Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 30 Oct 1969

Vol. 241 No. 13

Health Bill, 1969: Committee Stage.


I move amendment No. 1:

To add to the section a new subsection as follows:—

"(5) The Minister may by order revoke an order made under this section, and the revoking order shall contain such provisions as the Minister thinks necessary or expedient consequential on the revocation and in particular may fix another day or days for the coming into operation of this Act or any section thereof."

The purpose of this amendment is to allow the Minister to vary the appointed day on which the Bill may come into operation. We consider this subsection necessary in the light of previous experience. When the 1953 Act was passed it had in it sections similar to section 1 and, as the Minister knows, his predecessor provided, by a reckless order that the Bill and all sections of it would come into operation on a particular day. Because that was done it was subsequently necessary to come back to Dáil Éireann to seek a revocation of the ministerial order because it was found impossible to bring some of the sections into operation on the date which the Minister had provided in his regulations. Even to this day, 16 years after the 1953 Act was brought into operation, there are many sections which are, as the Minister knows, inoperative, particularly those sections in relation to dental and ophthalmic treatment.

It is undesirable that the Minister should make a regulation in the hope, perhaps, that it will be possible to implement certain provisions on a particular date or for the sake, perhaps, of causing political embarrassment to his political opponents when, in practice, the sections to which the regulation refers are not capable of performance. Because the qualified medical staff and the necessary buildings and equipment are not there to enable the particular section, or sections, to be enacted there is no possibility of providing the benefits and services which it is intended to bring into operation.

A responsible Minister, a Minister such as, we believe, the present Minister is, would not bring into operation a section of an Act unless it was capable of performance. Nonetheless, because of our previous experience, we have reason to fear there might be a repetition of what happened in 1954 under the 1953 Act when a reckless order was made, an order incapable of performance and, in order to allow the Minister the necessary room for manoeuvring in the light of experience or in the event of difficulties arising, we believe the Minister should have the power to revoke and amend, when necessary, any order he may make for the coming into operation of the Act itself.

In connection with this Bill we are taking the greatest care in regard to the carrying out of all the regulations and enactments. In order to enable the Bill to be implemented by 1st April, 1971, we have arranged a complete visual project of all the steps required to be taken and the Deputy can be assured that, with our prolonged experience of health legislation over the years, there is no need really for a revoking provision. Such a provision might, indeed, create a feeling of instability in the minds of those involved in the health authorities. If I were to revoke an order, for example, I might make the staffs of certain health boards redundant and an element of uncertainty might be created if I were to accept this amendment and that element of uncertainty might result in discouraging people from seeking posts with health boards or any other body established under the Bill. That would have repercussions on the bodies in the making of agreements. We have, for instance, provision for a choice of doctor. The long consideration of the Health Bill—let us be absolutely frank about this— and the period that must elapse before the principle of choice of doctor comes into operation, a principle which involves negotiations with the medical associations, has resulted in a great number of temporary appointments, as the House is well aware. We have had to mitigate the situation to some extent by advertising —I think it is some 18 posts—for dispensary officers where we think the choice of doctor principle will not be adversely affected by the appointment of such officers. We do not want to establish any feeling of uncertainty among the medical profession.

Therefore, I think Deputy Ryan has perhaps exaggerated the difficulties. I can assure him, however, that we have had the experience of the 1953 Act and other Acts and there are, perhaps we should say, more modern administrative procedures for watching progress very carefully, with all the enactments and the orders and the coming into operation of each of the services projected in this Bill, of which there are a considerable number— agreed to, I am glad to say, by the House, although, of course, members of the Opposition, such as the Labour Party, may be wishing for more in many instances. However, at least there is an additional expenditure, for example, of some £1 million that we know will be involved, that will be raised from taxation and not from rates, as a result of the services contemplated in the Bill for the year 1971-72.

I think I can with sincerity suggest to Deputy Ryan that this amendment is not necessary. We are going to take care in regard to this and then, as the House knows, resolutions will come before the House in relation to the constitution of the health boards and the House will have an opportunity of debating the administrative arrangements for the operation of the health boards at a later stage. So that this is a truly democratic procedure.

The Bill is going to be discussed again in this House in respect of the administrative regulations and in respect also of the regulations applying to the standards by which we prescribe medical cards. Those also have to come before the Dáil. So that we have arranged for democratic procedures in this case and this Bill does not have to be passed by the Dáil in the knowledge that Members will not have a further opportunity of discussing a number of important matters in relation to it. Deputy Ryan, I am sure, has studied the Bill and he knows the number of matters that will come before the House again.

We in our Party accept the general assurance given by the Minister. Frankly, we feel, and we would ask Deputy Ryan to consider the matter, that there are adequate procedural safeguards contained in the Bill and that there is no necessity for the introduction of what we respectfully regard as an amendment of somewhat arrant legalism. Therefore, we feel that, as the Minister has indicated, there is no real necessity for an amendment of such a sweeping nature at this point of time. We have no doubt that there are sufficient internal democratic safeguards to avoid the points raised by Deputy Ryan.

I will be perfectly frank and admit that this amendment was tabled by me when the Bill completed its Second Stage in the 18th Dáil because we had reasonable hopes that there might be a change of Government in the general election at the conclusion of the 18th Dáil and in the light of the experience it was very necessary to ensure that what happened in 1954 would not happen again. What happened in 1954 was that Dr. Jim Ryan, the then Minister for Health, for no purpose other than to cause embarrassment to the incoming Government, made a comprehensive regulation bringing the whole of the 1953 Act into operation. Sixteen years later there are still sections of that Act not yet in operation and which are the cause of perpetual complaint by way of Dáil Questions and otherwise. But even in the autumn of 1954 it was necessary for the then Government to point out the irresponsibility of the outgoing Minister who within 48 hours of the change of Government in 1954 brought a whole Act technically and legalistically into operation when it was incapable of performance.

While Deputy Desmond might want to refer to my professional background, the fact is that on the political facts of the situation, on the health facts, we are entirely justified in tabling this amendment. It is still conceivable that the new Health Bill will not see its full fulfilment in practice even within the lifetime of the 19th Dáil because, as I say, 16 years have passed and we still have sections of the 1953 Act not in operation, but it is still conceivable that in the last hours of the 19th Dáil, or in the event of a change of Government some time in the future, the Minister, for political purposes, might irresponsibly bring into operation all sections of the Act just for the sake of causing political embarrassment to the succeeding Government.

If it were not for that, certainly, we would not have tabled this amendment. I entirely appreciate all the arguments the Minister has advanced. It is undesirable to have uncertainty; it is undesirable to have Ministers making orders which, on the ministerial say-so, can be withdrawn. That might be as difficult and as undesirable as the situation which we in Fine Gael wanted to avoid.

I think the amendment has been useful in giving us an opportunity to remind the Members of this House of what happened 16 years ago and to remind the Members of the House and the Minister of the need to be careful before pretending to bring into operation any sections of the Health Bill because it is wholly undesirable that in our democracy we should pretend that health services, social services or any services are available when, in fact, we fail to take the necessary steps to make these services available. It is wrong to say that as a matter of law you can get your teeth extracted, that as a matter of law you can get new dentures, when, in fact, you may have to wait one, two or three years to get these things done. It is wrong to say to people that they are entitled to ophthalmic surgery, to say that that is what the law says, but who find that, even though the law says it, they may have to wait two years before they can get a bed in a hospital that would cater for this ophthalmic surgery.

It is to prevent that kind of grossly dishonest and wholly undesirable situation that we urge upon the Minister to ensure that services are available before orders are made bringing any section of the Act into operation. If that is the way in which the Minister is prepared to approach the matter, and I gather from what he says that it is, we will not press this amendment.

Amendment, by leave, withdrawn.
Section 1 agreed to.
Sections 2 and 3 agreed to.

Perhaps the House could discuss amendments Nos. 2 and 3 together, and, if the ministerial amendment is agreed to, then Deputy Ryan's amendment cannot be moved.

I move amendment No. 2:

In page 5, to delete subsection 2 (b), lines 14 to 17, and to substitute the following:

"(b) In a specification of membership of a health board by regulations under this section, the number of persons fulfilling the condition in paragraph (a) (i) shall exceed the total number of other members of the health board."

I have already had the pleasure of meeting a very considerable number of local authority representatives from all over the country in order to discuss the constitution of the regional health boards and I was very much impressed by the strength of opinion that the local authority representatives should be in a majority on the health boards. It is a fact that taking the country at large the State is responsible for about three-fourths of the total health expenditure. If one apportions the agricultural grant in each county as a percentage of the total expenditure by that county, including all the urban expenditure, in its proportion to the health expenditure of the county, then we are paying for three-fourths of the total health expenditure of the State, but I am also aware of the feelings of local authorities that they should have a dominant position on these health boards. So, quite early on, I decided to carry out the wishes, which are, in fact, expressed by Deputy Ryan in his amendment, and ensure that the number of local authority representatives would exceed the total number of other members of the health boards.

When I did refer to this at meetings of local authority representatives I said that, in my opinion, even if the numbers were equal, with the chairman with the casting vote, I did not feel there would be on many occasions a bloc vote as between the local authority representatives and the professional representatives. I did not think that would happen in practice. I think many people agree that it would be most unlikely to happen, if these boards operate in a truly professional way, looking after the interests of their people but also thinking in terms of a modern health service well administered. In spite of my feelings in that regard, I decided to agree with the members of local authorities of all parties that the local authority representatives should be in a majority and, for that reason, I am tabling this amendment.

The Minister's amendment says in different words what I was proposing in my amendment. I am glad he has seen fit to accept the suggestions Fine Gael made on Second Stage—suggestions which, as he correctly points out, have been accepted by the local authority representatives of all parties throughout the country. It is certainly true that no health service will operate successfully without the full and generous co-operation of members of the medical and nursing professions. It is a good thing to have our health service operated by a team consisting of the medical experts and members of local authorities and ministerial appointees, particularly when the service is one which is remunerated out of rates and the national Exchequer and is operated by members of the medical profession. But, where the members of the medical profession are the employees of the very service which they are seeking to govern, it is undesirable that, in voting matters, they should have strength equal to the voting power of the people who are paying the piper.

The proposals as made by the Minister, in his outline, underwrote our fears as expressed on Second Stage. In many cases, the Minister had an equality of numbers between members of the medical profession and his own advisers, on the one hand, and the members of local authorities on the other hand. We were naturally disappointed that it was not until the Minister's proposals had been processed through the local authorities that the Minister saw the error of his ways. One feels it was only because of the vigour of opposition from all parties which the Minister met when he interviewed the members of the local authorities that he gave way. One feels he has given way to avoid political embarrassment rather than on the merits of the case which we in Fine Gael believe should be made, namely, the entitlement of the people who are paying the money for the service to have a say in the manner in which the service should be run.

The experience in practically all cases has been that members of local authorities have been in no way niggardly in providing money for medical services. If there has been any brake on expenditure on health services that brake has been applied not by the local authorities but by the Department of Health which has held up a considerable number of proposals by many health and local authorities down through the years. Therefore, as far as the medical and nursing section of the hospital services are concerned, they have no reason, as far as I know, to fear in any way the voting power of members of local authorities on the proposed health boards.

The Minister in his amendment has not given us any indication of the size of the majority to be given to members of local authorities. I think it is important that this majority should not be a simple majority of one—such as he has provided in a number of the health authorities—but that it should be a majority of one-third or one-fourth, certainly not less than one-fourth. Human nature being what it is, it will not be possible for all members of these new health boards to be present at all times. I think there should be an edge of advantage in favour of members of local authorities to ensure that they will be, on balance of probability, represented at most meetings by a majority of members.

I think the Minister is right in saying that it is unlikely that there will be bloc voting; that it will be a question of the profession and the Minister's advisers against members of local authorities. If there is going to be any bloc voting, I would suspect that the bloc voting would be the members of the local authorities plus the professional members against the Minister's nominees. I think that is a more likely arrangement because that has been the pattern of thinking in medical services down through the years. However, as the Minister is seeking such extravagant powers in this Bill to appoint, in the first instance, the members who are to represent the professions, we believe it is undesirable that there should be any possibility of giving such people the power to overcome the wishes of members of local authorities.

Down through the years, members of local authorities have given—and they will continue to give—immense service on local health authorities. They represent the community, the patients, the sick, the invalided, the destitute. Their voice must be heard in any health service. To ensure that their voice will be heard significantly, it is imperative that they would have a generous majority on any of the new health boards. I am glad the Minister has seen fit to accept our suggestion. We would ask him to give an indication today of the size of the majority he believes members of local authorities should have on these new health boards.

We are concerned, from the union side, that there is not sufficient specification that, on the union side, there should be their membership on these health boards. Granted, we are glad to see the amount of decentralisation of authority involved in these health boards but, speaking from the union side, they are extremely anxious to ensure that important sections in the medical profession, who are not actually designated by name, will not be overlooked. For example, it is forgotten that there is an important element in our medical services—the psychiatric nurses. One would feel that such a section should actually be designated by name and that it should be understood that they would be part of the functioning of the local health board. The Irish Transport Union has a great number of such nurses around the country and would feel that such people should be dignified by being spelled out as being persons proper to take a part in the membership of such health boards.

