Vol. 159 No. 13
There is a correction to the text of amendment No. 1 as printed. The word "substitute" should be included before the words "Metropolitan Health Authority" in the amendment.
Amendments Nos. 1, 2, 3, 19, 20 and 24 form a composite proposal. Amendments Nos. 8, 21, 22, 23 and 25 form a related proposal and all may be discussed together.
I move amendment No. 1:
In page 3, subsection (1), lines 25 and 26, to delete "Eastern Regional Health Authority" and substitute "Metropolitan Health Authority".
I welcome the Minister of State to the House. This amendment repeats a concern which I expressed on Second Stage and is an effort on my part to deal with that concern. I welcomed the view expressed by the Minister that he would be able to do so.
This cluster of amendments is important for the customer of the new health boards. I purposely use the word "customer" because it is with customers that the boards will be dealing. I support the objective of the Bill and my amendments are merely an attempt to improve it. We will improve the quality of our health services if we develop a culture in which the people we serve are treated as customers, the people around whom the entire organisation of the health services revolves. It is important that we see things from their perspective. The customers of the new area health boards must identify with the health boards and consider them as their own. This will be made easier for them if we find a way for them to associate with their health board.
The name of a health board should be such that people readily identify with it and there should be no doubt or confusion about it. The naming scheme set out in the Bill is likely to cause doubt and confusion among at least some of the health boards' future clients. We are asked to think of the South-Western Area Health Board. If someone in Dublin, over the coming months, sees an ambulance bearing that name in the street, he will assume that it has come from Cork or Kerry. A person living in Inchicore or Kilmainham will feel no sense of ownership of that health board. If that person sees a second or third ambulance bearing the words "South-Western Area Health Board", he will begin to think there is an influx of people from Cork and Kerry to Dublin hospitals. The last thing he will think is that he is now part of the south-western area which has suddenly acquired a health board of its own. When people eventually realise that this is what is happening, they will think it is crazy and the first task of the new health boards, which is to identify with the communities they serve, will have been made all the more difficult.
I am trying to find a way to avoid this ambiguity. The same difficulty will apply to the Northern Health Board and the East Coast Area Health Board. The names must be clear and unambiguous or people in the affected areas will assume that the new boards do not know what they are doing.
I live in what will be the Northern Area Health Board. People in Howth or Portmarnock will be confused by this title. It does not include the words "Dublin" or "capital"– and I can see why it does not. The same confusion will occur throughout the new authority's area. We are carving up an area which is, in itself, artificial – the so-called eastern region. No particular bond ties together the people of the three counties involved in that region. When we divide up an artificial area and create three new artificial areas, all we do is cause confusion. We cannot use the word "Dublin" because three counties are involved. The Bill ignores the problem and uses terms which reflect a division of the eastern region but sow doubt and confusion in some people's minds, at least. This runs away from the issue. It is as if the person who drafted this Bill was unaware of the existence of any world outside the eastern region, but there is such a world and the words proposed in the Bill would be more readily associated by ordinary people with places in that world than with the subdivisions of the artificial region.
Names matter, not just commercially, but also if one wishes to create an identity and a link with people who will feel a closeness to that identity. The draftsmen have done things perfectly correctly, but without taking the viewpoint of the customer into account. Twenty years ago I became chairman of a body known as An Bord Poist. There was already Oifig an Phoist, alternatively Oifig an Phuist. We realised that people were not quite sure what An Bord Poist meant and had to have a translation. We sought commercial advice and came up with the title An Post. It has served well for fifteen years. An Post is a commercial concern and one might argue that a health board is not. However, the naming of organisations is a job for professionals and we should not expect it to be done by people who are not, even by people with the considerable talents of parliamentary draftsmen.
In drawing up these amendments I took professional advice and their wording reflects the naming scheme which was suggested to me. I would like to think there is a better name than "metropolitan" but we must find something better than what we have at the moment. My proposal is that the new area health boards be called variations of "metropolitan health board". The variations would reflect where each health board is in the metropolitan area. We would have the north metropolitan health board, the east metropolitan health board and the south-west metro politan health board. I do not particularly like these names but they are much better than the alternatives. From the customers' point of view, the word "area" does not need to be in the name, just as the word "bord" was not necessary in the name of An Post. As the legislation points out, these area health boards will be, effectively, health boards in their own areas. There is no need, in the name presented to the public, to distinguish between these area health boards and health boards in other parts of the country.
Part of the advantage of the word "metropolitan" is its vagueness. It does not have precise meaning in this country and can be used to suggest the area in and around the capital city without being tied down to established definitions of exactly where the metropolis begins and ends. I am not claiming that everybody knows the meaning of the word "metropolitan" or would adjust easily to it, but at least it would not be as misleading as the names proposed. If one was to see an ambulance with the words "South-Western Metropolitan Health Board" written on it, one would think that it came from Cork or Kerry. If people were more familiar with the word "metropolitan" it would not seem inappropriate in any way.
It does not matter a great deal what the overall body is called. It should, however, be linked to the others. It makes sense that if we were to name the area health boards in the way I suggest we should rename the overall body. If the Minister of State wants to stick with the Eastern Regional Health Authority, however, I will not press the matter.
From the point of view of customers of the area health boards, this is a substantive matter, one which will materially affect their success. A doubt is created and it would be incorrect to ignore it. What I am suggesting would be in the best interests of the success of these new bodies. I urge the Minister of State to give it serious consideration. It would be a mistake to create confusion.
I will not repeat the arguments made by Senator Quinn but I agree with the case he is making. Names are important. Even if it would mean that we would not finish the Bill today, I urge the Minister of State to think carefully about what Senator Quinn said.
When the old Dublin County Council was broken up I was sceptical about the adoption of the name "Fingal County Council". For most Dubliners, it did not have great resonance. Ten or 12 years later, it has real meaning. People identify with Fingal and Dun Laoghaire-Rathdown and know exactly where they are talking about. The name "South Dublin County Council" has been the least successful in terms of people knowing where it is.
The same principle can be applied in this case. It is important that people have a sense of ownership and can relate to the names. What we have is a proliferation of geographical regions without great meaning. Senator Quinn has made a full case which I fully support. I urge the Minister of State to think hard. The name produced by Senator Quinn would not be the ideal choice but it is better than the one proposed. Professional advice should be sought on the best name.
I was unaware of this problem until I listened to my colleague, Senator Quinn. While at first glance it appears trivial, he has unearthed something. If I saw an ambulance with "South-Western" on it, I would assume that it came from Cork or Kerry. There may be a degree of confusion and the Minister of State could assist the public by clearing it up.
Senator Quinn used the word "customers". I would use the word "consumers". "Customers" suggests an almost delightful voluntary experience that one has at Superquinn. Nobody voluntarily says, "I have a little touch of measles today, I will go to the nearest hospital".
I am slightly shocked that Senator Manning did not resonate to the word "Fingal". I commend to him the memoirs of Daisy, Countess of Fingal. There were two earls. What about the Fingal Harriers? It is situated north of the Liffey, which may explain the confusion.
Senator Quinn is to be commended for reminding us of something that is often implicit in legislation to do with health care where the recipients of State health care are not seen as customers or consumers but as recipients of State benevolance. This produces an attitude which is not necessarily the most conducive to first-class health care. Senator Quinn has reminded us that the recipients of health care are consumers and customers and should be seen as such, irrespective of how the service is paid for.
This highlights the dangers in leaving the selection of names to the parliamentary draftsman. If somebody in my home town of Athy rings the area health board and the person on the other end of the line says, "South-Western Area Health Board", he or she may think that they have got the code wrong and got through to the wrong number.
Names are important. Senator Norris can be eloquent about the importance of language and about the way it can make a difference. The wording proposed is wrong, it does not resonate and is not something with which people will identify. It will recreate the image that health services are something to which people have access because they are poor, badly off or sick. Nobody would give a commercial business a name like this.
Senator Quinn who has a great deal of experience in dealing with customers or consumers has made a good point. He said that in selecting the name Bord Bia we were making a mistake, that we should choose a title that is readily recognisable. He also gave the example of An Post and An Bord Phoist.
From the point of view of those who will deal with the various area health boards, the more simple the title the better. It would be a minor change. Only the titles of the area health boards would change. The Minister of State should consider the amendment favourably.
While Senator Quinn has a point, the word "metropolitan" is not the answer. Considerable thought was given to the names of the new authority and the three area health boards. The task force spent some considerable time debating the issue and various suggestions were made. I agree with Senators Manning and Norris who cited Fingal as an example. The names of various rivers and mountains were considered. I also accept Senator Quinn's point about An Bord Phoist and An Post. It is about branding, but there is no easy answer.
One of the problems is that the names have to reflect the geographical locations of the bodies concerned. Were it not for the fact that the remit of the authority extends to Wicklow and Kildare, the word "metropolitan" could be chosen. If there was a smaller area which took in the greater Dublin area, there would be no problem with including it. The areas included are Dublin city, Fingal, South Dublin, Dún Laoghaire-Rathdown and counties Kildare and Wicklow. The word "metropolitan" indicates the capital city. Given that rural areas must be reflected in the legislation, the word "metropolitan" would be inappropriate in relation to the authority and the three health board areas.
The point about the South-Western Area Health Board is well made. Issues such as branding and ambulances will still have to be addressed by the new authority. There is no reason why all ambulances cannot be ambulances of the Eastern Regional Health Authority. There will still be a commonality across the three regions in regard to many of the services provided, such as the ambulance service. If one considers the breakdown of the three areas, the east coast area is predominently rural, taking in most of County Wicklow. Having debated the issue at length, it was decided that east coast, south western and northern were the most appropriate titles. The utilisation of names will be a matter for the authority but, in a legal sense, the legislation is naming the three areas. Despite the fair points made by Senator Quinn and others, it was decided that, on balance, what is proposed is best.
Why not combine the two titles and use "metro-west", "metro-east" or "Dublin east region"? This is frequently done in America and would resolve the problem the Minister has identified.
