Health (Amendment) Bill 2004: Committee Stage.

I welcome the Minister of State, Deputy Brian Lenihan, and his officials. Does anyone wish to apply a time limit to the debate?

It might concentrate our minds, so that we can move along quickly.

Is 4.30 p.m. agreed? Agreed.


Amendment No. 1 in the name of Deputy McManus is in conflict with the principle of the Bill. Among other things, the purpose of the Bill is to abolish membership of health boards. The amendment proposes that an equivalent system be re-established.

This is draconian, and I object. The faceless people take it upon themselves to determine the political debate in this committee in a manner I find deeply objectionable. I have raised genuine concerns by means of this amendment. They need to be treated with respect, and should be heard. I am getting very tired of being told that I cannot speak out. According to the decision made, the principle of the Bill rather than any specifics would be changed by this amendment. One could apply that to any Bill or amendment if one so chose.

I am talking of a serious democratic deficit that arises as a result of hasty decision-making, rushed legislation and lack of thought about the checks and balances that any efficient, thoughtful, adequately capable government would ensure were in place. It is deeply disturbing that an amendment which is trying to ensure there is democratic accountability on behalf of the people represented by the Chairman, myself and everyone else is being ruled out of order. I cannot think of anything more appropriate to put forward in the form of an amendment. If I cannot put it forward in an amendment, how can I ensure that this Bill is in the public interests? I am not being given a chance to put forward the case. The Minister has never answered the case.

This is not a motion calling for the Bill to be rejected. It simply says that attention must be given, and redress in terms of democratic deficit. The Chairman is presumably here to represent our interests, just as the Ceann Comhairle is in the Dáil Chamber. Neither my interests nor those of the people I represent are being properly looked after. I resent this heavy-handed, thick kind of judgment passed down from on high. We are forced to accept this ignorance. I have already asked that the people who make these decisions should come before us. That was not granted. What is the point in our spending time here? We put forward amendments and get legal advice which for political parties in Opposition is hard to come by. We do the work, and then decisions such as this are thrown at us. it is not good enough. I would like to see face to face the people who make these decisions. I know that these decisions are not made by the Minister and that there is no point in getting at him. I want to get at the people who make these stupid decisions and pass them down. We are talking about lack of accountability, and this is a classic example.

I am disturbed at this sequence of events, and particularly because this Bill throws out the baby with the bath water. Worse, there seems to be a process of denying democracy. I am not satisfied with the notice I got for this meeting. I was not in a position to table amendments, which I would have liked to do. The health board over-representation has now become gross under-representation, and we will have quangos, along with a complaints system which will not work.

My presence here, with that of other Members, is a complete waste of time, because the amendment tabled by Deputy McManus which would address everyone's fears is not even being discussed. This is an unacceptable denial of democracy. Because of how this amendment has been ruled out of order, I do not intend to remain at this meeting. I am going to walk out in protest.

May I address my letter which rules out——

You can refer to it.

I agree with everything Deputy McManus said. My amendments Nos. 2, 7 and 8 have been ruled out of order for much the same reason. Not only is it heavy-handed and ignorant for someone to make this decision, it is also incorrect. The amendments are not in conflict with the principle of the Bill; they merely serve to provide in legislation the promises and commitments given by the Minister. If he is not willing to accept these amendments and have them incorporated into the legislation, we have no reason to believe anything he has told us in terms of the types of reforms he intends to introduce. He is wrong in saying amendment No. 2 is in conflict with the principle of the Bill. It does not involve a potential charge on the Revenue.

Amendments Nos. 7 and 8 relate to democratic accountability. The Minister has already promised some system of local accountability. Amendment No. 7 merely reaffirms that the provisions of the Bill are transitional in nature. That is precisely what the Minister told us. Amendment No. 8 provides that "the Minister recognises and acknowledges that public representatives shall have the right to actively participate in, and shape the role of the local health service at local level." He has already given this commitment to local authority members who are former members of boards. I do not see how it is in conflict with the principle of the Bill and how it is a charge on the Revenue. If the Minister is not even rejecting them but is ruling them out of order, then we should disbelieve everything we have been told about the purpose of the Bill.

