Question proposed: "That section 17 stand part of the Bill."

Does this section relate to health promotion programmes? Section 17 (1) (g) states: ". . . shall, in respect of its functional area, develop and implement health promotion programmes, having regard to the needs of people . . . ". Is that included because it is necessary to formalise it as most health boards are now in the process of formulating health promotion policies. How does the health promotion unit interact with the Department? What will the health boards be doing now in the area of health promotion?

Section 17 (1) (g) imposes a new statutory obligation on health boards to develop and implement health promotion programmes. There was a more general provision in the Health Act which required health boards to make available information and advice on health and health services so this gives them a statutory mandate to get involved in health promotion work. The need for health boards to be given an explicit statutory duty in regard to health promotion was identified in the health promotion strategy published last year.

As the Deputy knows, health promotion units are being set up in all the health boards and are quite advanced. There will be a central health promotion unit in the Department of Health. If we are serious about devolved systems, there will be needs in one area which do not exist in another and they would be addressed locally but there will be a central health promotion unit which will deal with national issues and there will be close co-operation. Leaflets, information, data, etc. will be provided.

There will also be circumstances where the more advanced local unit with progressive management will pilot something, the results of which will become national policy. We have seen examples of this already. An interesting programme on general life-skills was undertaken in the north-west with secondary school students recently. Groups of secondary school students in Letterkenny, County Donegal and in the north-west were given the life-skills programme but a control group in another area did not receive it. The students were given data, for example, on the fact that while alcohol is good, its abuse can lead to ill health and a similar programme was conducted on tobacco. They found that the group which had received the skills programme in respect of alcohol had a very good attitude to it by contrast with the control group which was not involved in the programme. The young teenagers had a significantly better attitude, both in theory and practice, to alcohol but it did not make one whit of difference in respect of tobacco. The only conclusion we could draw was that since tobacco is addictive the intervention was too late when the students were 13 and 14 years of age and approaching the Junior Certificate and that the Department would have to conduct the anti-tobacco education programmes in the senior primary school classes because by the time students get to secondary school they are already smoking. I was astounded at this because I thought the pitch was about right. Such information is fed back up into the system and we would take cognisance of it at national level even though it was promoted locally.

It comes back to the point I made that I do not want to put the dead hand of administration down on local initiatives which meet a particular local need but there will always be centralised programmes. The national drugs programme at present, for instance, is an important one. We are in the process of distributing 400,000 leaflets on meningitis from the Health Promotion Unit in Hawkins House to the health boards and GPs. There will always be centralised programmes, but there will also be pilot programmes in local areas involving feedback.

This does not just apply to health but to the promotion of health practices. For example, the family planning area continues to cause me concern because the availability of services is uneven. There are many blockages in the system. It is a sensitive issue and does not become a matter of public debate because frequently people do not wish to recite their difficulties. However, research in the area shows there are significant levels of dissatisfaction among women.

The local units will have a role to play not just in promoting healthy living generally but also in identifying specific areas and providing a new database through research and giving accurate information regarding what is happening locally so policy can be changed or better applied if necessary. It is most important that the health boards are free to do this activity. This will ensure individual health promotion units in the boards can form relationships with general practitioners in their area and patients visiting GPs will be in a position to access health promotion literature and messages from the unit while they are waiting.

Question put and agreed to.