It may be said that the health service is not simply and solely the concern of what we understand to be the medical profession—the doctors, and so on. There must also be included in this health service, and playing an essential function in it, all the extra medical staffs in our hospitals from the nurses and the other functionaries down to the ambulance drivers. All these people are involved in our health service. We feel that in this section the Minister could have gone further to break into their component parts the people taking part in our health service instead of using global descriptions. He does refer to ancillary professions but we feel that there has been this lacuna in official thinking, if one could describe it as such, this idea that the health services were primarily the concern of the doctors. There has been too little recognition of the function of the nursing profession and we believe that this Bill could certainly have spelt this out more clearly.

We have to some extent changed our attitude to health by a gradual agreement among all parties in this House that health is not something that is yours or ours by virtue of £sd, that one should not have a better health service because he has more cash. If this improvement, this civilisation, in our feeling has come about, likewise we must banish the last vestige of class attitude in the actual running of our health services. We must realise that the nurse attending the patient is equally as important as the doctor who gives the prescription. When we speak of a health board we must spell out exactly the function of each element in this health service. I believe that the Minister has not sufficiently lived up to this new attitude that all of us in this House share to health especially in the running of the actual regional health boards. We should involve the people who work in our hospitals from the kitchen to the ward. Therefore, we must spell out clearly the rights and respective representational quota appropriate to all interests in the health services in the regional area.

In this connection we would say that there should be at least two psychiatric nursing representatives on each health board. This would be commensurate with the importance of their contribution in each area. There should also be, we would say, two general nursing representatives. This could be considered by the Minister. I have referred to the contribution of other elements in the health service, the people who man the ambulances and all the other duties necessary to the running of a hospital, all of them equally essential. We would say that the extra medical staff should also be involved in the running of the health board.

The Minister in his previous ministerial appointments has always been anxious to get rid of friction in the areas under his control. I would suggest that there is no reason in God's earth why there should be friction in the running of the health service. We do not have the motives lying around in the health service that exist elsewhere in our industrial life. We do not have, or should not have, any particular vested interests in that area that would prevent the setting up of a rational control in our health service. It would, therefore, seem to me that we can look at this matter afresh. The Minister will agree that we merely seek to improve the efficiency of the proposals he has put before us, their acceptability, and we would put it to him, quite respectfully, that there should be on his part recognition of the role of these elements in our medical services. We will not be absolutely categorical about the manner of nomination. He might, for example, consider that the joint industrial council on the nursing side for psychiatric nurses could be considered as a nominating group on their side. This is certainly a thought. We would ask the Minister to consult with the unions in the health service to see whether any agreement or at least an understanding might be reached with them on this vital matter of representation on the regional health board.

If the Minister sets out to create what is certainly an improved edifice in the health service, then we would suggest that the best thing he could do at the very start to declare his good intentions of running a service free from friction would be to consult with the employees' side representing all sections of the nursing interest in the health service to see exactly how they may be represented and how their importance is acknowledged in the actual act. Too often we are ready to designate, to credit, other bodies in such Acts and surely it is high time that the employees side, the nursing side, were so designated in our legislation. I would, therefore, recommend to the Minister that he should consult with the employees' organisations, the union I belong to—the Irish Transport and General Workers Union, the Workers' Union of Ireland, the various nursing bodies, to ensure that their place in this Act is fully acknowledged. Perhaps, the Minister already intends to do this, in fact, but it is not quite spelt out in the Act. I feel it would be improved if their place and function were acknowledged in the Act.

Other speakers will go into detail on the actual make-up of the board. In general it can be said that the idea in theory is a good one. We may have some reservations about the still remaining powers of the Minister in the various boards. We will acknowledge I suppose that there must be a ministerial presence on these boards but whether this ministerial presence should amount to practical ministerial veto is another matter. Certainly we would appeal to the Minister to consult with the different employees' organisations to see how their persons can be more properly recognised in the Act as it is. We must, if we are to ensure a health service which in its attitude and its treatment of patients, gives to each patient equal attention, see that such a health service also gives to each category of employees involved in that service commensurate representation.

I would say that in their respective duties the housemaid in the hospital is as important as the surgeon. This may be considered a most peculiar attitude but I believe it is an attitude which, if it is lived up to, will ensure a smoothly functioning service. Skills may be more rare at the surgeon end but the dedication that is necessary from all groups in the hospital service is something that should be enshrined in our legislation, something that should be respected in our legislation. In our hospital service if it is to function properly we need a team going from the properly functioning kitchens to the operating theatres. We cannot have outmoded class distinction in such a vital matter.

We would, therefore, appeal to the Minister to see to it that this Bill does not seem to owe a certain tribute to past unfortunate attitudes in the health service, that it would be seen to be an improved one reflecting new attitudes both to the patient and to the people who staff our hospitals. All of them, whether doing humble duties or otherwise, are equally important, and all must have a say in the proper functioning of that service. If one category in a hospital decides to refrain from work, withdraws co-operation, decides on a sore thumb policy, all other sections and services in the hospital are affected and its general efficiency drops and who will say that in the treatment of any patient, impairment of efficiency can be tolerated in any section? Therefore, we would say the new Bill should give evidence of equal recognition to all the elements in our health service whose contribution is essential to the working of that service. We say to the Minister that he should ensure that the nursing side will have representation on the health board, that there be a clear commitment to a quota of representation from the nursing side, a clear acknowledgment of the part played in the health service by psychiatric nurses and that they should be so designated and that the same would apply to other elements in the nursing side. Just as we acknowledge the presence and importance of the doctor, the medical element, the treatment element and the professional element, we should also consider the importance of the other professions and their contribution to the health service and we should naturally follow up that acknowledgment by putting it into the legislation in this Bill.

May I join in urging, perhaps, with some repetition but I think with some necessity, a re-casting of the proposed membership outlined by the Minister? We welcome his second thoughts.

Would the Deputy yield to me for a moment because it is very important to establish procedure in debate?

Would Deputy Desmond allow the Minister to intervene on a point of order?


We are now discussing the setting up of regional health boards. The number of persons, their designation, by whom they are nominated—all that will have a full debate when the resolutions come before the Dáil. Deputy Desmond and Deputy O'Leary will then be able to speak in greater detail on this matter. I sent the proposed constitution to every member of the Dáil and Seanad so that they would have an even longer time to consider this. I have also sent to all the unions concerned a copy of the memorandum on the proposed constitution of the health boards. That indicates clearly to the House that we consider the nomination of the general nurse and psychiatric nurse. We want to get this immensely long Health Bill through the House in time to enable us to have the Bill in operation by the 1st April, 1971. It will put us to the pin of our collar to do that. There will be a full debate in the House on the constitution of the health boards. The procedure of the boards and the question of the appointment of the chairman and his powers will arise on the Second Schedule. Therefore, I ask Deputies to bear with me in this suggestion that we discuss the actual constitution of the health boards at a later date; otherwise it will mean repetition of discussion. I am very glad to have heard Deputy O'Leary, Deputy Ryan and Deputy Desmond and I have taken account of their views but they will all be discussed again later in this House.

Can we have an acknowledgement from the Minister that there will be representation on the union side in the manner suggested here this morning? Does the Minister disagree with any of those sentiments?

I have already indicated that in respect of certain groups in the health service I have sent out in advance a statement that there would be representations from the general nursing profession and the psychiatric nursing profession. I have already indicated that.

On a point of order, I suggest with respect that the speech that Deputy O'Leary made is irrelevant to the section. It dealt with matters on which I should like to have spoken and would have spoken except that I considered it to be out of order. We are concerned only at the moment with the question of whether or not the local authority representatives are to have more than half of the membership. I would say that the other matters are relevant on the section and while we appreciate what the Minister has said, I think Deputies are quite entitled to speak here at whatever length they decide on the section, but only on the section.

I am only asking for co-operation. If possible, I want to have this Bill enacted by the end of December if we are to make progress and put into operation all the new services provided in the Bill.

Certainly, I have every intention of staying within the rules of order because, in the first instance, I propose to speak on local authority representation as delineated by the Minister this morning. I welcome the change of mind by the Minister permitting majority representation from local authorities. For example, in his outline in the House and as circulated to Members, of the proposals for the board with which I am principally concerned, the Eastern Health Board, the weight of representation from local authorities was quite bluntly inadequate. The Minister tentatively proposed three members for Dublin County Council, six for Dublin Corporation and one member for Dún Laoghaire Corporation, three for Wicklow and three for Kildare. This was the original outline circulated to Deputies and members of local authorities. Quite legitimately, I think, and without being in any way out of order, we may request, through the Chair, some more firm indication from the Minister as to what increased representation he intends to give local authorities generally under the new regulations that he intends to bring in. I presume this has been the subject of intense discussion internally in the Department. In regard to the Eastern Health Board, for example, I suggest that any proposition which would limit Dún Laoghaire Corporation to one member would be unacceptable to public representatives and the constituency at large. The suggestion that one local authority member should represent 50,000 electors would strike one as gross under-representation and generally unacceptable.

There is another aspect of this which we cannot avoid discussing even though superficially it may appear out of order. One cannot take the representation of local authorities and, assuming they are to have a majority on the new health board, simultaneously ignore the representation of other branches on the health boards. This brings me to treating very briefly the point made by Deputy O'Leary. I consider it unbalanced that the Minister should give such a tremendously large representation to the medical profession vis-à-vis local authority representation and representation from other branches of the labour force in the health services.

We consider psychiatric nurses grossly under-represented in terms of one member. Similarly, we consider the general nursing profession grossly under-represented in terms of one member. There are many hundreds of general, administrative, clerical, internal professional workers in the health services represented by such unions as the Irish Local Government Officials Union, the Workers Union of Ireland and the Irish Transport and General Workers Union who are completely unrepresented on the health boards.

As a matter of general principle I want to make a point to the Minister. He mentions in relation to that section, "persons appointed by the relevant local authorities", and "persons appointed by the Minister". I would remind the Minister that there is the concept now coming into increasing vogue and I think generally acceptable to the Minister, of representative appointments by the workers employed in the various organisations. While this concept may be somewhat foreign to some Government Departments, I think there is a valid case for consideration by the Minister that the trade unions who organise the growing army of health authority workers throughout the country should have the right of general nomination and appointment rather than submitting an ad hoc panel to the Minister who, in his wisdom and benevolence, would make the appointments. This would bring into the health services an element of industrial democracy or workers' democracy which is very necessary in those services.

These in brief are my points. In fairness to the Minister I should point out that we in the Labour Party consider the setting up of these boards to be an extremely valuable innovation in the field of social planning for social services for the 1970s. We certainly welcome the decision taken by the Minister in this regard. As the Minister knows there is no reaction in principle against the composition of the health boards, by and large, but I would submit that there are serious undercurrents of unrest in relation to their composition. While we may have to wait some months before the Minister brings before the House the actual resolutions and orders in relation to the precise composition of the boards, we now have the opportunity of clearing this up and I think this would be appropriate. A final point on the section would be——

We are discussing the amendment, not the section.

I will leave it at that. I support my colleague and I would ask the Minister to deal with the matters which have been raised. They are a fundamental part of this Bill.

It is difficult to gather what Deputy Desmond's point is. The point he seems to be making is this. He wants to crowd out the health boards with representatives from various unions. I might well, for example, say that there should be representation of the patients.

That is a very superficial observation, with respect.

I think I know as much about the subject as the Deputy. What size should we aim at as the overall size in personnel on these health boards? What is the appropriate size? Those of us with any experience of committees in this House know quite well that with a larger personnel it is more difficult to get the work done. I would have thought that the Deputy might be more specific on the point he was making when he suggested that there should be representation for other members of the community. I have not got the least objection to representation for any members of the community. This point must be borne in mind. The Deputy is asking, first, for greater representation for members of the local authorities and, secondly, for greater representation for other members of the community. Where will he stop? What figure would the Deputy suggest for the establishment of the health boards?


I could equally suggest 40.

I suggested 35.

For example, I think I could make as good an argument for including the patients as the Deputy made for his point and, not merely that, but for the different categories of patients. So, when we come to consider the health boards in this context, let us be realistic and let us first of all decide what size of a health board will do the work expeditiously and, at the same time, provide balanced representation on the health board, shared equitably amongst other members of the community.

My experience in local authority affairs and, indeed, of committees of this House is that small committees work much better than cumbersone committees composed largely of people who might not be too interested in the job in hand. If we accept the principle that 24, for example, should be the membership of the committees, then we should be prepared to agree that the membership should be fair and equitable but, at the same time, we should bear in mind that in any given number we might nominate in this House—let it be 35, 45 or 50——


I should like to hear a better argument in support of 35 than the Deputy made. One would still have a large volume of people in the community who would still be unrepresented. One could make that argument.

Can the Minister tell us how the local authorities will nominate their members to the boards?

The Second Schedule of the Bill provides the method by which the local authorities will nominate their members to these boards and that can be examined in the House when we reach that point.

(Cavan): The Minister has to make regulations specifying how they are to be elected.