I support the previous speakers. There is much genuine concern about the Bill. It gives a clear signal about the whole area of public representation, especially at local level. These amendments go to the core of the concerns that have been raised.

Local representation on the health boards was regarded by an editorial in one of the leading newspapers as "codocracy". I was on a health board for seven years and while there were those who did not give the idea the attention it should have received, on the whole most people gave it much attention. They represented the views of the public, the people to whom the service was not responding. Perhaps such views should not have been represented; perhaps that is the attitude of the people who ruled these amendments out of order, namely, that there should be a chief executive officer who will rule by diktat rather than have a democratic approach to services such as health boards and local government. If health boards are ruled out today, county councils will be ruled out tomorrow.

Those who decided these amendments should not be discussed would describe those running for election on 11 June as involving themselves in "codocracy". Those of us who spoke on Second Stage expressed this concern genuinely and at length. Now we have an opportunity to raise this matter on Committee Stage. Ministers sometimes say to us that a matter can be more fully discussed on Committee Stage. Deputy McManus has given us an opportunity to do so but her amendment has been ruled out of order by whom we do not know.

If we accept this ruling, we are saying the principle of this Bill is to destroy democratic accountability. That is what the judgment states. If the Minister is willing to accept that as an accurate description of the Bill, then I have concerns about his judgment. If he is willing to go along with this charade as well as present the Bill to us, there are fundamental questions about what is happening here. This is not only about public representatives on health boards, it is about public accountability. Deputy O'Malley might remember this too. This is about public scrutiny through the media. Meetings are held in public and reports are published. All that will be lost when the Bill is passed. Whatever one thinks about public representatives, good, bad or indifferent, and whether they are worth having on boards, nobody doubts that it is vital there is public scrutiny through the media——

In the public interest.

——in the public interest.

Chief executive officers will buy and sell land and sign documents and contracts with the seal of a board but there will be no board. Nobody will know what is going on because it will be in secret. This judgment simply piles on the insult when it comes to the case we want to make for decent, democratic scrutiny.

The Minister of State would probably have much sympathy with that view. Now he is not even going to hear the argument, and he would probably reject it even if he did, but this is a Parliament and we have a right to put it forward. We are being prevented from putting forward the argument for public accountability and proper scrutiny. I object to this. One can walk out——

The issues in my constituency in regard to democracy and the health board are serious. The Bill will negate the opportunity for people to debate the issues in regard Dundalk Hospital, patient care and so on. There will be no public forum in which any of the issues can be vented or discussed. The fact that the Bill does not include any new process for public accountability and discussion is shameful. The auditing of public funds and the they are spent is an important issue. Major policy issues between acute hospitals in different health board areas will not be vented anywhere, except on the streets. That is a shame. There will be no democratic, accountable process whereby people can express their views through their public representatives. People will be out on the streets and there will be chaos and anarchy. The Minister for Health and Children and a group of officials on health boards will be accountable to no one. The health boards are important bodies which spend billions of euro of public funds. It is essential that the Bill is amended to include a new democratic, accountable forum. What is happening is shameful.

A number of amendments were ruled out of order and when I read them I agreed with the Clerk of the Dáil that they were out of order. I wish to outline the situation in which the Chair finds itself. I arrived at this meeting to be told these amendments had been ruled out of order.

Why were they ruled out of order?

Amendment No. 1 is in conflict with the principle of the Bill. The purpose of the Bill, among other things, is to abolish the health boards.

How does it conflict with the principle of the Bill?

The proposed amendment seeks to re-establish the equivalent system. Having read the amendments, I had no great difficulty with them but I sought clarification on this issue and was informed that the Clerk of the Dáil ruled them out of order. To add to my difficulties I have been informed that, because I signed the letters, I am in agreement with the Clerk of the Dáil that they should be ruled out of order. The invidious position in which I find myself is that if I had not signed the letters, I could have agreed with the members of the committee. The Chair has signed letters stating these amendments are out of order.

