Private Members' Business. - Health Bill, 1969: Committee Stage (Resumed).
Debate resumed on the following amendment:
In subsection (1), page 11, line 13, before "shall" to insert ", other than the Eastern Health Board,".
—Deputy Clinton.
Before the break for Private Members' Time I was making the case that the system of administration which I was urging to have continued had stood the test of time both in health and local government matters and that, if anything was wrong with this system, it was made more democratic by the Local Government Act, 1955, which gave the members the power to have recourse to section 4 and intervene in what was normally regarded as the manager's business and responsibility. We know that system has worked well. Nobody has complained about it. Every member of the Dublin Health Authority was, in the main, satisfied with this. The Dublin Health Authority is a very large health authority. It administers no less than 12 large-scale institutions, one of these being the largest general hospital in the State. It also administers two psychiatric hospitals, St. Kevin's and St. Ita's. When the area is enlarged there will be at least six more such institutions brought under the direct control of the eastern board. There is no doubt but that the system of direct control by the members, where all the decisions have to be made and day-to-day directions given, will become unworkable. I know this responsibility can be delegated to sub-committees, but I believe the Minister is against this sort of thing. The Maud Report in England advocates a system of administration which follows very closely the system we are advocating in this amendment and which has been acceptable, in the main, in the County Management Acts over the years. The Devlin Report separates very clearly the functions of the executive side and the functions of the elected representatives. It makes a clear distinction between policy-making and administration. Here is what the Minister himself said about this on the 30th October, 1969, at column 2193 of the Official Report:
I think if one looks back at the experience of very large boards one finds that the boards end up effectively in the hands of the chief executive officer who is appointed for the general administration of the service. It becomes impossible to do 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.
These are the Minister's own words and his decision on the matter. I do not want to see the affairs of the eastern health board end up effectively in the hands of any chief executive officer. I want to see the day-to-day administration being put squarely on the shoulders of the chief executive officer. I want to see the limited amount of time available to the elected representatives and other members of the board being spent in policy-making and not in detailed day-to-day decisions which must be made in a large administration of this kind.
I have probably made most of the points I want to make at this stage. When we went to see the Minister we raised this point and either the Minister or some of the people supporting him said, when this question of plural control was raised, "After all, we know in other bodies that this works well." We were given the example of vocational education committees and harbour boards. I was a member of one of the largest vocational education committees for at least ten years. I know the volume of business which was transacted. We could meet once a month and make all the decisions necessary in two hours. No analogy whatever can be drawn between the volume of work that will have to be done in the eastern region board and that done by the vocational education committees or harbour boards. Unless the members of this new board can be full-time members, meeting every day and making every decision and giving every direction, if anything goes wrong, I wonder who will be surcharged? If we give directions will they lead to surcharge on either the full board or on a sub-committee of the board? Will we be liable to surcharge? These are matters which arise. The Minister should look very seriously at this. I suggest to him that it is the wrong time to try out a new form of administration when such enormous and profound changes are being proposed in our health legislation.
I have been a member of a board of a health authority for nearly nine years. I was chairman one year. I feel that the present system of administration of the Dublin Health Authority is second to none. It is an excellent system. I may be conservative but I do not like to see anything that is functioning well disturbed. We discussed these matters at great length in a committee of Dublin County Council, Dublin Health Authority and Dún Laoghaire Borough Council. We thought that the amendment we agreed to here was in the Tánaiste's interest and in the interests of good administration. Responsibility should not be taken from the chief executive officer. I am not being personal. Hundreds of hours were spent on the various boards trying to perfect the regional hospital board. I found my experience in attending the Dublin Health Authority meetings for nine years very helpful. At the beginning it was like all other boards, having the usual growing pains. As the administration developed we had the present chief executive officer and his staff. The secretary at that time was Mr. Nolan who worked when this board was set up in 1960 until he fell out of his standing on a few occasions from overwork. We saw that and we advised the Minister that it was time to give more authority to the CEO to do the job that we wanted him to do. We wanted each Department of the health authority to work under the direction of the CEO and to be a separate branch of the authority. Speaking with that experience, I support this amendment. We have only one such man in Ireland and that is the CEO of the Dublin Health Authority. County secretaries and county managers do it all over the country. I want to support this amendment. I am giving my opinions for what they are worth.
