act of 1945 and 1954, or as to the extent to which and the manner in which a person should receive treatment or otherwise avail himself of any such services.
We, in fact, were copying a section from a previous Act which never gave rise to any complaint or caused any scandal or resulted in very important representations from the Medical Association. We altered the section to the way in which it appears in the present Bill. There is no intention to interfere with treatment. This refers to administrative arrangements which are to be made for the treatment of persons availing themselves of services under the Health Act. Many administrative arrangements have to be made by the CEO of a kind which have no relation to the manner in which the patient can be treated.
In view of the fact that the section I have quoted in the previous Act never gave rise to trouble, no one can object to the way in which the section has been amended. No one with commonsense could object to it, particularly when I have explained it twice in the Seanad. Having explained it twice in the Seanad, the Members of this House could imagine what would happen if the CEO started to use this section in such a way as to conflict with the independence of the judgment of members of the IMA.
I have heard the Minister explain twice why those words are not necessary at all: if they were used it would cause such a scandal that the CEO would have to change his mind. The Minister told us there never was any row in the past about this. They never caused a scandal. The Minister did not give us a single example of positive value coming from this or a way in which this could be used. The Minister said if it were used in a bad way it would cause an enormous row. The Minister did not give an example of a good way in which it might be used. It sounded to me that the only way in which it could be used would be a way which would cause an enormous row and therefore, it would not be used in this way and would not be used at all. This could be useless or dangerous. I support the amendment.
I fully accept the Minister's explanation. I have no doubt the Minister would act in this reasonable and fair manner. The associations have pressed this one point for months past and have regarded it as extremely serious. I fail to understand why, if there is not some tremendous importance to the draftsman behind these words, and if they are not of significance, the amendment cannot be accepted. I do not like quibbling over small points, but the associations regarded this as a very important point. Since the last meeting of the Seanad I have been approached by them on this score. I would not have brought up an amendment again on the same terms as before if they did not consider it important. The Minister says no case has come before him. The associations are conscious of decisions made by county managers in the past which the doctors have found difficult to live with. There is strong feeling about this matter. I am sorry that the Minister could not accept this amendment.
Amendment, by leave, withdrawn.
Miss Bourke
I move amendment No. 8:
In page 12, lines 12 and 13 to delete "or for continuing as an officer".
This is a repetition of an amendment put in on Committee Stage. I have chosen to move it again because I was not satisfied with the explanation given by the Minister. I am not satisfied with the fact that we appear to be continuing, in this new Health Bill, a practice which is part of local government appointments in this country, and that the only explanation I can pin on the wording "for continuing as an officer" is that once a woman marries she will no longer be employed in a permanent capacity by the board. Therefore, in many cases now the position is that a married woman will be re-employed in a temporary capacity. This would be greatly to her disadvantage. On Committee Stage, the Minister mentioned the wonderful Commission on the Status of Women which would look into the whole question of the employment of women. I welcome the fact that the Commission are being set up. We must not continue malpractice in our legislation, particularly legislation on a large-scale social question like this, pending the findings of this Commission when they are eventually set up. They will report and presumably a long period will elapse before the report is implemented. I think that now in the beginning of 1970 we ought to eliminate from future legislation what I see hidden here, and that is discrimination against married women.
I should like to support Senator Bourke on this amendment both for the reasons she has given and also because we have been informed that in the section there is a sentence referring to a woman continuing as an officer in a temporary capacity if she had married, and this certainly is against the spirit of the age. More important, I cannot see any reason for the phrase at all, because surely the conditions of appointment can be written into the initial conditions and these would be fixed and could include things like continuing good health and continuing single. One might interpret this phrase as saying that some time in the future there might be a change in conditions for qualification for appointment which could be to the detriment of a person holding the position, and I would therefore very strongly support Senator Bourke in asking for the deletion of this phrase.
I do not think I need to prolong this debate. The amendment which is moved is the same as the amendment on the Committee Stage. I did not agree to look at either the amendment or its implications between Committee Stage and Report Stage. I really have nothing to add to what I said before and I regret that I cannot accept this amendment.
In 1970 we are still apparently prepared to victimise women civil servants for the crime of marriage. I do not know whether the Minister sees where this will ultimately lead. It could be an encouragement for women civil servants to live in sin, which apparently is the basic result of this, and to use the fact of marriage against a woman as if it were some crime against the community or some cardinal sin surprises me in the Seventies. I am also surprised that the present Minister before us should support such a retrograde attitude, and I am disappointed that he cannot accept this amendment. I am disappointed, too, that he has not had better thoughts since the Committee Stage.
Amendment, by leave, withdrawn.