I am not clear about one aspect of the Bill. I presume there is no attempt at central isation of medicine because there should be no problem referring from one area to another. This practice has always been jealously guarded in Irish medicine so that doctors in one area can refer a patient to a consultant or colleague in another area despite the fact that they may not be from within the same sector. For example, I would not like to see a situation develop whereby a colleague of mine working in Dún Laoghaire-Rathdown would find it impossible to refer a patient to a consultant in Beaumont Hospital in the Fingal area. This is an extremely important principle from the patient's point of view and I would like to be assured that the changes being made in the Eastern Health Board will not involve any attempt to change that practice.
I agree with what Senator Manning suggested. The Minister has made the case, a debate has taken place and a decision has been reached. This is exactly what happened in the case of An Bord Phoist and the IDA. The customers of the IDA are foreign industrialists from all parts of the world to whom we are trying to sell Ireland, but the word "Ireland" was not included in the IDA. A company called the Industrial Development Authority was created. This was completely out of touch with reality, given that we were trying to sell Ireland against other industrial development authorities around the world in places like China, Singapore and California. The word "Ireland" should have been included within the Industrial Development Authority. I believe that if we sought professional advice at that time, we would have been advised to create a title which would identify Ireland to its customers. Bord Fáilte's customers are travel agencies from around the world and we did not include the word "Ireland" in that title either. However, it is called Bord Fáilte Éireann now.
We need professional advice in these matters. I would like the Minister to take this into account and we might be in a position to table an amendment on Report Stage. The Order Paper does not indicate that Report Stage is being taken today. I did not expect the Minister to say that this was a great idea, but I thought he would consider it for Report Stage, perhaps next week. Like Senator Manning, I am not enthusiastic about the word "metropolitan", but a professional adviser might make some other suggestion.
I live in the northern area but I am not sure if I am associated with that area. If someone lives in Portmarnock or Skerries, they might assume they live in the east coast area. Nevertheless, they are not in the east coast area, although they live on the coast. The east coast area stops at the Liffey. Therefore, the east coast refers only to the east coast south of the Liffey. It sound more like a radio station. I do not disagree with the term east coast but I suggest that there is a need for professional advice. I would like the Minister to consider what I have said and I will withdraw my amendment until Report Stage. We should not jump into this because there are many examples of parliamentary draftsmen and civil servants who are experts in many areas, but they cannot claim to be experts in the area of branding. I urge the Minister to consider this issue before taking Report Stage.
For the information of Members, it was agreed on the Order of Business to take Committee and Remaining Stages today.
The Senators have made three points regarding branding. I have been around long enough to remember the Balrothery and Rathdown health board authorities. I take the point that area authorities such as the eastern, north-eastern or south-western do not connect with the Irish people. This has been going on for hundreds of years since King John devised the county system. I always take Cork county as being one of the great aberrations because east Cork people have more in common with the west Waterford people than they have with west Cork people. However, this is just an observation of mine.
The other point was about consumer orientation. This occurs mainly in the hospital services. People working in the health services feel they are providing a service and they do not think of the consumer, they think of the service.
There will have to be a significant change in that thinking over the coming years.
Sectoralisation is creeping into the health services, mainly in relation to psychiatric services. If a person has a medical card, they may only attend a psychiatrist in their area. Such a person does not have the freedom of a private patient. A doctor may refer a private patient to a professional he or she believes can offer the services suited to that patient. That does not happen in the psychiatric service. Medical card patients must go to the psychiatric service in the area in which they live. It is a very rigid rule, especially in the Dublin area – I do not know the position in rural areas – and it is nearly impossible to break it down.
I strongly support Senator Quinn. I remind the Minister that a few weeks ago the Qualifications (Education and Training) Bill came before the House and it proposes to establish a new authority. The Bill did not refer to the country in which the authority would operate, although the qualifications awarded by it would apply worldwide. The Minister for Education and Science, Deputy Martin, accepted a number of amendments I put down to add the words "of Ireland" to the title of the Bill. As Senator Quinn said about the IDA, it may seem obvious but it was left out.
Senator Quinn made a series of important points. I know the House agreed to take Committee and Final Stages today but at this stage, this Bill could wait another week. We should take only the Committee Stage today. I ask the Mini ster to reflect on this, although he may still hold the same view next week. This is important as it will be the public face of the new authorities.
If during the course of the week and if Senator Quinn could put his expert research at the disposal of the Minister, as I understand he has done some research on the matter, we could come up with names which will find more general acceptance. I guarantee the House that my party will not be obstructive next week and will facilitate the Minister in every way to ensure Report Stage is completed. Given the length of time the Bill has been around, a delay of a week will not be particularly serious.
I thank Senator Manning for those words. On Second Stage I noticed this Bill was initiated in 1997, if I am not mistaken. I noticed that the name of the late Deputy Pat Upton was mentioned in relation to some of the amendments. If the Bill is that old and has taken that length of time to get through the House, a further week to ensure we get it right would do no harm.
I would be disposed to postponing Report Stage were it not for the fact that this name has been around for nearly three years, since the original work started. While I accept the point made, an amendment being tabled at 3 p.m. yesterday, the final day, would indicate that it is very late in the day to start to talk about such a fundamental change. As a compromise, I am prepared to put to the new authority the contents of this debate. From an operational point of view, there is no reason the authority cannot come up with another name if it wishes. We are dealing with the legal end of things.
In light of the fact that this name has been around for so long – I just looked at documents from the Minister's predecessor, Deputy Noonan – it is too late in the day to start to think again. We need to introduce this legislation immediately and for that reason and as a compromise, I am happy to put to the new authority the contents of this debate, the concerns expressed, the views on branding and so on and to leave it to the authority.
The authority must still deal with a number of issues such as this and it is within its remit to do so. I believe it can deal with this particular aspect. I have to reject the amendment reluctantly but, as I said, this amendment on such a fundamental issue was tabled in the last week. If there were such strong views about it, even when the Bill was going through the Dáil, it is a pity we were not made aware of them at that stage.
I am disappointed and a little concerned. If the Minister is saying there is no point having a debate because after whatever length of time it is too late in the day to table amendments and that he will not consider them, I do not know what we are doing here. That is not treating this House with the respect it requires. The Bill was passed by the Dáil very recently and it came to us a week ago, if I am not mistaken. Although the Minister said we should have tabled the amendments before yesterday, I would be more concerned by the Minister's words to the effect that although we are having a debate today, we must not delay matters, that he does not intend to do anything about amendments tabled and that he wants to get the Bill through after two years.
I have to correct Senator Quinn on a fundamental point. This Bill was issued to Members in November 1998, so let us be fair and straight about it. There is no question that I would not consider amendments but this amendment seeks to make a fundamental change at the last moment. During the debate on this Bill in the Oireachtas and elsewhere, there was never any suggestion for a name other than the Eastern Regional Health Authority. I came here with a reasonably open mind but, having listened to the argument on such a fundamental issue, I am not convinced we should go back to the drawing board.
Will the Minister reply to my point about centralisation? Senator Fitzpatrick made the point most eloquently when he said medical card holders cannot go from area to area within the psychiatric service.
There is no question of any change in terms of referrals between one area and another. We have an efficient system of referrals from other health board areas, particularly to Dublin. It is a major cause of concern in other parts of the country that our acute health services, in particular, are so focused on Dublin and that there is a very serious regional imbalance as a result.
On the point made by Senator Norris on the eastern metropolitan region, the problem is that we are not talking about the Dublin area – if we were this would be an easier problem to solve. It is for that reason the idea is so difficult. That was what the task force found when it quite intensively examined it.
We should accept the Minister's offer. In the main, county and city councillors will run the health boards and they are near to the pulse of the people. Rather than have the Minister issue a fiat on what to call them, why not let the health board decide? There is nothing in this Bill to stop a board calling itself the Fingal health board. The Minister has made a good offer which we should accept.
I rise in defence of this House, although I had not intended to do so because this debate has gone on for a long time. If the Minister is under some illusion that Members of the House will draft amendments to a Bill on the basis of what is introduced in Dáil Éireann, then he has an extraordinary expectation. The reason able position is that one waits until a Bill has left Dáil Éireann where it may be fundamentally re-written. I have seen legislation turned inside out, particularly that which was not the basis of inter-party wrangling but which was so fundamentally flawed, that everybody agreed it had to be re-written.
The classic example was the Child Care Bill which I remember because I was involved in it. It took years to pass through an all-party committee in the Dáil. It was completely rewritten during that process and still had to be rewritten in this House because there were fundamental omissions. That is the way this bicameral system works. It is very wrong for the Minister to wave November 1998 at us. The date on which this Bill became available for consideration is printed on the back of it – it is 19 May, a week ago.
We should confine our discussion to the amendment. We can debate the status of the House on another occasion.
With respect, the Minister's point about the amendments being tabled late is not valid. The whole point of Committee Stage is to tease out the implications of a Bill. The great value of an amendment like Senator Quinn's is that nobody else spotted it. It has come late in the day but that does not mean it is not valid.
We do not want to spend all day on this and I do not wish to be obstructive. It is an important point and I am sorry the Minister cannot be more flexible on the issue. I am sorry he feels the Bill is so important that all Stages must be taken today. The point is sufficient to warrant postponement for one week. As I said – and I always keep my word on these matters – there will be no obstruction.
Senator Fitzpatrick stated the boards may decide to consider the issue and the Minister could recommend them to do so. That would go part of the way and I am prepared to accept his view that the boards will have strong local representation and will be able to reflect the feelings of the areas they represent. The battle is not completely lost and I would like to think of that as a way out if the Minister is insistent on the Bill going through the House today.
I do not intend to delay the Bill on this basis. I wish to correct the Minister, and Senator Ryan also made this point. Part of the reason for my delay in tabling the amendments was that I had used the wrong document. I had not used the Bill passed by the Dáil but the Bill as initiated and there were so many changes that all my amendments except those on page 1 were on the wrong pages. It was not possible to study the Bill until it was passed by the Dáil seven days ago.
