I move: "That the Bill be now read a Second Time."
The provisions in the earlier Parts of this Bill deal with the establishment of a new structure of administration for the health services and with the financing of the services in the future: the later provisions consolidate much of the present law on the health services and propose a number of changes in the services. The logic of the draftsman's science requires that the Bill be structured in this fashion, but I do not think that, in speaking on the Bill, I should follow the same order, because the nature of the health services, and not how they are administered, is of more fundamental importance. Therefore, I propose first to speak on the provisions on the services in Part IV of the Bill.
This Part essays to consolidate most of the present law on eligibility for the various health services, to propose a number of changes in those services and to express in a clearer and more codified form the general policy of the Government on their development. On this occasion I do not, of course, intend to go into detail on each of the provisions in this Part of the Bill: that will be a matter for Committee Stage. Rather is it my intention to speak on the general policy underlying this Part and to refer only to the more significant changes which it proposes in the law on the services.
The 1966 White Paper made it clear that the present Government had not accepted the proposition that the State had a duty to provide unconditionally all medical, dental and other health services free of cost for everyone, without regard to individual need or circumstances. Their policy has always been to design the services, and the provisions on eligibility for them, on the basis that a person should not be denied medical care because of lack of means, but that the services should not be free for all.
In the application of this policy, about 90 per cent of the population have become eligible for hospital and specialist services but, as family doctors' bills do not impose the same financial burdens, only 30 per cent of the population is entitled to the general practitioner service. The White Paper went on to say—
By following this broad principle, there has been a more effective use of the necessarily limited proportion of the national product which can be devoted to the public development of health services than if an effort had been made to develop on a much broader basis a scheme with the features of a comprehensive free-for-all national health service. The present services meet the essential needs of the population: in so far as it is now proposed to make changes in them, these changes are justified in each case by special considerations, which are mentioned in Part III of the White Paper. With increasing prosperity in the future it should be possible to make these changes without adverse effect on the present services. The social development of the State, in the Government's view, calls for future changes such as are now suggested but the Government would emphasise that their proposals do not represent a radical departure from the principles set out in the preceding paragraph.
The basis for the Government's health policy, as thus expressed, remains unchanged and I should make it quite clear that there is no intention in the Health Bill to change it.
Events since 1966 have, if anything, strengthened the case for this approach to eligibility for health services as against a policy in favour of having a comprehensive free-for-all service. This issue was debated at some length a few months ago in this House and I do not intend to dwell on it at length now. I will but point out that our health services which, in 1965-66, cost about £33 million to run, are now costing about £51 million, including the deficit payments to voluntary hospitals. This increase has come without any spectacular changes in the services: it has arisen from increases in remuneration and prices and from some steady improvements in the existing services. As the House is aware, this increase in expenditure has not been unattended by financial problems at local and central levels.
To make a big change in the scope of the services, whether by making all the services available to everybody free of cost or by extending general medical services to the middle-income group, would mean that, apart from the ordinary rise in expenditure which can be expected to continue, an extra sum, which I estimate could amount to a minimum £20 million a year, would have to be raised in some way. It should not be assumed that this could be done by any form of central taxation, and certainly local taxation could not be called upon to bear a share of such an addition in expenditure. Neither should it be thought that insurance contributions would provide a source for such expenditure on such a scale, whatever advantages they might have as an ancillary source of finance.
If, to pursue a particular political philosophy or to attempt to meet an alleged public demand, this Bill were to have proposed a widening in eligibility so as to admit all citizens to all the services, or most of them to most of the services, this would have been an irresponsible and foolish move. For we must recognise that the amount of public finance which is available now for the health services, or which will be available at any time in the future will be limited. If the additional money which can become available for the services is dissipated in an attempt to widen unnecessarily the groups eligible for them, then it logically follows that there will be little if anything left for the improvements in the essential services for the groups who have a real and clear need for them.
What money will be available must be concentrated on the improvements on services for the care of the aged, for the development of general medical and nursing services for the lower income group, for bringing up to date our facilities for the treatment of mental illness, for meeting the large problem of the care of the mentally handicapped, for developing the preventive child health services and for other essential projects of this nature. Therefore, in putting this Bill to the House, I make no apology because it does not contain any spectacular proposals on the extension of eligibility for services. That it does not do so is deliberate and well justified Government policy, as I have just explained.
