I move that the Bill be now read a Second Time. The main object of the Bill is to rectify the existing arrangements for providing and administering the health services in the territories represented by the boroughs and counties of Dublin, Cork, Limerick and Waterford, respectively. These arrangements are complex and over-lapping; and, because of this, are a frequent source of avoidable annoyance and sometimes grave hardship to those for whose benefit the services are intended. They are in some measure a legacy from the past; a past which in the form of certain administrative anomalies has survived the great changes and developments in our health services which have taken place since World War II.
The House will recall that the changes in question originated with the Health Act, 1947. Not alone did this Act introduce notable developments in the preventive health services; it also designated county councils and county borough corporations as health authorities and conferred on them powers and functions in relation to health wider in scope than local authorities had had before. The 1953 Act continued this development and brought it to its present stage. By reason of these Acts the position today is that throughout the country— except, however, in Dublin, Cork and Waterford—the county council (and in Limerick county borough, the City Council) as health authority is responsible for all the general health services.
Unfortunately the conditions which existed when the Act of 1953 was under consideration made it, for the time being, impracticable to simplify administration in Dublin, Cork and Waterford. There were in each of these areas at that time a number of boards and other joint authorities, each of which had its separate staff and provided some, but not all, of the services. The task of introducing the provisions of the Act of 1953 over the whole State imposed a great burden on the staff of my Department and on the staffs of the local authorities concerned. The task would have been an impossible one, if, at the same time, an attempt had been made to merge the existing authorities within each of the areas concerned for the purpose of administering the new code. The fact that it has taken several years of almost constant consideration and continuing negotiation to produce anything like acceptable conditions for the mergers, confirms this view.
Moreover if the Act of 1953 had compelled the county councils and county borough corporations, for the areas to which the Bill relates, to provide, as health authorities, all the re-organised services, it would have entailed the splitting of several existing organisations. For example, the services provided in St. Finbarr's Hospital and other institutions by joint boards would have had to be divided between the Cork Corporation and Cork County Council; and similarly the hospital services in Waterford would have had to be apportioned between city and county, instead of being provided by joint boards.
Having regard to the new services and to the extensions in existing services which the local administrations were then being called upon to provide, it was decided, wisely, that any drastic administrative surgery in these four areas would, at that stage, be inadvisable. Accordingly, as a temporary measure, it was decided in 1953, that, while the health authorities in them were to be responsible for the services, it was to be arranged that the appropriate co-existing bodies should provide some of them on an agency basis. The instruments allocating the performance of functions to the bodies in question are most complicated and it has been by no means easy to administer them.
The question of unifying the administration of the health services in Dublin, Cork, Limerick and Waterford had, however, been under consideration before the 1953 Health Bill, and it has since been the subject of correspondence and discussion with the local authorities concerned. Thus these bodies have had the opportunity of considering unification exhaustively and of furnishing their views on the proposals in the Bill.
As well as unifying the health services in the four areas specified in it, the present Bill, if enacted, will merge the administration of the mental health services with that of the general health services. When I come to deal with Section 20, which has been drafted to provide for this, I hope to persuade the Dáil—if indeed persuasion is necessary —how very desirable such a merger is. In the meantime, however, before I outline the principal provisions in the Bill, I should like to direct the attention of the House to some figures. They show why any Minister for Health must be anxious to ensure that the best administrative organs which can be devised should now be established in the four areas to which they relate. They show too why the general body of taxpayers should be concerned to the same end.
The total expenditure on local authority health services is estimated at about £16½ million in the present year. Half of this, as the House is aware, is paid by the ratepayers, half by the Exchequer. Of the total expenditure of £16½ million, about £7½ million, representing nearly half the expenditure for the country as a whole, is spent in the Dublin, Cork, Limerick and Waterford areas. Half of this sum in turn, that is, £3¾ million, is paid by the general body of taxpayers throughout the State from the Health Services Grant which the Budget provides. In the face of these figures, it cannot be said that only the residents and ratepayers of the four areas where unification is to take place, have an interest in the financial aspects of my problem. The public generally are also largely and vitally concerned in it and should be as determined as I am to see that in the administration of the health services avoidable inefficiency and over-lapping should be prevented.