It would be worth it to delay Report Stage in this House. I agree entirely with Senator Manning. There will be no obstruction. If nothing better arises at least we will have had one week to consider it. It would be a better Act and there would be a greater possibility of success than if it is passed flawed in a small way.
I repeat the offer I made which has been clarified by Senator Fitzpatrick. I understand the spirit of Senator Quinn's statement and reiterate that I accept its principle. He has a point. Given the consideration given to this subject, the existence of a task force and that it went through two Administrations, I feel it is more appropriate to allow the issue to go back to the board. I will recommend that in view of this debate the new authority should look at this issue. It can be dealt with there.
I reiterate, as a former Member of this House and someone who has suffered the frustration of Governments introducing legislation and not being prepared to listen to good amendments, that I would never come here with a preconceived notion that a Bill would go through this House without careful consideration. I made considerable changes in the only Bill which it has been my privilege to introduce as a result of Opposition amendments. I reiterate this to Senator Ryan and I agree with everything he said in this respect.
In view of the history of this I must stand by my earlier position. I will recommend to the authority that it should look at the issue rather than our considering this again next week. The Bill was published in November 1998 and was circulated to every Member of the Oireachtas. To make a fundamental change on the last day would be doing things the wrong way.
I wish to draw attention to the peculiarities of the legislative process. Perhaps this is an eccentricity of mine. Section 1 contains a definition of a reserved function and an executive function.
I believe the Senator is speaking on section 2.
It is time for Senator Ryan's eccentricity.
I am entitled to it, I have been a Member long enough. Reserve function and executive function are important terms. Reserve function "has the meaning assigned to it by the No. 3 Act of 1996 (as amended by section 24)". The No. 3 Act of 1996 states that it comprises the functions listed in the Schedule. The Schedule refers to sections from the 1947 Act by section number rather than words and to the 1970 Act and the Child Care Act, 1991. If an independent Member like myself – independent in the sense of having to do it on my own – wishes to find out what is a reserve function, he must sift through legislation dating back 40 or 50 years. There must be a better way to do our business than searching through Acts which are 50 years old, some of which do not even have a table of contents.
I support the eccentricity of Senator Ryan. He has a valid point. Perhaps the draftsman might consider ways in which legislation can be made more consumer friendly. Senator Maurice Hayes recently made the point that the 1898 Act setting up our local government scheme was probably the finest legislation he has ever read due to the clarity of language. Anybody reading it could understand it. Senator Ryan has a valid point which applies to more than this Bill. Perhaps the Minister would suggest to his colleagues that draftsmen should consider ways to present legislation in a more consumer friendly way.
I too support Senator Ryan. One can be driven witless reading Acts to try to discover the original meaning of something within a Bill being considered. If the Minister could urge people in the Department and other Departments to have more clarity in definitions it would be a great help to us. We too are consumers.
I recommend to the Senator the CD of the Acts of the Oireachtas as a potential reference source.
Definitions should be consumer friendly but they must also be legally watertight.
They are not mutually exclusive.
I always do this because I believe it is my duty. What are sections 4, 5 and 26 (1) of the Principal Act and section 65 of the Health Act, 1953?
We will give the Minister a moment to find out. We are dealing with section 7(6).
What are the items of legislation referred to in subsection (6) which states "sections 4, 5 and 26 (1) of the Principal Act and section 65 of the Health Act, 1953, shall not apply to the Authority".
Section 13(6) and (7) of the Principal Act were temporary provisions which dealt with the appointment of the first chief executive officers of the health boards in 1971.
What is section 65 of the Health Act, 1953?
Subsection (6) provides that certain sections of the Health Act, 1970 and the Health Act, 1953 shall not apply to the authority because they are being replaced by provisions of this Bill. They are not being repeated because they will continue to apply for the time being to the other seven health boards. Section 26(1) of the Health Act, 1970, and section 65 of the Health Act, 1953 are the mechanisms by which the health boards fund voluntary service providers at present. This will be replaced in the case of the new authority by section 10 of this Bill.
Section 8(2) provides that the authority shall, having regard to the resources available and as it sees fit, plan, arrange for and oversee the provision of services in its functional area. Is that a reserved function or an executive function of the authority? I am confused about the distinction in the Acts.
Reserved functions are clearly defined. The reserved functions include agreeing the annual service plan, adopting annual accounts, approving the purchase or sale of lands and appointing a chief executive officer. Essentially they are functions which must be managed on a day-to-day basis. What the Senator quotes is in line with the recommendations of the task force. It will not provide any service directly. Therefore, it is not a reserved function.
Subsection 3(d) provides that the authority shall provide certain information in its annual report. When will the annual report be published?
The Minister may be confused. I understood that reserved functions of a health board were the major decisions. In the 1970 Act, what are regarded as reserved functions have to do with the appointment of a chief executive officer, the suspension of a chief executive officer, the removal of a permanent officer, the discon tinuation of the provision of a service. It is the fundamental decisions which are reserved functions, but most of the service provision in every section of the Child Care Act, 1991, with the exception of two, is an executive function, and they are not all routine matters. Furthermore, there is an amendment to the 1993 Act which specifically puts into law that a health board shall not take any decision or give any direction in relation to any function of a health board that is not a reserved function. Essentially, the board cannot give a direction or take a decision on anything that is not a reserved function. Such functions are reserved to the executive. It is not just a couple of small details that are left out. It is a huge area of work, including every section, except for two, of the Child Care Act, 1991.
Anything that is not a reserved function is an executive function. Executive functions are carried out by the chief executive officer and are defined in legislation as functions which are not reserved functions. There is no confusion.
I do not know whether the people in the Adelaide and Meath Hospitals, incorporating the National Children's Hospital, should be cheered by reading subsection (4). By an extraordinary coincidence, the Adelaide Society met yesterday and its chairman, Professor Ian Graham, said that the hospital was being starved of funds. Looking at this subsection, I do not know whether it will be better or worse for the hospital that it is getting this special treatment. Does it mean that nothing will make any difference in respect of the hospital? Does it mean it will be in an improved position or that things will be just as bad?
Subsection (4) is what is referred to in legal parlance as a saver. The boards of the Adelaide and Meath Hospitals incorporating the National Children's Hospital had expressed concern that the provisions of the charter that governs the hospital might be adversely affected by the establishment of the regional health authority. The charter, which was ratified by the Dáil in July 1996, enabled the three base hospitals to come together to form the board of the new Tallaght Hospital. This provision has been inserted to ensure that none of the provisions of this Bill will affect the performance by the board of the Tallaght Hospital of its functions under the charter.
I move amendment No. 4:
In page 9, subsection (2)(b)(i), line 19, after "hospitals", to insert "not less than 2 non-consultant hospital doctors,".
It is one of the extraordinary peculiarities of the health service that there is no career grade below that of consultant. There are many in the medical profession who believe it is a wondrous thing and provides a wonderful service. There are many who are not consultants who take a quite different view. It seems strange then that the majority of doctors working in hospital care have no legal right to have any representation on health boards or, in this case, on the Eastern Health Authority. Our amendment provides that at least two of the members of the medical profession should be non-consultant hospital doctors, because they are a large body of people who provide a service.
Let me anticipate a couple of arguments. The first is that they are a frequently changing body. However, every university and institute of technology in the State makes provision for student representation on its board of governors, and that changes annually as student representatives change. If we can deal with the transitory nature of student representation on the governing bodies of our educational institutions, the less transitory, but admittedly somewhat transitory, nature of non-consultant hospital doctors can easily be dealt with.
I support the amendment. There are some consultants who are not in the least happy about the lack of a career structure within the health services. There is movement of non-consultant hospital doctors, but frequently it is within the same area. They are not even necessarily in a different part of the country. Therefore, the fact that they are perhaps only six months or a year in a certain job does not mean it is impossible for them to be on the board. They comprise two thirds of doctors working within hospitals. It is a serious mistake not to have them represented on this authority which is enormous.
The authority is far too big. Having been in the past a member of the Eastern Health Board, which was just a little smaller than this, I know it was a most unwieldy body. I am sorry that so many people are on this but it has apparently been decided that this is the correct thing to do. If nine medical practitioners are to be included, it would be an extremely good idea if this amendment were accepted and two were from the non-consultant hospital body. In numerous other situations now non-consultant hospital doctors are represented and their contribution is extraordinarily valuable.
I support this amendment. If we are to strengthen the expertise of the organisation, this is the way to do it. I support what Senators Ryan and Henry have said.
I oppose this amendment. Where boards are spending public money, as this Eastern Health Authority will be, the only people who should be entitled to be on it are publicly elected representatives. I would not include specialists such as doctors and nurses, who are not answerable to the general public, on the board. This concerns a fundamental democratic principle. I have no doubt that doctors, nurses, NCHDs, etc. can make a valuable contribution, but they are not answerable to anybody other than their own specific interests. When the going gets tough these people are not seen or heard – public representatives on the board have to take the flak. I think we have gone too far down this road. The point has been argued in relation to other legislation discussed in the House regarding the preclusion of public representatives from boards. For example, public representatives are precluded from being chairmen of enterprise boards. These boards spend public money and are answerable to the Oireachtas and the general public, yet we downgrade democracy or our respect for it by putting people who are not answerable on such boards. I make this point not as a doctor – maybe I should speak for my profession – but as a publicly elected representative. It is very important that the idea of democracy and public accountability is kept foremost in our minds.
It is important that we are public representatives. However, there are others with expertise. I have been on boards, such as those of voluntary hospitals, where the expertise of those who served on them through altruism has been invaluable. The board being proposed lacks several things, one of which is the lack in the number of people who can be appointed by the Minister on a non-political basis because of their expertise. We may not like to believe it, but there are many extraordinarily good people who will not run for public office but whose advice is invaluable, particularly at board level.