Within this general framework of policy, however, the Bill proposes a number of important changes. The most notable of these is the intention, as expressed in section 56, to replace the dispensary system with a service offering choice of doctor in the general medical service for the lower income group, in so far as this is practicable. There seems to have been some misunderstanding of the intention behind this section and, indeed, Deputy Fitzpatrick in a comment when the Bill was published, suggested that the Government intended under the Bill to retain the dispensary system. This, of course, is not so. The dispensary medical service operates under section 14 of the Health Act, 1953. Dispensary districts are governed by section 51 of that Act and district medical officers for those districts are appointed under section 52. These three sections are scheduled for repeal by the Bill. It thus clearly sounds the death-knell for the dispensary system as we know it now.
The new legal basis for the general medical service will be primarily in section 56 of the Bill. Under that section and section 25 the new service can be organised by making arrangements with participating general practitioners in such form as may be negotiated. Section 56 requires that choice of doctor be offered in so far as it is considered practicable by the Minister. There is nothing sinister in this saver. Obviously, absolute choice could not be provided for in the Bill, as it could not be required of the health authorities that a choice be offered on, say, the Aran Islands or some of the remoter areas in the West. Apart from such areas, however, it is the firm intention to offer a choice of doctor by participating practitioners.
Perhaps more important, it is the firm intention for all areas that the present arrangements of separate premises and arrangements for public patients will be ended. The White Paper expressed the Government's proposals on this service as involving "substituting for the dispensary service a service with the greatest practicable choice of doctor and the least practicable distinction between private patients and those availing themselves of the service". This remains the Government's policy and section 56 of the Bill and the other provisions I have mentioned will provide the legal basis for this policy.
While this major change in the general medical service cannot come into effect until the Bill has been passed and the necessary ancillary steps have been taken, I can report much progress in the preparatory work for making this change. I have had a number of meetings with the Irish Medical Association and the Medical Union on these proposals and details of them have been discussed at several meetings between the organisations and my officers. Substantial agreement has been reached on most things in these discussions and the essential features of the arrangements for the new service which I propose following these discussions are:
Participation by doctors would normally be on the basis of an agreement with the health board;
An eligible person would, subject to certain restrictions—mainly as to distance—be allowed to register with any participating doctor willing to accept him and would be allowed to transfer to another doctor after giving proper notice;
Persons could be assigned to a participating doctor where this was necessary;
Special arrangements would operate for group practices and partnerships;
There would be control on entry by doctors into the service;
Future vacancies in the service would be filled by public competition;
Patients would normally be seen in the doctor's premises, but the health board would have power to make accommodation in clinics or health centres available to general practitioners where appropriate;
Special arrangements would be incorporated to keep doctors in remote areas.
Those who now hold posts as permanent district medical officers will be given guarantees in relation to entry into the new service which I have agreed with the profession and other doctors who are in general practice for a minimum period will also have an initial right of participation.
I must report, however, that up to the present agreement has not been reached with the medical organisations on the method of payment of doctors under the service. Both the organisations were required by resolutions of their members to seek payment on the basis of a fee for each item of service. I informed them that I would not favour such a system, mainly because of the complications and administrative expense in operating it and the difficulties in controlling abuses. Initially, I favoured a system under which there would be a flat comprehensive annual capitation payment for each person on a doctor's list, but to meet the views of the profession I subsequently told the organisations that I would be agreeable to a modification of this so that there would be a separate payment to cover the doctor's practice expenses, a basic annual capitation payment to cover ordinary medical care and medical attention and, in addition, special fees for unusual items of service. After further discussions on this, which did not, of course, commit them to acceptance of this concept in principle, I sent to the organisations on 14 February last a detailed statement on this proposal and on the rates of payment.
At a further meeting on 3rd April, the association and the union indicated that they did not consider that the rates of payment offered were sufficient and also made the case that my fears in relation to the fee-for-item-of-service method of payment might be allayed if the profession were to suggest adequate controls. I did not accept what they put forward in relation to the rates of payment which I had proposed but, before considering this particular matter further, agreed that a small working party should be set up to consider the suggestions which they would wish to put forward on the controls needed under their suggested system of payment. This working party is now being set up and I expect it to report shortly. I cannot, in the circumstances, report to the House that the details of the system of payment have yet been agreed on, but I can assure the House that the professional organisations and myself are very anxious that this issue should be resolved soon. This is desirable on several grounds, in particular to end the uncertainty in relation to the future which has seriously affected the operation of the dispensary system in some areas.