I move amendment No. 9:
In page 12 between lines 16 and 17 to insert the following new subsection:—
"( ) The Minister shall not approve or direct any qualification specifying that any woman holding office be either unmarried or a widow."
Again, this amendment was down on the Committee Stage and what has been said on the previous amendment applies to it with the difference that the Minister replied to this amendment on the Committee Stage and did point out—and very rightly—that this, of course, would be a Cabinet decision and that we could not expect him to take this decision on his own. I did, however, point out that perhaps between it and the Report Stage he could consult with the Cabinet, and though he did not undertake to have a Cabinet decision I think he gave some sort of an indication that he would consult with the Cabinet.
I was also rather hopeful that he would accept it, having discussed it with his Cabinet, because there are many members of the Cabinet who are on public record as being in favour of improving the status of women in the community. This qualification seems to apply only in the public sector. I have never come across it anywhere in the industrial sector and in fact at the moment in the industrial sector they are positively encouraging women to stay on after marriage. They are probably becoming an economic necessity now, and recent statements from the FII and the FUE would seem to indicate that this is the position.
Senator Sheehy Skeffington has made some very true comments about what it might encourage women in the Civil Service to do. I think that perhaps we might refer the Minister to the famous case of the French air hostess who tried to sue the airline for encouraging concubinage because they had a similar regulation there. I presume that the Minister would not fancy having a future member of the staff of a health board having to take a similar action.
I understand there are provisions in the 1941 Act which cover this point about which there is some doubt as to whether it is contrary to the Constitution. I have had some legal advice on it. Again I am asking the Minister to at least give an assurance that he will not bring in any qualification. The Bill as it stands gives the Minister power to bring in any qualification. If the Minister would give a personal assurance that he would not, in fact, bring in any such qualification specifying that a woman health officer should have to be either unmarried or a widow I would be prepared to accept the Minister's assurance and not press the amendment.
Although I sympathise with a lot of what is being said in relation to the status of women, I cannot initiate a precedent in this matter until there is a general consensus of the whole community expressed through a Government decision and a Dáil decision on the question of the position of women in our society. The Bill does not prevent married women from being employed by health boards if the qualifications are changed. This Bill does not deal with the position of married women in employment, but qualifications are declared, and it is a fact at the moment that qualifications are declared which do not admit married persons becoming candidates for certain positions. I simply cannot create this kind of innovation. I honestly think that it would create chaos in the administrative world and indeed in the political world if a Minister could quite suddenly introduce a completely novel concept in advance of any other Minister or in advance of a general consideration by the community at large. I think that it is asking too much of me to take this step, so I am afraid that I have to refuse this amendment. Might I say again that there is nothing in the Bill which prevents qualifications providing for the rights of married women to apply for certain positions.
I am disappointed with the Minister's reply when he tells us that he cannot be an innovator. Why not? Is there some basic principle that no Minister can ever think in advance of any other Minister? Does this mean that nothing should ever be done for the first time?
Donnchadh O'Malley.
This is a very good enunciation of conservative policy, that nothing should ever be done for the first time. I think that something should be done for the first time, and occasionally some Ministers should be in advance of their colleagues—and Senator Belton has given us one example. I see no reason why the present Minister should not set a good example. I have indicated the horrible effect that might result from encouraging women civil servants to remain unmarried, but even worse probably could result, since it could be regarded as encouraging them to take positive steps to become widows. This is a disturbing aspect of the matter. In all sincerity I believed that the Minister would go further in theory on this road, but in practice he has continued to be so reluctant to be in advance of any of his colleagues, and that is a pretty grim admission.
Again, to sum up, I am disappointed because the Minister in his reply has not indicated whether he did discuss it with the Cabinet. I do not know whether he had time to do so, and perhaps it was rather short to look for a decision by the Cabinet, but I fail to understand why the Cabinet as such would not accept this as at least a start to bringing the women of Ireland into the 1970s. I think it is very retrograde that we have to wait for a commission to put things right, and that until the commission tell us that a thing is wrong we cannot accept an amendment to put it right.
Again, I think that the existence of this type of regulation in the public sector is discriminating against a particular class of person, and the nursing profession is one that has suffered terribly from this. I recently heard an example of a nurse who was taken back into a local hospital when she returned from her honeymoon. She could only work night duty and she could only do a certain number of hours and she was given pay at the day rate. This is absolutely ridiculous, and it is not a thing that we should like to continue.