In relation to other boards the Minister has more power to appoint people with expertise, something which is not being availed of in the context of this authority. This is a mistake. Of course as public representatives we are worth our weight in gold, but there are others who have a contribution to make. Taxpayers' money is important and taxpayers deserve to get the best advice possible, but perhaps the best advice could come from people other than those elected by the public. There are people who will not stand for election and whom I have found to be invaluable on such boards.
I accept the point being made and I am glad that one public representative feels we are worth our weight in gold because some of us are beginning to wonder.
The Bill does not purport to reform the membership of health boards – that is a matter for another day. The task force stated in its report that the issue is one of broader representation for the medical profession over and above that which currently applies in the Eastern Health Board and that it would have implications for the membership of all health boards. I take the point made by Senators, but it is a wider issue which is not covered by the Bill. The Bill proposes a structure which will allow the health service in the eastern region to be planned, managed and delivered in the most efficient and effective way. The membership proposed is consistent with the membership of the other health boards and it is not possible to change it.
I did not expect the Minister to accept the amendment. However, he is somewhat disingenuous in the reason he gave, namely, that it is a matter for more broadly based legislation. The Bill contains the most radical change in the operation of health boards. Section 21 concerning the health board executive provides for a fundamental change in which every executive function of every health board could be taken by a body independent of the health board and the Department of Health and Children without the consent of the members of the board and carried out by a national health board executive. It is disingenuous to say this is a limited Bill dealing with the Eastern Regional Health Authority as tacked on to it is a very fundamental change for all health boards. I accept the Minister will not accept the amendment, but I cannot accept the validity of the argument that the Bill is not sufficiently broadly based. It will bring fundamental change to the way health boards operate. Nothing could be more fundamental than the provision in section 21. What I am proposing is minor by comparison with what is provided for in the Bill.
I move amendment No. 5:
In page 10, subsection (2)(d), line 6, after "Minister" to add "who shall have regard to the desirability of achieving a reasonable gender balance in the overall composition of the Authority".
This amendment is an attempt to address the issue of gender balance. As the Minister is aware, the practice in recent years is to insert a minimum degree of gender balance where appointments are under the control of the Minister. I think everybody recognises that this is a good thing and an overdue development. However, the nature of what we are dealing with here is different as, while most of the members are in theory appointed by the Minister, he has no control over who most of them are. Most appointees will arise through nominations by various bodies as a result of an election. In such a situation it would obviously be futile for the legislation to require a gender balance – it is impossible given the number of separate elections which will take place. It is not possible to dictate to a particular organisation the gender of the person they select – the Minister will have to accept those who are proposed.
This issue has emerged time and again on boards constituted in this manner. The election and nomination process has a tendency to give results which are very unbalanced by gender – there are no prizes for guessing how the balance normally goes. I am sure Members have heard enough about this in the past. My amendment is an attempt to come to grips with the issue. It is highly undesirable to pass legislation of this kind without making reference to gender balance. On the other hand, there is no point in including a provision which is unenforceable or purely aspirational. I am suggesting that when the Minister makes his own few appointments to the authority, one of the elements he should have regard to is the gender composition of the membership which has emerged through the nomination process. Obviously, many matters will be vying for the Minister's attention at that stage and I am not attempting to upstage him. However, we should specify that one of the matters vying for his attention should be the desirability of achieving some semblance of gender balance. Doing so would be a useful gesture.
When the higher education awards legislation was being debated in the House the Minister for Education included a proviso whereby a body appointing two or more people should have regard for gender balance. Given that it was possible to include such a provision in that legislation, I do not see why it is not possible to include such provision in this Bill.
When I was appointed to the Rotunda Hospital, a maternity hospital, 25 years ago, I discovered to my astonishment that the board of 40 was made up entirely of men. They were very distinguished and eminent people, but there was not one woman on the board. After some time, when I had achieved my great ambition of getting a few women on the board, four women – 10 per cent of the board – was considered enough. However, times have changed dramatically. Recently I was told that when an extremely eminent male solicitor of about 60 years of age was approached to know if he would go on the board, he kindly asked whether it would not be better if they found a young woman of child bearing age and that such a person would be a little more useful in the circumstances. There has been a tremendous change in trying to make sure that those involved in running institutions and authorities are more representative of consumers, customers, patients, etc. If will be a great shame if we do not include this in the Bill. The Minister for Education and Science, Deputy Martin, managed to include this in his Bill and I do not see why the Minister for Health and Children, Deputy Cowen, could not do so also.
Every time I speak on the subject of gender balance I get into trouble. I do not support the amendment. I support the sentiments expressed but I do not think law, which should be binding or not, is the place for aspirational gestures. The Minister should be aware – and if he is not he should be reminded – of his responsibilities in this regard. Reluctantly, I could not support such an amendment.
I was interested to hear Dr. Henry's comments. I had the honour to serve on the board of the Rotunda Hospital. Whatever about gender balance, the age profile did not reflect the consumer base. The Minister, if some day he has the power to do so, might write an instruction to Dublin maternity hospitals stating that it would please him and the Department of Health and Children if all future masters were females of child-bearing years. The service, which is excellent, would then reflect the consumer base.
I agree with Senator Quinn's comments. It would be a pity to constrain the Minister's discretion in the manner proposed. It is Government policy that there should be gender balance in ministerial appointments to all boards. The policy stipulates that at least a minimum of 40 per cent should be made up of women. I assure Senator Quinn that that stipulation will be adhered to in this case.
I accept the Minister's assurance. The words were purposely included to be modest. They were not quite aspirational.
Quite in character.
Yes. I will use this opportunity to raise a point with the Minister of State. I am on the board of Hume Street Hospital set up by charter from the king in 1912. The charter states that the board shall be made up of 12 gentlemen of Roman Catholic faith and 12 of non-Roman Catholic faith. That is very interesting. The 24 members of that board are gentlemen. When we tried to change this we were told by the parliamentary draftsman's office that they were too busy to do it immediately. We have two women on the board of Hume Street Hospital both of whom are female doctors, but provision for that change has not been made in the 1912 legislation. Perhaps somebody will find time to do what is necessary to change the legislation or the royal charter of 1912. I hope that will happen in the near future.
That is one example of many whereby our legislation restricts progress.
I move amendment No. 6:
In page 10, subsection (3), line 24, after "day" to insert "pursuant to a recommendation from the Local Appointments Commissioners".
The purpose of this amendment is to put the appointment of the first regional chief executive on the same basis as is later provided for in the case of the first chief executive of the area health boards. It was only upon reading the Bill that I realised there was a difference. We are talking about the time before the bodies are established. It is presumably desirable to put a chief executive in place before the authority and the statutory area health boards are constituted. It is therefore appropriate that the Minister should appoint the first chief executive in each case.
There is no parity between the procedures for appointment. In the case of the area health board chief executives, the Minister is required to act "pursuant to a recommendation from the Local Appointments Commissioners". That is perfectly right and proper and we have no problem with that at all. This section, which deals with the appointment by the Minister of the first regional chief executive, gives the Minister absolute power to appoint whomever he likes. I hope I am not alone in thinking that this is not acceptable. We are surely under a greater obligation these days to avoid even an appearance of any suggestion, shadow or scintilla of impropriety. That is not how the legislation is currently framed. This is a crucial appointment not just for the health services but in the wider context of public administration. To allow any suspicion to enter the legislation that an appointment could be made on the basis of other than the established objective procedure for making such appointments, would be more appropriate to bygone days. I hope this is just an oversight. If so, my amendment will rectify the matter and we can move on. All other appointments are made "pursuant to a recommendation from the Local Appointments Commissioners". We have made an exception and I do not understand why.
I support the amendment. Much concern has been expressed about this issue. It is important, for the Minister's protection, that the Local Appointments Commissioners be consulted on this issue.
It is of the utmost importance that the period of transition to the new arrangements is carefully and competently managed. The implementation of the proposals in this Bill will present a major organisational challenge for the Eastern Health Board, the voluntary providers, the Department of Health and Children and the task force which established the authority. The provision whereby the Minister is permitted to appoint the first regional chief executive without recourse to the Local Appointments Commissioners is being inserted so that a suitable person with the requisite experience and leadership qualities can be appointed without delay. The person will lead and oversee the transition phase and ensure that the new authority is established on a firm footing. The Minister intends to make the appointment as soon as possible after enactment of the Bill.
As the Senator is aware, the Minister stated in the House last week that he hopes the new authority will be in a position to take over the functions of the Eastern Health Board on 1 March 2000. Given the timescale involved, it is vital that the right person is appointed without delay. Accordingly, I cannot accept the amendment.
The date, 1 March 2000, is a long way away. Is it that we are so slow that the Local Appointments Commissioners would not be able to put forward names? That is not a good enough reason. I do not have a serious problem with this. I have a slight suspicion that the Minister already has in mind a person to do the job. That may well be the perfect answer. I wonder why the exception is being made and I do not think the question of time is a valid explanation. This organisation is to operate for many years and the appointment of the first chief executive is very important. The fact that the appointment of the first chief executive by the commission could delay this for a month or two is not a well-thought out reason for not doing so. We should be seen to be appointing the best person for the job whilst ensuring it is done above board.
Much work has to be done before 1 March 2000. It is vital that a person is appointed very quickly. That appointment is for a three year period. There is considerable difficulty in making appointments. I have had the experience of trying to set up the social service inspectorate. The appointment of a person, going through the normal procedures of the Local Appointments Com mission, has taken many months. One of the particular difficulties we came across was that when it was not possible in the first interview to get a person of the calibre we needed we had to go back to the drawing board. It is a slow and cumbersome process but it was felt that in the interest of quick action the first appointment would be made in this way.
This is another classic example of centralisation. Departments are adept at prescribing detailed procedures for agencies under their control. They will say it is hard luck that their procedures are slow but that is how it must be done and how it should be done. When it becomes inconvenient for them to be subjected to similar rules they just change them. This is widespread in terms of reporting and accountability.