Why did you sign them if you do not agree?

I did not realise there was a difficulty. Something must be done with amendments which are ruled out of order. There must be consultation prior to the meeting with the Chairman of the relevant committee. It is a little invidious to hand a Chair a ruling, not knowing exactly whether he or she agrees with it. I will be quite open and honest about this. I find myself in a dilemma now that I have signed the two letters agreeing that both amendments be ruled out of order.

I propose that we adjourn Committee Stage and have the Clerk of the Dáil come to explain that political decision. This is exactly the problem that we will have on the health boards - an unelected person impeding and curtailing democratic political debate. I propose that we adjourn the debate until the Clerk of the Dáil is here to explain what it is that he objects to in all the amendments now ruled out of order in a political way, and I hope that Deputy O'Malley will support us in the interest of public scrutiny and accountability.

It is an unacceptable political intrusion into the debate.

I second that.

I propose that we suspend for 15 minutes to allow the Chair to discuss these matters with the Clerk of the Dáil and report back to the committee. Is that agreed? Agreed.

Sitting suspended at 3.20 p.m. and resumed at 3.55 p.m.

Let me first make it clear that Deputy Cowley did not put down an amendment to any section of the Bill for Committee Stage. He reported to the Clerk of the committee today at 12 p.m. seeking to put down amendments but he was informed that amendments should have been submitted by 11 a.m. the previous day. In view of this there is no question of his having any amendments in place.

I presume the Deputy was notified about this Committee Stage meeting.

Yes, he was. The reason for the walk-out is, therefore, hard to understand. With regard to Deputy McManus, amendment No. 1 in her name seeks to provide that the removal of elected representatives of health boards, area health boards or the Eastern Regional Health Authority "shall not come into force until such time as provision is made for an equivalent democratic scrutiny". The Chair has been advised that the Deputy seeks to put in place something equivalent to what the Minister is proposing to remove. That is against Standing Order 125, section 1. The Deputy, I am informed, could table an amendment on Report Stage, but the word "equivalent" would cause grave difficulty in terms of the principle of the Bill.

I will return to it on Report Stage, but I must state for the record that I do not accept the ruling. When the provisions of the Bill would come in is an issue of timing. That is what the amendment is about. It is not in conflict with what the Minister keeps promising. I am still perplexed as regards a supposed conflict in this regard.

Amendment No. 1 not moved.
Question proposed: "That section 1 stand part of the Bill."

Concern has been expressed about the whole question of procedure since the Chairman informed us he had got very little notice before examining this issue. The secretariat, too, had little notice of the procedure and placement of amendments. Everybody needs time. Even those of us who got them need time to study our colleagues' amendments.

I believe Deputy Devins has a motion.

I probably reflect what the committee feels. There seems to have been a very short period from the time the amendments were submitted to the Clerk. I propose that the committee should accept that the amendments and the rulings on them, as well as any reasons thereof, be given to the Clerk so that she or he would have adequate time to give it to the members - with an explanation attached as to why an amendment is ruled either in or out.

Is that agreed? Agreed.

It is not a question of members submitting amendments earlier. No matter how early we submit them we will still only get the list on the day.

Yes, but we will be given reasons and time to consider them. We will not get them just before we come in to the meeting.

I believe the Deputy is saying it is unfair to give the Clerk to the committee these decisions just prior to the meeting, without any opportunity to evaluate them.

That is correct.

Question put and agreed to.

Amendment No. 2 in the name of Deputy Olivia Mitchell is ruled out of order.

I object to this. The amendment seeks to do no other than put promises given by the Minister into the legislation. He has given a commitment that the legislation is only transitional. It is to be in force only until such time as the Health Service Executive is put on a statutory footing, which he has said will be 1 January. If he believes that, he can accept the amendment. I cannot see the problem with it. I realise we have taken that matter as far as we can but I wish to record my objections.

Amendment No. 2 not moved.
Section 2 agreed to.