The rules for nomination are in the Second Schedule, rule 2, and can be discussed when we reach that point. It would be undesirable to discuss this at the moment because that would make it very difficult to make progress with the Bill.

I have listened to Deputies who have spoken about the constitution of the boards. This, of course, is difficult matter because, as Deputy Carter said, you have to relate the desirability of an efficient board to the desirability of having as much representation as possible of the various interests concerned. There are five or six trade unions, for example, representing workers in the health services.

I agree with Deputy Carter that it is undesirable that the membership of any board should exceed 30 at the very utmost—indeed, 25 would be preferable. I believe this because I think if one looks back at the experience of very large boards one finds that the boards ended up effectively in the hands of the chief executive officer who was appointed for the general administration of the service. It becomes impossible to do the business effectively. That can be mitigated, to some extent, by the appointment of committees for certain purposes but those committees cannot make important or vital decisions. They can only examine facets of administration, or the efficiency of administration, or the scope of administration.

If Deputies look at the proposed constitution of these boards they will find that there are to be 14 to 16 members representing the local authorities and 14 to 16 other professional representatives of the nursing and psychiatric professions together with the ministerial nominees. We have to look at this problem realistically. I am not going to say what I am going to do until I have listened to all the local authority representatives from all over the country. I still have two or three meetings in front of me where this matter will be discussed. It would be wrong for me to tell the Dáil what my feelings are at the moment until I have met these local authority representatives from Cork and Kerry and from the mid-western and midland regions. However, I shall bear in mind everything that has been said here today. I do not disagree with the general principles which have been enunciated by the Members of the Labour Party. It is simply a question of what is practicable and, perhaps, choosing representatives from the nursing profession and the psychiatric profession which form part of the great body of medical operatives, shall we say, as distinct from the clerical staff.

It would be impossible for me to say at this moment what should be the extent of the majority of local representation, but if the House will agree with me that 25 to 30 is the absolute maximum, there could not be a big majority of local authority representation if there is to be adequate representation from the medical profession; and the participation of the medical profession in the health board I regard as a matter of very great consequence and importance. The medical profession is again divided into various disciplines, general practitioners, physicians, surgeons, people in charge of the preventive health service, county medical officers of health and so forth. We are trying to represent a profession with a great many disciplines and so I shall not commit myself about the extent of the majority.

I should like to say again, however —and I may prove wrong, as other people in this House have proved wrong in their predictions about how an administration will operate—I do not believe there will be a cleavage between local authority representatives and the professional representatives on important and vital matters. I believe there will be various combinations of votes on these matters. I may be wrong but I have been assured on this by some of the most experienced county councillors whom I consulted about this, and when I spoke at the meetings of local authority representatives I said this and a good number of seasoned county councillors on both sides nodded to me when I said that I did not believe that on a great many occasions there would be a solid local authority vote versus a professional vote on an issue. Therefore, I do not see that we need to have a big majority of local authority representatives. I have not made up my mind about it and I would beg the House to go with me in suggesting that this matter is better discussed when the resolutions come before the Dáil at a later stage.

When the Minister was drawing up the tentative details of proposals for the health boards how did he come to allocate representation on these health boards as between different local authorities? Was it by greater valuation or was it by population?

I am afraid it was on what might be described as a pragmatic, commonsense basis. You could not have it by population because if you had you might then deprive, in some instances, certain political parties from having representation. It was done with the object of giving some of the smaller counties slightly bigger representation than they would deserve on the basis of population or valuation in order to ensure that they would not feel that they were too much of a minority interest. It was done also on the basis that, if it could possibly be arranged, there should be at least three representatives from each county to deal with the political issues, those with an independent view, Labour Party, Fianna Fáil and Fine Gael representatives. This pragmatic method could not be perfect. You could not constitute a manageable health board of 25 to 30 people and apply an exact rule as to the number of representatives from each county to be part of a health board.

I hope we do not start an argument on that in this House because we could have a discussion here on every single county which could last until December. This will come up again in the resolutions for the constitution of the health board. I myself rather dread that debate because everybody will naturally and rightly have his own point of view. It will be found that people even of different political parties will agree with each other in some instances and disagree with each other in others. Therefore, I beg the House not to follow the pattern of the Deputy who has just spoken and start discussing how we are going to have representation to the boards until the resolutions come before the Dáil.

While I accept the substance of the Minister's reply and acknowledge there must be difficulty in arranging such representation, there is a danger here and I have had this from a number of local politicians, that the representation which has been agreed for health boards will affect the apportionment of expenditure of the various local authorities. I submit that this is a big issue.

The health expenditure will be allocated as at present until the Minister for Local Government, in his wisdom, decides with the approval of the Dáil, to alter the allocations of the rating structure as a result of the investigations that have been carried out. The fact that a particular county has more representatives than another does not mean that its financial commitment will in any way alter.

I am prepared to await the Minister's introduction here of the resolutions for the constitution of the boards themselves, but in view of the fact that we have pressed so strongly in this matter might I ask the Minister if he would be prepared to consider increased representation from the para-medical staffs, from the psychiatric and general nursing staffs and particularly from the general administrative staff, in the introduction of the resolution? The Minister has already circulated this document very widely and it has provoked a reaction. We want at least to assure representatives of this large body of workers that they will have representation. I appreciate the Minister's difficulty in giving effective representation to the different branches of the medical profession, but I do suggest that providing nine representatives for physicians, surgeons, county medical officers of health and general practitioners would result in the exclusion of some thousands of workers from participation which would detract substantially from the great merit and the tremendous competence with which the Minister has faced the Bill and the extensive consultation he has undertaken with local authorities in recent weeks.

The Minister, before this stage of the Bill, circulated his proposals, and, indeed, his own memorandum in relation to it was headed "Committee and Later Stages". Therefore, he cannot blame us if we discuss what he put before us because he obviously intended us to have this in our minds when we were discussing this Bill. I feel justified in strongly criticising the Minister for the manner in which he proposes to sell down the drain the people of Dublin by grossly under-representing them in his proposals by giving the people of Dublin only six seats on the proposed Eastern Health Board for a population of 568,000 while he gives three seats on the same board to Wicklow, which has only 60,000, and to Kildare, which has 66,000.

The Minister has given the people of Dublin, the population of which is nine times greater than the population of Wicklow, only twice the representation he has given to Wicklow. He has given the people of Dublin, the population of which is eight times greater than the population of Kildare, only twice the representation he has given to Kildare. He has given the people of Dublin, who spend over £10 million, a representation of only six, while counties which spend less than £1 million on the population of the county, are given half the representation of Dublin. If ever the people of Dublin were handled in a contemptuous way, this is it.

There are 42 hospitals in the Dublin region and yet they are given only twice the representation of Wicklow, which has only four hospitals, and Kildare which has three. Perhaps because Dublin's local authority has been abolished, the Minister is not inclined to listen to the people of Dublin or to give them fair representation. No doubt the appointee of the Government, who for the time being is supposed to be administering the affairs of the city, has not complained because he is incapable, on his own admission, and unwilling on his statement, to represent the people of Dublin on the hospital visiting committee. The Commissioner could not care less if the people of Dublin, with ten times the population, are given only six representatives, while counties with one-tenth of the population are being given half the representation.

This is heavy taxation without adequate representation, and it is simply not good enough. Dublin, out of its own resources, has to provide a much greater percentage of the health bill than the other authorities which are to be represented on the Eastern Health Board. The Minister's own figures, in reply to a question of mine on Tuesday of this week, indicate that as far as the Dublin County Borough is concerned the people are contributing about 50 per cent of the cost of the health services, add a small percentage to take into account what is and what is not a proper health charge, whereas Kildare and Wicklow are only contributing one-third of the cost of the health services in the Dublin region. Yet, the Minister proposes grossly to unrepresent the people who are paying 50 per cent of the cost. This means that the greatest percentage of the cost of the health services comes out of the rates of the people who have ten times the population, ten times the number of hospitals and ten times the expenditure of other health authorities yet they are in a minority vis-à-vis their own local authority colleagues and in an even smaller minority as far as the total membership of the Eastern Health Board is concerned. This is an appalling situation and we feel justified in protesting vehemently about it.

When the Minister eventually brings into this House for approval the regulations which he must bring in under this section, he will have his mind more or less made up by then. No matter how open-minded the Minister may be and no matter how generous his personality it would be contrary to all previous ministerial performance, in this or any other Parliament, for a Minister to come in and substantially change the nature of his proposals as they appeared in the draft regulations. This is, therefore, the only opportunity for us to complain about the unfair manner in which the people of Dublin are being treated under the Minister's proposals.

I have mentioned Kildare and Wicklow and as far as they are concerned they have no reason to grumble population-wise or expenditure-wise, but Dún Laoghaire, which has only one representation, has a population which is greater than the population of either Kildare or Wicklow. No matter how objective that person may be he is unlikely to be able to represent all shades of social, medical and political thinking in Dún Laoghaire and in this way the people of Dún Laoghaire will not gain adequate representation. Unfortunately, I was not given the precise population of Dún Laoghaire by the Minister but I know enough about its electoral status to know that it must have a population greater than that of either Kildare or Wicklow for it to carry representation of four seats in this House.

The Minister has included Dún Laoghaire in his figures for Dublin county and under that arrangement Dublin county, including Dún Laoghaire, is to get four representations for a population less than half of the population of Dublin city while Dublin city is to get only six. On the basis of giving Dún Laoghaire and Dublin city equal representation in relation to its expenditure and its population Dublin should have ten.

While I appreciate what the Minister says, and what Deputy Carter and others have said, about the undesirability of having a huge unwieldy health board which would probably be as inefficient as it would be divergent in its conflicts, the Minister will have to make radical changes in order to give more equal representation relating to population, expenditure and hospitals.

In the region of Dublin county, including Dún Laoghaire, there are 17 hospitals which are to have only four representations against two other areas having only three or four hospitals which are to have three representations. This indicates a dangerous frame of mind and one which the Minister will have to rectify. It may well be that the cure will be to have two health boards instead of one for the eastern region.

The population to be represented by the Eastern Health Board as proposed by the Minister is almost one million. Experience in Britain has shown that a health board providing for one million people is inefficient and incapable of discharging its duty towards its own population. The most recent investigations in England suggest that the population for any health board should be a quarter of a million but the Minister is proposing a population four times greater than that considered more suitable elsewhere.

We have to recognise there are different needs and different levels of a health service. It is possible for a hospital board to cater for a population of one million people but a board which is supposed to look after general medical services is not capable of performing efficiently if it is looking after a population of that number. I suggest that the medical needs of the people in Glencullen would be different from the medical needs of the people in Ballymun. The personal services which a health authority need to give in Athy and Rathdrum are entirely different to the type of services that should be organised in Benburb Street and North Earl Street in Dublin, two thickly populated localities. It is because the Minister has tried to transform the hospital services and the general medical services of rural Ireland into urban services in the new Dublin region that he is in the difficulty that the areas which are most densely populated, most heavily taxed, are the areas most under-represented on the board. I urge on the Minister to make radical alterations in the health board in the eastern region.

I have been 28 years in general medical practice and I think I may be of some help to the Minister. About 95 per cent of the total number of cases do not require hospitalisation. They are dealt with by general practitioners. The introduction of the White Paper, giving choice of doctor, proposed a wonderful new scheme for cities and towns but in the country, where I have been for 14 years—the previous 14 years I spent in the city here—it has been found that choice of doctor is not practicable, that the old system of dispensary services, with all its snags, guaranteed the services of a doctor to everyone, even those living in the most remote areas. Under the new scheme, the Minister and the Department and the Medical Association are all thrashing out this entire question. Somehow or other, GPs throughout the country——

We must have some order in the debate. This matter arises under section 56.

I was about to draw the attention of the House to the fact that the Deputy is completely out of order. We are on section 4 of the Bill.

(Cavan): We are discussing amendment No. 2, dealing with section 4, which is a much neater proposition.

However, the Deputy was irrelevant.

It is my first time ever standing up here.

(Cavan): Everybody else has been out of order in the past hour.

I was arriving in the House when the Minister was protesting about lack of progress. This debate this morning has been on democracy but I am afraid the Deputy has been carrying the democratic bit a little too far.

I do not wish to restrict discussion but I should like to point out that there will be many opportunities throughout the debate on the Bill to discuss the composition of the health boards, and we shall never make progress in this way. I should be delighted to get everyone's point of view if everyone wants to give it.

Am I to assume that the Minister wants to bulldoze this thing through and that he is getting a little annoyed at us? Is he trying to set himself up as a kind of dictator, trying to get our assent to something?

May I make clear what we have done? We have sent to every local authority information on a general concept of regional health services. I am meeting every regional health board and I am meeting groups of all the local authorities. We are debating here today the general scope, the general concept of the regional health boards. Local authorities will receive the minutes of the meetings at which I was present and they will have an opportunity of writing to me again on what they think should constitute health boards. As a result of these discussions, there will come before the House a complete set of resolutions indicating the numbers on each health board, the number representing each county and borough authority in each area, the numbers representing the professions and the numbers appointed by the Minister for Health. They can all be discussed in the House. Some of the procedures for the operation of the health boards and the method of election of local authority representatives arise on the Second Schedule to the Bill. Accordingly, there is immense opportunity for discussion. At the moment I am merely trying to channel the discussion into the right line.

