Limerick East): I will reply to Senator Finneran on the issue of co-operation between the local authorities and the health boards. He also referred to health boards providing accurate information when asked.
Section 5 of the Local Government Act empowers local authorities to represent the interests of local communities in such manner as they think appropriate, and to ascertain and communicate to other public bodies, including the health boards, the views of the local community in relation to functions of those authorities. Section 2 of this Bill imposes a statutory obligation on the health boards to co-operate with local interests and, in particular, to co-operate with local authorities and co-ordinate their activities with them.
It seems that the local authorities acting under section 5 of the Local Government Act and the health boards acting under this Bill will be placed in a position where they will have little choice but to formalise their relationship because, once the statutory obligation is put on the health board to co-operate, it must find some mechanism for formalising that obligation. It seems we could easily move back to what Senator Sherlock requested on Second Stage, that is, the reestablishment of a committee which would be the vehicle for the local authority to fulfil its statutory obligations under section 5 of the Local Government Act and the vehicle for the health board to fulfil its statutory obligations under section 2 of the Bill. I do not want to get involved in dictating the detail but it seems very likely that this obligation will need to be delivered by the health boards in a structured way and that an informal liaison arrangement would need to be formalised because, as the Senator mentioned, the present informal liaison arrangement does not always work.
In terms of providing information, a majority of health board members are local authority members and we are all familiar with the manner of the appointment of health board members and the different constituencies. I have no plan in changing the Eastern Health Board, for example, to diminish that majority position of the locally elected members. When a locally elected member puts down the question under the standing orders of the individual health board, there is a legal obligation on the chief executive officer to provide accurate information. There is an interest wider than simply the membership of the board and it runs back into the wider local authority, which is the level of government closest to the people.
The combination of the two sections to which I refer under the Act and the Bill will make it very difficult for a health board not to have some form of arrangement. I would advise Senators to take up the matter locally either through the health board or the local authority once this Bill passes through the House because this is quite a strong section.
On Senator Sherlock's question about voluntary organisations and the new relationship, the present position is that when it comes to funding health services the health boards are given block grants which they carve up and subdivide into the different areas of their activity, including the acute hospitals under their remit. However, the voluntary organisations for physical or mental handicap, for example, and the big voluntary hospitals are not funded through the health boards but directly from the Department of Health. Outside Dublin and Cork, that comes down to arrangements being made with the Sisters of Charity, the Daughters of Charity. various voluntary groups, section 65 loans, etc., with which Senators will be familiar from their work on health boards. When it comes to Dublin, the Mater Misericordiae, St. Vincent's Hospital, St. James's Hospital, and all the big hospitals not funded from the Eastern Health Board, they are funded vertically from the Department of Health with which they must negotiate.
The policy enunciated by the Minister's predecessor, Deputy Howlin — and this is also my policy — is the health strategy which states that we will change the funding arrangements so that everybody will be funded through the local devolved authority. In most cases, that will be the health boards as they exist at present, although I have made a commitment to change the structures in respect of the Eastern Health Board and I will do so.
That is the big change. Many voluntary organisations which had a good relationship traditionally with the Department of Health asked if they will be disadvantaged. Relationships have been built up over the years with hospitals run by health boards. Hospitals, such as St. John's in Limerick, Portinuncla, the Bons Secours in Cork or the other large hospitals in Dublin, could say it will take time to build those relationships and that they need some protection. I accepted amendments in the Dáil to ensure the voluntary organisations had statutory rights under this section.
When I amend the legislation governing health boards, part of it will be to ensure the voluntary sector is represented on the boards as another constituent part in the way other groups are represented. That is a major change which will take time to implement. There is no such thing as a Minister saying we will do all this on 1 January.
At present, in respect of the organisations for mental and physical handicap in the Mid-Western Health Board and the Midland Health Board areas, pilot projects have been developed to see if we can change the funding arrangement in 1997 but they have not been finalised yet. We started to look at Portinuncla Hospital and St. John's in Limerick as being the first in which we could negotiate a position where they would be funded by the health boards rather than by the Department of Health.
The objective is that the vertical relationship which exists would end over a period and that there would be lateral relationships with the health boards. It is easy to do this in health boards other than those in the east. The problem in the east is that there are huge voluntary hospitals in Dublin and we will have to handle this carefully to ensure every one is brought along with the change. That will result in the Department of Health being responsible for policy and it will have more time to dedicate to it. It will also be responsible for measuring the outcomes of the different hospitals to see if the taxpayer is getting value for money.
At present there are 66,000 people working in the health service while the number of staff in the Department of Health is approximately 320. Much of the time they are managing crisis situations. If there is a bout of flu in winter, all hands are on deck to sort it out. Insufficient time and resources are given to policy formation, another area which is vital is the measurement of outcomes. We can say a hospital is good but we do not have a way of measuring one institution against another. It frequently comes down to the quality of the bedside manner which might not necessarily be a valid measurement of how the hospital is performing.
I would like the Department to have the resources, time and focus to continue to develop policy based on the measurement of what is happening, particularly the measurement of outputs. We must recognise what the voluntary sector has done over the years. Fortunately it will continue to exercise a valid role. It is simply the funding relationship which is being changed and the voluntary sector has asked for the statutory provisions we have happily included.