I may now proceed to refer to the salient provisions of the Bill. Those set out in Sections 2, 3, 4 and 5 are fundamental. These Sections respectively provide for the unification of the Health services in the areas of Dublin, Cork, Limerick and Waterford, and for the setting-up of a new health authority in each. In the case of Dublin, the authority will consist of nine members appointed by the County Council, fifteen members appointed by the Dublin Corporation and 3 members appointed by the Dún Laoghaire Corporation. But on all occasions when the operation of the Mental Treatment Acts is to be dealt with by the Dublin authority, three members of the Wicklow County Council, appointed for the purpose, will be entitled to attend the meetings of the authority and to participate in the discharge of that particular business. In the cases of Cork, Limerick and Waterford, a complication such as this does not exist; and the new bodies in such cases and for all purposes will be composed solely of members of the appropriate county council and county borough corporation. As in the case of Dublin, the members will be duly appointed by the parent bodies. It will be the duty of each of these new health authorities to provide, for the whole of its functional area, all the services at present made available therein by the existing local authorities.
Section 7 provides for the requisite transfer of health functions from the local authorities which heretofore have exercised them; and sets out the scope of the services covered thereby. They include the general hospital services, maternity and child health services, the tuberculosis service, dental services, the infectious disease service, the general medical service given by district medical officers, food hygiene, the control of the sale of food and drugs and the supervision of midwives in their practice. All of these services are necessary either for the protection of the general health of the community or to meet the needs of individual citizens who may happen to require medical, surgical, dental or other curative or preventive treatment. They are very comprehensive; they affect everyone in some degree; but they touch the vast majority of our people very closely in a great variety of ways. Their effectiveness depends in the main on close integration with each other.
Yet in the four areas with which the Bill deals, responsibility for them is at present divided among no fewer than nineteen authorities. In Dublin, there are seven such authorities; the Dublin Corporation, the County Council, the Dublin Board of Assistance, the Rathdown Board of Assistance, the Balrothery Board of Assistance, the Grangegorman Mental Hospital Board and the Dublin Fever Hospital Board. Each of these separate authorities is concerned with some only of the services. None is concerned with them all, nor is there any authority with general responsibility for their co-ordination. Similarly, in Cork, the Corporation, the County Council, the South Cork Board of Public Assistance, the Joint Mental Hospital Board and the Joint Sanatoria Board each operates services; but again there is no co-ordinating authority for the services as a whole. In Waterford, there are the County Council, the Board of Assistance, the Corporation, and the Joint Mental Hospital Board and in Limerick we have the County Council, the Corporation and the Joint Mental Hospital Board. Once again, in neither area is there a co-ordinator. It is self-evident that a multiplicity of authorities, separately administering services so closely related as those I have enumerated, must result in an irrational dispersion of function and responsibility which, as I hope to show, breeds confusion and inconvenience for the ordinary citizen. To remedy this the administration of the services must be integrated and simplified; and the readiest way of doing this is to set up the new authorities, unifying authorities, contemplated by the Bill.
But, before going further at this stage into this proposal, it would be convenient to explain now the reference in Section 7 of the Bill to the Public Assistance Act, 1939. No health service is now provided under the Act; it governs only the administration of home assistance. At present home assistance is provided and administered by public assistance authorities, including those Boards of Public Assistance which I have named and which will be dissolved under Section 7 of the Bill. With the abolition of these boards, it is necessary to make provision for the continuance of the home assistance service. As Minister for Health I would prefer that it should not be dealt with by the new authorities; but, on the other hand, if it is not handed over to them, it will be necessary to keep all the existing boards of assistance in being, to administer what is now a very minor service indeed. Accordingly the management of home assistance is one of the functions which will be transferred. The granting of allowances under the Blind Persons Act, 1920, is under the control of the Department of Social Welfare and is not a health service. It will still remain under the control of that Department but will, like home assistance, be administered through the new authorities. These Social Welfare functions, however, will constitute only a relatively insignificant part of their duties.