I move amendment No. 3:

In page 3, before section 2, to insert the following new section:

2 -Section 237A of the Local Government Act 2001 (inserted by section 3 of the Local Government (No. 2) Act 2003) shall apply to the dealings between health boards, area health boards and the Eastern Regional Health Authority and members of the Houses of the Oireachtas or of local authorities as it applies to dealings between local authorities and members of the Houses of the Oireachtas, with any necessary modifications.".

I would argue the case already accepted by the Government as regards local authorities and the standing down of representatives, with the exclusion of Members of the Oireachtas. There is legislative power under the Local Government Act, which provides for a belt and braces approach with regard to the democratic accountability of local authorities. Not only are the people elected to such authorities entitled to have decision making powers and accountable structures within the local authority, Members of the Oireachtas are also provided with information and a full record of local authority business. In this case the health boards are being abolished, no public representative will be sitting on a health board, no immediate scrutiny will be allowed and yet unless it accepts this amendment, the Government intends to have no system of accountability.

What I propose is modest replica of what is already in legislation as regards local authorities. It is certainly not adequate, but it is at least feasible, simple, tried and it works. If it is nothing more than a democratic nod to the principle of accountability, at least it is some means whereby the public interest may be protected. I do not know whether the Government has disconnected itself so much from the public that it does not have any understanding of what exactly is going to happen as a result of this Bill. The decisions at health board level will be made by one individual, in secret. The creation of a despot is what is fundamentally at the heart of this Bill. I oppose that principle. I do not agree with despots.

Democratic accountability is the object of my amendment but the principle of the Bill is to get rid of it. Perhaps the Minister of State should also eliminate this amendment as it is a small modest attempt at some form of democratic accountability. The Government has a problem about being accountable so I suggest that the Minister of State consider whether this amendment is in order. If it is, the mechanism applied works and should be applied as an interim measure while we await the great legislation promised by the Minister, who is good on promises but bad on delivery. A raft of legislation has gone to Never-Never-Land. I have a horrible feeling that democratic accountability will go that way too, along with the medical practitioners Bill, the nursing Bill and all the other Bills we were promised. There is now no indication as to when they might be introduced.

Could the Minister clarify that the Bill is not going to undermine the ability of this committee or of the Oireachtas to make all health executive decisions accountable to us?

We will not be told.

Accountability to the Oireachtas will not be diminished.

Does the Deputy think we will be told?

I would not like the notion to go around that the health boards can run amok following the enactment of this legislation. That is the impression that is being given.

I welcome the intervention by Deputy O'Malley.

I bet the Minister of State does.

: The health boards remain responsible to the Minister and to this committee as heretofore and the Bill does not change that in any respect. Although I am subject to correction by the Chairman I believe that three chief executive officers have already appeared before the committee.

Yes, but we need to call them.

On the issues of substance raised by Deputy McManus, I notice she was fond of the expression "despot" in the context of this Bill but in reference to her colleague, the British Prime Minister, "Tsar" is the more appropriate term.

He is not my colleague.

He is not her colleague, excuse me.

The Minister of State should confine himself to this part of the world.

The British Prime Minister prefers the word "Tsar" to "despot" in the context of this type of operation. I always thought that international solidarity lay at the heart of the Labour movement.

That is stretching the point. The Minister of State is grasping at straws.

The first point of substance I should make is that the Deputy's amendment is about information, not accountability, so accountability has nothing to do with the proposed amendment. It is simply a proposal seeking to equate the position of a Deputy vis-à-vis a local authority with that of a Deputy vis-à-vis a health board and to give a Deputy the right to elicit the same type of information or empower the Minister to draw up regulations to enable the Deputy to elicit the same type of information from a health board as can be elicited from a county council.

We have that power as of right. Local authorities must provide us with information. It is not drawing out information.

That is true but it remains a matter concerning information, not accountability. It is the mandatory provision of information.

One cannot hold someone accountable if one does not know what the person is doing.

With respect, the Freedom of Information Act applies to health boards.

It is an insult to a Member of Parliament to say that he or she must submit a freedom of information question in order to get information about the health service.