I would have thought we would have got better from the Cabinet, because there seems to be some forward thinking now among Ministers. The Minister referred to their recent Ard Fheis at which they adopted at least two resolutions which have been put forward. I do not think that this amendment is anything away out of line at all. I do not think we are asking too much for the Minister to accept it or to give a personal assurance. He has pointed out that there is nothing in the Bill at the moment, but it was to anticipate that which has happened in the Civil Service and the local government service would not be brought into the health boards I put this amendment down. If I got an assurance from the Minister that he would not introduce any qualification, then I would withdraw the amendment. Otherwise, I shall have to press for a division.
I cannot.
Is the amendment being pressed?
Yes.
Amendment put.
The Seanad divided: Tá, 16; Níl, 22.
Tá
- Belton, Richard.
- Boland, John.
- Bourke, Mary T.W.
- Butler, Pierce.
- Dooge, James C.I.
- Dunne, James.
- Farrelly, Denis.
- Fitzgerald, Jack.
- Horgan, John.
- Kelly, John.
- McDonald, Charles B.
- Malone, Patrick.
- O'Higgins, Michael J.
- Owens, Evelyn P.
- Russell, G.E.
- Sheehy Skeffington, O.L.
Níl
- Alton, Bryan G.
- Brennan, John J.
- Brugha, Ruairí.
- Cranitch, Mícheál C.
- Crinion, Brendan.
- Doyle, John.
- Eachthéirn, Cáit Uí.
- Farrell, Peggy.
- Fitzsimons, Patrick.
- Flanagan, Thomas P.
- Garrett, Jack.
- Hanafin, Desmond.
- Honan, Dermot P.
- McGlinchey, Bernard.
- McGowan, Patrick.
- Nash, John J.
- Norton, Patrick.
- Ó Maoláin, Tomás.
- O'Sullivan, Terry.
- Ryan, Eoin.
- Sheldon, W.A.W.
- Walsh, Seán.
Tellers: Tá, Senator J. Fitzgerald and Senator Owens; Níl, Senator Honan and Senator Hanafin.
Amendment declared lost.
Amendment No. 10 has been ruled out of order.
Government amendment No. 11:
In page 13, between lines 17 and 18, to insert the following:—
"(6) Whenever an officer of a health board is suspended under this section, the chief executive officer may, if he thinks fit, make with the consent of the Minister an ex-gratia payment to the suspended officer.
(7) Any sum paid under subsection (6) shall be repayable by the officer to the health board and may be deducted from any moneys payable by the board to him.
(8) Any sum paid under subsection (6) shall not be reckoned as salary or emolument for the purposes of the Local Government (Superannuation) Act, 1956."
This amendment is quite self-evident. I agreed that I would consider this question of the possible payment of exgratia payments to officers who might be under suspension. The amendment is perfectly clear and I recommend it to the House.
Very simply, but nonetheless sincerely, I should like to thank the Minister for this.
We agree with the Minister on this.
Amendment agreed to.
Miss Bourke
I move amendment No. 12:
In page 13, between lines 17 and 18, to add a new paragraph as follows:—
"( ) a decision either on the termination of such suspension or the removal of such suspended officer shall be taken within three months of the notification of the suspension to the Minister by the chief executive officer, as provided within the procedures set out in section 22 and section 23".
The amendment which has just been put forward by the Government and agreed by the House meets some of the dangers of the procedure under which we were going ahead under section 21 of this Act as regards the suspension of an officer. The amendment that is being put forward here would complete that process in setting a maximum period within which the suspension would last before there was a decision on it. In a sense, it is in accordance with the principle of natural justice that a person has a right to know within a fairly short period what is his status and whether his suspension will last. It is important that there be a time limit on the suspension and in this case three months is more than adequate because the position for a suspended person would be an invidious one. If one is wrongly suspended there ought to be a right to a hearing within a short time.
I agree with Senator Bourke that the previous amendment covered most of the problems concerning this section. However, there still remains the case of a person who would suffer undue hardship because of the section. I can understand the Minister telling us in his reply the last day of the hitch there might be in the case of personnel who might be waiting for trial on a criminal offence, in which case it would not be possible to go ahead with the proceedings for suspension in a certain fixed limit, but very many cases that come up would not fall into these categories and could be disposed of fairly quickly. At the same time, there would be many cases in which there was no question of criminal proceedings or of illness and it is for that reason that I should like the Minister to try to see his way to putting in some further clauses which would mitigate hardship.
I have been extremely co-operative on this Bill and, therefore, I do not consider that the House should take any extensive time on repetition of the Committee Stage in regard to the section. I have nothing to add to what I said on Committee Stage and I regret that I cannot accept the amendment.
Amendment, by leave, withdrawn.