Reverting now to the prime purpose of the Bill, the Dáil may wish me to give some examples of the confusion, inconvenience, unjustified expense and positive hardship to individuals, which have been occasioned by the existing fragmentary administration of the health services over the whole area represented by the county borough of Dublin and the administrative county of Dublin (which includes, of course, the borough of Dún Laoghaire)—an area inhabited by over 700,000 persons. This I shall proceed to do, but please bear in mind that the cases which I mention are a few only of the great many which have come to my notice.
In Dublin, persons applying for, say, hospital services under the Health Act, 1953, make an application which is sent to the Corporation or the County Council, as appropriate. These services are available to what we designate as the lower and middle income groups and whether or not the applicant is within the eligible category is determined by the Corporation or County Council. This is relatively simple, but when it comes to the matter of charges for this service, complications arise. Those outside the lower income group may be charged up to ten shillings a day; those in that group are not to be charged anything at all. If, therefore, the patient feels that he is entitled to these services without charge, he must show that he is in the lower income group which is the class entitled to what is commonly referred to as the "Blue Card".
The grant of such cards, however, is not a matter for the Corporation or the County Council but for the Board of Assistance for the area in which the applicant lives. To prove his entitlement to the service free, therefore, he will first have to apply to the appropriate Board of Assistance—there are three of them in the Dublin area—for a "Blue Card" as evidence to support his application to the Corporation or the County Council. Ingenuity and compassionate administration can and have reduced the annoyance and hardship which can be caused by this complicated procedure; but they cannot provide an adequate substitute for having eligibility for all services determined by the one authority.
There are other complications and annoyance peculiar to the persons— and there are over 50,000 of these— who live in those suburbs of Dublin which are just inside or outside the city boundary. A case came to my notice recently of a lady who lives just within the city boundary in Churchtown, but convenient to the dispensary premises in Dundrum. Dundrum being in the county, these dispensary premises are owned by the Rathdown Board of Assistance. There is, however, sufficient co-operation between that body and the county council to allow of the use of the premises by the county council for poliomyelitis vaccination. The co-operation, though, does not extend far enough to have this service provided at a county council clinic session for city residents, so when this lady wished to have her children vaccinated against poliomyelitis, she had to bring them three times to the Dublin Corporation clinic at Crumlin. To get there from Churchtown is no inconsiderable journey, especially for a busy housewife.
The Crumlin clinic, on the other hand, is quite convenient to many persons resident in the administrative area of the county council; but because they are not in the city area, they cannot avail themselves of the services provided there. In the area near Crumlin, there is, in fact, a salient about half-a-mile square extending from the county into the city. The population of this salient is about 3,500, comparable with many of our smaller towns in Ireland. The housing development within the salient is essentially of the same type as in the surrounding district—working class and lower middle income houses—and, of course, those who occupy the houses in either area are likewise similarly circumstanced. Nevertheless the inhabitants of the county salient may have to travel considerable distances, if they wish to avail of the medical services. If, for example, one of them should need to attend a tuberculosis clinic, he or she, must go to that maintained by the county council in Long Lane, which is at the back of the Meath Hospital. Whereas if the administration were unified, the service could be given at the Crumlin clinic.
