I move:
That Seanad Éireann approves the following Regulations in draft:
Health (Hospital Bodies) Regulations, 1972 (Amendment) Regulations, 1978,
a copy of which Regulations in draft was laid before Seanad Éireann on 21st November, 1978.
Health (Hospital Bodies) Regulations, 1972 (Amendment) Regulations, 1978: Motion.
The motion seeks the approval of the House to a draft of the Health (Hospital Bodies) Regulations, 1972, (Amendment) Regulations, 1978, as required by section 41 of the Health Act, 1970.
The functions of Comhairle na nOspidéal, as provided for in section 41 of the 1970 Act, are set out in the explanatory memorandum which has been circulated with the draft regulations. That memorandum also details the legal background to the regulations and the necessity for them.
The draft regulations now before the House provide for a continuance of the existing procedure whereby all the members of Comhairle na nOspidéal are appointed by the Minister for Health. The original regulations—the Health (Hospital Bodies) Regulations, 1972— provided for such a method of appointment for the period ending on 31 December 1975. The three-year term of office of members of the comhairle appointed in accordance with those provisions will expire on 31 December next. It is necessary, therefore, to make, before that date, the appropriate legal provision to enable members to be appointed for subsequent periods. This the draft regulations now before the House will do. It would be my intention to continue the practice of appointing members for a three-year term of office.
The 1972 regulations provided for the direct method of appointment of members only for the period ending on 31 December 1975, because it was considered at the time—and, in my view, rightly so—that consideration could best be given to the optimum method of appointing members only when experience had been gained for the actual working of the comhairle over a period. I consulted a very wide range of interests, including medical and nursing organisations, health boards and voluntary hospitals, before putting the present draft regulations before the House. Nearly all those interests favoured a continuance of the method of direct appointment of members by the Minister for Health.
There are, of course, alternative methods such as an election procedure or on the basis of nominations from particular interests or organisations. I am satisfied, however, that the majority view which I have mentioned is the right one and that adoption of any of the alternative procedures would inevitably lead to an unmanageable and largely ineffective body if the need for a balanced representation of interests and geographical areas were to be maintained. I should perhaps point out also that actual membership of the comhairle is not altogether essential for the purpose of securing a completely balanced representation of interests, since the comhairle is empowered to appoint committees for specific purposes, to which non-members may be appointed.
The draft regulations before the House also provide for an increase in the total membership of the comhairle from 23 to 27, of whom 14 must, under the Act, be hospital consultants. The views which, as I mentioned earlier, I obtained from a wide range of interested bodies indicated that some increase in the present membership of 23 would be desirable. The increase of four members which is provided for in the draft regulations will enable me to go some way towards meeting the requests made by a number of those bodies for better geographic representation and for wider representation generally.
I should like to take this opportunity to express in this House, as I have already done in Dáil Éireann, my appreciation of the interest shown by the various bodies which I consulted and of the reasoned and constructive views which they put forward. I am confident they will appreciate that, in an exercise such as this, it is not possible to meet in full the viewpoints of all interests.
I should also like to avail of the opportunity to express my appreciation of the work done by the members of the present comhairle. I know that they have worked diligently and conscientiously in the discharge of their functions and I am most grateful for the time and energy which they devoted to their task.
I recommend that the House approve of the draft of the regulations which is before it.
The introduction of these new Health (Hospital Bodies) Regulations, 1978 are necessary, as the Minister pointed out, because the period ends on 31 December in terms of the original appointments for three years ending on 31 December 1975. To that extent we in Fine Gael support the regulations because of their fundamental necessity. We have reservations for other reasons.
One of the problems with representation which has been criticised and to which the Minister referred is the charge that has been made from time to time that there is not a sufficiently wide geographic representation on Comhairle na nOspidéal, that there is not sufficiently good regional representation. The Minister, to an extent, acknowledges this. He states that he is increasing the number from 23 to 27 partly for this reason, to deal with the question of better geographic representation. It is fair comment to suggest that going from 23 members to 27 on a board such as this is not achieving the objective of getting a wider spread; the interests tend to be narrower, especially when one takes into account the fact that there is a very large and necessary medical consultancy representation, with which we do not quibble.
With the new membership of 27 the ruling will again be adhered to, that an excess of 50 per cent of members will come from the consultant medical profession, which means a membership of 14. Whilst we support the view that strong medical representation is necessary on a board such as this, it means that there is a limitation to the extent to which adequate representation can be given to large community interests, to medical and nursing interests, and the general public. It was for that reason that in the Dáil yesterday our spokesman on Health, Deputy Boland, sought to introduce an amendment which was not acceptable. Being a draft it was either a question of accepting it or rejecting in toto. But he sought an amendment under which there would be substantial representation by the health boards in the form of their chief executive officers. The reason for that was simply to get this better spread, to get a strong regional base in Comhairle na nOspidéal, to give stronger administrative representation and through the chief executive officers being members it would mean that they would reflect the views of their health boards which could result, perhaps, in a better approach, having regard to the whole geographic social aspect of medicine. The danger is that in a grouping of speci alist medical people, whilst the medical input is absolutely sound, there are many other factors which in certain circumstances may not be got right for different reasons. I want to make the point again that the base is somewhat narrower, that we would prefer to see health board representation for the reasons I have stated. I regret that that idea was not accepted by the Minister.