Local authorities must report to the Department of the Environment and Local Government. They must seek permission. They must follow detailed prescriptions but they can not get guaranteed structures of decision-making, timescales, etc. Local bodies, health boards, hospitals and institutes of technology must follow a detailed prescribed appointments procedure, no matter how urgently they need new staff. For instance, all the institutes of technology are desperately trying to employ staff to increase the number of students at third level education. Universities are in a similar position. All these sectors must follow carefully prescribed procedures to avoid any hint of misbehaviour. However, central Government does not have to do so. This is the classic inconsistency which devalues the system. If procedures do not apply to everyone then we are saying they only apply to minions and not to real people.
It is not a question, as the Senator said, of creating different procedures. The Local Appointments Commission has the huge task of appointing people throughout the public sector. The commission must fill each post as it occurs. Therefore, it is not possible for the commission to deal with exceptional cases. For that reason it was decided that in the best interest of the authority that the Minister would make the appointment. It is a three year appointment which has been brought about by a unique item of legislation.
I move amendment No. 7:
In page 11, lines 8 to 11, to delete subsection (2).
Subsection (2) is remarkable. I had to read it three times. It smacks more of the Stalinist era than of our bright new millennium of openness and transparency. Do we need to place a draconian restriction on the regional chief executive? Perhaps the Minister did not read this subsection because I did not think anyone would have allowed this subsection to be passed. I cannot believe it was passed in the Dáil without being torn apart and deleted. Do we live under a regime where the merest whisper of criticism of the powers that be is to be suppressed at all costs? I hope not. Is there a precedent in legislation for such a provision? In the time I have spent in the Seanad I cannot recall any legislation coming before us that contained a provision like this. Perhaps I am wrong and there is an explanation for it. To the best of my knowledge I have no recollection of reading anything like it. It is something one might find in a George Orwell novel or back in the 1940s.
What is it about the health services that we require this type of submission and silence to be copperfastened in legislation? It is a ridiculous situation. If a regional chief executive loses the run of himself the Minister has the power to dismiss him. That should be enough control for anyone. It is insulting to insert a provision like this into legislation. Why should this draconian measure only apply to a regional chief executive? Why not apply it down the line? Why not apply it to every hospital porter and nurse? Why insert a provision like this without attaching a sanction? How will a regional chief executive who infringes this Orwellian type subsection be punished? Can he expect a visit from the hospital's thought police at 6 o'clock in the morning?
If we are going to insert an offence in the legislation then we should insert a penalty. I cannot see the sense in this subsection. It belongs to a different era, generation and century. I move that we strike it from the Bill and that is why I called for its deletion in my amendment. Let us delete this subsection.
I support Senator Quinn's amendment. The subsection is a recipe for disaster. If a chief executive officer feels strongly that a policy is damaging an area for which he or she is responsible, under this legislation they will have no option but to resign before they can speak out about it. As Senator Quinn has said, there are no sanctions mentioned but it is an offence for a chief executive officer to speak out. This is an unworkable subsection. Chief executive officers by definition will be responsible people. If they feel a Government policy will damage their area of responsibility then they are obliged to speak out. They should be free to do so. In the past we have suffered too much from repressing things and not allowing people to speak their minds. Anyone should be able to speak his mind without fear of sanction or reprisal.
Hear, hear.
I, too, support Senator Quinn's amendment. Attempts have been made to stifle criticism in the health service but they have been resisted. As the Minister of State will know, directives were issued stating that members of the medical profession could not criticise whatever was happening within a health board area without permission from management. It was unlikely that management would ever give their permission. This suggests that a regional chief executive must do whatever he or she is told to do by the Minister, no matter how seriously deficient or wrong they consider the policy being pursued by the Government or the Minister. This could have such an immediate and detrimental effect, particularly in the health sector, that it would be unwise to leave this subsection as it is.
I support my colleagues. This is a directive to the regional chief executive that if he comes before the Committee of Public Accounts he must not express an opinion on the merits of any policy of the Government when he is asked about the matters on which he is required to report to it.
Section 13 refers to "the regularity and propriety of the transactions recorded or required to be recorded" and "the economy and efficiency of the Authority and the Area Health Boards in the use of their resources". The regional chief executive is supposed to explain how his area health board and the authority are using their resources efficiently. If he feels he is underfunded by the State and cannot provide the proper controls, he is not allowed to tell the Committee of Public Accounts because the Government has an embargo on its staff. The section provides that when he goes before the Committee of Public Accounts he "shall not question or express an opinion on the merits of any policy of the Government or a Minister of the Government or on the merits of the objectives of such a policy".
If, for example, the Government imposes a freeze on appointments and it turns out there is poor cost control because staff cannot be appointed, the regional chief executive must sing dumb, although he knows the reason he cannot have adequate cost control is because he is not allowed to employ staff. He is being directed not to give information to the most important committee of Dáil Éireann, which has been set up under the Constitution. It is the only one with constitutional status. We are introducing into legislation a directive to an employee of the State that he must not co-operate fully with the Committee of Public Accounts. This is a profound affront to the Constitution.
We are indulging in hyperbole. Chief executive officers are the servants of the board which appoints them. Senator Ryan's apocalyptic vision will not come to pass because a chief executive officer is in daily contact with the Department of Health and Children and their officers. The nature of the work of a chief executive officer means he must carry out the instructions of his board. There is nothing to stop him putting his opinions on paper and bringing them to the notice of the Department. We must have a poor opinion of the Committee of Public Accounts if we believe it would not cross-examine chief executive officers in detail about their stewardship. It may be overstating the case to say that chief executive officers, who are not a downtrodden class and are well able to look after themselves, are being put down.
This subsection is in the Bill because they are inclined to make their opinions known.
I am surprised Senator Quinn is proposing to delete subsection (2) which is a standard provision that applies in all legislation relating to the appearance of public officials before the Committee of Public Accounts. I do not accept that the provision muzzles chief executive officers any more than it muzzles a Secretary General who comes before the committee. We are trying to maintain the impartiality of our public administration system, which has served the country well. It would be a retrograde step to change it. This is a long-standing tradition which applies to appearances by secretaries-general of Departments.
The Senator is seeking to amend an accountability measure. The regional chief executive will appear before the Committee of Public Accounts to account for the expenditure of the authority and his stewardship of it in implementing Government policy. The chief executive officer, like any other official, cannot be put in a position where he or she would be critical of the policy of the Minister. To do so would entail a major change in the political culture of our public service. I doubt that would be a change for the better.
In seeking to delete subsection (2), the Senator has misunderstood an agreement by all sides of the House. Under the Committees of the Houses of the Oireachtas (Compellability, Privileges and Immunities of Witnesses) Act, 1997, the House agreed that civil servants could not make a statement on the merits of a policy. It would be a retrograde step if we changed that. The Senator does not understand the implications of deleting this subsection.
I do not remember seeing such wording in a Bill before. Subsection (2) states:
In the performance of his or her duties under this section, the Regional Chief Executive shall not question or express an opinion on the merits of any policy of the Government or a Minister of the Government or on the merits of the objectives of such a policy.
I am surprised at the Minister's comments that this is normal. Senator Fitzpatrick said there is nothing to stop a regional chief executive from putting his opinions on paper. He would be breaking the rules if he did that. The subsection does not state that he "shall not question or express an opinion verbally" but that he "shall not question or express an opinion". He is expressing an opinion if he puts it on paper. Is it possible to express an opinion on paper but not verbally?
I am confused. While I support the practice outlined by the Minister because I do not want the Secretary General of a Department to make political statements which are partisan if he disagrees with the Minister but objective if he agrees with him, I want the Secretary General to appear before the Committee of Public Accounts, if that is appropriate, to answer for his or her stewardship. I want that practice to continue because it preserves the correct balance. Like Senator Quinn I am puzzled by the draconian nature of the section and by the apparent need for its existence in the Bill. It does not have to be included and the world would still be the same.
Perhaps I did not express myself correctly. We are talking about the separation of powers between the policy makers, the politicians and Government of the day, and those who implement policy, the Civil Service. This separation of powers must be real and apparent. Civil servants express opinions not so much on the merits of proposals but on their implementation. Their daily work is to implement edicts or instructions from the policy makers. If we blur the distinction between the Civil Service and the Government, we will go down a slippery slope.
I am reluctant to take issue too greatly with the Minister of State. The chief executive officer is accountable to the authority, not to the Minister. He is not a civil servant at the head of a Department who is clearly accountable to the Minister and that is the difference. The reason the Secretary General of a Department should not express dissenting opinions is because his boss decides policy. The eastern regional authority is the boss of its chief executive officer and it could have a view on Government policy which he or she is forbidden to express if he or she appears before the Committee of Public Accounts. The chief executive officer will not be allowed to carry out the legitimate instructions of his or her employers because it would embarrass a Minister. That is the fundamental difference between the role of the chief executive officer of the authority and the Secretary General of a Department. Will the Minister of State name another agency where the chief executive officer is in a similar position?
In response to Senator Manning, the section is modelled on section 19 of the Comptroller and Auditor General (Amendment) Act, 1993, under which Secretaries General appear before the Committee of Public Accounts. I am glad he clarified his position because I was going to invite him for a pint to discuss the matter.
The Minister of State can still invite me.
I appreciate the point made by Senator Quinn and that he does not understand the background to this. However, as Senator Fitzpatrick said, it is essentially a question of the separation of powers. If we were to follow Senator Quinn's logic, we may as well allow the permanent government take to over while we go to the pub.
Is that not what we are talking about?
The bedrock of our system is that policy is decided by elected representatives and it would be a retrograde step if civil servants were able to question policy in a public arena set up by the Oireachtas.
That is not true.
The Minister deals with the authority and the chief executive officer implements its policies. There is no differentiation between the chief executive officer of the authority and Secretaries General in Departments.