Another case which comes to my mind is that of a person resident in the city who, when visiting a house in Dún Laoghaire became suddenly ill and the gravity of his condition was such that he had to be removed for an urgent operation to a voluntary hospital in the Borough. He was entitled to General Hospital Services under the Health Act of 1953; and if he had been admitted to a city hospital, the Corporation, in the normal course, would have accepted full liability for the payment to the hospital. The Corporation, however, did not have an arrangement to accept such liability for patients admitted to the hospital in Dún Laoghaire. The luckless patient then had to pay a substantial bill for his treatment; for the Corporation, because of the fortuitous circumstances which had put him into the Dún Laoghaire hospital rather than into a city hospital, would not, in respect of his treatment, accept more than its limited liability under Section 25 of the 1953 Act. On the other hand, if this man had been resident in Dún Laoghaire or the County, the County Council would have paid all his hospital expenses.
Deputies in another connection recently have had occasion to study the zig-zag and, apparently, arbitrary course which the boundary between the administrative area of the Dublin Corporation and that of the Dublin County Council tends to follow. They will have noted how the county boundary runs through the suburbs of Dublin, not around them, and in many places divides communities which are essentially one. This has created difficulties for all concerned with the health services, whether as operators or beneficiaries, for which, I submit, there is neither rhyme nor reason.
For example, the boundary crosses Whitehall Road, Kimmage, at a point about one-third of the way along that road from Kimmage Road West to Whitehall Crossroads. The consequence is that persons living on one section of the road have to deal with quite a different set of health officers and to resort, when necessary, to quite different health institutions such as clinics, to persons living in the other. And yet they are very much alike in all their circumstances. They are alike in the fact that administrative boundaries notwithstanding, they are part of the same urbanised community.
This is true, of course, of not only those who live within the actual city boundary, but of a great many more who live in the administrative area of the county. Most of us may not realise how the population of these areas is actually distributed; that, for instance, the population which lives on the fringes of the city and the borough of Dún Laoghaire makes up more than half the total population of the county. A few figures bearing on this point may help us to appreciate why the existing administrative position is highly anomalous, at least so far as the health services are concerned.
In 1956 there were nearly 706,000 persons resident in the Dublin area. Of these 539,000 lived within the city boundary, 48,000 in Dún Laoghaire and 119,000 in the county. Of the last mentioned figure, more than half, that is about 62,000, resided in suburbs of the city or Dún Laoghaire. Thus of the 706,000 persons living in the city and county of Dublin, about 650,000 lived in definitely urbanised communities which are contiguous with each other. The remaining 56,000 must include a considerable number of persons living in rural areas so near to the city or Dún Laoghaire that their economic centre and the centre for them of public services of various kinds is in the city area. It is thought, in fact, that the population of the areas in the county which can be described as truly rural is only about 36,000 or 5 per cent. of the total population of the city, the county and the Borough of Dún Laoghaire. Having said this, I think I have, so far as Dublin is concerned, fully established the case for the proposed innovation.
In Cork there is a similar, though somewhat less striking situation. The population of Cork City, living within the administrative area of the city corporation, in 1956 was 80,000. The "census suburbs" for the city had then a population of over 34,000. If to these we add the contiguous rural areas, it would appear that there are at least 40,000 people, whose natural centre is Cork City, who work there and shop there and who are separated from it for the purposes of many health services.
The county population of 257,000 is, of course, much greater than that of the city; but included in that figure are, as I have said, at least those 40,000 persons detrimentally affected by not being able to avail themselves of the city health services. I think it is clear that all of these and very many more, whether resident in the City or County, will benefit by the enactment of the Bill.
The problems arising from having surburban populations cut off from city services do not materially arise in the cases of Limerick and Waterford. The main case for unification in these areas rests on the fact that the population in each case is too small to be saddled with the expense of more than one health authority.
In this connection I may point out that the population of Limerick City and County in 1956 was under 138,000; which is less than the population of Galway and not much more than that of Kerry, Mayo and Donegal. In each of these areas, health services are administered by a single authority. The population of Waterford City and County is even much smaller, being only 74,000 or less than that of many counties.