Government amendment No. 13:
In page 13, between lines 32 and 33, to insert the following:—
"(5) Removals of officers and servants under this section shall be carried out in accordance with regulations made by the Minister and such regulations shall provide—
(a) that effect shall not be given to any proposal for removal unless prescribed notice has been sent to the officer or servant of the reasons for the proposal, and
(b) that any representations made by him or on his behalf on the proposal which are received within a prescribed period shall be considered".
This amendment arises out of an undertaking which I gave during Committee Stage. Under the amendment, it will be open to the person to whom it is proposed to remove to request his trade union or representative organisation to make representations on his behalf. This is another case in which I was trying to do what I could to ensure absolute fairness in regard to all these matters. The amendment is quite clearly self-evident.
We welcome this amendment also which is the implementation of the assurance given by the Minister on the Committee Stage.
Amendment agreed to.
Amendment No. 14 not moved.
Government amendment No. 15:
Before subsection (6), inserted in Committee, of section 31, to insert the following:—
"(6) A person appointed by the Minister to make or vary a determination under this section shall have regard to such matters as may be specified by the Minister after consultation with the Minister for Local Government".
Again, this is another case of my examining proposals made on the Committee Stage. The purpose of the amendment is to enable the Minister after consultation with the Minister for Local Government to specify the fact as to the person making the determination in regard to the nature of allocating contributions by the local authorities. It was Senator Alexis FitzGerald who first mooted this, not Senator Alton. The sort of factors which might be taken into account are the present proportion in which local authorities meet local expenditure the previous system for division of costs, for example on a valuation basis, or in the case of numbers of patients. Instead of reading down a list, I think I should say that the person appointed by the Minister to arbitrate on the division of the allocation of costs will have regard to such matters as I will specify after consulting the Minister for Local Government.
As the House knows, the Rating Committee have been sitting examining the whole question of valuations. The Minister for Local Government has said he will do something with regard to some measure of equalisation in regard to the rates proposed as between one county and another. There has recently been a very interesting report by the Economic and Research Council in regard to county incomes but this only relates to county incomes in 1960 and 1965 and the increase of incomes which has taken place between those two periods. There may be other studies which will be useful and for which the consent of the Minister for Local Government might be forthcoming, so I think it is best to put it in as I have in a general way: "such matters as may be specified". I think the Minister for Local Government would naturally try to conclude whatever seemed relevant in the prevailing circumstances.
On behalf of Senator Alexis FitzGerald and the other two Senators whose names are appended to this, and on behalf of my Party, I want to thank the Minister for his concession on this. I think he has made an effort to meet us in the particular addendum we put down on this amendment. I am sure when Senator Alexis FitzGerald hears about this he will be pleased.
Amendment agreed to.
Government amendment No. 16:
In page 17, lines 50 and 55, to delete "1959" and substitute "1968".
This is purely a drafting amendment.
Amendment agreed to.
I move amendment No. 17:
In page 21, between lines 8 and 9, to insert the following:—
"( ) the provisions of section 10 (2), 10 (3), 24, 25, 26 and 27 of the Local Government Act, 1941, as amended by section 17 of the Local Government Act, 1955, shall apply in relation to a health board and its officers who are transferred under this section as if it were a local authority and they were officers of a local authority.".
The Health Bill before us contains a provision in respect of the Local Government Superannuation Act from which it would appear that the health boards to be established will not be local authorities within the meaning and for the purpose of the various Acts referred to in section 8 (2) of the Health Authorities Act, 1960. This would appear to remove the protection of those Acts from officers of health authorities or other authorities which will be transferred to the health boards. Many of those officers came into local government service under the various Local Government Acts and it is felt the Health Bill should ensure by positive statement, not by implication, that the existing conditions which will apply to those officers under the Local Government Acts should continue to apply on the establishment of the health boards.
I think the main worry of the various people who have been in touch with Senator Belton in regard to this was that there were certain provisions in the various Acts from 1925 onwards which the officials at present working for health authorities more or less took as their charter and they felt they had a certain amount of protection from various sections of those enactments. They do not seem to be too clear now as to whether they will have the same sort of protection as they had heretofore. They feel if this charter is being removed their conditions of service are being worsened and it is because of this we have suggested that this amendment might be accepted so as to make it quite clear to those officials that their position is not in any way being damaged. This is the main reason we have tabled this amendment.
I have made it clear the position of officers who are transferred will not be worsened. There will be a joint consultative council. I understand the rights officers have in regard to superannuation and all essential matters will remain the same under this Bill. I have a very long statement I could read out and it goes through all the sections of the Local Government Act, 1945, which apply and the extent to which they are applied in this Bill. However, I think the best way is as I have done already. If I were to accept this amendment I would be applying law relating to local government officers to some officers of health boards and not to others and this would lead to complexity and uncertainty in regard to the legal positions The Local Government provisions and those in the Bill are sufficiently similar for me to be able to give a guarantee to the House that no person who is transferred to a health board will suffer because of a failure on my part to have the Bill amended by applying the various provisions of earlier Acts to any greater degree than they have already been applied. I do not think the House need worry about this.