Deputy Loughnane has been speaking on section 56. His contribution would not cause any trouble if we had been discussing that section.

The Chair would like to point out that if we are to make progress on this Bill we must deal strictly with the amendment before the House. Discussion is confined to amendment No. 2.

As a new Member, the Deputy opposite should be allowed a little latitude.

Of course I am not familiar with procedure. I will leave that to smarter men. I had thought that with my experience in the city and in the country I might be of some help. I am a member of the Medical Association and of the medical group who are in consultation. I will leave it until we come to the relevant section.

The Deputy will have an opportunity of dealing with these points later.

I did not know Deputy Loughnane was a new Member. When I heard him mention 28 years I took it that he had spent that length of time in politics, not in the medical service.

I would not have lasted that length of time in politics.

The Minister has indicated his willingness to concede that local authorities' representatives should have majorities on the proposed board. It is quite in order to discuss the constitution of the boards on this amendment. It is also in order to discuss the size of the area to be covered by each board and the population within that area. How the personnel of the boards are to be selected also comes within the scope of the section. Ten years ago the Minister's predecessor, Deputy MacEntee, told the House of the advantages, the step forward in the health services and their administration, by the enactment of the Health Bill at that time. He indicated that it would cure all ills as far as the general administration of health services was concerned.

That does not seem to be the case now. It is evident that Fianna Fáil, particularly the Government, have decided to wipe out, to abolish or to downgrade local authority representatives in every possible way. If we take this Bill in conjunction with other legislation shortly to be enacted, it means the beginning of the end of the local authority structure as it exists at present.

The Chair points out to the Deputy that the question of the area concerned relevantly comes under subsection (1) of this section, which the Deputy will have an opportunity of dealing with when the section as a whole is being debated. At the moment we are dealing with the amendment which only concerns membership of the boards.

If you take the area comprising the southern region—Cork city, Cork county and Kerry—you have three substantial local authority areas. I understand, according to the appendix submitted, that that area is to have 15 representatives elected by the people. What is relevant to this discussion is whether we are moving towards a system of bureaucracy whereby the Minister and some of his colleagues feel it more advisable to have people appointed on those boards in a non-elected capacity, the main idea being to do away with the system of local representation we have at present.

I want to say, so far as this section on the composition of the boards is concerned, that local authority representatives have to go before the people and get elected in the same way that the Minister had to get elected in his own constituency, as had every other Deputy in the Dáil. The local elected representatives, who can be drawn from any profession, should have a vital say on such boards. The only others who should be included on the boards are technical people to advise and help the boards. I do not see why it is essential to give such people full membership rights. The people who go before the electorate and get the approval of the electorate should constitute the board, but they should be given technical advice. In that connection I would like to see more technical advice available to health authorities generally.

We are going away from having boards democratically elected by having this system of bureaucracy, which is coming into our local authority administration in many fields. Health is only one. You will have housing, roads and others coming along after this. So, to comply with your wishes, Sir, and to keep the discussion on the amendment as confined as possible, my views are these: first of all, the membership of the board is entirely too small and, secondly, the area is entirely too big. Possibly there are other sections on which we can refer to those matters. Members of the boards should be elected by the people; non-elected people could be included on those boards in an advisory capacity.

When this Bill was drawn up by the Minister these bodies were denied the right to elect a chairman and vicechairman. I believe that is to be changed because it was not acceptable to his own backbenchers. Let all those people, the medical profession, the nursing profession and all others associated with the administration of the health services be on the boards in an advisory capacity. I do not think they should have the right of voting on issues which would come before the board. That is my view. I am a firm believer in democracy; I firmly believe that in the constitution of boards of any kind, particularly important boards such as hospital boards, only those who have secured the approval of the people should be entitled to absolute membership.

(Cavan): This section, as originally drafted, provided that at least half the members of the health boards should be elected members. The Minister has told us that following representations which he received from all over the country he has decided to concede that more than 50 per cent of the members of the health boards should be elected members. He has, for that purpose, introduced the amendment with which we are now dealing. This is in substance the same as the amendment put down by Deputy Richie Ryan. However, the Minister's amendment merely concedes that out of say 24 members on a health board, as there would be in the north-eastern region, 13 of those shall be elected members.

The general feeling of the House, as I see it, is that that is not enough, that we should have an assurance from the Minister that the elected representatives will have something more than a bare majority on the boards. I agree with the sentiments expressed by Deputy Murphy—that members of the medical profession, the nursing profession and other ancillary professions should be represented on those boards in an advisory capacity, that they should not be on the boards in such numbers that they can come into conflict with the elected members. Indeed, I believe if the medical profession and the other professions mentioned were on the boards, particularly in an advisory capacity with, of course, the right to vote, their advice would invariably be accepted; but if we get a position where the medical profession and the professions ancillary to the medical profession are going to feel it is a case either of their way or the way of the elected representatives you will not have harmony.

Take the proposed composition of the north-eastern board. I think I am in order in referring to that for the purpose of demonstrating that the elected representatives are entitled to more than a bare majority. It is proposed to have six doctors on that board out of a total board membership of 24. That is an unnecessarily high number of doctors. I do not think it is necessary to have six doctors, which is one-fourth the total membership of the board. Probably three doctors would be sufficient to cover all phases of all branches of medicine. I will be coming to this in connection with a later amendment. If you had three medical men, fairly and honestly representative of the medical profession, they would carry great weight on that board and I do not think they would be regarded as a vested interest on the board. I believe their advice would be listened to.

We should have an assurance from the Minister that instead of having a bare majority of elected representatives we will have a fair majority of elected representatives, considerably more than 50 per cent. The Minister could give the elected representatives considerably more than 50 per cent of the personnel of the board and still have the medical profession, the nursing profession et cetera fairly and adequately represented so that their views could be brought to bear on all deliberations of the board and I am sure they would be listened to.

I do not think there is any need to say anything more about what my colleague, Deputy Murphy, said when he laid emphasis on the elected principle in the formation of such bodies and said that it was of such great importance. This is only a question of interpretation of the best means of electing people to the boards and the best means of representation on the boards, but we made the plea earlier this morning about the importance of representation on the various health boards being on the vocational principle. Elections based on this principle usually teach one a lot about human nature. That, I suppose, would be a qualification for membership of a health board, whatever about a knowledge of human anatomy. This vocational principle would ensure that there would be an election; and I would imagine that a medical doctor who would be elected on the vocational principle to the board by his organisation would hold his position of trust as validly as somebody who might be elected by general franchise.

We certainly need specialised knowledge in the running of a health board. I made a plea earlier on that we have a doctor on that health board in a full-time capacity. We would also need representatives of the nursing profession in a full-time capacity on the board. Unions seeking representation on such a board would have no objection to having their people elected to such positions on that particular board by union members of the area. I agree with my colleague that the elected principle is important, but there are various forms of election and some different points of view. If a health board is to function properly there must be cooperation between the different skills and interests involved in the health service.

It is important, too, that the various professions involved are represented to the fullest possible extent on the health boards. I do not think that we would be doing the best job in the world if we were to say that we are suspicious of any form of government save that which comes entirely from the general franchise of the people. For the union side—and, I am sure, the medical profession would agree—I would say that they would be quite pleased to see democracy operate in their choice of management. We have an unfortunate tradition in this country so far as the vocational principle is concerned. We talk about an ombudsman, but we must be the most over-represented country in Western Europe. There is no shortage of all sorts of ombudsmen—from the urban councils to the county councils and to the Dáil. We are, if you like, on the crucifix of over-representation in this country.

I do not see any signs of sinister tyranny in the fact that the elected principle was not seen to operate fully in the regional health boards on the basis of the general local election franchise. I agree that there must be certain proposals left to the Minister's own discretion, but I would say that the system of majority decision should operate on the elected principle but tempered by the vocational method of selection.

One of the things that has bedevilled health legislation in this country is that, heretofore, there has not been sufficient vocational representation. I agree with the principle that the elected representatives should have a majority because in doing that we are accepting democracy but, at the same time, it is very necessary that we have a strong vocational representation.

I was a member of the National Health Council for quite a few years and we were representative of all sections. Any moves that were made and any advice sent to the Minister, as it was our function to send advice to him, were initiated by the various interests we had on the council: the psychiatric nurses, the doctors and members of the ordinary nursing profession. These people were in a position to offer advice to the board. Therefore, the vocational interest is of paramount importance. I do not envisage any cross purposes between the elected representatives and the medical fraternity; in fact, as far as I can see, the administration will be largely carried out by the chief executive officer who will have available to him the advice of the vocational interests, and by vocational interests I mean not only the medical profession but also the county managers who will certainly be in a position to contribute a great deal to the satisfactory and amiable working of a council of this type.

I was not here earlier on when the Minister was speaking on this section but I understand that it is his intention to appoint the medical fraternity himself for a start off. That is a mistake. We should get off to a good start. There is plenty of time before these boards will be set up and the Minister should consult the interests concerned so that they may elect their own representatives. Perhaps I have a suspicious mind but I have a feeling that if the Minister appoints the medical fraternity for a start they will largely come from the Custom House. Surely the aim of this whole Health Bill is to try to remove from centralised government the administration of the health services? Therefore, it is very important that we make a good start and that, as far as the medical profession are concerned, we will have a representation of persons who are conversant with rural life, because these boards will in the main be catering for medical services for a rural community. After all, we are a rural community and as such we should face the fact that an organisation such as the Irish Medical Association—of which I am still a member although I have not had much to do with medicine for the past 10 or 12 years—would be the right organisation to put forward members.

There are, possibly, other organisations in the medical world which could offer suggestions or put forward people for the board. I do not want to see a board consisting of Custom House appointees who will not be entirely free to express their opinions as private medical practitioners would be. We want people on this board who are free to express their opinions. I do not want to see a board appointed entirely from the medical fraternity from hospitals, because although they will be largely dealing with administration in hospitals at the same time they will be dealing with the rural community and the only medical people who understand the rural community, their wants and needs, are the people who practise as medical practitioners in rural Ireland. I would exhort the Minister if he decides to appoint a board—and I suppose the majority of Dáil Éireann will give him the right to do so—to bear in mind these facts when appointing people from vocational interests.

If this board gets off to a bad start it means that the whole principle behind the health services will be a fiasco. None of us wants to see that. There is plenty of time for the Minister to consult all the vocational interests and to ask them to put forward their suggested members now, but if he still persists—which I hope he will not do —and forces the issue by a division here in the House, by a majority of Dáil Éireann which he has, and insists on appointing a board himself at least I would ask him to give cognisance to the fact that he is catering for a rural community and not alone for the big centres of population. The trouble about medical legislation has always been that it has been controlled from the Custom House and with the best will in the world the people there are not the people who understand the conditions. The people who understand the conditions are the people who live and work in rural Ireland.

When this debate started I understood that we were dealing with the majority of public representatives on this board. It has developed into a situation where there is in-fighting between different groups for positions on this board. The important thing about a board such as this is that it should be efficient. Its duties will be to make the best use of the money available to it, on the one side, and secondly, to see that the highest standard of medical service is available to the people. As such, the doctors, the psychiatric nurses and other members of the nursing profession will probably be both ratepayers and taxpayers. As such their interests will be identical with those of the public representatives. The Minister has already made this point. From the point of view of the standard of services, the nurses, the pharmacists, the dentists, and, unfortunately, the doctors, will some time be patients themselves. From this point of view they will have the same identity of interests with the public representatives.

The Chair does not wish to inhibit the debate in any way but the Minister's amendment would seem to be dealing with a specific matter with regard to the membership of the health board. It deals with the number of persons fulfilling the conditions who shall exceed the total number of other members of the health board. It does not seem to be concerned with the actual personnel.

I accepted that in my opening remarks. The discussion has been extended somewhat and I wanted to point out this and then I will sit down. It is unfair to suggest that the members of the profession would have a view that would not be in the interests of the public in general. That is not correct. I will accept the ruling of the Chair.

Everybody has strayed from the amendment. I want to get some information. These regional boards will be dealing both with hospitals and what we might call general practice. There is a little difficulty here. A regional board can operate a large area as regards hospitals. It is not so easy to see how the same board will manage the same area as regards general practice. Local county committees will be set up but they will have a different pattern. Perhaps the Minister at some stage would make a comment on that point which I feel is important.

The Chair would like in a matter like this, where the area is concerned, that we might deal with it in the discussion on the section. In this amendment we are dealing with a specific matter which the Minister proposes.

The matter referred to by Deputy Hogan arises on section 6.

A certain amount of latitude has been allowed to the Deputies until now. The Chair is now restricting the remainder of the Deputies to a tighter line.

At present the Chair is trying to keep the discussion within the framework of the amendment. The wider implications in regard to this matter could be raised by Deputies when the section itself comes to be dealt with. The Chair is trying to be helpful in regard to the amendment before the House.

This Bill is not like a Bill where one clause decides everything. It is an immense Bill. There are enough sections in it to have every conceivable question discussed without having discussions which are not relevant.