I have a problem with the provision and I am glad Senator Manning intervened. I agree entirely with the separation of functions. However, Senator Ryan explained the matter. The employer of the chief executive is the new authority. It comprises 55 people, 30 of whom are elected representatives from councils in the region. The Bill does not state that the chief executive officer must not express an opinion publicly. That is why Senator Fitzpatrick's intervention attracted my attention. Section 13(2) states:
In the performance of his or her duties under this section the Regional Chief Executive shall not question or express an opinion on the merits of any policy of the Government or a Minister of the Government or on the merits of the objectives of such a policy.
That is draconian if the chief executive officer's employer is the new authority. Why set up a new authority if it cannot have any power, even though it comprises 55 members, 30 of whom are elected representatives, is not an employer and its chief executive officer must never question a Government or ministerial decision? It is bad law and it would be wrong to allow it to stand without reconsideration.
The chief executive officer is a servant of the authority. If he or she says that the policy being pursued is wrong and gets his or her way, he or she becomes the authority. What happens to public representation? Where is public accountability?
The Minister is protected.
The chief executive officer cannot criticise the Government.
We are talking about policy.
Senator Quinn is missing the fundamental point. Health boards are bound to carry out the policies initiated by the Minister.
That is true, but they are not required to keep their mouths shut.
The Senator misunderstands me. Nobody is asking the authority to keep its mouth shut.
If the authority is directed by the Minister to do something which causes waste, the Comptroller and Auditor General will then investigate and identify the waste. The authority will say that because it is doing what is required under law, resources will be wasted. The chief executive officer cannot communicate that fact to the Comptroller and Auditor General. He is precluded from discussing the merits of the objectives of such a policy with the Comptroller and Auditor General, even privately.
I want to know if a similar provision exists in regard to other bodies. The Minister of State said that this occurred widely but quoted one inappropriate example, that of the Secretary General of a Department. Does it apply to city managers or the chief executive officers of SFADCO or the IDA? If any of them appear before the Committee of Public Accounts, are they allowed to express an opinion on the merits of Government policy on behalf of their employers? The Minister of State must have many examples of such a provision, otherwise he is making this up as he goes along.
The Senator completely misunderstands what we are talking about, which is an appearance by the chief executive officer before the Committee of Public Accounts. He or she is entitled to bring his concerns on any matter to the attention of the Comptroller and Auditor General. The chairman or any member of the authority is quite within his or her rights to publicly criticise the Minister or his policies, as they do every day; I have no problem with that.
According to this legislation the only person who can be summoned and required to appear before the Committee of Public Accounts is the chief executive officer. Section 13(1) states:
The Regional Chief Executive shall, whenever required by the Committee of Dáil Éireann established under the Standing Orders of Dáil Éireann to examine and report to Dáil Éireann on the appropriation accounts and reports of the Comptroller and Auditor General, give evidence to that committee . . .
He is the only person who can be compelled to appear before the committee but is not allowed to express the views of his authority on Government policy.
I hope I am incorrect but I do not understand this. Section 13(1) states:
The Regional Chief Executive shall, whenever required by the Committee of Dáil Éireann established under the Standing Orders of Dáil Éireann to examine and report to Dáil Éireann on the appropriation accounts and reports of the Comptroller and Auditor General, give evidence to that committee on . . .
Section 13(2) states:
In the performance of his or her duties under this section the Regional Chief Executive shall not question or express an opinion on the merits of any policy of the Government or a Minister of the Government or on the merits of the objectives of such a policy.
I have great difficulty with this because I do not understand why, if the chief executive officer appears before the committee, he or she cannot comment on or criticise Government policy. If we are to have a healthy and successful organisation the chief executive officer must be able to question policy when asked about it.
Senators are not making a distinction between policy and implementation of same. The chief executive officer is responsible for the implementation of policy, not its formulation. Why should he or she have an opinion as long as he or she carries out his or her duties as instructed?
This is a matter of a person called before the committee to answer for his or her stewardship in implementing Government policy. Subparagraphs (a), (b), (c) and (d) of section 13 spell out the reasons why the chief executive officer would be called before the committee.
Will the Minister of State tell me where else this applies outside the public service? Are there precedents for this provision in other legislation which deals with the role of chief executives of other bodies where certain authority is devolved? If there are, will he tell me what they are?
There are but I am not in a position to supply their names. I will forward them to the Senator immediately.
I have been in this House for a long time and I do not remember a provision like this being introduced before.
If Senator Ryan wishes to put down a motion to the Members of both Houses to change this fundamental principle, he can do so and see how much support he gets. I doubt he would get much.
I will not press the amendment but I would like the freedom to come back to this on Report Stage, which I hope will be next week and not today.
Amendments Nos. 9 and 12 are related and may be discussed together by agreement.
I move amendment No. 9:
In page 11, subsection (2), lines 21 and 22, to delete "and may acquire, hold and dispose of land and other property".
This amendment refers to a point I made on Second Stage. It involves needless duplication to set up a regional health authority over a trio of area health boards. The four entities are then to be equipped with the same powers as if they were totally independent of each other. Either the area health boards are subsidiary to the regional health authority or they are not. If they are, and I believe they should be, then we have the opportunity to save considerable expense by centralising such issues as property ownership. The ownership and management of property is a distinct professional skill. Specialist expertise is needed to do it properly and it is not a matter just for clerks. It is unreasonable to expect this expertise to be put in place in an area health board and, although I doubt this will be done, it would be an unnecessary expense to put it in place in each one.
When one thinks considers that the Office of Public Works looks after Government property in the whole country and the expertise in that body, one sees how inappropriate and foolish it is to try to duplicate property management and expertise down the line. At the very least we should not take it below the level of the regional health authority. It is that body which should look after central issues which can best be looked after at that level. By duplicating them at health board level we create a whole new series of self-sustaining little empires and we increase expense unnecessarily. In all probability we will end up in a position worse than the previous one.
I am all for devolving decision-making right down to the customer interface but that does not, need not and should not apply to administrative matters which can be done much more economically at the regional level. When one sees provisions such as this in the Bill it is almost as if someone thought we were setting up three independent health boards to replace the Eastern Health Board. That is not the intention, of course. We are putting in a two-tiered structure: a regional authority and individual health boards. Unfortunately, that idea seems to have been lost along the way and what we have is a two-tiered structure with functions duplicated across the area health boards that would be done just as well, if not better, at the regional level. I suggest we leave it to the higher level.
I was on the Eastern Health Board and it did not know how much property it owned. The board had to appoint an estate manager and he did an outstanding job, although it took him years to trace all the property that belonged to the board. The board faced the problem, although it was unaware of it, that certain areas were not represented on the board, so councillors who would have known about old health centres, garages and so on were not there. It was very costly to collate all the evidence and trace deeds through the Land Registry but it was done eventually. However, if this function was devolved to the local level again, local councillors on area health boards would have better knowledge and would be better able to oversee the disposal or acquisition of property by the health board.
What if there is a conflict between the authority and an area health board about the property to be bought in a certain area to set up a clinic, for example? Would the views of the authority or those of the health board prevail? This is the kind of practical problem I see arising from such duplication of powers.
I understand the Senator's concern to avoid unnecessary duplication. These provisions are essential in order that the authority can delegate effectively to the three boards. For example, there would be an amount of litigation against the Eastern Health Board at any one time and by giving the area health boards the power to sue and be sued in their own name, the Bill allows this work to be delegated.
The powers in relation to property allow for the possibility in the future of delegating to the area health boards functions in relation to the development of facilities within their own area. I emphasise that the Bill does not provide explicitly for the delegation of either of these functions. It is for the authority and the regional chief executive to decide which functions are to be delegated. The purpose of the provisions is to ensure that the Bill does not inhibit the authority from delegating power in the future if it so chooses.
I accept that.
Are the area health boards covered by the Freedom of Information Act? How does it apply? I have a further amendment relating to the executive. The authority is covered explicitly because it has the nature of a health board but these bodies do not have the nature of a health board.
They are covered by the Freedom of Information Act.
How? The Bill states that any reference to a health board shall be construed as including a reference to the authority.
They are covered as constituent bodies.
I take the Minister of State's word for it but they are independent.
I move amendment No. 10:
In page 12, subsection (1), line 22, after "Board" to insert "which shall include in each case at least one member of each profession referred to in paragraph (ii) to (v) of section 11(2)(b)”.
This amendment addresses a concern that the non-medical professions, which are very important in the provision of health services, would not have adequate representation on the area health boards. We wish to require that the regulations the Minister makes about the membership of the health boards shall include in each case at least one member of each profession referred to in paragraph (ii) to (v) of section 11(2)(b). The requirement would be to have nurses, pharmacists, etc. represented on the area health boards.
Concern was expressed during the debate in the Dáil about representation on the three area health boards for the registered professions which have only one representative on the authority. The professions in question are general nurses, psychiatric nurses, pharmacists and dentists. The Minister accepted that there was a problem and, in response, tabled an amendment which provided that those professions would be entitled to attend meetings of the area health boards of which they were not members. This amendment was agreed by the Dáil on Report Stage and now forms subsections (7) and (8) of section 16. Subsection (7) provides that the members of the authority who are representatives of the general nurses, psychiatric nurses, dentists and pharmacists will be entitled to attend meetings of the two area health boards of which they are not formal members. They will be allowed to participate in the discussions of those meetings but will not have voting rights. Subsection (8) ensures that expenses can be paid for those attending meetings in an observer capacity.
The amendment proposed by Senator Ryan and his colleagues does not address the issue in question adequately. The effect of the amendment would be that each of the four individuals concerned would be full members of the three area boards. This would add two or three new members to each area health board and would upset the balance of membership between local authority members and others. In two of the three boards the effect would be that the local authority members would no longer be in the majority. As majority representation for elected representatives if a key concept of the Bill, I cannot accept the amendment.
The Bill also provides for representation of these professions on the area health boards in a manner which does not interfere with the overall balance of membership of the authority. Accordingly, I ask the Senator to withdraw the amendment.
I move amendment No. 11:
In page 15, subsection (6), line 7, after "1993" to add "and the Minister shall, as soon as may be, cause a copy of the said financial statements to be laid before each House of the Oireachtas".