The Member can ask a parliamentary question. I do not recommend that this amendment be accepted. Section 237A of the Local Government Act 2003 provided for the making of regulations by the Minister for Environment, Heritage and Local Government in regard to the dealings between Members of the Oireachtas and the local authorities. This provision arose directly from the decision to abolish the dual mandate for membership of either House of the Oireachtas and a local authority. The regulations provide that Deputies and Senators shall receive documentation of such matters as notices, agendas, and minutes of local authority meetings, corporate plans, annual reports local authority budgets and local development plans as well as documentation on planning permissions and by-laws.

Section 237A and the consequent regulations would not be applicable to the interim arrangement which will be put in place under this Bill. The amendment is consequently vague as to what information should be available under it. There will be no health board, no Eastern Regional Health Authority meetings, therefore, the amendment is meaningless in that context. The wide range of information which might be covered under it is already widely available, such as the service plans or the annual reports. The annual reports must be published and made available under section 15(5) of the Health (Amendment) (No. 3) Act 1996, which is not being affected by this Bill.

Deputies have raised a wider question about accountability and a democratic deficit in regard to the new arrangements which will be put in place when the health boards are replaced by the health services executive. I reiterate the Minister's commitment made in Dáil Éireann on Second Stage concerning his intention to bring forward proposals to provide opportunities for democratic participation in the context of the new structures. Consideration is being given as to the most appropriate mechanisms to support the development of appropriate links at regional and local level between local representatives and the health services executive with a view to including provision for these mechanisms in the legislation which is being drafted.

To argue that this is not a provision for accountability because it is concerned with the provision of information is scraping the bottom of the barrel, particularly when we know that the Bill is about eliminating democratic accountability. My initial amendment was ruled out of order because I was trying to provide for the return of democratic accountability on a temporary basis. This is about information. Members of health boards have, on a regular basis, been getting reports from the health boards on a range of issues, not just service plans and annual reports. There is a constant flow of information. Public representatives grill health board officials to get information. It is a process of information being disseminated not just to the members but to the public at large, particularly through the media. Meetings are held in public. That reservoir of knowledge and information will now be closed off. That is a very serious matter.

I do not see checks and balances to replace that in the Bill. I am worried about what will happen in terms of the drying up of accountability and of information. This amendment is about information. Let me illustrate by way of example. The chairman of the health services executive, Mr. Kevin Kelly, attend the committee and started his presentation by saying that the executive had held several meetings none of which was in public. In response to the question about what the executive would do he said that it had a plan, a roadmap to which it was working. I asked that we, as Members of the Oireachtas, might have a copy of this. On this point, again, Deputy O'Malley seems to have a very naive view of what information is or is not given out. Mr. Kelly said that would be feasible but shortly afterwards he seemed to resile on it.

I would like an undertaking from the Minister of State to reiterate the commitment Mr. Kelly gave that we, as members of the Oireachtas Joint Committee on Health and Children and as the last bastion of protection of the public interest, would at least have that information. It is down to the few members present here if the Minister of State does not accept the amendment. It is in the public interest to know what is in the plan to which the health service executive is operating. If we do not know what is in it we cannot ask the executive about it. It is like a game, we cannot ask the questions because we do not know the content of the proposals so we cannot get any answers. Everything is in the dark, it is like Blind Man's Buff: we are trying to find the target but we cannot see it because we are blindfolded. Will the Minister of State ensure that we are given the information promised to us by Mr. Kelly, chairman of the HSE?

Is this in the context of reform?

It will be given.

I thank the Minister of State.

I support the amendment. I am opposed to the Bill in principle because I believe it will lead to less accountability and democracy. The health boards served a useful function. There will be a clampdown on the flow of information, which is not good for democracy and in the long run will not be good for the health service. I urge the Minister of State to favourably consider the amendment.

What level of information will the Joint Oireachtas Committee on Health and Children receive from the executive and to what extent will we be able to question it in order to get information? The Minister of State made a reference to freedom of information. That is not the way we should be conducting our business in the House. We are elected representatives and it is regrettable that one of the few ways we can get information is through freedom of information. That is not the way it ought to be. We should be able to get information from Ministers. It should not be a case of having to ask the right question. Information should be forthcoming. One of the main purposes of the legislation appears to be to ensure there is less accountability and responsibility and that the Minister will not have to come into the House and answer difficult questions which can be fobbed off on the executive.