I must take issue with Deputy Ryan on a number of points he has made about representation in the eastern region. He pointed to the fact that the representations from the two rural constituencies which, with the county of Dublin, make up that region, are heavily weighted as regards the numbers on the board. I could not agree with him on that. His main argument is based on population and financial matters as compared with the population in the city as against that in either Kildare or Wicklow. In that respect, from the Minister's figures, there are three members from Wicklow, three from Kildare and the remainder of 26 members in all will obviously have to come from the county and city of Dublin. Undoubtedly, a county the size of Wicklow which is by its nature a very hilly region should have a larger representation.

Would the Deputy accept the suggestion of the Chair that when the section comes to be dealt with this matter could be dealt with? If we could dispose of the amendment before the House, which is the Minister's specific amendment in which he lays down that a certain number of persons shall exceed a certain number of other persons in regard to the composition of the Board, we could then move on.

I would appeal for a larger number from rural areas which adjoin the large towns because of the difficulty of members representing larger rural areas. To suggest that one or two people could bring forward the problems of an area of that size is ridiculous and I do not accept Deputy Ryan's allegation that Dublin is in some way out of line in its representation.

Again, the Chair would like to point out that all this would be appropriate at another stage, but it is not appropriate on this amendment.

I think the majority representation on any of these regional boards should come from the medical profession.

Fine Gael policy.

When it comes to the administration of health one should, I think, try to get as many as possible of the medical profession on these boards. A great many of the teaching profession are elected to educational committees and other local bodies, possibly because they have more time to give on these bodies. If one were to take a majority from local councils, as the Minister suggests, then there would be representation by those who have been elected through public elections and that would certainly suffice. I would be in full agreement with that, but I do not think the kind of local bodies we have, which would be involved would have sufficient representation from the point of view of nurses, doctors and public health workers to justify our giving over complete control to non-medical people, as it were. Medicine is very specialised. The suggestion that doctors and nurses might use the position to increase their own salaries is quite ridiculous and unworthy of the person who made it. I was disappointed to hear such a suggestion coming from the Labour benches. A happy medium would be the ideal with representatives from local councils with a medical interest or a medical background of some kind. I also think it would be no harm if some kind of post-graduate diploma similar to that in hospital administration were introduced.

This does not arise on the amendment. Deputies will get ample opportunity of discussing these matters in detail at a later stage.

I was merely trying to point out that greater representation by the medical profession would be compatible with the running of the health board in the best interests of the profession, of the local body and of the public.

Amendment agreed to.
Amendment No. 3 not moved.

I move amendment No. 4:—

In paragraph (e), line 51, after "board" to add "provided always that any board may with the prior consent of the Minister amend such rules in any manner approved by resolution of such board."

In this amendment we seek to delete the provision which would exempt the first members of the new boards, who represent the medical profession and ancillary professions, from the obligation of being elected by their respective bodies. We have already urged the Minister on an earlier amendment to give an indication of the size of the majority he proposes to give to members of local authorities over the medical and ancillary professions and the Minister has been unwilling to give that. We are sorry he did not give it. Let me emphasise one reason why we want a sizeable majority. If the Minister does not accept our amendment, then it is he who will appoint the medical practitioners and the other people representing the ancillary professions. The Minister will appoint the doctor, the nurse, the psychiatric nurse, the dentist and the pharmacist. He will also appoint his own direct nominees. But that will not be an end to the Minister's activity. Under the Second Schedule he will also appoint the chairman and vice-chairman of the health board.

We are going through a charade of democracy here. We are pretending that the health boards will be elected bodies representative of the people for whom the health service will be set up. We are pretending they will be representative of the sick, of the ratepayer, of the taxpayer and of the professions. We are pretending they will be democratically elected bodies. The truth is that from the word "go" the Minister wants to make these new health boards his own instrument, obeying his dictates and carrying out his wishes; if they do not do that then his own appointees—the chairman and vicechairman—can be removed from office.

The Minister may say, as his predecessor said when we objected to this on the Second Stage, that the only purpose in not having elections for the first boards is because the medical profession and ancillary professions have not in operation the machinery necessary to carry out such elections. Most of these organisations already have election machinery to select their own presidents, secretaries and other officers. Several of them have their own unions and they are quite accustomed to using the electoral machine. I cannot see why there would be any particular difficulty in using the same machinery for the purpose of selecting their nominees to these health boards. I have been in consultation with a number of the bodies concerned and they have told me that it is not right to say they are not in a position to make the first appointments by means of election. They are in a position to do that and they want to do it. The Minister is seeking here to prevent them electing their own nominees. It is open to the bodies in question subsequently to reverse the appointments even before the term of appointment comes to an end. That may be the fear but, human nature being what it is, it is more than likely that the various bodies will confirm in office the person who has been already representing the particular vocation.

This is highly undesirable and I feel sure that if Members opposite were on this side of the House they would have the same objection to this proposal. It is wrong that the boards should in the first instance be little more than the slaves of the Custom House, people who will be thankful to the Minister for appointment, be concerned to carry out the Minister's wishes, be anxious not to rock the ministerial boat during the first voyage of the health boards. That is not necessarily the best way in which to get the wishes of the professions themselves or the wishes of the nurses or the wishes of sick people voiced and given effect to in the decisions of the health boards.

We, therefore, urge upon the Minister sincerely not to press for the inclusion of this subsection in the Bill. It takes away from it the possibility of getting maximum goodwill and maximum co-operation in the first instance. If these health boards get off to a bad start, or if even one of them gets off to a bad start, then the Minister and the Department and the Minister's successors will have the greatest difficulty in trying to get them back on the rail.

We are setting up under this Bill a most complicated hierarchy of new health authorities. We are going to have local health authorities for the individual counties, above them, these health boards we are discussing and, above them again, regional hospital boards. If there is a spoke stuck in the works anywhere along the line there will be terrible consequences. The Minister, I think, realises that without maximum co-operation at all levels he will not get the health service he wants and that the country wants working properly. His proposal here is unnecessary to give proper representation to the medical and other professions. It is unnecessary to protect the ministerial interest and the State's interest in the operation of the health service. It is likely to be a cause of considerable vexation and annoyance and I would urge the Minister to accept our amendment.

Could I be allowed to adumbrate on this and perhaps it will shorten the debate?

Paragraph (c) is included simply because of the time element. I do want these boards to be effective from the time they are appointed and we do intend to appoint the regional health boards in October, 1970, and to do planning, to get acquainted with what their final duties will be and that they will be in operation without statutory powers until 1st April, 1971. If I am to do that it will be utterly impossible for the officers of my Department and myself to devise statutory electoral machinery for all these different professional interests and I want the House to take my word for this. Whatever my defects have been in public life, my word is generally taken on matters of this kind. We simply would not have the time to work out the statutory arrangements for the nomination of the professional boards.


What we propose to do is that when I have the power of nomination I will consult the representative organisations of psychiatric nurses, nurses, consultants, and that they will submit names to me of people whom they think would be qualified to represent their interests in the different boards. That means that, in effect, there would be a reasonably democratic element in the appointment of these people in the case of the first board. In the case of the second board which will be elected in connection with the next county council election in 1972, by that time we will have the machinery set up.

I should like at the same time to make quite clear to Deputy Ryan that even if I did appoint the people myself and accepted no nominations, no propositions, from the organisations concerned, I certainly would not appoint people who would be my slaves. They would be people who would be sufficiently eminent in their field to be able to act in an independent way. I think it can be said that my predecessors of all parties when setting up the very, very numerous semi-State boards connected with health—as the Deputy will find if he looks through the list—appointed a great many eminent people who were independent, whose political affiliations in most cases had nothing to do with their appointment, who were eminent in their professional field. I would certainly not dream of appointing people who would simply be my slaves and simply go on the boards in order to take my decisions. That would not be my idea and it would be grossly contrary to even the political interests of my party if it became known by the public that the regional hospital boards were going to be simply politically controlled from the Custom House. My party would suffer even more than the Opposition party if this were the case. Let us get rid of this notion that I have some idea of creating a kind of Tammany situation in the regional health boards. I have no such idea.

Now, will the House accept my word that we will in a non-statutory fashion ensure democratic appointment of these professional members of the regional health boards as far as it is possible to do so; that we do want to have them appointed by October, 1970, that it is quite impossible for us to prepare the electoral machinery by that time?

Does the Minister propose to make the appointments mainly on a political basis? That is the experience of the past.

No. That is not my idea.

I wish to support completely Deputy Ryan's approach. He was at his most constructive best —excuse the phrase—on this occasion. It is quite preposterous and quite ridiculous for the Minister to suggest to this House that it is beyond the capacity and ability of the Irish Medical Association, the Medical Union, the Irish Transport Union, the Workers Union of Ireland or any one of the various nominating occupational and vocational groups to exercise their imagination between now and October, 1971——

1970—that it is beyond their capacity between now and then to have a formal electoral procedure created between the Minister and the nominating organisations. I do not accept at all the analogy the Minister makes between State-sponsored body appointments and appointments to regional health boards. It is rather fatuous to attempt to draw such a parallel. Nor do I accept that because people may be eminent in the medical sphere they are immune to and have been suddenly removed from political pressures—intense political pressures. I do not think one can go on that assumption. Some of the most intelligent people in Ireland are some of the most intelligent politicians and most intelligently committed individuals in the medical profession and every other profession. Therefore, assurance as to their eminence does not in any way put an illusion of whitewash on the proposition before the Minister. The section proposed by the Minister is open to the gravest political objection.

While I am quite prepared to accept from the Minister that he will be objective and while he may assure us in good faith of his intention to appear to be objective in appointing people in the first five years, we must remember that this is for a five-year period and that, to put it bluntly, out of a board of 24 persons there will be 13 local authority representatives elected. Six medical profession people will be appointed by the Minister. A psychiatric nurse, under the current proposition, will be appointed by the Minister. A dentist will be appointed by the Minister. A chairman will be appointed by the Minister. Three other independent members, if he wishes, will be appointed by the Minister. It will be difficult enough to convince all the local authority representatives and the multitude of county councils and the various urban district councils of the need to introduce rationalised area regional health boards in the country. Even if he had to wait another ten years, I think the Minister must introduce it on a system which is not only democratic but, above all, which is seen to be democratic. While the Minister states that, above all, it would be utterly impossible to bring in the elective concept at this point of time——

The electoral register and the whole of the complicated apparatus concerned.

Frankly, I do not accept it. The names and addresses of all the psychiatric nurses in this country can be written on a couple of sheets of foolscap and can be produced with no great difficulty in the Custom House. To get the name and address of every registered practitioner is not an impossibility in terms of general production. There are general physicians who are members of the ancillary branches of the medical profession; the registers can be produced in a very short time. I have no doubt whatever that the Medical Union and the IMA would willingly co-operate and would burn the midnight oil to enable an election to be held among their own members and therefore appoint on that basis.

I would not dream of accusing the present Minister of it, but I am afraid we are brought back to a slight autocratic tinge which a former Minister for Health had. Deputy MacEntee became so obsessed with the nominating concept and with his prerogative of making initial appointments that the development of the health services, the introduction of a more rational approach and, above all, the introduction, as Deputy Ryan so rightly pointed out, of the element of co-operation in services was distorted for a number of years. Therefore, I would strongly urge the Minister that there is every opportunity open to him to introduce statutory electoral machinery as of October, 1970, so that by April, 1971, when they assume their statutory powers, these particular boards will certainly be seen to be in operation on a completely democratic manner.

These, then, are our propositions. I can assure the Minister that, from any consultations I have had with the representative vocational occupational organisations, they are profoundly unhappy about this aspect of the Minister's initial nominating powers. I could see a certain case to be made on their part if you nominated for 12 months but you are providing here for the first appointment of members of the health boards and you are nominating for five years. It is a very serious matter that they would be in operation for that period. There is no assurance from the Minister that five years will not be the operative term.

Two years.

We will come to the period of appointment later on. These, then, are my overall objections. Frankly, I think it is a denial of electoral procedure. To put it quite bluntly, it is a farce and, as Deputy Ryan said, somewhat of a charade. I strongly urge the Minister at this point of time to reconsider his approach. Otherwise, I am afraid we would do something which we would be reluctant to do in this House, bearing in mind that the Minister has worked very hard on this Bill and the extensive consultations he has had on it. I do not think anybody in this House would want, at this point of time, to accuse the Minister of in any way acting in bad faith on it. Certainly, I think we can cast that from our minds. I do think, however, we need emphatic assurances not just of the non-patronage element of the Minister's administration but, in fact, of the opportunity of the people themselves to elect themselves from the first "go" and not from a ministerial push of appointment in the first instance.

Would it be of help if I agreed to put into the Report Stage of the Bill a section saying that, as Minister, I would accept nominations from the organisations specified in the regulations that have finally come before the House and that the question of organising statutory arrangements can come later?

I would support that. I would accept that.

Would the House be willing to accept the withdrawal of this amendment and then, on the Report Stage, I will have a section introduced making clear that I will accept nominations from the professional organisations——


We accept that.

A great deal will depend on the organisations. A question may arise as to what organisations are to be consulted and whose nominations are to be accepted.

I would not at this point quibble. We have got the concession. This will be difficult.