The major reason for setting up new health authorities in the four areas with which the Bill deals is to co-ordinate the health services in them, to improve those services, and to make them more readily available to the members of the public. But a further purpose is to achieve substantial economies in administration. Between the four areas, there are, as I have already mentioned, at present nineteen authorities concerned with the operation of health services. Each of these, in addition to its medical and nursing staffs, has its own secretarial, accounting and administrative staffs. In each area the several existing authorities are engaged on similar administrative work, perhaps, indeed, in relation to the same person at the same time.
With the establishment of one authority in place of the several which now operate in each area, we may expect that expenditure on this type of duplicated administrative work will be significantly reduced. Centralisation of the accounting and other procedures should also result in additional considerable economies.
The total expenditure on health services in the four areas is, as I have mentioned, about £7½ million. It will be clear that, with figures of this magnitude, it should not be difficult, by cutting out duplication, to save a sum ultimately running into five or, perhaps, six figures each year.
All these economies, I concede, will not be achieved immediately. Existing staffs, for instance, have certain rights, and it is not intended to deprive them of these. Staffs, of course, will have to be transferred to the new authorities, but all those affected will be dealt with fairly. It is apropos to mention that I have had some preliminary representations regarding the position of the Dublin Corporation clerical and administrative staff. Naturally, I shall consider these most carefully, between now and the Committee Stage of the Bill.
Since 1952, as I have already mentioned, there have been consultations with the rating authorities concerned with the proposals now before us. On the whole, I think I can say they have been satisfactory. Thus in the Dublin area, I am glad to say, the corporation, the county council and the Dún Laoghaire Corporation have signified their agreement with the scheme, subject to the costs being divided among them in a certain way. In Limerick, also, I understand that the local authorities' reservations similarly relate only to the same matter of costs. I trust that on this point the Bill, as drafted, will be satisfactory to these and the other authorities which it affects.
Section 11, in fact, has been drafted with such reservations, regarding the apportionment of costs, in mind. I have sent copies of the Bill to all the authorities concerned, and have indicated to them that I will be prepared to consider for the Committee Stage any amendments in detail which they may wish to suggest. May I say in relation to Dublin and Limerick that it is gratifying to see how all public authorities in these areas are ready to co-operate with each other to provide the best possible administration for their health services? It is evidence too that in this respect the desire for better administration is not a product of the Custom House alone.
In the remaining two areas, that is, Cork and Waterford, I am afraid that I cannot report that the local authorities in them are at one in favour of the proposals. But I trust that, as the Bill progresses and its provisions are better understood, the local authorities in both districts will fall into line with Dublin and Limerick.
Fears have been expressed by some of the members of the rating authorities that they will lose what have been described as "their present rights" to participate in the control of the health services. Section 10 of the Bill, I submit, should dispel all legitimate fears in this regard.
Under Section 10, local committees of a health authority can be appointed; and these may include even more members of the parent council than are on the authority itself. Moreover, each of the health authorities, as defined in paragraph 2 in the First Schedule to the Bill, will be so constituted as to ensure that each local electoral area in a county will be represented thereon by at least one member. Furthermore, where an appointing authority so decide, they may, in accordance with paragraph 6 of that Schedule, remove from office the members they have appointed to the Health Authority and appoint others in their stead.
Deputies no doubt will have noted the special provisions which are set out in the Second Schedule to the Bill in relation to the estimates of the new health authorities. These represent a noteworthy departure from the present position in regard to estimates, and are designed to give the rating authorities concerned a position of greater authority so far as expenditure proposed by these bodies is concerned.
As things are now, rating authorities are not informed, even in a preliminary way, by the existing subsidiary authorities of their estimates and demands until the latter are furnished in final form. Under the new procedure as laid down in the Schedule, provisional estimates will be prepared by the new health authority; and before that authority formally adopts them, the rating authorities concerned will be given an opportunity to examine them and to comment on them. This procedure should enable the rating authorities to influence and in some measure to control expenditure by the new health authorities.