We should address the amendment tabled by Deputy McManus. It seeks to apply the section of the Local Government Act 2001, as amended by the 2003 Act, which provides for the giving of information by local authorities to Deputies. The Deputy quite rightly corrected me on this point. If one looks at the regulations drawn up by the Minister on foot of that section, there is a reference to notices, agendas and minutes of local authority meetings. There will be no such documentation regarding health boards because they will no longer exist. It is often those items that are of the greatest interest to Deputies in regard to local authorities.

That is a subjective view for which the Minister of State has no basis.

I am entitled to it. Given that health authorities will not exist, in a sense we are back again to the substance of the Bill regarding the abolition of health boards. Matters in regard to health boards such as corporate plans, annual reports, local authority budgets and local development plans are in the public domain. They are matters on which Deputies frequently receive information from health boards and the amendment does not add to what is already readily available.

Amendment put and declared lost.
Question, "That section 2 stand part of the Bill", put and declared carried.
Question proposed: "That section 3 stand part of the Bill".

I oppose this section because it is fundamentally anti-democratic. It repeals all reference to members of health boards. We will now have so-called health boards existing in law which are not boards but consist merely of a chief executive officer. It is not correct to allow a word to be used in legislation that has no meaning. A board is a collective decision making body, whether it is a board of directors, health board or whatever. We will not have a collective decision making body, we will have one man or woman operating in secret, buying or selling land, signing contracts and possibly doing things he or she should not be doing. The one thing that cannot be said about this individual is that he or she is a board. It is inaccurate and misleading for someone to have the seal of a board. It is pretending something that is not the case. If we want to have clarity and rigour in legislation we should not refer to health boards from the date on which they are abolished. We should state that individuals are being appointed to these positions of immense authority and power and recognise it in law. God knows, these new despots at least deserve to be given recognition in law. The reality is that nobody will be able to say "boo" to them. Nobody will know what they are doing anyway.

This is a retrograde step. I suspect many members of the Government parties as well as the Opposition are deeply opposed to it. There is also a great deal of discomfort among the public in this regard.

I agree with Deputy McManus. I meant to interject in the exchange on the last amendment because the Minister of State kept referring to the abolition of the boards. The boards are not being abolished, it is the membership of the boards that is being abolished. What is the status of what is left? It does not appear to equate with any corporate status. It is not like a semi-State body that has an accountable board. This entity has no legal status of which I am aware. If I had more legal training I might be in a better position to question what is being done. We are not even allowed discuss such matters. We are taking away the membership of boards and leaving an entity that has no recognition in law with which I am familiar. It is no wonder the Minister of State referred to the abolition of the boards when it is the membership that is being abolished. What are we left with when the membership is taken away? I am sure it is an interesting question for some legal expert.

What one is left with is a legal personality. It is a juristic person. When I spoke of the abolition of the boards, it was in the context of their eventual abolition, which is the scheme envisaged under this legislation. This measure is essentially a transitional provision and the section opposed by the Deputies is a technical provision which enables the Minister, on commencement, to repeal certain parts of earlier Acts. Section 3(2) is a saver for the provisions of the Health Board Regulations 1970, which established the health boards, other than the Eastern Regional Health Authority and the area health boards, and defined their functional area. The purpose of section 3(2) is to keep alive the boards so they continue to operate in their functional areas following the commencement of this section. If this section were deleted the Bill would be inoperable. It is a particular manifestation of the general principle of the Bill, which is a transitional measure that envisages the temporary continuance of the boards in a transformed character pending the final implementation of the reforms.

Question put and agreed to.
Amendments Nos. 4 and 5 not moved.

I move amendment No. 6:

In page 5, before section 4, but in Part 2, to insert the following new section:

4.---The Principal Act is amended by inserting the following section after section 4:

4A.---(1) In this section, "committee" means a committee appointed by either House of the Oireachtas or jointly by both Houses of the Oireachtas or a subcommittee of such a committee.