It is intended that, under this new service, drugs and medicines will, as far as practicable, be issued through retail pharmaceutical chemists. Again, in preparation for the enactment of the Bill, this has been discussed with the retailers and also with the manufacturers, importers and wholesalers of drugs. A large measure of agreement has been reached on the means by which such a service would be operated and I foresee no insurmountable obstacles to agreement on the final details of the operation of these arrangements.
The practical problems involved in listing and pricing the various drugs, medicines and appliances and in calculating payments to chemists are very formidable. Millions of prescriptions will have to be priced and paid for each year. My Department have been involved in practical studies on the best methods of arranging for this and in this respect I would like to acknowledge assistance which we have obtained from the authorities in Belfast, Edinburgh and London who are responsible for operating similar arrangements. The initial preparations for this part of the service are being put in train in anticipation of the legislation, because the date of the commencement of the new general medical service will largely depend on the date on which these arrangements can come into effect. It cannot, I estimate, be earlier than the middle of 1970.
These major changes will, of course, relate only to general medical services for what we now call the lower income group, or what is defined in the Bill as "persons with full eligibility." For others, family doctor services will continue to be arranged privately. So will the purchase of drugs and medicines in normal circumstances. However, section 57 (2) introduces an important provision to safeguard the middle income group—in the Bill defined as "persons with limited eligibility"—against having to meet, unaided high expenditure on drugs and medicines. Much is done at present in this respect by the operation of the "hardship clauses" but I think the scheme under the new Bill will be better. It will be clearly spelled out that expenditure by a person with limited eligibility over a specified amount in a period of, say, a month will be recoupable in whole or in part by the health board. The minimum amount will be specified by regulations and will not be determined until this new provision is coming into operation but it is intended that it will be a sum which a person in the middle income group could readily afford to pay himself. Two pounds a month might be an appropriate figure.
I intend that this scheme should be simple to operate and should be clearly understood by the public. It will mean that persons in the middle income group will know that they will not be expected to budget from their private resources for excessively high expenditure on drugs and medicines.
In addition to these general schemes, there is provision in section 57 (3) under which health boards will be authorised to arrange to supply drugs without charge for long-term diseases and disabilities in persons of all income groups. As the House is aware, such a scheme operates at present for diabetics. This scheme will be extended to other conditions, such as cystic fibrosis and phenylketonuria. For such conditions only rare households could afford the expense of the drugs and medicines required and it is right that an exception should be made here so that all income groups will benefit from this provision. To sum up on these provisions for the supply of drugs, medicines and appliances—the lower income group will get everything free through, I expect, chemists' shops; the middle-income group will be guaranteed against excessive expenditure and the higher income group will be assisted as respects long-term and expensive items. These changes, with the introduction of choice of doctor, will involve a considerable additional outlay of public money, which may be between £½ million and £1 million a year.
Part IV of the Bill, in codifying the provisions in the other health services proposes a number of other improvements and extensions. Section 43, dealing with the definition of "full eligibility" departs from the old public assistance terminology under which "persons unable by their own industry or other lawful means" to make private arrangements for medical care were expressed as being eligible for the services. This formula has been dropped in favour of more modern terminology and it is made clear that only the means of a husband and wife as well as a person's own means will be taken into account in deciding whether or not he has full eligibility. Furthermore, there is provision in section 43 (3) under which regulations can be made specifying classes of persons who will automatically be regarded as coming within this category. This will lead to general uniformity in decisions on eligibility and, as the regulations will be public documents, it will mean that in future the standards for assessing eligibility will be known. However, it should not be taken that this definition of classes to be included among those with full eligibility can be all-inclusive. Because of varying circumstances, particularly in the agricultural community, it is necessary that the formula should retain considerable flexibility.
Section 45 contains a new right of appeal on all decisions relating to eligibility. There is no appeal at present on the question of issuing medical cards and the appeal in relation to inclusion in the middle income group is only of a limited nature.