I know it is a difficult one. That is the problem. It should have been looked into before now. I certainly appreciate the Minister's gesture.

(Cavan): What the Minister has now suggested is a vast improvement on the section as it stands. It is obviously something that would need a lot of consideration. If the Minister proposes to introduce such an amendment on the Report Stage then I think that this particular section should be recommitted on the Report Stage and that we should have a general discussion on it in Committee again. In view of what the Minister has suggested, I do not want to be very long now in what I have to say but I think, as Deputy Sir Anthony Esmonde said—perhaps a little out of order when he was speaking—that it is of the utmost importance that these health boards get off on the right foot.

They will only get off on the right foot and inspire confidence if (1) the public representatives are adequately represented and (2) if the representative of the medical profession, or representatives, has or have the confidence of the profession and is really representative of that profession. The same goes for the psychiatric nurses, the dentists, the pharmacists, and so on. If all of these people are to be appointed by the Minister in the first instance, the whole health board will be regarded as something like the National Agricultural Council which was a complete fiasco a couple of years ago because it was really a shadow of the Minister for Agriculture and Fisheries. I know and I feel that the Minister for Health would not wish that we would set up health boards of that kind.

Even if he had not suggested the amendment which he has now suggested, I know that the Minister has told us he would not have appointed political nominees just because they are of his political Party. However, I am afraid our experience of such appointments in the past has been that they are invariably political appointments. I have known occasions when three names have been sent up to the Minister for Local Government, or to some other Minister, from the Association of Municipal Authorities and I could bet any money on the name that would be selected. Invariably the strong man of the Minister's Party is appointed. This was so even in the case of an appointment to the Nursing Board recently. I speak subject to correction but I think that in the case of the appointment to the Nursing Board two names were sent up. One of them was a public representative without any nursing qualifications as far as I know. The other was a psychiatric nurse. Of course the member of the Minister's party was appointed.

Therefore, if the Minister is introducing the suggested amendment I would urge him to provide in that amendment that the nominee of the body concerned will be appointed by him and that he will not, as Deputy Hogan mentioned, ask for a panel of three names out of which he will select one. That is really not enough. These people should have the right to nominate their representative and unless they do so the representative will not have the confidence of the association concerned.

There was one remark which the Minister made which I did not quite follow. He said when he spoke first on this amendment that these appointments would be made by him in the first instance and that after the next county council elections, due to be held in 1972, they would be elected in a different way. Of course the Minister appreciates that the appointees that we are mentioning here have nothing to do with local government elections and that the local government elections will in no way influence these appointments because the appointees that we are concerned about here are the professional appointees—the doctors, nurses, et cetera.

The professional members' term of office will be coincidental with the term of office of the local authority representatives. Therefore, they will be subject to a new election in 1972 if the local elections are held in that year.

(Cavan): I understand the Minister's reference now. The suggested amendment is a big improvement but we would want to have a full discussion on it on the Report Stage and I assume the Minister will agree to recommit the section for that purpose.

Question put: "That the words proposed to be deleted stand".
The Committee divided: Tá, 59; Níl, 36.

  • Aiken, Frank.
  • Allen, Lorcan.
  • Andrews, David.
  • Barrett, Sylvester.
  • Blaney, Neil.
  • Boland, Kevin.
  • Boylan, Terence.
  • Brady, Philip A.
  • Brennan, Joseph.
  • Briscoe, Ben.
  • Browne, Patrick.
  • Carter, Frank.
  • Childers, Erskine.
  • Colley, George.
  • Collins, Gerard.
  • Connolly, Gerard C.
  • Cowen, Bernard.
  • Cronin, Jerry.
  • Crowley, Flor.
  • Davern, Noel.
  • Dowling, Joe.
  • Fahey, Jackie.
  • Faulkner, Pádraig.
  • Fitzpatrick, Tom (Dublin Central)
  • Flanagan, Seán.
  • Foley, Desmond.
  • Forde, Paddy.
  • French, Seán.
  • Geoghegan, John.
  • Gibbons, Hugh.
  • Haughey, Charles.
  • Healy, Augustine A.
  • Herbert, Michael.
  • Hilliard, Michael.
  • Hussey, Thomas.
  • Kenneally, William.
  • Kitt, Michael F.
  • Lemass, Noel T.
  • Lenehan, Joseph.
  • Lenihan, Brian.
  • Lenihan, Patrick J.
  • Loughnane, William A.
  • Lynch, Celia.
  • Lynch, John.
  • McEllistrim, Thomas.
  • MacSharry, Ray.
  • Meaney, Thomas.
  • Molloy, Robert.
  • Moore, Seán.
  • Nolan, Thomas.
  • Noonan, Michael.
  • O'Connor, Timothy.
  • O'Kennedy, Michael.
  • O'Leary, John.
  • O'Malley, Des.
  • Power, Patrick.
  • Smith, Michael.
  • Smith, Patrick.
  • Wyse, Pearse.


  • Barry, Peter.
  • Begley, Michael.
  • Belton, Luke.
  • Belton, Paddy.
  • Bruton, John.
  • Burke, Joan.
  • Burke, Liam.
  • Crotty, Kieran.
  • Donegan, Patrick S.
  • Donnellan, John.
  • Esmonde, Sir Anthony C.
  • Finn, Martin.
  • FitzGerald Garret.
  • Fitzpatrick, Tom (Cavan).
  • Governey, Desmond.
  • Hogan, Patrick.
  • Hogan O'Higgins, Brigid.
  • Jones, Denis F.
  • Burke, Richard.
  • Byrne, Hugh.
  • Collins, Edward.
  • Conlan, John F.
  • Coogan, Fintan.
  • Cott, Gerard.
  • Creed, Donal.
  • Kenny, Henry.
  • L'Estrange, Gerald.
  • Lynch, Gerard.
  • O'Donnell, Patrick.
  • O'Donnell, Tom.
  • O'Hara, Thomas.
  • O'Sullivan, John L.
  • Ryan, Richie.
  • Sweetman, Gerard.
  • Taylor, Francis.
  • Timmins, Godfrey.
Tellers: Tá, Deputies O'Malley and Meaney; Níl, Deputies L'Estrange and R. Burke.
Question declared carried.
Amendment declared lost.
Question proposed: "That section 4, as amended, stand part of the Bill".

The first point I want to make quite clear is that the Labour Party did not vote on the last amendment because we had accepted the Minister's public assurance. This was accepted by Deputy Desmond on behalf of this Party. We heard what the Minister said and we take it he will keep his word. I hope he will still be Minister for Health in order to keep it and that there will not, by any accident, be any falling down on that. I think that is reasonably certain. We thought the Minister's promise was reasonable—and we accepted it—that he will accept the nominee of the body, in the first instance, and that there will be one nominee, or whatever the number will be. That is the second point on which I want to speak on this section.

This section is full of "green Toryism" on the basis of nine representatives of the medical profession, to take an example, and one representative of the nurses. This is really intolerable in our society. It shows that we still are not a genuine democracy and that in fact we have departed from the kind of democracy we had in this country 30 or 40 years ago when we have these types of figures put before us. We all know the work the Minister has put into this Bill. Nobody will accuse him for a moment of not being a hard-working Minister but there is a difference between judgment and hard work. They are two different things. Many people expend a great deal of energy which has not much judgment behind it. There certainly is not much judgment behind this kind of composition.

The Minister has improved the Bill by saying there will be a majority of the representatives of the local authorities. That is an improvement. I do not agree with Deputy Carter's point earlier today when he asked why should not the patients be represented. I take it that the local authority representatives are, in fact, in the main, the representatives of the patients, that is to say, the representatives of the people who are likely to be the patients, or may be the patients, at some time or other. I do not think that point was worth a great deal.

If I may interrupt the Deputy, I gave that as an example only. I did not advocate representation for the patients. I gave it as an example in the context of replying to another Deputy that many sections of the community could be represented.

The Deputy made it a point of absurdity so to speak. I am pointing out that the Deputy's point has no reality in it.

Can we not discuss this on the regulations?

It has already been pointed out that further discussions will be available for Deputies.

May I deal with that? I am long enough around politics to know that discussions on regulations are not worth a fig. They are not worth twopence. They are completely worthless. It is well known that Departments will not accept amendments to regulations. I do not remember a single case in which regulations were altered in either House of the Oireachtas. I may be wrong in that, but I do not remember a single case. The Minister may be quite honest in the offer he makes to us in this context.

These are resolutions which come in detail before the Dáil. They have to be passed by the Dáil.

This is all verbiage, if I may say so with respect. We are just getting verbiage when we want the reality. This is the time for the reality. The reality of the discussion is here today, and we will have it here today, and the Minister knows that. I appreciate that if a man works very hard at something—and this has happened to myself—he feels that other people are messing him around by the kind of views they put forward. This is a serious piece of legislation. If I might venture to tender a little advice to the Minister, he would be well advised to take what comes to him. After all, he was protesting on section 4 by 11 o'clock that he was being delayed. This is absurd. Section 2 of the Central Bank Act, 1942, was discussed for seven days. One of the difficulties is that we might be seven days on this section. The Minister should handle the House gently. He has been good this morning.

This kind of repetition is absolutely idiotic. It is mere repetition.

I will say something that is not repetition. The Minister talked about a big body of 35 members and then he talked about a body of 25 to 30 members, presumably as a small and efficient body. What is the difference? There have been tremendous discussions about the right size of a body. Many people believe that, if you want really efficient work, a body of about seven people would be right. We see that the Government here and the British Government do not like the number of Ministers to go above about 16 or 17. There is no difference between 25 members on a body and 35 members on a body in my frank and honest opinion. This is an honest opinion just as we have got honest opinions from the Minister today.

As I say, this is serious legislation. I will not hold up the Minister any longer. I have made my new point. The Minister accused me of repetition but I am entitled to repeat what other people say. The Minister knows that. This is not a dictatorship. I have heard members of the Fianna Fáil Party repeat the same thing three times in Committee. I have heard the Minister's colleague, Deputy Aiken, do it three times over. There is no use in the Minister interrupting me in this fashion. I know that the Minister works hard and that he is working for the people, but he has this autocratic turn of mind and he does not like being held up, but the fact is that he will be held up much less if he co-operates with the House and allows Deputies, perhaps, to talk themselves out. I am not like other Deputies. I will not talk for half an hour or three-quarters of an hour or an hour. I could do it but I will not do it.

The reason why we in Fine Gael voted as we did was that we felt that the obnoxious subsection should be taken out of the Bill altogether and, although we certainly accept the Minister's assurance, as a Member of this House and a gentleman for whom I have the greatest personal regard, we are entitled to stand by Parliamentary procedure and when we see something which is wholly repugnant to our principles we vote against it.

We did not say a word about you.

We are entitled to do that. Having made our point, not only in the debate but by voting, we are looking forward to the ministerial amendment which, we hope, will go some part of the way to meet our objections to the section.

We are very much in favour of having direct nomination by the workers in the health services to the health boards. The workers in the health services are all those who are employed by the health services, whether they are medically qualified, whether they have not received a university or other advanced education, whether they are on the clerical side, or whether they are on the domestic staff side. If we are to have representation on the new health board it should be on the basis of having representation on behalf of the people for whom the service is intended to operate. They are the sick, the invalided and the aged in our community, together with those who operate the services. We certainly will not have a health board fully representative of those who operate the service unless we have all grades and we feel, therefore, that the membership clause does not go far enough perhaps.

The subsection provides:

(4) The Minister shall consult the council of a county, the corporation of a county borough or the Corporation of Dún Laoghaire before making regulations under this section which relate to the functional area of the council or corporation concerned.

It is fair to ask in present circumstances where Dublin Corporation are not permitted to operate, with whom the Minister proposes to consult so far as the setting up of the authority in the Dublin region is concerned? Surely the Minister will not go through the pretence of consulting with the Commissioner, appointed by the Minister for Local Government, who for the time being presumes to represent the people of Dublin, the ratepayers of Dublin, the taxpayers of Dublin and the people to whom they gave their votes in the local elections in 1967.

It is essential that the Minister should consult with the elected representatives of the Dublin region. I venture to suggest to the Minister that the best thing he could do would be to consult, even on an informal basis, with those persons who were elected to the Dublin Corporation two years ago. After all, such people are, for certain purposes only, deemed not to have power but they are, nevertheless, still the members of the Corporation of Dublin, as all candidates for the Seanad well knew only a few months ago. I would, therefore, respectfully urge upon the Minister that he should consult with the members of Dublin Corporation before he proceeds to make the regulations permitted by this section.

If he does not do that, I would urge upon him that he should meet the members of Dáil Éireann who represent the constituencies within the county borough of Dublin. If he does that he will find in relation to his proposal for the Eastern Health Board, objections as strong if not stronger, than those already voiced to him when he met public representatives from other local authorities both in the eastern region and throughout the country in recent months.

When I was speaking earlier I had no wish to deny adequate representation on the new health board to the good people of Wicklow. I am well aware that their geographical and physical problems are much greater in some respects than those of people who dwell in urban areas but one must, nevertheless, try to distribute representation in relation to the tax burden, and the total health bill for Wicklow is, I think, something in the region of £900,000, of which the State accepts responsibility for £700,000.