In the Dáil debate Deputy Boland and the Minister had a verbal battle about the Roscommon issue. It is merely one example of the difficulties we can run into. The Roscommon issue was not a question, as the Minister seemed to allege, of the Opposition making political capital of something. What happened there was very simply a dispute within the Minister's party between the Deputies from that constituency and the Minister in regard to who said what. To that extent it was a matter of the Government's, or the Fianna Fáil Party's own making if there was a problem in that area.
Is the Senator giving a quotation?
No, I am just referring to reports of speeches contained in today's newspapers. That is the extent of my contribution.
I should like to welcome these regulations and take the opportunity of congratulating the members of Comhairle na nOspidéal for the very considerable amount of work they do. I do not think we fully realise the considerable burden which is placed on the members of this body, not only in terms of meetings of the full body and their sub-committees but also in terms of this very considerable amount of background work and research which a number of them put into their work in connection with Comhairle na nOspidéal. It is indeed something for which we should be very grateful, that the members of this body discharge their duties with so much thoroughness and conscientiousness, indeed, with such a high quality of input into their deliberations, suggestions and conclusions.
I agree very much with the small increase in numbers which the Minister is suggesting. It is about the maximum; one cannot go very much beyond that sort of size before the body becomes unwieldy and inefficient. Thank God this body—and this is the view of most of those involved—have been functioning very effectively. This further slight increase in representation will enable them to discharge their duties, perhaps not so much better but will indicate just a little more than they are fully representative. I welcome this very much. They are a very necessary and sensible series of regulations.
I am very grateful to the Seanad for the expeditious manner in which they dealt with this proposal of mine to reconstitute Comhairle na nOspidéal. I would like to re-echo in particular what Senator Conroy said about the membership of the comhairle and the job of work they have done. The fact that they may not always have won popular approval for their course of actions is readily understandable; anybody who sets out to do a good job in that sort of area cannot expect to be popular. But that is not what matters. What matters is that they should endeavour to give us a structure of services, a staff structure in the hospital services which would serve the needs of the people to the best possible extent bearing in mind the various constraints we have upon us, financial constraints, constraints which are related to the scarcity of skilled personnel. We want to avoid overlapping. We want to avoid having serious gaps in the structure. All these things must be taken into account. The decisions which are subsequently arrived at will not always necessarily be readily acceptable by those who will be affected.
In the health services unfortunately, in the different areas many people want to have everything everywhere. I have spoken about this before on a number of occasions. It is not possible to have everything everywhere; one must have priorities and rationalisation. One must have a distribution of skilled personnel to the best possible advantage. We cannot have every specialty represented in every area in the country. The general structure envisages the necessary specialties available throughout the country, and, on top of that, certain very technical specialties available at regional level and, finally, some particularly exclusive specialties available at national level only. That is the way we have to proceed. That structure predicates that there has to be a very great deal of thought given to the right disposal and dispersal of personnel throughout the structures.
Bearing all those things in mind the out-going comhairle have done quite a good job. Certainly, they have been very assiduous, dedicated and have put an enormous amount of time and energy into their work. We are all very grateful to them for that. It is my wish to get an incoming comhairle of a similar calibre, a comhairle which will devote themselves to the task with the same energy, dedication and enthusiasm of the out-going comhairle.
We talk about having regional and area opinion reflected in the comhairle. On the other hand, we do not want to go too far with that process. If this comhairle, at national level, are to do their job properly they have to be impartial and very objective. Very often—for the overall structure of the service—it will have to discount particular feelings for particular areas to the extent that the people of that area might wish. Whereas we would like to have all legitimate opinions coming before the comhairle, being expressed, and taken into account by the comhairle, nevertheless the comhairle to some extent will have to be removed, be objective and impartial and look at certain areas and regions as a whole, even look at the national picture as a whole.
The Fine Gael Party in the Dáil made a case about not having the comhairle appointed. Senator Staunton was inclined to reiterate that view here. I do not want to be political about this, but I am afraid the Fine Gael Party in this regard find themselves out of step with the majority of opinion in this area. They are also out of step with their previous opinions, views and actions. All my predecessors, looking at the thing in the round, decided that the only way to get the mixture, spread and representation was to have the Minister appoint the members of the comhairle. Previous Fianna Fáil Ministers came to that conclusion, and a Coalition Minister came to that conclusion. There are so many different interests who would like to be represented that the only final way of arbitrating on the matter is to have the Minister receive all the lists and views that people wish to put before him and then decide, from his central position, how best to reconcile and balance all the different interests involved.
On this occasion a very wide spectrum of views, a wide range of bodies, organisations and institutes concerned in the medical and hospital world were consulted by me. The overwhelming opinion is that, whatever are the disadvantages involved, the best way to do this is to have the Minister make the appointments, not because he is all wise or anything else but because of the multiplicity and variety of the interests seeking representation. No other system will enable us to have a balanced comhairle which will represent, in the best possible way, the best possible mix of these different and various interests.
I am grateful to the House for dealing with the matter so expeditiously. I hope they will be able to approve the motion so that I can go ahead and proceed to appoint a new Comhairle na nOspidéal which I hope will be of great value in helping to continue the development and improvement of our hospital services.
Question put and agreed to.