(2) Subject to subsection (3), at the written request of a committee, the chief executive shall attend before it to give account for the general administration of the Authority and all such other information as may be required by the committee.

(3) The chief executive shall not be required to give account before a committee for any matter that is or has been the subject of proceedings before a court or tribunal in the State.

(4) Where the chief executive is of the opinion that a matter in respect of which he or she is requested to give an account before a committee is a matter to which subsection (3) applies, he or she shall inform the committee of that opinion and the reasons for the opinion and, unless the information is conveyed to the committee at a time when the chief executive is before it, the information shall be conveyed in writing.

(5) Where the chief executive has informed a committee of his or her opinion in accordance with subsection (4) and the committee does not withdraw the request referred to in subsection (2) in so far as it relates to a matter the subject of that opinion——

(a) the chief executive may, not later than 21 days after being informed by the committee of its decision not to do so, apply to the High Court in a summary manner for determination of the question whether the matter is one to which subsection (3) applies, or

(b) the chairperson of the committee may on behalf of the committee make such an application,

and the High Court may determine the matter.

(6) Pending the determination of an application under subsection (5), the chief executive shall not attend before the committee to give account for the matter the subject of the application.

(7)(a) If the High Court determines that the matter concerned is one to which subsection (3) applies, the committee shall withdraw the request referred to in subsection (2).

(b) If the High Court determines that subsection (3) does not apply, the chief executive shall attend before the Committee to give account for the matter.”.

This amendment is a fall-back position in anticipation that the other amendments may be rejected, whatever about being ruled out of order. I submitted the amendment to ensure the accountability of the chief executives, of whatever legal personalities are left when we abolish the membership of the health boards, to the Houses of the Oireachtas or a committee or sub-committee of the House. However, as stated earlier, in reality this is far from ideal, particularly if we are trying to replace the kind of public scrutiny that occurred at health board level with what can happen here at committee meetings. We would be obliged to be here 24 hours a day, seven days a week, 365 days a year if we were to try to keep abreast of what happens at health board level. Being denied the flow of information, we would not be able to provide the same level of accountability.

Politics apart, removing all levels of accountability other than those outlined in the section is a major mistake. The Department of Health and Children is not like other Departments. It is too local, immediate, personal and important to leave matters to faceless bureaucrats and not put in place some safety valves. If money is wasted in CIE or some other public body, the matter can be discussed in two or three years' time and it is not the end of the world. However, if something happens in the area of health it usually means that people's lives are at stake and the difficulties drag on until they finally come to the surface. That is why the scrutiny at local level, which is immediate in nature, is extremely important.

I ask the Minister of State to accept the amendment. From what he has stated, that level of accountability will exist in any event. However, I want a belt and braces approach taken in the legislation, even if it is only transitional legislation.

I am opposed to the section for the same reason Deputy McManus opposed section 3. The Government is intent on decentralisation. For it, this means moving civil servants down the country. In my view, decentralisation is about empowering local government and local bodies. The entire thrust of the legislation is to take power away from the health boards. There will then be less accountability and less democracy. This is part of a trend being followed by the Government. Over the years it has centralised more power by taking it away from local authorities. This legislation is part of the trend to which I refer and it represents a terribly retrograde step.

We know from experience in other countries that the best way to run a health service is on a decentralised model. However, this is not happening in Ireland. Time and again we have seen centralisation in the health services here. I refer to the shutting down of maternity units being shut down. In 1973 there were 108 maternity units, whereas there are now only 22 and plans are afoot to reduce this number by ten. In addition, many hospitals have closed and people must now rely on ambulance services in order to get to hospital. This is complete madness as far as I am concerned.

As stated earlier, I am opposed, in principle, to the legislation. The Minister of State indicated that if Members oppose certain sections of the legislation they will make a nonsense of it. That is correct. That is why I am opposed to it.