I know that this is difficult but what I was trying to get at was if there was any provision in local Government Acts up to this that on the transfer of those officers authority would be taken away from the transferees, that is under the health boards when the transferees are transferred from one health board to another. If the Minister can assure me that those people will not suffer I would be prepared to withdraw the amendment.
If I may speak again by leave of the House, I do not want to start a precedent.
I do not want to press this in any way. However, I should like to have some clarification and I should be pleased if the Minister could give it to me.
The provisions of section 22 are modelled on sections of the 1941 Act. They are in fact an improvement on them in so far as they provide a more democratic procedure where it is proposed to remove an officer because of misconduct or unfitness. The Committee investigating the removal under section 23 will include persons selected from a panel of persons nominated by his representative organisation. I understand that is the only difference regarding the privileges of officers. All the others remain the same.
I accept that. May I meet the Minister's secretary sometime for clarification on that?
Amendment, by leave, withdrawn.
Government amendment No. 18:
In page 22, line 3, before "shall", to insert the following:—
" , after consultation with such bodies representative of persons concerned with the provision of hospital services and such other bodies (including bodies engaged in medical education) as he considers appropriate,".
This is an amendment which arose out of a discussion on the formation of Comhairle na nOspidéal. I said I would examine questions raised by Senators. This would leave it open for the Minister to decide with which bodies he should consult with regard to any particular aspect of the regulations which I will be framing under section 40 regarding Comhairle na nOspidéal. There is separate provision in the Bill for consultation between the various bodies on the establishment of the regional hospital boards.
Amendment agreed to.
Amendments Nos. 19 and 20 may be discussed together.
Miss Bourke
I move amendment No. 19:
In page 22, to delete lines 26 and 27 and substitute:
"(vi) to perform such other functions necessary to the implementation of these functions as may from time to time be prescribed by regulation of the Minister".
This is almost the same.
Miss Bourke
I appreciate that but I still feel that I should like to put forward the amendment because at the Committee Stage I described the clause as it stands as being the type of blank cheque which ought not allow functions to be delegated to any body which we set up. It is out of tune with other functions of the section. The amendment which I brought in at Committee Stage was not the proper amendment. It purported to delete the phrase. As the Minister and other speakers pointed out, this regional hospital council are a new body which require certain flexibility. By deleting that phrase entirely this was giving away the necessary flexibility in the regional council. The amendment which the Government put forward will now insert the word "cognate". If the Minister would accept "by regulation of the Minister" following that I would accept that amendment simply because further on in the section it says that such regulations have to be laid in draft before the House. The House would know what cognate functions relating to the existing functions were being given to this new regional council. If the Minister would consent to add on the words "prescribed by regulation of the Minister" I would accept it.
The Minister has taken an important step in suggesting that this should read "other cognate functions". I would feel happier if there could be a combination of these two amendments. Senator Miss Bourke is right when she says that the paragraph should not end on the words "as may be prescribed". It is important that the manner of prescription and the person of the prescriber should be quite clear. As at present drafted it reads "as may be prescribed" by any body. The manner of prescription is not given either. The word "other" certainly improves the paragraph. Senator Miss Bourke is right in asking that the words "by regulation of the Minister" be incorporated in it.
This is another of those questions. I am learning more in relation to precise definitions. In section 2 of the Health Act, 1947, there is an expression which has not been repealed. It says that "prescribed" means prescribed by regulations made by the Minister under the Act. So long as the word "prescribed" is in it it covers what the Senator suggests.
Miss Bourke
Those interpretative words are not included in the interpretation of this Act.
They are. We will have to spend some time studying the number of references to previous Acts.
Miss Bourke
Regulations would have to come in draft before this House.
Yes. The word "cognate" is sufficient. "Prescribed" includes it.
Amendment, by leave, withdrawn.
Government amendment No. 20:
In page 22, line 26, after "other" to insert "cognate".
Amendment agreed to.
It was agreed at the start of business to recommit this amendment.
Bill recommitted in respect of amendment No. 21.
I am grateful to the Minister for recommitting this amendment. I move amendment No. 21:
In page 22, line 48, to delete "one-half" and substitute "two-thirds"; in line 51 to delete "one-half" and substitute "one-third" and to add after "appropriate" in line 56 ": provided, however, that a majority of members on the board shall consist of persons who are members of a council or of a county borough or of the Corporation of Dún Laoghaire".