And the moneys will be spent in Dublin. Very little will be spent in Wicklow.

The figures I am speaking of are the figures of the health service rendered by the Wicklow County Council, and that money would include payment for services in the Dublin region which are charged to the Wicklow ratepayers.

You get nothing for nothing in Wicklow. I can assure the Deputy we pay our way.

I am not suggesting you do. What I am saying is that on the official figures given here by the Minister on Tuesday of this week, of the £900,000 bill for health services——

I was not allowed by the Leas-Cheann Comhairle to speak on that line.

We are now on the section, if the Deputy will bear with me, and I would welcome his observations if he wishes to make them. It is not because of any desire on my part to do down the Wicklow people I am saying this. What I said earlier—and I think Deputy Kavanagh will recall this—is that there should be at least two health boards for the regions which the Minister seeks to have under the one umbrella of the eastern board which puts Wicklow in the position of having three representatives for £900,000 expenditure where fellow Irish people in another part of the same region have only six representatives for an expenditure of nearly £11 million.

The problems are different. Deputy Kavanagh emphasised that, and I entirely agree with him. That is what is very wrong with trying to bring people with entirely different problems under the one health board. I know there will be local health boards, but again what is the Dublin position? The Dublin area is not to have a health board because the county borough of Dublin has no corporation; it was abolished because it insisted—as everybody in this House agrees they were right in their viewpoint, whatever about the way of expressing it—that the present method of financing the health services was wrong. That is the very reason they were abolished and that is the very reason why they will not have any health committee. Now with the Minister's proposal they are to be put in a more invidious situation. Even if they are reconstituted in 1972 they will be in an inferior position, an unfair position, in which they will have representation which is much less than their tax and rates burden or their population would justify.

The Minister owes it to the taxpayers and the ratepayers of Dublin to give more adequate representation to the people within the county borough of Dublin on any health board for that region. He also owes it to himself to consult with the public representatives of Dublin city so that he will get their views regarding the representation which should be given to the ratepayers and the taxpayers of Dublin and to the sick people of Dublin on any new health board which is to be set up.

I would urge upon the Minister to meet the fair views expressed by Deputy Kavanagh, and which I know are also held by Deputy Sweetman in relation to Kildare, by not trying to amalgamate under one vast authority which will be unable to perform this service properly the rural and urban interests that are within the eastern region as at present constructed. As I express that view, I appreciate that the metropolitan area and its services must be available to people in the adjoining areas. Clearly some specialities will only be available within the urban environment. In the future as in the past it will be the practice to feed people into these hospitals, but nevertheless, it is not necessary to have one health board for the whole region to cater for general medical and hospital services in order to have that kind of thing operating.

The Minister proposes to have two general hospitals, one on the north side of the Liffey and the other on the south side. I would suggest that this might be a line for dividing the eastern region. We would then have a situation in which at least your numbers would become somewhat manageable and would be a lot nearer what is regarded as the most suitable number of people to dwell within the region of any health board. This could be done without preventing a feed of patients and a dovetailing of services as might be necessary along the dividing line between the north eastern and south eastern regions. I would urge these things upon the Minister and trust he will do his best to meet them.

Deputy Ryan seems to me to have a split mind on this matter. He would accept the principle but he wants a monopoly, as usual, for Dublin. At the moment we in the rural areas. perforce, send many thousands of patients to Dublin hospitals in respect of whom we pay the expenditure there, and yet we have no say in the matter. The Deputy referred to the Dublin Corporation and made an eloquent plea as to why its members should be consulted regarding section 4 of this Bill. The corporation disquen enfranchised itself and let down the poor of Dublin last spring by refusing to strike the necessary health rate in order to provide cover for these patients. Therefore, if the Minister has an obligation to consult, I am afraid it lies elsewhere than to consult those people who deliberately reneged on the duty of the corporation, namely, to provide for the health of the poor of Dublin.

In relation to section 4 (2), I should like to note as did some other Members of the House, the fact that there is no representation provided for the non-medical staff in the hospitals. All shades of political opinion in this country have been paying lip service to the principle of industrial democracy, and it is, indeed, surprising that when we are recasting the whole system of administering the health services, we should let this opportunity slip of giving the ordinary, non-medical staff, some degree of representation in accordance with the principles of industrial democracy.

Under the aegis of these health boards there are, as well as surgeons and medical people, the administrative and executive staff in the hospitals; there are wardsmaids, domestic staff, general labourers, ambulance drives and other categories of employees. All these are denied representation under the tentative proposals put forward by the Minister. The Minister has always been noted as a man well up to date on modern thinking and social issues even if he sometimes takes a rather conservative line. It is, therefore, surprising that the Minister has not recognised the need to ensure that these people are given representation on the health board, because the decisions made by the health board will have a considerable effect on their livelihood. It does seem anomalous that the most highly paid category, the medical profession, should be given what could only be described as inordinate representation while the administrative staff, the wardsmaids, the labourers and so on are given no representation whatsoever. They are all employees of the health board yet the highest paid category has been chosen as the only one to be given heavy representation. I notice the Minister does concede some small degree of representation to the nursing profession. I believe the ratio is one representative of the nursing profession to every six of the medical profession, and this is a very surprising ratio because the probability is that there are six nurses to every one doctor.

I wonder if perhaps the basic thinking behind the Minister's proposal is that those who have a high degree of expertise in surgical and medical matters are the best people to sit on the health board and those who are less qualified are not. The Minister should recognise that the commonsense knowledge of what one might describe as the lower grades in the employ of the health board can in many instances make a more useful contribution than the medical profession. The idea that one has to have a long list of qualifications after one's name in order to be able to make a useful contribution about one's work is a rather paternalistic view which I do not think should commend itself to the Minister. I find fault with this section because it does not recognise the principles of industrial democracy and as a consequence it does not give representation to all grades in the employ of the health board.

Since first entering public life I have heard a lot about regionalisation and rationalisation with regard to the running of our hospital services and our local authority services. Under this section the Minister envisages a situation in which he rationalises and regionalises three or four counties into one. Surely, this is what we have been aiming at over the past number of years. I see this as a logical step towards the integration of, say, Dublin County Council, Dublin Corporation, Kildare County Council, Wicklow County Council and the Dún Laoghaire Borough Corporation.

You get further away from the people all the time.

This is not the point. The Deputy was talking about industrial democracy which has nothing at all to do with this. I am sure the Minister will deal with the Deputy's suggestion but if he were to have the kind of representation which the Deputy is talking about he would have to make some sort of a Solomon-like judgement to be able to satisfy every section of the community.

I should like to ask the Minister why only one member of the Dún Laoghaire Borough Corporation is going to be represented on the Eastern Regional Health Board? Deputy Ryan, who made a great case for Dublin, as a former member of the Dublin Health Authority should know that when the Dublin Health Authority were rationalised to work for the city and the county they became a most efficient and workable organisation. I think all members of this House who regularly deal with the authority could have nothing but the highest praise for their efficient working and for the manner in which they deal with our queries. I was delighted to hear from Deputy Kavanagh that County Wicklow will pay its way. We on this side of the House would expect County Wicklow to pay its way and to give assistance in the context of any new proposals made by the Eastern Health Board.

The question of medical representatives on these councils has been criticised and the argument has been advanced that the medical profession has too great a representation. This country has probably the worst designed hospital service of any country in the world and this largely stems from two things: First, from poor advice from the Custom House and on occasions advice which was not taken, and secondly, because of a lack of consultation with the medical profession, who are the people working in the field. This is the first attempt made to try to secure a degree of co-operation.

A good spirit already exists between the Minister for Health and the medical profession, which is largely due to the Minister's predecessor, and I think it is only right that that should be put on record. The Minister is going along the right lines in giving fair representation to the medical profession because this is primarily a medical rather than an industrial service. Deputy O'Leary spoke about representation on a union basis but we are trying to set up a medical service where the advisory content rather than the representative content should be the paramount consideration.

I do not go all the way with my colleague, Deputy Bruton, who seems to have put too much emphasis on the question of numerical representation but again I would say I do not think the question of industrial democracy should receive the emphasis that has been placed on it in this House because this is not an industry.

Some of the categories are getting no representation at all.

It is no wonder that the young doctors have to talk back to the BMC in Britain. I was glad to see that young Irish doctors talk back hard to them.

I wish to return to a point I tried to make earlier—the composition of health boards under two divisions, that of county councils and corporations on the one hand and the medical and ancillary profession on the other. Deputy Ryan and I are in some disagreement on the first heading as regards the breaking-down of representation, particularly in relation to the Eastern Health Board. As I mentioned earlier, I had been looking with regard to the Wicklow representation, for an extension of the membership because in the case of Wicklow and Kildare—and I am sure Deputy Ryan's colleague from Kildare will agree with me—they are just the tail of a very large dog and we will not wag this dog because when these boards come to be set up we may find ourselves with only six representatives from both those rural counties while at least 26 or 27 members could be from the county and city of Dublin.

There is no suggestion that doctors from Wicklow or Kildare will be given any special representation on the board so that in the event of election, as has been promised by these bodies, it is quite likely that representation will be heavily weighted in the direction of Dublin, and I appeal for an extension of representation from those two rural counties. Deputy Ryan has suggested that, perhaps, we should have two boards instead of one in the eastern region. I do not see how this is practicable because at present this eastern regional board are, in effect, set up in so far as there are only four hospitals in the County Wicklow and three of these are necessary as rest or county homes for the older people in the area. As far as medical services are concerned, at the moment when a patient requires attention he is usually sent to Dublin by ambulance for treatment, whether it be for something as small as an X-ray or a broken finger.

I do not think that the making of two boards would change that situation. Many years ago Wicklow was promised a hospital and a portion of land was acquired at Rathnew. The land is still there and I am afraid the possibility of a hospital being built on it can be ruled out completely. I accept the practicality of putting Kildare and Wicklow into the eastern region but we must remember that whereas Wicklow covers half a million acres, Dublin city and county could be covered adequately by a sixpenny bus ride.

You will not get very far these days for that.

Tell us where.

My point is that whereas one end of Wicklow is 50 miles from the other, in a Dublin constituency the average distance would be three miles. The Minister will, therefore, see the need for larger representation on the board from these two rural counties. It is all the more necessary because with only three members from Wicklow it will happen that certain political persuasions will not be represented at all. It could turn out that my party or the Fine Gael Party would not be represented because the Minister has the selection of one representative. I have no doubt that the same possibility exists in other constituencies. My point is that both geographically and from the point of view of representation, a larger number of representatives are required from the rural constituencies.

Deputy Ryan dealt with the financial aspect and I interrupted him to say that each constituency will have to pay its way. We in Wicklow will undoubtedly pay our way when the board are set up. At present, the main health expenditure by Wicklow County Council is in the Dublin area because most of our patients are sent to Dublin hospitals. Therefore, the Dublin area benefits by having large establishments in both the corporation and county council area. Dún Laoghaire, as well, benefits because one hospital there is used extensively by the Wicklow hospital authorities. Wicklow will not benefit correspondingly from any finances provided by Wicklow County Council for health services.

I should like to deal briefly with the breakdown of representation from the medical and ancillary profession. Deputy Bruton adverted to the fact that these representatives will number nine in the eastern region. They include nurses, dentists and pharmacists as well as doctors. In this respect I would point out that the efficiency of the health service to be provided will depend to a large degree on the ambulance service, which will have no representation. Because of the larger units involved in the future and the larger areas to be covered, an efficient ambulance service will be a very important factor. Therefore, this category should have representation on a board of 32 members.

Most of the people in the ancillary medical professions have done quite long terms of training, such as nurses, yet their representation is reduced to two, taking psychiatry and general nursing together. I had hoped for greater representation for that section. The Minister, who has indicated he is prepared to accept reasonable suggestions from all sides of the House, should keep this point in mind and try to provide greater representation for the people I have mentioned when we come to the next Stage of the Bill.

Question put and agreed to.

I move amendment No. 5:

In paragraph (e), line 51, after "board" to add "provided always that any board may with the prior consent of the Minister amend such rules in any manner approved by resolution of such board".

Section 5 provides the manner in which health boards will operate and be constructed, and the purpose of the amendment which I move in the name of Fine Gael is to give some room for manoeuvre as to their mode of conduct. The section provides that the rules set out in the Second Schedule shall apply in relation to the board. It is reasonable to assume that some of the rules would be irksome, that they would not be beneficial and that they would hinder rather than assist health boards.

Where a health board wishes to recommend an alternative in the rules I think it is reasonable that such alteration might be made. We have provided that such alteration could be made provided the prior consent of the Minister is forthcoming. There are very many matters in this Bill which the Minister knows are to be fixed by way of regulation. Indeed, our complaint about the Bill is that so much has been left undone in the Bill.

It is a permissive Bill which permits matters to be determined by way of regulation but if there is any argument to be made in favour of legislation by way of regulation it is because it permits a flexibility and allows amendments to be made in the light of experience and according to peculiar local requirements. It does seem unreasonable to expect that all the rules in the Second Schedule to this Bill will be the ideal rules for each of the eight regional boards which the Minister has in mind. Indeed, there may be other health boards as well.