The second purpose of the Bill, as I mentioned earlier, is to amalgamate the administration of the mental health service with that of the general health services. This service still remains separate from the other health services, there being a strict legal distinction between them. What it is proposed to do in this Bill is to abolish this distinction throughout the country.
In Dublin, Cork, Limerick and Waterford, the change is made easy by effecting it in conjunction with the wider proposals for those areas. In the case of seven other counties where the mental health service is administered direct by the county council, the effect of the proposals in the Bill will be that that council will continue to perform those functions, but in future as health authority. In the remaining areas, where there are joint mental hospital boards at present, these boards will be replaced by new boards appointed by the health authorities. After the enactment of this measure, therefore, the one and the same body of law will deal with the administration of both the mental health services and the general health services throughout the State.
Mental treatment, as I think everybody in the House is aware, at one time was almost entirely a matter of custodial care of the patients and there was, unfortunately, a social stigma attaching to any family which had been so luckless as to have had a member committed to a mental hospital. The last ten years or so, however, have seen important advances in the treatment of mental disease. Due to chemotherapy and other techniques, complete recovery in very many cases is now not unusual; and in others the distressing conditions caused by mental disorders have been greatly ameliorated. At the same time there has been a gradual change in the public attitude towards mental illness.
To foster and encourage this change of attitude, and to bring about more rapidly a situation in which mental illness will be regarded exactly in the same light as any other illness, I have included in the Bill proposals, as set out in Section 20, for merging the mental treatment services in the general body of health services. We must strive to end, once and for all, the idea that mental institutions are not hospitals, and that there is something inferior about the services which can be provided for mental patients.
The Mental Treatment Act of 1945 represented a considerable advance on the legislation which operated before it, but over the years since it was brought into operation, experience has shown that many changes in the code are necessary or at least desirable.
Because of the developments in treatment and care to which I have referred, there is, indeed, a need for a comprehensive review of the code. That review will, however, take time, and as an interim measure, I hope to introduce shortly an amending Bill to deal with the more urgently necessary changes. The present Bill, therefore, deals only with the changes in the legal and administrative spheres which I have mentioned.
Other provisions in the Bill may require elucidation. I have already referred to Sections 2 to 5 relating to the setting up of the Dublin, Cork, Limerick and Waterford Health Authorities, and to the constitution of these authorities as referred to in the First Schedule to the Bill.
These, as the House knows, are the principal sections of the Bill. Except for those relating to the mental health services, most of the remaining sections are consequential on the establishment of the new authorities.
Section 6, for instance, specifies the general powers of the authorities and provides that the members of each shall be members of the parent council. I think this is essential in view of the very considerable amount of money which the authorities will spend and the need to maintain control by publicly-elected members over the comprehensive services which they will provide.
I have dealt earlier with Section 7, which lists the functions which will be transferred to the new health authorities.
Section 8 will apply to the authorities the general body of the local government code which governs the activities of local authorities generally. I would, however, draw attention particularly to sub-section (1) of this section under which the County Management Acts will be applied to the new bodies.
This means that either the city or the county manager for the area will be designated to perform the executive functions for the authority. This is the normal practice for joint bodies, but, in relation to the Dublin health authority the sub-section should be read in conjunction with Section 17.
The local committees to be set up under Section 10 are, as I have mentioned, designed to meet the views put forward by some of the local authorities in the areas concerned. These committees can consist of as many members of the county council or corporation concerned as these bodies may desire.
In any county there may be up to three such committees. Their functions will be limited to certain services of a local nature, such as the dispensary medical service and the maternity and infant care service, which will be specified in the regulations. As respects these services, the local committees will have full power to obtain information from the county manager on their operation.
Section 11 deals with the method by which the expenses of the new health authorities will be met. They will be contributed by bodies appointing members in such proportions as they may agree upon or, in the absence of agreement, as may be determined by a person appointed by the Minister.