The purpose of the amendment is to ensure that the composition of the hospital boards will be in line with the composition of the health boards. As I read the Bill, it could happen that a substantial majority of the hospital boards could be non-local authority members. I do not know whether that was the Minister's intention in this section of the Bill. He has accepted in principle that the health boards should contain a majority of elected representatives—the nominees of the local authorities. The same principle should apply in regard to the hospital boards for the same good reasons put forward when the House argued on the composition of the health boards.
I do not want to go into it in great detail. The amendment may not be the correct way of achieving this purpose. I am prepared to agree with the alternative wording the Minister suggests. I suggest strongly that in the interests of working together as a unified body the same principle should apply in regard to the larger hospital boards.
I should like to support Senator Russell on this. Although the argument for a preponderance of local authorities on the regional hospital boards is not as strong to me as on the regional health boards, I feel that local representatives would take issue with us who are councillors if we did not press their case to have adequate representation, and by adequate I would say at least equal or more than equal representation on regional hospital boards.
However, the Minister may have very cogent reasons why he did not include this in the concession he gave on the regional health board. I can see that he might have, and we are putting this amendment forward to bring these out and to get his reasons, if they are valid, why he cannot accept this amendment. We are very strong in our advocacy of local representation being preponderant on the regional health boards. We may not be as strong in our advocacy here, but we felt at the same time that in order to allay the fears of local representatives throughout the country we had to put down this amendment.
I thought that I had dealt with this matter sufficiently on a previous occasion. The regional health boards will be planning bodies with very important co-ordinating functions and they will be doing some of the work being done by my Department in relation to future hospital planning. They will be working towards the greater integration and/or co-ordination of the voluntary and the health board hospitals, but some 44 per cent, I think it is, of the patients who go from the local authorities go to voluntary hospitals for treatment, and in relation to this regional planning we have also to think of the hospitals which have a teaching function, and as the State pays about 75 per cent of the total cost of the health services I want to be very certain that the whole of this planning is carried out on a basis of considering the positions of the hospitals themselves; so in connection with the regional hospital boards I do not think there should be a majority of regional board representation thereon. I think that I should have a considerable part to play in the appointment of those people. They will be planning bodies, and I am quite certain that the representatives from the health boards will be well able to play their part through the present arrangements under the Bill.
I can see Senator Belton's point of view about this, but I think that I have gone far enough in giving local authority representatives a majority on the health boards. I hope that the representatives nominated to the regional hospital boards from the health boards will consist of local authority health board members who have a very wide view of this whole subject and who have the capacity of thinking collectively as well as being representatives at the same time of their own health board area, because this is a very complex question of how far we provide ambulant consultants for a health board area, how far we agree to the provision of certain superspecialities being undertaken in a regional hospital board area, and other complex matters, on which I want the advice of everyone that I can get including the medical consultants employed in both types of hospitals—voluntary hospitals and health board hospitals—and consultants interested in the teaching side on this question which is inevitably linked with it. I do not think that anybody would say I was wrong in insisting on the provisions in the Bill.
I hope the Minister will forgive me saying that I think he is wrong. The position is that in certain circumstances the local authority representation could be as low as 25 per cent, because the Minister is aware that these health boards will consist of nominees of local authorities, possibly just more than 50 per cent, and representatives of the medical and other interests. When it comes to electing the personnel on the regional hospital boards, the same proportions may very well ensue, and with all due respect to the Minister I think that in order to have adequate planning and the forward-looking boards that he hopes to achieve, it will be necessary to have adequate representation for men who have given long years on local authorities and in some cases on the existing health boards.
As this section of the Bill stands it is quite possible, in fact it is almost certain, that they would not be represented, and there might be an inclination on the part of the health boards to exclude representatives other than members of local authorities from the hospital boards. I think that this would be a detrimental step, and in order to ensure that the temptation to do this will not arise, I am suggesting—I am prepared to give way on the question of the majority but—that the Minister should in principle accept that the local authority representation should be adequately represented on the hospital board. I think this is vitally necessary for the Minister's hopes, and that public representatives have an important part to play in the planning and other work of these boards. I hope that the Minister will find some method of ensuring adequate representation for local authority representatives. As it stands at present they need not be adequately represented.
I agree with Senator Russell on this. The Minister is placing great importance, and rightly so, on these new hospital boards and on the fact that they will be engaged in long-term planning and rationalisation of the hospital services. I know that the Minister would like as much as possible to have the views of all the people concerned in the hospital service adequately represented, and, as Senator Russell pointed out, the number of local authority representatives on the new hospital boards could well be as low as 25 per cent if the health boards wanted to appoint an equal number of non-politicians as well as of local authority representatives.