The purpose of this amendment is to ensure there will be no delay in laying the accounts before the Oireachtas and that the Department will do so promptly. This provision is standard in new legislation and is provided for in section 17 which deals with the report of the accounts of the health board executive. We have before us the old, not the new mode. There should be no doubt which one we should follow.
One of the few things I have achieved in this House is the early publication of accounts. In November two years ago I asked for the RTE accounts of the previous year. I was told they were not yet published. On further inquiry, it was discovered that RTE had given the accounts to the Minister four or five months previously. The accounts were published within a week. This amendment attempts to ensure that the Minister does not hold on to the accounts and that they are presented to the Oireachtas as soon as may be. I am sure the Minister will accept this amendment.
I support Senator Quinn. It is too easy for reports to become historical documents before they are seen publicly. I am sure the Minister will see the sense of this amendment and accept it.
The amendment is not necessary. Section 17(7) already provides for the consolidated accounts of the authority to be laid before the Oireachtas as part of the package of accounts relating to the activities of the authority. Section 18 provides for the five sets of accounts to be laid before the Oireachtas. Section 17(7) provides that when the Minister has received all five sets of accounts he will submit them as a package to the Oireachtas. This will enable the Oireachtas and the Committee of Public Accounts to obtain an overall picture of the expenditure in the region. The amendment is not necessary.
In my determined pursuit of legislation which one can understand, I ask the Minister what are "choses-in-action", as referred to in section 19(3)? I am not trying to make life difficult for the Minister. Are they French things in action?
It means property transactions which are under way and not yet completed.
I am educated further.
I move amendment No. 13:
In page 16, between lines 26 and 27, to insert the following new subsection:
(2)Where but for this section the Organisation of Working Time Act, 1997, would not prevent the Authority or a Board from entering into or approving a contract of employment which provides for hours of employment (including training and on-call periods) of more than 48 hours (or, for a transitional period of 7 years from the passing of this Act, 54 hours) per week in any week, averaged in accordance with that Act, no such contract of employment may be made with or approved by the Authority or a Board.
This is a topical amendment. Many people are becoming more and more bemused at the astonishing hours we expect non-consultant hospital doctors to work and believe the Government handled this issue very badly in recent weeks. The amendment seeks to ensure that, for a transitional period of seven years from the passing of the Act, nobody can be required to sign a contract to work – where work is defined as training and being on-call – for more than 54 hours per week and after seven years, more than 48 hours.
There appears to be a macho – a terrible word to use about a profession which is increasingly female – mystique about medical training which requires people to work insane hours. I am the spouse of a medical doctor. I was associated with my wife when she was a junior doctor and saw her soporific condition on many occasions when she had worked one or two nights with virtually no sleep. I have no idea what purpose is achieved by this system which pretends to provide medical care under conditions which would not be tolerated in any other area. I have some experience of the pharmaceutical industry. If a company in that industry were to require people to work those hours continually, the Health and Safety Authority would close it down. The system is dangerous to the health of doctors and patients. We propose this amendment to begin to put sensible regulation on this area.
I have spoken on this subject many times and I support fully what Senator Ryan and his colleagues seek to do. Senator Farrell said, on the Order of Business this morning, that people worked these long hours 20 and 30 years ago and that had been fine. It was not fine. I was a non-consultant hospital doctor then and it was not fine at all. It was extraordinarily foolish to have us working such hours and it is even more foolish nowadays when there has been a great increases in technology and in the expertise expected of junior doctors. Patient expectations are also much greater now than they were years ago. We are allowing ourselves to continue arrangements in which the health of doctors and patients is severely affected. Medical insurance company reports show how frequently problems arise when people have been on duty for a very long time. What is the reason for perpetuating this stupid practice? It does not improve the practice of medicine or the treatment of patients. There is considerable evidence to show that this is a foolish practice.
There appears to be no separation of thought between the Department of Health and Children and the health authorities in the United Kingdom. It appears that if the Department is in doubt about any matter someone telephones the UK authorities in the Elephant and Castle to ask what they are doing. This practice has led us into serious difficulties in many cases and I wish we would stop it. Ireland and the United Kingdom were the only two countries who pressed in the Council of Ministers for the long interim period before bringing in better working hours for junior hospital doctors. I compliment Commissioner Pádraig Flynn on the work he has done on this issue. His disappointment that his work has not borne fruit is shared by me and a large number of those who work in the hospital service.
I said what I had to say about hospital doctors and the scandal of their working hours on the Order of Business yesterday and today. I agree with the sentiments of my colleagues. I have a problem, however, with the amendment. Bringing forward what would be a partial solution which would apply only to one section of the medical profession is not a good way of tackling the problem.
Senator Ryan has used the opportunity in an enlightened way to force the issue. What I would like is an acknowledgement of the failure of suc cessive Governments to tackle the problem. There are serious risks. I would be much happier if the Minister of State could give a commitment that, rather than wait for the nod from London or Europe, an Irish solution to the problem of junior hospital doctors will be produced within a short time.
Everything that I wanted to say has been said by Senators Manning, Henry and Ryan. It has not been explained by anybody why we cannot act on our own on the question of junior hospital doctors. Reference has been made to London and Brussels. Last Friday, following a little accident, I was admitted to the emergency ward at the Mater Hospital where I was well looked after. It did not dawn on me at the time that the doctors may have been working the number of hours that I have been told they work and something might have gone wrong. We do not appreciate the value of those working these outrageous hours until we suddenly have to undergo treatment. The Government has to explain its position and, even better, do something about the problem.
I wish the Senators were about when I went through the mill.
I was.
The Senator is far too young. In my time the average number of hours worked per week was 100 and one was expected to do it. Times have changed. Senator Henry alluded to the introduction of technology.
General practitioners, especially rural GPs, provide continuity of care. In introducing shorter working hours for junior hospital doctors in training there is a need to educate patients not to expect continuity of care by the same person.
I support Senator Fitzpatrick. The Minister of State has much to look at. Many general practitioners and hospital consultants retire in their late fifties and early sixties. Experienced labour is being lost. The Irish Hospital Consultants Association recently produced some interesting figures. Consultants who retire at 62 live on average seven years. Those who retire at 65 live on average a year and a half.
Senator Manning commented on Senator Ryan's ingenuity in tabling this amendment. I am reminded of a comment made many years ago by the actor, Mick Lally, on the practice of students in UCG of sitting on the bonnet of their favourite professor's car outside the archway, not alone solving the problems of the university but those of Galway, Ireland and the world.
I compliment Senator Ryan on his ingenuity. While all agree that this is a problem that needs to be solved urgently, it would be more appropriate to deal with it in the Organisation of Working Time Act, 1997. The Minister will make a substantial statement on the issue at Question Time in the Dáil later today.
In November 1998 the European Commission brought forward proposals to bring excluded groups, including junior hospital doctors, within the 1993 working time directive. In the case of junior hospital doctors, the European Commission proposed a transition period of seven years during which junior hospital doctors could not work more than 54 hours per week. A significant number of member states, including Ireland, regarded the proposals as impractical. The matter was discussed at a meeting of the Labour and Social Affairs Council on Tuesday. Ministers unanimously agreed to a 13 year transition period. We did not slavishly follow the United Kingdom which sought a 15 year transition period. It was unfair of Senator Henry to accuse us of slavishly—
I am glad moderation was exercised.
The relevant provisions will be implemented in five stages. The matter has been referred to the European Parliament. The Minister is anxious to bring about an improvement.
Given that the Minister will make a statement on the issue later today I will not press the amendment. I am not agreeable, however, to the next group of amendments being grouped.
We now proceed to amendment No. 14. It Is suggested that amendments Nos. 15, 16, 17, 18 and 26 are related.
I would like amendment No. 15 to be taken separately.
It may be taken on its own. Amendments Nos. 14, 16, 17, 18 and 26 may be discussed together.
I move amendment No. 14:
In page 17, subsection (1), line 6 to delete "Health Boards Executive" and substitute "National Health Boards Executive".
The case for this amendment has been made. I will not repeat it.
As the Minister stated at the commencement of the Second Stage debate in this House, health board chief executive officers have been meeting regularly and co-operating voluntarily for many years. Up to now, however, they have not had the legal powers to enable them to conduct this activity formally. The purpose of the section is to give them a legal basis to act jointly as a group, employ staff and acquire office space to further their co-operative ventures.
The executive relates only to the performance of the collective executive functions of chief executive officers on behalf of health boards. As such, it will not be a national body in the accepted sense of the term. It is important that the nature of the new body is reflected in the title. Consequently, I cannot accept the amendments.
It is proposed that the Minister should consult with each health board before deciding what functions the executive might perform and before making regulations under the section. The functions to be exercised by the health boards executive will be executive functions only. Under the Health (Amendment) (No. 3) Act, 1996 which was enacted under the previous Administration, the members of a health board are prohibited from taking any decisions or giving any directions in relation to the exercise of executive functions. In my view there is little merit in consulting with a body which has no function in relation to the matter in hand. However, there is no question of keeping the members of the health boards in the dark about the activities of the executive. They will be kept informed by the chief executive officers in accordance with existing legislation. Subsection (16) of this section explicitly provides that chief executive officers must inform their health boards whenever they delegate a function to the executive. There is no need, therefore, for these amendments as they would add to the bureaucratic and administrative machinery to no great affect.
The fact that functions are separated into reserved and executive functions is understandable, although one could spend a lot of time arguing about what should be executive and reserved functions for all bodies, whether health boards or local authorities. The fact that the legislation was introduced by the previous Administration does not concern me because I was not a member of a party involved in that Administration, least of all a member of the previous Administration. However, I am concerned about the setting up of a body to centralise a series of enormous parts of the operation of the health service because reserved functions are the only ones which the health boards can insist be carried out. For instance, only two sections of the Child Care Act, 1991 to do with child care advisory committees and with a review of services are reserved functions. All the other functions of that Act are executive functions. We are bringing all of this potentially under the aegis of a body which may not even be covered under the Freedom of Information Act. We should discuss this matter separately because it is of fundamental importance.