I have been very interested to hear what Deputy Paddy Burke and Deputy Clinton have said in connection with this amendment. Knowing the complexity of this Bill— I found it very complex when I started to study it—and knowing the history of local government, I do not blame either of them for having some fears in regard to disturbances that might occur in the administration of the Dublin Health Authority. While I am quite willing to accept the statements of the two Deputies that the health authority has operated efficiently, I suppose it is true to say that one can always do better. Perhaps, I have not made the position sufficiently clear.
The only difference between section 16 and the corresponding regulations under the county management system are that we have given, generally speaking, the powers to those health boards that health authorities and county councils have at present, taking into account the County Management Acts and the Act of 1955, which the Deputies know well. There is not any other real change. My predecessor felt that because public opinion varies throughout the country as to the desirability of the management system he should limit the powers of the chief executive officer in a certain definite way as prescribed in subsection (3) a, b, c and d. I take it from hearing those two Deputies speak that they would not want the eastern health board to have any of those powers. It would place them in an impossible position. There is also subsection (e) which would give me the power to add some other functions to those of the chief executive officer if I felt that the machine was creaking or inefficient or, equally, if I received from a health board some suggestion that they would like in a definite way to have some function specifically transferred to the CEO. I can assure the two Deputies that when the eastern health board comes into operation because the Dublin Health Authority will be far the biggest part of it once the new chief executive officer and the other officers are appointed I do not envisage any change in the manner of administration. In regard to any powers or functions in respect of day to day management that the Dublin Health Authority have already given their chief officer, which may in turn have been delegated to his deputy officer, they only have to pass the necessary resolutions in order to ensure that the same kind of administration will continue, subject to whatever changes are required because of the addition of Wicklow and Kildare.
Quite obviously, there will have to be some officers whose particular duty will be to co-ordinate Wicklow and Kildare with Dublin. The addition of Wicklow and Kildare will make a material difference and, as the Deputies have remarked, the great bulk of the work is done in Dublin city and county. I can assure the Deputies that under section 16 (1) there is nothing to prevent the new eastern health board from, at least in the first instance, saying: "We want to carry on the same method of general direction, the same delegation of functions as has been the case up to now" subject to Wicklow and Kildare being added in with a proper co-ordination and integration of these counties.
There may be nobody on the new regional health board in a position to say that. There could be a complete change of personnel.
I do not imagine that the health board would have changed its complexion to that degree. As far as the people appointed from the profession are concerned, it would be to their immense interest that the machinery would continue to move smoothly. I am sure that if there was to be any change and if the health board wished to take on any further executive function, of the kind Deputy Clinton suggested they might have to do, that at least they would examine it before they attempted to give themselves the overwhelming burden of activity which has been indicated by the two Deputies who quite rightly do not want to sit every day going through a massive agenda if there can be a proper delegation to the chief executive officer.
That is how I see the position. I might add that I will be responsible for the operation of this measure and if by any chance something creaks in relation to the operation of section 16 I will be the first person to be responsible for it and I will have to come to the Dáil with an amending measure but I do not see the necessity. Subsection (1) enables the board to delegate executive functions to the chief executive officer. There are certain specifically reserved functions and I can add such other functions as may be prescribed. It seems to me that the machinery will move smoothly.
I should say that the Maud Report did propose the enlargement of local government areas but the main purpose of the report presented to the British House of Commons in relation to the health services was to co-ordinate the hospital administration, the public health administration and the medical service administration, which is what we are doing in this Bill. However, Britain is a very different country from our own particularly because of the enormous density of population. I do not think it would be possible for the eastern health board to operate successfully if the very able person who holds the position of city manager automatically remained the chairman of the eastern health board. I feel that it is possible to arrange co-ordinating functions between the health and local government services either by administrative co-ordination at a lower level, between the local authorities within the health board and the other local authorities in the Dublin area. It is essential to have a chief executive officer who will hold that position for the eastern health board, and such Deputies as may be required. I want to assure the two Deputies again that I do not see a tremendous revolutionary change in the character of the administration.
Deputy Clinton caught me out, and I accepted it in my speech on the 30th October, when I referred to the kind of functions which sub-committees could exercise within the eastern health board. I was really thinking of functions which involved the spending of money that had not been budgeted for. The sort of thing I can see being possible for a sub-committee of the eastern health board would be that the sub-committee would be told by the health board how much there was to spend in the year 1970-71 for child health services. A committee could be formed which could have the power of saying how that money would be spent, what child health services could be expanded within an area, whether a site could be obtained for a new child health centre, how the service for the examination of children under six could be performed in certain areas where there was no child health centre, or how it could be performed in the dispensary of a practitioner. Provided the sub-committee understands that if it is to spend money it must be part of a budgetary process, Deputies can think of other functions which could be given to a sub-committee.