As Senator Russell has pointed out, if the health board members are obsessed by this idea of their small representation they might conceivably use their slight overall majority to see that all their appointees to the hospital boards are elected representatives and exclude the professional representatives from the health boards. You could also have a point that if a hospital board were comprised of 30 members, only seven or eight of those, that is about one-quarter, being public representatives, the viewpoint of any one of the political parties might not adequately be expressed at that hospital board meetings.
I know, as I said, that the Minister very sincerely feels that these boards will play an important part and that he will want to hear the views, and probably the contrary views, of everybody in a sincere effort to bring about the proper planning of the hospital services. In this I assume that the views and attitudes and policies of each political party would be represented, but it could be that there might be only one or two representatives from one of the major political parties serving on these boards and their real contribution which could be made would consequently be lost. The Minister might think out this whole problem in the light of this suggestion, which we have made not in any political sense but in the sincere effort to see these hospital boards working as well as possible.
I cannot accept the amendment.
Is the amendment being pressed?
Yes.
Amendment put.
The Seanad divided: Tá, 16; Níl, 25.
Tá
- Belton, Richard.
- Boland, John.
- Butler, Pierce.
- Dooge, James C.I.
- Dunne, James.
- Farrelly, Denis.
- Fitzgerald, Jack.
- Horgan, John.
- Kelly, John.
- McDonald, Charles B.
- Malone, Patrick.
- O'Brien, Andy.
- O'Higgins, Michael J.
- Owens, Evelyn P.
- Russell, G.E.
- Sheehy Skeffington, O.L.
Níl
- Alton, Bryan G.
- Bourke, Mary T.W.
- Brennan, John J.
- Brugha, Ruairí.
- Cranitch, Mícheál C.
- Crinion, Brendan.
- Doyle, John.
- Eachthéirn, Cáit Uí.
- Farrell, Peggy.
- Fitzsimons, Patrick.
- Flanagan, Thomas P.
- Gallanagh, Michael.
- Garrett, Jack.
- Hanafin, Desmond.
- Honan, Dermot P.
- McElgunn, Farrell.
- McGlinchey, Bernard.
- McGowan, Patrick.
- Nash, John J.
- Norton, Patrick.
- Ó Maoláin, Tomás.
- O'Sullivan, Terry.
- Ryan, Eoin.
- Sheldon, W.A.W.
- Walsh, Seán.
Tellers: Tá, Senators J. Boland and McDonald; Níl, Senators Brennan and Fitz simons.
Amendment declared lost.
The Bill is reported from Committee without amendment.
Amendments Nos. 22, 23, 25 and 26 are cognate and, therefore, will be taken together.
Government amendment No. 22:
In page 23, line 6, to delete ", 16 (1) and (3)".
The Seanad looks forward to amendment No. 36 introduced in the Second Schedule regarding the holding of meetings by the health board, and if Senators look at the amendment they will see that it would not be desirable to impose a rigid requirement on Comhairle na nOspidéal or the regional health boards in relation to the number of meetings that they would hold each year. Amendment No. 25, which is being taken with this amendment, makes a consequential provision and makes it clear that each of the bodies shall hold such other meetings as may be necessary for the performance of their functions. These two amendments have to be read with No. 36, which has not yet been reached.
Amendment agreed to.
Amendment No. 23 not moved.
Government amendment No. 24:
In page 23, line 6, to delete "30" and substitute "32".
Again, this amendment is consequential on the introduction of two new rules in the Second Schedule immediately before Rule No. 30. These are amendments Nos. 44 and 45 and, therefore, this is a drafting amendment.
Amendment agreed to.
Government amendment No. 25:
In page 23, between lines 10 and 11, to insert the following:
"(4) The first meeting of a body established under this section shall be held on a day to be appointed by the Minister and the body shall hold such other meetings as may be necessary for the performance of its functions."
Amendment agreed to.
Amendment No. 26 not moved.
Government amendment No. 27:
In page 24, between lines 12 and 13, to insert the following subsection:
"(12) A body established under this section may accept a gift of money, land or other property on such trusts and conditions as may be specified by the person making the gift, but shall not accept a gift if any conditions attached to the acceptance thereof are inconsistent with the functions of the body."
This amendment arises out of an undertaking which I gave to the House during Committee Stage in connection with a proposal by Senator Alexis FitzGerald that we ought not to lose the opportunity which might arise for some of these bodies to accept gifts of money or land. Therefore, this amendment is put forward with that object. Comhairle na nOspidéal could accept a gift of money or land or other property and I hope they will be made gifts of this kind.
Amendment agreed to.
Amendment No. 28 not moved.