The only major change in Chapter II of this Part, dealing with hospital services, is related to the eligibility of children for these services. At present, children of persons in the lower or middle income group are entitled to hospital services but children of those in the upper income group are entitled only in respect of defects discovered at school health examinations in national schools. This leads to an artificial distinction. Many higher income group children do not attend national schools and, even in the case of those who do, it is often purely fortuitous that it is at a school health examination a defect is discovered. The Bill will terminate this anomalous position, but will compensate parents in the upper income group by making in-patient services available for their children for permanent or long-term diseases and disabilities no matter where discovered. The most important of these would be mental handicap. As most upper income group people are covered by Voluntary Health Insurance, the loss of the right to free treatment on the grounds of discovery at school health examinations should be of no serious consequence to them, particularly in the light of the concession made for long-term conditions, which might not be fully covered by the voluntary health scheme. These changes in eligibility are, in general, on the lines of recommendations in the Report on the Child Health Services published last August.
Where in-patient hospital services are concerned there is at present a definite statutory provision under which charges up to 10/- a day may be made on persons in the middle income group. This is being replaced by section 51 which contains power to impose charges by regulations. Policy in the exercise of this power can be determined from time to time and consideration given as to whether the present charges should be retained in their existing form, or modified, or dropped. This issue could be affected by a future decision on the question of introducing a scheme of contributions by the middle income group for the services to which they are entitled.
In the case of out-patient services the Bill proposes to drop the existing charges for those services and to make the services available for all defects discovered at health examinations in pre-school as well as school children, as at present. Again, these changes accord generally with the Report on the Child Health Services.
The hospital services, are, of course, by far the most expensive sector of the health services. I think that the present pattern of eligibility is generally satisfactory and, having regard to the existence of the voluntary health insurance scheme, there is no substantial pressure for extending these services to a wider group of the population. Accordingly, section 44 re-states the present definition of persons entitled to these services. It will be noted, however, that under section 44 (3) there will be power for the Minister by regulations—which will be subject to the consent of both Houses of the Oireachtas—to change the definition of eligibility. This power could be used to make allowances from time to time for changes in the value of money or it could be used to change the general formula for eligibility. A suggestion in this respect was made in a Parliamentary Question by Deputy Donegan on 13 July, 1967, to the effect that the standard of eligibility for the services should be different for single people, married people and married people with dependants. While the Government have made no determination of policy in this respect, I would draw the attention of the House to the fact that a change of this kind could readily be made under this section, without of course necessarily charging the total number eligible for the services.
The provisions in sections 60 to 64 of the Bill relating to the services for mothers and children also have regard to the report to which I have referred earlier. An important change from the present law is proposed in section 64 (1) under which an examination service for pre-school children will be arranged. The present law limits this to clinics and health centres operated by the health authorities. By referring to "other prescribed places" in the new section, we leave the way open to bring the family doctors into this service. This was recommended for rural areas by the Report on the Child Health Services and, indeed, there is some feeling in the medical profession that family doctors in urban areas too should play a part in this service.
Section 62 takes into account the change in the value of money since the maternity cash grant was first fixed at £4 in 1953. This grant will be increased to £8 and a further concession is made whereby a double grant will be paid where there are twins, a treble grant for triplets and pro rata for any other multiple births.
Another change of some importance is contained in section 67, under which, in assessing if a person is eligible for a disabled person's — maintenance — allowance, only the person's own means and those of a husband or wife will in future be taken into account. Under the existing law, regard is had to the means of sons, daughters, and parents and of any brothers or sisters normally resident with the person.
While I dealt at some length earlier with the changes in the general medical services, my comments on the other provisions in the Bill on services have been brief, but the points to which I referred and, no doubt, many other aspects of the sections in this Part of the Bill will come up for discussion at Committee Stage. I will welcome views from all sides of the House on the details of these provisions at that time and may I sincerely say that I hope because the principles behind these provisions may not be in tune with the political philosophies of all Members of the House, that this will not prevent them participating in fruitful discussion on those details?