I am not aware at the moment of how Dublin Health Authority operate in relation to committees but I am sure there are some operating. Between these, and the delegation of authority to the chief executive officer to the extent which the eastern health board may think wise, the whole organisation will be enabled to proceed smoothly. I would imagine, if the other members of the eastern health board share the feelings of the two Deputies—and I am quite sure the majority of them together with the professionals will—they will, in order not to have any difficulties arising immediately transfer such functions as the Deputies think are over and above those clearly reserved to the chief executive officer, at least for the time being. Then they can examine how this board will operate with the addition of Meath and Kildare, particularly in relation to some of the new services which will be established at the time the Bill comes into operation. I hope I have been helpful to the two Deputies.
I want to press the Minister to accept these amendments which have been brought to the House from a meeting of the Dublin Health Authority where it was unanimously decided to ask the Minister to accept them. It was not from this side of the House or that side of the House, it was unanimous. Therefore, I would press the Minister on this. I am not satisfied with what the Minister says about the new eastern health board. When it meets it will have very little in common with the old health authority. There will be very few members who have been on the health board. So far as I am concerned, like the other two speakers, I have been on the Dublin Health Authority since it was brought into being and I consider it has worked well. Therefore, I would press the Minister to accept these amendments.
I do not quite follow this section. On the one hand in subsection (3) the chief executive officer is vested with the control and supervision of officers and on the other hand subsection (1) says the officers of the board shall perform their functions in accordance with the decisions and directions of the board. Those two subsections appear to me to be inconsistent. Perhaps the Minister would look into that.
As I said, I have been on the health authority since its inception. It has worked well and I would press the Minister to continue the system under which we worked on the health authority. As time goes on, it is getting more and more difficult to find people who can devote time to public duties. Under this Bill the position will be quite impossible in respect of the amount of time members of the eastern regional health board will have to devote to day-to-day administration and it is because of that aspect of it that we are asking the Minister to accept these amendments.
The Minister prefaced his remarks in relation to this amendment by saying that one of the reasons why he made a change in the administrative system in this Bill was because in the country some people had reservations about whether or not the present Management Act worked well. I agree with this. This is quite true. In many of the counties one comes across members of local authorities who would love to be in a position to hold the gun to the manager's head all the time. This is often the attitude of people where there is not a very large volume of work to be done. They like to have that power. I hold they have been given that power through section 4 of the 1955 Act.
I want to make it quite clear to the Minister that we in this area are not concerned with what system is operated down the country. Deputy Percy Dockrell, Deputy Paddy Burke and I are very concerned about what happens in the eastern region because, as the Minister said, the major portion of it is the Dublin Health Authority area. We are asking that a system that has been tried and found to work efficiently and effectively should be continued. This is all we are asking in this legislation. I wonder does the Minister appreciate that there should be a distinction between the system proposed for the eastern health board and the system proposed for the smaller boards? Does he bear in mind that the eastern health board will be catering for approximately half the population the other seven boards will be catering for and one-third the total population of the country? It does not necessarily follow that a system which might satisfy the people on the smaller boards would be satisfactory for the eastern region.
The Minister may not have been listening fully when Deputy Dockrell was drawing his attention to something which he would have liked the Minister to refer to. The Bill states at section 16 (3) that the chief executive officer is vested with the control and the supervision of other officers. Subsection (1) states that the chief executive officer and other officers shall perform their duties and functions in accordance with the decisions and directions of the board. I cannot see how the two can be reconciled. Clearly, that would inevitably lead to a conflict of loyalty by the officers in their relations with the board and the CEO. I should like to hear from the Minister on this point. Deputy Dockrell tried to draw the Minister's attention to this but the Minister at the time was concerning himself with something else.
I will examine this before Report Stage. Under section 16, the functions reserved to the CEO in subsection (3) cannot be taken away by any decision the board make under subsection (1). However, I agree to examine it before Report Stage to make certain that this is clearly the case. I agree with the Deputies that it should be clearly the case. I understand the difficulties expressed by Deputies Burke and Clinton about this. If they feel doubtful about the attitude the eastern regional health board may take when the new members are elected, although the Dublin County Council and Dún Laoghaire Corporation and the professional people at least would fall in with what the Deputy suggests, I will agree that before this Bill comes into operation I will meet the old Dublin Health Authority and have a period, shall we say of six months, during which the functions prescribed in paragraph (e) of the subsection can be quite clearly demarcated in respect of the eastern health board, functions which Deputies Clinton and Burke think should be additional functions of the eastern health board. This could be done for a period until the board get under way.