It has been necessary, in the Dublin area, to make a modification of this whereby, in the first year of the health authority's establishment, the Dún Laoghaire Borough Corporation as such will not make any direct contribution. The reason for this is that the corporation will not have budgeted for such a contribution in its rate for that year.
The Wicklow County Council will also bear its due proportion of the cost of the Dublin health authority for each year.
Until the various contributing authorities have reached agreement on the basis of allocation, or until this has otherwise been determined, the expenses of each health authority on health services will, under Section 12 of the Bill, be contributed in proportion to their expenditure in the local financial year immediately preceding that in which the authority is established.
The expenses of the authorities in the provision of home assistance will not be divided in accordance with the scheme which I have mentioned. It is specifically provided by Section 11 of the Bill that these expenses will be met on the basis of each contributing authority paying the cost of services provided for persons in its own area.
Section 13, in conjunction with the Second Schedule to the Bill, provides for the special procedure to which I have referred earlier for the examination by the rating authorities of the estimates of the new authorities.
Section 14 makes some technical adjustments in the channels through which the health services grant will be paid, but does not affect the total amount which will be paid from that grant nor the amount which will be paid to any of the areas affected by the Bill.
Under Section 15 of the Bill, it is proposed that in every area to which the Bill relates all the public authorities concerned with the administration of the health services, including boards of assistance and certain other bodies, will be dissolved and their functions taken over by the new authorities.
The property, offices, assets and liabilities of the bodies thus dissolved must be taken over also by the health authorities which replace them. The provisions of this section and the Third Schedule, which should be read with it, follow the usual pattern of legislation transferring functions from one body to another.
Among the public authorities affected by Section 15 is the Dublin Fever Hospital Board about which I should like to say a word. Like so many other aspects of medicine, the pattern in regard to infectious diseases has changed very materially in the past 20 years. Previously, it was necessary that the emphasis should be on the isolation and treatment of patients suffering from these diseases. Nowadays, the development of prophylactic procedures—immunisation and vaccination—has permitted the emphasis to be shifted to prevention, and the rôle of the fever hospital, while still important, has become a secondary one.
Accordingly, most of the county fever hospitals and all the fever sections in the general voluntary hospitals have been closed or diverted to other purposes.
Experience in recent years lends us to hope that, within the next decade, prophylaxis will be so effective, and so generally availed of, as to reduce still further the need for fever beds. It is likely, therefore, that inside that period, not alone will it be possible to close one of the two remaining fever hospitals in Dublin, but that even one of them will be too large for the number of patients involved.
It is important to ensure that any part of the existing fever accommodation which may become redundant will be used to the best advantage in the interests of the public. I feel, therefore, that this is the time to make provision for the transfer of the hospital at Cherry Orchard now administered by the Dublin Fever Hospital Board to the Health Authority.
In case Deputies may have forgotten the fact, I should make it clear that the Dublin Fever Hospital Board is a public authority. Unless there were some particular reason for doing so, there would be no logic in leaving this body outside the scope of the unification proposals any more than there would be for leaving out, say, the Rathdown Board of Assistance or the Balrothery Board of Assistance or the Dublin Board of Assistance. This was recognised from the time the proposals were first being developed in my Department in 1952 and the proposal in relation to the Dublin Fever Hospital Board has remained part of the scheme ever since. I am in full agreement with this.
I am satisfied that the prevention and treatment of infectious diseases are essentially matters for the local health authorities and have no doubt that the public interest will be served best by the proposal in the Bill. The Dublin Fever Hospital Board, to whom a copy of the text of the measure was sent, however, do not accept that view, so I have agreed to meet a deputation from it in the near future.
Section 16 deals with the officers of the Corporations and County Councils who are now engaged on services which will be transferred to the new authorities.
Section 17 makes special provision for a Chief Executive Officer of the Dublin Health Authority.
Because of the size of this authority and of the extensive scope of the services which it will provide, it is considered unrealistic to apply, in the ordinary way, the provisions of the County Management Acts under which the City Manager would become responsible for the executive functions in relation to the Health Authority.