I would like now to revert to the earlier Part of the Bill, on the administration and financing of the health services. I hope that the general purpose is clear from the Bill and the explanatory memorandum circulated with it. The intention is to transfer the administration of all the health services to the new health boards. The membership of these would be made up of representatives of the local authorities in the area concerned, persons elected by the medical and other professions and persons appointed by the Minister. The boards would thus, in the words of the White Paper "represent a partnership between local government, central government and the vocational organisation". The arguments for making this change were given in the White Paper and were derived from two separate considerations. First, it was clear in 1966, and has been made more clear since by the Fitzgerald Report on the Hospital Services that, for those services, the county is too small as a unit. A much more effective service can be provided by grouping a number of counties for the administration of hospitals.
A modern hospital service is an extremely costly and complex undertaking. It requires not only a great deal of money but a large number of expert medical, technological and nursing staff of whom there is a short supply. In order to ensure that these expert staffs can work effectively it requires, too, that it should be based on large hospitals and large units of population. Obviously, in a country with our demographic pattern, you cannot realistically expect to be able to base this sort of service on every county. If then, as proposed by the Fitzgerald Report, our main general hospitals are to be located at a smaller number of centres, each catering for a number of counties, it follows that the administration of the service should also be based on groups of counties. The health boards will ensure that all counties participating in the service will have a say in its administration. They will also provide a means whereby persons, other than local authority representatives, with valuable knowledge or experience can be brought on to the boards.
The case for grouping counties is not as clear, of course, for other services and, indeed for some of them, such as the child health service, one could well argue that the county remains a suitable unit of administration. However, the White Paper concluded that the main advantage lay in having all the health services within an area under a single body and that if health boards as proposed were to be set up, they should have comprehensive responsibility for all the services.
I should mention that our views on this particular point have been confirmed by certain developments in Britain since the White Paper was published. In two green papers—that is documents putting out ideas for preliminary discussion—one for England and Wales and another for Scotland, proposals were put forward for a system of comprehensive health boards like those proposed in the Bill to replace the present divided system of administration in those countries. In general the idea of unified administration has been welcomed there and it looks quite likely that the next few years will see legislation in Britain for the establishment of health boards rather like those which we are now discussing.
The second reason for the White Paper's advocacy of a change to this form of administration lay in the fact of the State's increasing financial commitment towards the health services. The Government, by the White Paper committed themselves to acceptance that the cost of specific further extensions of the services—such as that in the general medical service as set out in the Bill—should not be met in any proportion by the local rates and, indeed, since the White Paper was published the proportion of health expenditure met by the State has increased substantially. This is another reason for the proposal for the transfer of administration to the health boards on the lines proposed.
The health boards will be bodies outside the ordinary Local Government system. The Bill proposes that the number of these boards and the area to be administered by each will be determined by regulations. In accordance with section 4, the Minister is required to consult the relevant local authorities before making such regulations and the regulations must be submitted in draft for approval to each House of the Oireachtas before being made. This means that there will, after the enactment of the Bill, be adequate opportunity for the local authorities, and later for this House, to consider the details of the scheme. It also means, of course, that I am not in a position to give any firm indication to the House now on what the detailed pattern will be. My Department have been studying the issue and, provisionally, I have in mind that the number of these boards should be about eight and that, as far as possible, the functional area of each will consist of a number of whole counties. Furthermore, it will be appreciated that in designing the regions I will have regard to regions for other purposes, and particularly those for planning and development.
Naturally, only a proportion of the members of each county council or other local authority concerned can be appointed to each health board. It is proposed, however, by section 7 to associate other members of the local authorities with the work of the boards by establishing local advisory committees for each county or other appropriate unit. These committees will primarily be there to advise on the provision of health services in their own areas but the board will have authority to delegate functions to them if that should appear appropriate.
Sections 12 to 23 of the Bill deal with officers and servants of health boards. These provisions draw much on the law on officers and servants in the Local Government Acts but there are some significant distinctions. The most important of these is that the statutory office of chief executive officer to a health board will not be analogous to that of a county manager. The latter performs all functions for a local authority except specified functions reserved to the elected members: the chief executive officer, under section 16 of the Bill will perform his duties on behalf of the board and in accordance with its decisions and directions— except as regards certain things in which he is specifically given functions by the Bill. These will be mainly decisions on individual applications for services and on the control of officers.
It has been said to me that there will be little practical difference between the operation of this provision and the normal relations between a county manager and the members of his council. That may be so, because a good manager will always act in concert with his council and without stressing his own sovereignty but I nevertheless think that the different legal status of the members of a health board vis-àvis the board's chief executive officer and other officers will be significant in giving considerably more weight to the authority of the members.