Amendments Nos. 29 and 30 are cognate and will be discussed together.
Government amendment No. 29:
In page 27, lines 1 and 2, to delete "for the purposes of this section".
This is a drafting amendment arising out of a point made by Senator Alexis FitzGerald on Committee Stage and which I do not need to go into in detail.
Amendment agreed to.
Amendment No. 30 not moved.
I move amendment No. 31:
In page 28, between lines 35 and 36, to insert the following new section:
"(1) Where the chief executive officer of a health board is of the opinion that the 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 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 requistion such services as he deems to be urgently necessary.
(3) The cost of providing services under subsections (1) or (2) shall be recouped by the board which provided such service from the board which availed of that service."
This is phrased exactly as one of the two amendments coming out of Committee Stage and it is put down, because, after some discussion, and because the Minister said that he would have a look at it before Report Stage and because he assured the House that this can be done very easily.
In view of the fact that he said this I have put down the same amendment. The reasons I gave on Committee Stage were that they are two separate parts and the third is a part concerning methods of recruitment. The first is where a semi-emergency would occur and in which case a board could meet. The second part of this amendment is to ensure that when an emergency arises, the CEO can request services from a neighbouring board—in other words, that the borders of the eight boards can be crossed for emergency services. It can be done by the chief executive officer. This is different. The Minister made the point on Committee Stage that this could be done by arrangement between boards but supposing no arrangement exists between boards, supposing boards do not agree. Then I want this amendment to go in so that in those cases the CEO would have the power in semi-emergencies to ask permission, and so that in emergencies the services would be requisitioned from the neighbouring health board, that is, emergency services like ambulances, resuscitation and other services of that nature. The point is self-evident.
It is now six o'clock. Would it be the wish of the House to finish this amendment before we adjourn for tea?
I am in the hands of the Minister, yourself or anybody else.
If it will not take long.
We will finish the amendment.
All right. I will not be long. The amendment is self-evident. The argument the Minister made on the Committee Stage was that the boards could get together, and I know there are provisions for the boards to come together to deal with certain services, but there are two points which may invalidate his argument. They may not come together because the word "shall" is not used in that section. The boards do not meet that often and some power should be given to the CEO or the responsible officer of the board at the time in the case of a semi-emergency where expedition might be of value that he could ask the neighbouring health board to give him the services required and when an emergency occurs that he requisition the emergency services from the neighbouring health board. The recoupment is set out there and it is quite obvious what it will be.
I have examined this argument and the legal officer advises me there are adequate provisions under section 25 (2) for two health boards to carry out an arrangement by which one can cross the border to the area of the other and obtain the services required under the various Health Acts. In regard to emergency services, there are really two ways of doing it. When the health boards first meet one of their first ordinary resolutions will be to instruct the chief executive officer to take advantage of this section of the Bill for the conducting of emergency services as between two neighbouring health boards. Secondly, if they did not do that or if they were lax in their obligation I could at any time under section 16, subsection (4) (e) give to the chief executive officers of health boards sanction to take the decision themselves in regard to health boards collaborating on emergency services or indeed on any such services where there ought to be a permanent arrangement. The legal officer advises me that there is no need for this amendment.
I formally second the amendment.
My difficulty is, and the Minister will appreciate this, that there is not an actual provision for this in the Bill. Section 25, subsection (2) states that: "Two health boards may". There are two points in that. Those are health boards. When do they meet to carry that out? Secondly, the word used is "may".
They are intelligent and surely they would be bound to do it. Each one of the health boards can pass an omnibus resolution covering all such emergency situations. We could even help them frame the resolution, if any Members of the House thinks it is necessary and this is one of the things we could send them in the sheaf of information they will get before they start operating. We could make this recommendation to them that they ought to pass this resolution the moment they meet.
I accept the Minister's word that they ought to pass aid to neighbouring boards. That, of course, should be the case but I think it is worthy of being embraced within the Bill and that is the reason I have put down this amendment. It is a very important point and it also goes beyond the power allocated to the chief executive officer at certain stages. I am going beyond that in this amendment. I appreciate what the Minister says. I appreciate also that if he sees a failure in this he will rectify it, but I feel it is of such great importance that neighbouring boards should be made to cooperate in such a manner as I have said and also that a board should relinquish the chief executive officer in certain cases of semi-emergency or emergency. Roughly, that is the whole purpose of this amendment.
Is the amendment being pressed?
I do not want to press it. The Minister has said he will look into this.
The Senator can be assured, as I have said, that there is no need for this amendment. If necessary I will have it amended afterwards.
Amendment, by leave, withdrawn.
Debate adjourned.
Business suspended at 6.10 p.m. and resumed at 7.30 p.m.