At present, these functions in the Dublin area are delegated to a special Assistant City and County Manager. It is intended that they will remain with the City Manager in law but that they will, in practice, be delegated to the Chief Executive Officer.
The City Manager of Dublin, therefore, will thus retain overall responsibility; there will, however, be a clear cut line of authority through the Chief Executive Officer to the other officers of the authority. Where functions are delegated to any other officer of that authority, he will perform them under the supervision of the Chief Executive Officer.
Under Section 18, there will eventually be a single office of Chief Medical Officer for each of the four areas, instead of the separate city and county medical officers which there are at present. The advantages of this change, I think, are obvious and it would be quite illogical to do anything else in the context of the establishment of the new authorities. However, difficulty may arise at the beginning in bringing this provision into operation.
It is accordingly intended that, where there are at present holders of separate offices, they will be permitted to retain these offices until one of them becomes vacant. When this happens, Section 18 will be brought into operation in relation to the area concerned, and the person then holding the office will become Chief Medical Officer for the entire area. In fact, this should happen immediately on the establishment of the authority in the case of Cork and Dublin, as there are vacancies in those counties at present for County Medical Officers. Vacancies do not exist at the moment in the other areas, Limerick and Waterford, but under Section 19 an easy procedure is provided under which, if either the city or the county medical officer agrees, he can be transferred to another county.
The transfer of mental hospital functions to health authorities is effected by Section 20. The necessary adaptations of various references in the Mental Treatment Acts are made, and under sub-section (4), the Minister will be required, under powers which he already has, to set up the new Joint Mental Health Boards to which I have referred earlier. All the institutions at present operated under the Mental Treatment Act by local authorities will become subject to the law governing other health institutions.
On Section 21, I would just like to explain that the reserved functions of a local authority are those which can be performed only by the elected members and not by the Manager.
The miscellaneous amendments specified in Section 22 are such as are necessary or desirable in a number of enactments because of the altered position arising from the establishment of the new health authorities.
It will be noted that, in the case of the Meath Hospital in Dublin and the Infirmaries in Cork and Waterford, it is intended that the health authority will in future make the appointments to the governing body which are now made by the county and city councils.
I think I can leave any explanation of other amendments provided for in this Section to the Committee Stage. The remaining Sections of the Bill are of a routine nature and I do not think that I need make any comment on them.
The First Schedule to the Bill lists the provisions which will govern the membership and meetings of the new Health Authorities. The first members of such an authority will be elected after it is established and subsequent appointments of members will follow each local election.
I have already referred to the provision in paragraph 2 of this Schedule which will ensure that each electoral area in a county is represented on the Authority. The procedure for election set out in this paragraph is based on the provisions which at present govern the election of members of joint public assistance boards and the remaining paragraphs of the Schedule are such as normally govern joint local bodies.
I have already referred particularly to paragraph 6, which permits an appointing authority to withdraw its members from the Health Authority and replace them should it so decide.
In the Second Schedule are two sections, which in respect of the Health Authorities, established by the Bill, will replace Sections 9 and 10 of the City and County Management (Amendment) Act, 1955. The latter sections are those which govern the preparation and adoption in the normal course of the estimates of a local authority. The difference between them, and the sections in the schedule, which will be applicable only to the new Health Authorities, is that, in the case of the latter sections, the estimated procedure is extended so as to permit the rating authorities to comment on the estimate of the joint authority before it is finally adopted by that body.
The paragraphs of the Third Schedule are such as are normally included in a Bill which provides for the transfer of functions from one set of authorities to another. The effect of the provisions of the Schedule is that the new Authority will, as respects property rights, liabilities, contracts, legal proceedings and the employment of officers, take the place of each body in their area which is dissolved under section 15 of the Bill. This Schedule will also apply to the dissolution under section 20 of the present joint mental hospital boards and their replacement by new health boards.
I trust the House will give the Bill a Second Reading.