In principle, I do not object to this amendment, particularly as the Oireachtas committee has, under its standing orders, the power to request the chief executive officers to appear before it. Such powers have been written into legislation which established the Courts Service, the Human Rights Commission and the National Tourism Development Authority among others. However, in considering that, the amendment does not exactly reflect the standard provision contained in the other legislation to which I refer. I would welcome the opportunity to consult the Parliamentary Counsel on the matter and I propose to deal with the issue on Report Stage.

Amendment, by leave, withdrawn.
Section 4 agreed to.
Amendments Nos. 7 and 8 not moved.
Sections 5 to 26, inclusive, agreed to.
Question proposed: "That section 27 stand part of the Bill."

This section relates to the existing members of health boards. It is a pity that their position has been denigrated to such a degree. There is a great deal wrong with the health boards but there are many people who have served and worked hard and effectively on them. These individuals raised issues that would never have been raised at any other forum because there was no other appropriate forum at which they could have been dealt with. As Deputy Olivia Mitchell stated, the health boards are often close to communities and deal with personal issues relating to health.

I hope that the Minister of State might reconsider this section to see if an accommodation could be reached, particularly in respect of the provision of information to members of health boards or local authority members. We must see if a system of information can be provided at local level because when these people are no longer in place a vacuum will exist in that regard. I remind the Minister of State that when Professor Niamh Brennan investigated the issue of the reform of the health services and the inefficiencies therein, a great deal of consideration was given to how the system might be made efficient and accountable. Following all the internal discussions among members of the task force, it emerged that public representatives are the only people who could be identified who would be in a position to truly represent the community at large.

At no stage did Niamh Brennan call for the measure before us. She clearly distanced herself from the Government which took the opportunity, with Hanly coming down the tracks, to shift all forms of local accountability and debate out of action. This ensured that whatever opposition there might be to Hanly in terms of local accountability, nothing would happen in terms of organised, proper, official debate at health board level because there would be no health boards to provide it. I ask the Minister of State to reconsider the section and to return on Report Stage with a provision to put in place some system - this might take the form of simply providing information to local authority members - rather than removing this entire tier of government and not ensuring accountability, even in a limited form.

This is a central section of the Bill. It terminates the membership of all members of the health boards from the date on which the order bringing the provisions of the Act into operation is made. As Deputies are aware, there are three categories of health board members. These include councillors appointed by the relevant local authority, elected representatives from the medical and other professions and the persons appointed by the Minister. The first category will automatically cease to hold office after the next local election, scheduled for 11 June 2004. However, new members will be appointed by the local authorities in accordance with the provisions of Schedule 10, paragraph 8(7) of the Local Government Act 2001, which is also being repealed in section 3 and in the Schedule.

The term of office of members from the other categories varies. Some are not due to finish their term of office until 2007. The purpose of this subsection is, therefore, to ensure that the term of office of all members is terminated at the same time. If the Opposition amendment was accepted, or if its objection was accepted, it would mean that only the members from the local authorities would cease to be members of the health boards. On technical grounds, this is clearly not a practical or sensible proposal.

However, I appreciate that Deputy McManus raises a wider point than the simple technical issue, that if we do not have this section, the boards continue without any public representative on them. The Minister has acknowledged there is an issue about how public representatives participate in the new system. He will bring forward proposals on that in due course.

Question put and declared carried.
Section 28 agreed to.
Schedule agreed to.

Amendment No. 12, in the name of Deputy Olivia Mitchell, has been ruled out of order.

It was not.

The notes for the information of the Chair state it is outside the scope of the Bill and is, therefore, out of order.

That is not mentioned on my letter.

It mentions amendments Nos. 4, 5 and 12.

Sorry, the Chair is correct. I accept it is out of order.

Amendment No. 12 not moved.
Question proposed: "That the Title be the Title to the Bill."

I urge the Minister to accept the thrust of what I was trying to achieve with my amendment because it is a matter of vital importance. What the Minister has set up is restrictive in terms of limiting what is being proposed, particularly for the examination of one particular issue. I urge him, if the inquiry is to be of any use, not to restrict it to that extent.

Question put and agreed to.
Bill reported without amendment.