I should mention that I have received representations from the medical profession that each chief executive officer should be a doctor. I cannot accept this, as the primary qualifications for this office must lie in administration, but should a doctor succeed in competition in qualifying in this respect, I would be glad to see him becoming a chief executive officer. This is a point on which I would be particularly interested to hear the views of other Members of the House.
There is an interesting departure from Local Government law and practice in sections 22 and 23. Local Government officers are subject to discipline by the manager and to removal from office on disciplinary grounds by the Minister. Under the Bill, it is intended that the Minister will not be involved initially in disciplinary cases affecting officers of health boards, other than the chief executive officer. The investigation of a proposal to remove an officer on disciplinary grounds would be in the hands of a special committee appointed under section 23 and the Minister would become involved only on an appeal. This proposal is in accord with the general aim of devolving detailed functions from the Minister and his Department as far as practicable.
May I now turn to section 40 of the Bill, dealing with bodies for the co-ordination and development of hospital services which should be looked at in conjunction with the earlier proposals on health boards. This section in some degree reflects the thinking on administration of hospitals in the Fitzgerald Report. That report advocated a separate system of hospital administration in which there would be a central body to be known as the Consultants Establishment Board dealing with the control of specialties, three regional hospital boards and, under them a number of hospital management committees. This completely separate system of hospital administration is not acceptable, for reasons which I have outlined above and because of the administrative duplication to which it might give rise.
However, certain features of these recommendations of the Fitzgerald Report have been embodied in the Bill. While the basic administration of hospitals will be in the hands of the new health boards and, for the voluntary hospitals in the hands of their boards of management, the idea of a central co-ordinating body and three regional hospital boards is incorporated in section 40. The central body will be known as Comhairle na nOispidéal and its main function will lie in advising on the regulation of the number and type of consultant appointments in hospitals. It will also be concerned in the qualifications for such appointments and will have general advisory functions. At least half of the members of this body will be hospital consultants.
The three regional hospital boards based on Dublin, Cork and Galway will have the different function of being concerned in the general organisation and development of hospital services in the health board hospitals and the voluntary hospitals participating in the services within the regions. Each regional hospital board will draw one-half of its members from the health boards within its region and the other half will be appointed by the Minister after appropriate consultations.
Some critics have seen in the provisions relating to the administration of the hospital services an attempt by me, by the State, to end the traditional independence of the voluntary hospital system. I have already stated that that is not my intention. I repeat that now. We owe a great deal to our voluntary hospitals, to the religious communities and lay boards associated with them for the standards of hospital care and medical teaching which they have established and maintained during their long history. It would not only be thankless but foolish for me if I were to attempt to end their independent status and put them all in a bureaucratic strait-jacket. But having said that, and emphasised that, I know that I can expect those voluntary hospitals participating in the public services to accept certain restrictions and conditions in the interests of the hospital system as a whole.
It is not necessary for me to labour the fact that the cost of running our hospital service is by far the largest element in the soaring cost of the health services. The administrative machinery I am now proposing for the hospitals is aimed at securing a more efficient and effective service and a better return for the money we are spending. Obviously this must necessarily involve a willingness on the part of all hospital authorities to accept a planned and rational approach towards the future organisation and development of the service.
Section 40 represents a compromise between what the hospital consultants might regard as the best form of administration for the hospital services and what the Government think public representatives at national and local level would accept for this purpose. Like most compromises, it will not fully satisfy everybody. I have not yet got in detail the views of the organisations concerned on the actual text of the section but, when I have these views and have considered them I may wish to suggest some modifications in the section on Committee Stage.
It became clear to us in framing the new form of administration that, with the establishment of these bodies and the general transfer of administration to the health boards, the Hospital Commission would no longer have a sufficient function to perform. Accordingly, it was decided to include provision for the eventual dissolution of the commission. The Hospitals Commission was established in 1933 mainly for the purpose of advising on the spending of money derived from the Hospital Sweepstakes. Conditions were, of course, much different then from what they are now. During its existence the commission has performed a very useful function and in recent years it has become involved, by agreement with the voluntary hospitals, in general work designed towards encouraging efficiency and economy in those hospitals. The chairman of the Commission and its members and staff are to be complimented on the manner in which they have done this work. That it is now proposed, because of the evolution of administration, to dissolve the commission reflects no discredit on them.