On that account if any health board resolves an amendment should be made in the rules applicable to it it should have the right to ask the Minister to make the necessary amendment. If the prior consent of the Minister is required before an amendment is made it will prevent any local health board making a decision which might be in conflict with national overall requirements. It is a small matter but it is one worthy of the Minister's consideration.

From what I understand Deputy Ryan to mean in this amendment I think it would be undesirable that some of the rules should be subject to variation in the way he suggests, even with the consent of the Minister having to be obtained. For example, the provisions in rule 2 of the Second Schedule are designed to prevent any one political bloc on a local authority obtaining a monopoly of representation on the council. I do not think that should be subject to change, even with the consent of the Minister. Although I do not think there would be any Minister, looking back on past history, who would be so unscrupulous as to permit some group on a county council to alter the rules effectually preventing a minority interest from being represented which would be represented before such rule was changed I still think the principle is bad from the point of view of democracy.

I also think the general basis for the election of professional members should be uniform for the entire country. In other words, when the register is set up and when the health boards are elected on the second occasion there should be some consistency throughout the country. Otherwise I think we will be in for trouble. The rules provide a fairly definite framework which, in fact, protects local authorities from arbitrariness on the part of whoever is Minister for Health. If the Deputy likes I, again, will try to meet him, and I am sure the Deputies of my own party would agree with me in this, by considering a provision in the rules which would make it possible for certain types of rules to be altered.

I want to make it clear that I do not think it is a good idea that a council could alter the grouping principle with the consent of the Minister. There must be consistency. Although there might be some desirable variation as between one health board and another there must be general consistency. If there is not general consistency I am afraid the public will not accept changes of the kind that might be made by a regional health board who might be actuated by motives which might be very human but which might not be in the public interest. The framework of those regional boards must be considered collectively as well as independently. I think I have made the point clear. I am not averse to some kind of power to alter the rules but it would have to be very carefully examined.

I accept what the Minister says and I would be grateful if he would have a look at the matter in that light.

Amendment, by leave, withdrawn.
Section 5 agreed to.

I move amendment No. 6:

In subsection (1), page 6, line 2, after "local authority" to insert "(other than a sanitary authority)".

This is purely a drafting amendment. It is to obviate the situation which would arise if this amendment was not put in whereby the function of adding fluoride to public water supplies would come under the regional health boards, whereas it is decided this should be left to the sanitary authorities. The purpose of the amendment is to make it clear that this function will not be transferred to the health boards. It is purely a minor matter.

Considering it is a most unhealthy practice to add fluoride to the water supply I quite agree it should not be given to the health boards.

Amendment agreed to.

Amendment No. 7, as the Deputy has already been informed, involves a potential charge on State Funds and is out of order.

I must raise a point of order. On Tuesday of this week I asked a Parliamentary Question to which the Minister replied in the form which I expected. I asked the Minister whether the national Exchequer bears any part of the cost of the operation of the Public Assistance Act, 1939. The Minister's answer was that the State did not bear any part of the cost, that the cost was borne by the local authority. It, therefore, seems to me that the suggestion that my amendment is out of order because it might impose a charge on the national Exchequer is erroneously made, that it is not well founded because the law is that public assistance may not be charged to the national Exchequer. If this is so, then requiring that the public assistance be operated by the local health board cannot add anything to the national Exchequer. I ask the Chair to reconsider the matter.

This matter was carefully considered and the ruling given to the Deputy has to stand. What the Deputy proposed was carefully considered but was found to involve a potential charge on State funds. Accordingly, the information conveyed to the Deputy in regard to the amendment is correct and the amendment must stand ruled out of order.

While I appreciate that the Chair at the moment must stand by the decision which has been erroneously arrived at, I propose to challenge it elsewhere.

Amendment No. 7 not moved.

I move amendment No. 8:

In page 6, between lines 26 and 27, to insert the following new subsection:

"(4) Section 10 (1) (a) of the Vital Statistics and Births, Deaths and Marriages Registration Act, 1952, is hereby amended by the substitution of `the health board' for `the public assistance authority under the Public Assistance Act, 1939 (No. 27 of 1939),' ".

This is another drafting amendment. We propose that the operation of the Births, Deaths and Marriages Registration Act, 1952, be undertaken by the health boards. It is a drafting amendment to provide that when a superintendent registrar retires or dies—there are only a few of them in the country —his function would be taken over by the health board and not the public assistance authority. It is purely a drafting amendment.

Amendment agreed to.
Question proposed: "That section 6, as amended, stand part of the Bill".

Ever since the 1953 Act, and, perhaps, earlier, home assistance has been administered by local health authorities. Prior to that it was a service conducted by the local authority or the sanitary authority. Home assistance is very definitely a personal service. It is in the nature of a social welfare service subsidised for the purpose of ensuring that certain people have adequate food, clothing and shelter.

It seems to me to be entirely wrong and contrary to modern social thinking to be using this Bill to take away this very personal social service from the health authorities and to be handing it back to a sanitary authority. It is one of the great drawbacks of our existing social services that there is a multiplicity of means tests and a large number of different investigating officers pursuing their inquiries and employing different means tests and different standards for the purpose of determining what assistance people should receive from various public institutions. It is for the purpose of avoiding the wholly unnecessary and anti-social trend in this connection that I tabled the amendment which has been ruled out of order—though, since the Minister's last amendment, I can see that, perhaps, there will be some extension of the Public Assistance Act of 1939. My question dealt with home assistance and I believe that I am right in saying that home assistance, as such, would not add anything to the cost on the national Exchequer if it were left with the health board rather than the local authority while the registration of births, deaths and marriages probably does add some expense.

I urge the Minister not to take the retrograde step of taking away home assistance from health authorities. They are the people most closely in touch with those in need of home assistance. In recent times they are providing other kinds of services such as meals on wheels, occupational therapy and chiropody for old people. These people are best qualified to deal with necessotous cases. It is not a job to be performed by engineers and architects or the people who empty bins and clean the sewers. I should like to hear what the Minister has to say on this.

I should like to add my voice to that of Deputy Ryan in saying that the public assistance service ought to be administered by the health board. Those of us who have served on health authorities are aware of the fact that public assistance is paid for entirely out of the rates. Perhaps there is some substance in the Chair's ruling from this point of view, but if the health board administered the public assistance service an exception would have to be made unless there was a change in the amount of Exchequer subsidy. At the moment, there is no Exchequer subsidy on public assistance. This is wrong and is a limiting factor on a service that is very necessary.

Anybody who has ever been on a county council knows that the reason why a certain figure is voted for public assistance is not based on the need for such assistance within the area but that it is based on the ability of the ratepayers to pay. This is an incorrect approach. As Deputy Ryan says, the people who are now providing meals on wheels and other related services are the ones who know best whether home assistance is necessary in particular cases. What will happen now will be that there will be a multiplicity of correspondence between the public assistance officer of a local authority and the officers of a health authority.

Deputy Ryan has done a service to the House in pinpointing this error and it is something that the Minister should consider. He could ensure that public assistance was administered by health authorities. The Government may say that they cannot afford an Exchequer subsidy towards public assistance, but I think they could. Perhaps their trouble is, and I do not say this in a critical——

We seem to be widening the scope of the debate by dealing with the section rather than the amendment.

Perhaps we are talking about what is not in the section rather than about what is in it, but I bow to the ruling of the Chair. What I was about to say was that the Government might be of the opinion that they would be drawing attention to the fact that not a penny comes from Government funds for public assistance at the moment. That is not something that one could make political capital of and I ask the Minister to consider including public assistance in the section.

Perhaps the Minister will allow me to make one other point. The practice differs somewhat between how it is operated in an area where there is no separate health authority and a region like Dublin where there is such an authority. Therefore, there might appear to be some conflict between what Deputy Donegan and I said. However, I just mention that in passing. The problem is that at the moment the Dublin Health Authority are providing a number of services which have a high medical content—meals on wheels, chiropody for old people, home visitation and other aids which help to keep patients, particularly geriatric patients, in the community and much of this is paid for out of the public assistance vote. If this is now taken away from the health authority a situation could arise in which a health board would no longer be able to provide those services.

I have a certain amount of sympathy with the general concept of, perhaps, co-ordinating certain social welfare services with the health service and I can see that this is a debatable point. The Minister for Social Welfare has announced that he is studying the entire assistance services with a view to seeing whether they should be left as they are or whether there should be some further provision or different rules of administration. Until he has completed that study it is impossible for me to make any pronouncement about what changes are likely. The Deputies will realise that in a long Bill it is very hard for me to remember everything in the Bill before me. In section 59 there is a provision which reads:

A health board may make arrangements to assist in the maintenance at home of sick and infirm persons or their dependants or of persons eligible for institutional assistance under section 54 of the Health Act, 1953, either (as the chief executive officer of the board may determine in each case) without charge or at such charge as he considers appropriate.

I have some part in the directions that will be given by the health board in regard to that matter. The meals on wheels and other valuable domiciliary help can be given by health boards and they can appoint home helps for this purpose. So far as co-ordination is concerned the officers who decide on the provision of home assistance are those who estimate the means and circumstances of the people who receive home assistance. These same officers investigate the means so far as medical cards are concerned. There is administrative co-ordination. There is not ignorance in respect of the home circumstances or the financial circumstances of someone who needs home assistance and the medical provisions required for him They are not in two watertight compartments even though in the case of home assistance all the money is raised by each local authority through the rates. There is logic in it. If 100 per cent of the funds is raised through the local authority charges the local authority should continue to have the main administration of the home assistance until the whole question is examined. I do not think I need go into that any further. Home assistance and medical assistance are not separately administered. They are not in two watertight compartments. The same officers examine one section of the community for the right to have medical aid and the right to have home assistance. That prevents some of the undesirable features which might arise and which have been suggested by Deputies. Section 59 enables the health boards to give the meals-on-wheels type of assistance and domiciliary assistance. The Minister for Social Welfare is examining the general question of home assistance.

I am sure the Chair would not allow me to open a debate on section 59. I am grateful to the Minister for refreshing my memory on it. It has its limitations. A person must be sick or infirm before he can get assistance under section 59. The purpose of many services at present rendered by the Dublin Health Authority is to prevent people becoming sick or infirm. They would not necessarily be persons who would come under section 59. Furthermore, the Dublin Health Authority, and presumably other health authorities throughout the country, sometimes render assistance by way of home help for the families of widowers or of widows, where the widow may have to go out to work, but if she has infant children she cannot go out to work to earn a decent livelihood. Such people could not be assisted under section 59 to which the Minister made reference. We have the Minister's sympathy in this matter. I would urge on him to channel those sympathies by having a look at section 59 in order to bring in the kind of people I am talking about, or else to retain the operation of the welfare services under the Public Assistance Act within the control of a health authority. That is where it operates. It operates under that Act where there is a separate authority as in Dublin, Limerick, Waterford and Cork. That is where it should be left. It should not be handed over to the local authority.

(Cavan): The Minister has set out in the memorandum which he circulated the various areas to be covered by the health boards. I am familiar with the north-eastern region which comprises Cavan, Monaghan, Louth and Meath. Section 6 of the Bill sets out the functions of the health board. I know another part of the Bill provides for the establishment and running of hospitals. In the health scheme, as we hope to have it enacted, provision is made for the establishment of general hospitals. I want to ask the Minister will the functional area of the health board coincide with the functional area of the hospital board? I do not think so. For example, as I understand it the health board in the north-eastern region will deal with the four counties I have mentioned—Louth, Meath, Cavan and Monaghan. The Minister says he has not studied the Fitzgerald Report yet but there are provisions for a hospital for that area. Such hospital would serve Monaghan, Cavan, portion of Leitrim, portion of Longford and portion of Meath. I asked if the functional areas of the hospital board and the health board will be the same. If not, as I see it, the hospital board may be serving an area which would not be represented on the board by publicly-elected representatives. I do not know whether I am making this point clear but if a hospital were established in either Louth, Meath, Monaghan or Cavan to serve portion of Leitrim and portion of Longford, would the Longford or the Leitrim people have a say in the running of that hospital? It would be more desirable if the central area to be served by the health board and the hospital board were the same. I would like to hear the Minister on that point.

We propose that the regional health board should be responsible for the day-to-day running of the hospitals within their area. We are also setting up regional hospital boards. There is one for the whole eastern part of the country comprising the north-eastern board, the midland board, the eastern board and the south-eastern board which will help to co-ordinate the organisation of the hospital services and make suggestions for their improvement.

(Cavan): I had in mind the 300-bed general hospitals and not the large regional hospitals of which there would be only four or five in the country.

It is proposed that the regional health boards would have responsibility for the day-to-day operation and management of hospitals that are not voluntary hospitals.

We have an Act which deals with the registration of nursing homes. I am not certain of its title. We have a Registration of Maternity Homes Act. In this long list of statutes I do not see the Registration of Nursing Homes Act. Is it an Act which should be within the ambit of the health board?

The Registration of Nursing Homes Act is included under the Health Acts.

It was not given a separate identity of its own?

Question put and agreed to.
Progress reported; Committee to sit again.