I find it extraordinary that we are saying chief executive officers of health boards, who give their members more than enough trouble because of their capacity to operate independently, should now be given an entirely separate forum within which they can make these decisions and simply inform people afterwards about this. We are taking away functions on which there is already an executive power – it is the executive of a health board who has to do this – and while he or she cannot be directed or instructed to do something contrary to what he or she wishes to do in exercising his or her executive functions, members are in a position to express opinions, demand information or add information to supplement the information available to a chief executive officer. All this can be potentially taken away by these provisions.
This is a classic centralising provision. The belief that the centre knows better than the regions has been a fundamental flaw in Irish public administration for 77 years. Because there are difficulties with awkward customers who are members of health boards, the solution seems to be to take it all back and centralise it. This is a classic mistake which will not work and will produce alienated health services run by people who are not accountable to the people they serve.
No one objects to intelligent collaboration. I said to someone yesterday that if the chief executive officers of health boards are not collaborating intelligently, they should be sacked. It should not take an Act of Parliament to make them engage in sensible collaboration. This is not sensible collaboration, it is a transfer of power to a new body, the health boards executive. That body will have executive power in all the areas where chief executive officers currently have executive power. That is an enormous amount of power. If an equivalent local authority executive were created whereby the county manager and city managers would come together and decide independently of the elected members how they would do things, there would be outrage, and correctly so, from members of local authorities. We are doing precisely this in the case of the health boards and the least we could do is insist that members agree to this transfer of power.
Will this interfere with the collaboration between health boards north and south of the Border? There is very good collaboration, as the Minister knows, between the North Western Health Board and the North Eastern Health Board and the North Western Health Board and Southern Health Board in Northern Ireland. It would be a great pity if that collaboration did not continue because it has produced some extremely imaginative schemes and great savings for both areas.
On listening to Senator Ryan, I do not get the same impression from the section. This will be more in the nature of a collaborative body to pool information. We already have the City and County Managers Association on which I presume this is modelled and, as a public representative, I do not feel threatened in the discharge of my duties by this association.
The legislation is not about taking away anyone's functions, it is about collaborating on functions more effectively and giving the legal powers for that collaboration. If we are bedevilled by anything it is by the fact that we do not have proper collaboration, a proper inter-agency approach, synchronisation and co-operation between the various Government agencies. This is the single most significant impediment to progress in my area of looking after the interests of children.
The section states, "The Executive shall be a body corporate with the power to sue and be sued. The Executive shall provide itself with a seal and all courts of justice shall take judicial notice of the seal." It is a corporate entity. It states also, "The Executive shall perform, on behalf of the health boards [not collaborate] such executive functions of the health boards as may be specified, from time to time, by the members of the Executive who are the chief executive officers of the health boards." In other words, it will do on behalf of the health board that which the executives of the health boards, on their own, without reference to anyone else, will decide shall be done, or other executive functions in relation to improving the efficiency and effectiveness of the health and personal social services as the Minister may, from time to time, direct. The Minister can tell them to do other things in addition. Again there is no reference to the health boards. There is a City and County Managers Association which meets, discusses and co-ordinates, but it does not have the power to carry out executive functions, take them from the health boards and carry them out centrally through an executive, nor does the City and County Managers Association have the right to claim that the expenses shall be met by the health boards. This means there will be an executive which may undertake whatever executive functions it wishes and then insist that the health boards provide it with the funding. If the members of the executive do not agree, the Minister can make the decision, and if the health board declines to provide the funding on which the Minister decides, he will deduct it in the budget the following year. This is not a case of meeting every two months and having an intelligent discussion. This is a body with power and teeth to exercise considerable functions and powers. I realise the aspiration is to provide better services, but it is not an innocuous talking shop, it is a body with enormous power. It has the combined executive power of all the chief executive officers of the health boards. That is a fundamental change in service provision.
Chief executive officers have executive powers. They are obliged to consult with their health boards on various issues. Senator Ryan's description of this body is not accurate, nor is his interpretation of it correct.
I move amendment No. 15:
In page 17, between lines 7 and 8, to insert the following new subsection:
"(2) Paragraph 1(2) of the First Schedule to the Freedom of Information Act, 1997, is hereby amended by the addition, after 'the Environmental Protection Agency,' of 'the Health Boards Executive,'.".
This body will be called the Health Boards Executive. It is not listed in the First Schedule to the Freedom of Information Act since it did not exist when the Act was passed. It is not a health board or a Department. If my amendment is not accepted, I would like to know how the body will be covered by the Freedom of Information Act. It is not a subsidiary of a health board but is a new body with executive powers. My amendment seeks to amend paragraph 1(2) of the First Schedule to the Freedom of Information Act by inserting the Health Boards Executive as one of the bodies listed to ensure it is covered by that Act. If it is not, we will have a secret body carrying out executive functions on behalf of the health boards, which is not covered by the Freedom of Information Act.
Surely we will have to add different bodies to the Freedom of Information Act from time to time. I hope this amendment will be accepted.
As I said, I understand the three authorities are covered by virtue of their relationship with the central authority. I take the point made by Senator Ryan on this issue. If, on investigation, it transpires that there is a need for regulations to be made by the Minister for Finance, it will be done. There is no intention on the part of the Minister to exclude the area boards from the Freedom of Information Act. We are prepared to investigate the point further to ensure they are included under the present structure and if not, regulations will be made to include them.
I accept the Minister of State's assurance that it is the intention of the Minister that the area boards and the Health Boards Executive will be fully covered by the provisions of the Freedom of Information Act. If we run into a problem, I will find plenty of opportunities to raise this matter again.
In my merry dance through the various health Acts of the past 50 years, I missed out on the previous formulation. I had read it, but do not remember it. I refer to section 24 which amends the 1996 Act. Section 24(b)(2) states: “A health board shall not take any decision or give any direction in relation to any function of a health board that is not a reserved function.” Is that subsection different to what is contained in the 1996 Act?
Section 24(b) replaces section 3 of the Act with a new section which is considerably less ambiguous but otherwise makes the same provision as the original.
Why is Loughlinstown Hospital not included?
It is funded and operated by the Eastern Health Board whereas the hospitals in question are funded directly by the Department.
I thank my colleagues in the Seanad and the Minister of State for taking this Bill in such an informed and non-rancorous manner. The quality of contributions was excellent and showed an insight into our health care delivery systems and what needs to be done to improve them. I was glad there was an insight into the difficulties under which practitioners of all ranks labour.
I join with Senator Fitzpatrick in thanking the Minister of State and complimenting him on getting the Bill through. I regret there was not a gap between Committee and Report Stages, but it is one of those things which happen. The Minister of State is lucky to have a colleague with such great common sense as Senator Fitzpatrick.
I also compliment the Minister of State on his usual good humour in taking this Bill and for the information he always gives us. I wish the Bill had been introduced in this House—
Hear, hear.
—because we could have had much discussion on it in a far less party political way than one has to endure in the Dáil. We might have made some improvements to it. No one wishes more than I that this will work well because, like Senator Fitzpatrick, I will be one of those who will have to work under the legislation.
I congratulate the Minister on this worthy Bill which is well worth supporting. Like Senator Manning I would prefer to see a gap between the Stages as a point of principle. Every effort has been made by Senators, particularly those in the Independent benches, to improve this Bill. I am sorry the Minister did not find it possible to accept any amendments. That disappointment will be overcome by the fact that it is a good Bill and has been improved as it passed through the other Stages. I congratulate the Minister and his officials who worked on this Bill.
I associate myself with my colleagues in saying the Minister showed his usual good humour. Sometimes I am more rancorous than I ought to be and if so I apologise. I did not mean to be in any way rancorous. This is interesting legislation and I hope it works well. I hope he is right about the Freedom of Information Act, otherwise he will have to introduce more legislation.
I thank Senators for their contributions. I have great admiration for Senators such as Senators Quinn and Ryan for the amount of work they put into their amendments and for their knowledge while working single-handedly. I really mean that. Great credit is due to them for the depth of knowledge they have shown in complex legislation. Given the back up we have from civil servants it is easy to find answers. I cannot help but feel it is past time we had proper research support in the Oireachtas for Members so they can have more assistance in the type of research which has gone into today's Bill. They should have further support. In particular Senator Ryan's question on "choses-in-action" shows the amount of work he spent carefully reading the Bill.
It is a perversity of mine.
I mean it. It is unfortunate that constituency politicians do not put in the time and effort they should on legislation. The effort put in is a credit to both Senators.
I regret it was not possible to give more time to the Title but the House agreed the procedures today. It is not my problem. The point was well made and I will undertake personally to see consideration is given to the points made when the new authority and chief executive is established.
I thank Senators on the Government side, particularly Senator Fitzpatrick for his understanding. I thank my two officials from the Department of Health and Children. I have introduced only one Bill but I have represented various Ministers in both Houses on Committee Stages and without hesitation I say I have been better briefed on this Bill than on any other. It is a great credit to the two officials. They were able to come up with fast answers to properly put questions by Senator Ryan.
This legislation will have great significance for the eastern region and Dublin in particular. The health services in the Dublin area, because of the structure existing up to now, leave a lot to be desired. I say that because I have a serious concern about an area of my responsibility, namely children. I have no doubt this new structure will enable the great people who work in the Eastern Health Board to do their job better. The problems are not due to the good people who work there. They are due to the structure within which they operate. I look forward to this new structure enabling the health professionals throughout the service in the region now represented by the Eastern Regional Authority to do a much better job than previously.
When is it proposed to sit again?
Dé Céadaoin seo chugainn ar 2.30 p.m.
An bhfuil sé aontaithe? Aontaithe.
The Seanad adjourned at 1.55 p.m. until 2.30 p.m. on Wednesday, 2 June 1999.