The establishment of health boards and of the new hospital bodies will cause somewhat of an upheaval in health administration. As well as the Hospitals Commission, the Dublin, Cork, Limerick and Waterford Health Authorities, the seven joint mental health boards and the Western Health Institutions Boards will be dissolved. In all, as against the 12 or so new bodies being set up, 13 will disappear. There is also provision for the transfer of health staffs from county councils. These matters are dealt with in sections 33 and 36 of the Bill. These sections will affect several classes of officers and many individuals. The next of the Bill has been sent for comment to organisations representing the various categories of health staffs. I would like at this stage to say that their views on any difficulties which they expect on the working of these provisions will be received most sympathetically by me, both before the enactment of the Bill and later. If necessary, I will be prepared to bring in amendments in this respect on Committee Stage.
Sections 26 to 32 of the Bill contain the provisions on the financing of the new health boards. Their accounts will be kept in a prescribed form, they will be audited by Local Government auditors and the certified abstracts of accounts will be presented to the Minister and to the local authorities concerned. The Minister will present copies to the Houses of the Oireachtas. Budgetary control of health boards will be exercised under sections 29 and 30 as, under these sections, the authorised estimates of health boards will be binding on them and may be departed from only with the Minister's consent. The chief executive officer of the health board will be given a function, similar to that which the accounting officer of a Government Department has, to ensure that the financial controls are properly observed.
The sources of finance for the health boards are specified in sections 31 and 32. The boards will be financed mainly by way of State grants and local contributions. The State grants will meet one-half of the total running expenditure and a further proportion as determined from time to time. The local contributions will meet the balance. The contributions for individual local authorities will be determined by regulations made by the Minister for Local Government, which will be presented to the Houses of the Oireachtas.
The effect of these provisions, of course, is that there will be no such thing as a statutory "freeze" on the amount of the local contributions, but I should point out that the section is framed so that, should the Government of the day decide in future that such a freeze was desirable, it could be provided for. I would personally not think it appropriate that future Governments should be firmly committed by the Bill in any way in this respect. The decision on this is something which has to be taken from time to time in the light of the general financial circumstances—central and local. Accordingly, section 31 in its present form seems to me to be more appropriate than one setting out a more rigid financial basis for the services.
The Bill contains several other useful miscellaneous provisions. By the transfer, under section 42, of the administration of the Dundrum Central Mental Hospital to the appropriate health board we should achieve a much better use of that institution as it should greatly benefit by co-ordination with other psychiatric hospitals in the area. A simple procedure for amendment of hospitals charters or private Acts is proposed by section 73: this will enable the boards of governors of hospitals to avoid the expense of private Acts. Confusion relating to health authorities' powers in the removal of bodies of dead persons found in their areas, which has led to some distasteful incidents in the past, should be removed by section 74. Finally, by the provisions of this Bill, certain repeals of the Mental Treatment Act, 1945, and the proposals for the adaptation of those Acts under section 78, the remnants of the distinctive legal provisions on the provision of services for the mentally ill will be removed, so that the same law—as contained in this Bill—will apply in relation to eligibility for those services and the provision of those services as applies to other hospital services. The only part of the mental treatment code which will remain will be those necessary provisions governing the procedures for the admission of patients to mental hospitals and the retention of patients in those hospitals. I should hope that, in the future, a separate Bill will repeal these remnants of the Mental Treatment Code and replace them by a simplified procedure. For the moment, I would point out that the Health Bill takes what might be called the penultimate step in removing the distinctions which have traditionally existed for the care of the mentally ill.
This Bill is a highly technical document in its provisions on the administration of services, the financing of services and eligibility for health services but, basically we are discussing on it what the public authorities should do for our people as a whole in the prevention and cure of disease and in caring for the ill, the infirm and the aged. I present the Bill to the House as offering what the Government consider the most rational solution to a number of the problems which arise. I put it to the House with no apology for its not being something else, such as a Bill for the introduction of a comprehensive national health service: we do not think that the people need that or want that. I hope the House will accept the Bill as offering the most reasonable vehicle for the future development of our health services in accordance with the general philosophy and traditions which have served this country well in the past.