I do not think I could do it perpetually, because Wicklow and Kildare are added, but I can meet the old Dublin Health Authority in the interests of efficiency and so as not to disturb the officers. The object of this would be a demarcation of functions which would ensure the kind of continuity of administration that the two Deputies and Deputy Dockrell require. That would preserve democracy because I do not want to have inconsistency as between the eastern health board and the others throughout the country. For a period of 12 months I could prescribe the functions and after that I am certain the newly constituted eastern health board will realise the immense amount of administrative work they will have to do if they are not to delegate functions other than those referred to in paragraph (c). Will that suit the Deputy?
The Minister seems to be making a very generous offer, but I do not believe he is. One of the greatest curses in this country is uniformity—uniformity of an area that has no uniformity about it. I have already said that this board will be catering for half as many as the other seven put together. Why, then, should we have a uniform system of administration? I do not follow the Minister in this. Earlier the Minister said that the eastern board, when set up, could in effect pass a resolution in respect of the functions in relation to the eastern board as they apply to the chief executive officer. Is that not what the Minister has said? I want to confirm that what the Minister said is that if the new board, meeting for the first time, want to pass a resolution to continue what is in existence at the present time, and if they give these functions to the CEO and leave in existence the functions the Dublin Health Authority already have, he will be prepared to accept that.
I would nearly accept that, although I say that it is doubtful. I still say it should be written into the legislation because half of the members of the new board will not have any experience whatsoever of the administration of health services and will not have the knowledge of the problems that are met with in the administration of health services in that large area. The existing members of the Dublin Health Authority know it but the professional people and the Minister's appointees will not have that experience. They will be likely to vote in any direction because they will not have that experience which the members of the health authority had—and they were members of every party, plus some independents. I appeal to the Minister not to say: "Because there are reservations about this in the country, we will have uniformity". Uniformity in this context is not worthwhile when you are not applying it to the same thing.
I endorse the remarks of my one-time colleagues of the Dublin Health Authority and I am concerned that what the Minister considers to be certain to happen may not, in fact, happen. Although I appreciate the Minister's desire in the distribution of the personnel of the new eastern health board, on the figures already submitted by the Minister the position is that there will be only four members out of 32 on the new eastern health board who have had previous service in the Dublin Health Authority, because the inadequate number of six proposed to be given to the Dublin Corporation will not be in a position to take up their membership unless there is legislation to enable Dublin Corporation to be reinstated.
Therefore, out of 32 members there will be only four, at most four, who have had the privilege of being members of the Dublin Health Authority. I should like to say at this stage that I consider myself, though the Minister and some of his colleagues do not, still to be a member of that authority. Because the Dublin Health Authority have not been able to do their work, we have been asked to take on some of the duties that should be carried out by members of the health authority because they are not able to carry them out. We are asked, unpaid and unhonoured, to work on hospital visiting committees.
We know something from past experience of the work of the Dublin Health Authority and I can say without reservation that they worked extremely well, as did the system. There were some members of the authority who had reservations when the authority was being reconstituted nine years ago. But the Minister said it worked so well, why not make it larger? You cannot have the optimum: you can just have the perfect organisation and to make it bigger may destroy it. I believe that is the real danger now and I appeal to the Minister to leave well enough alone and, if he can, to allow the Dublin Health Authority to remain more or less the same size as it is and not to have the acquisitions he is suggesting. If he cannot do that, let him at least allow the existing system to operate, as it is. That is the purpose of the amendment of Deputy Clinton and Deputy Dockrell which Deputy Burke has supported. When there is such unanimity among people not noted for their agreement the Minister should be swayed to accept the amendment and write it into the Bill. Why is there this resistance sometimes on the part of Ministers to writing into Bills what they say they are prepared to do so long as it is not written into the Bill? The Minister has been very good at many stages when listening to what he has accepted as reasoned argument. I hope in this connection also he will recognise the sincerity of those arguing in favour of the inclusion of this provision in the Bill so as to make certain that what we know has worked we will be the situation in future.
Before the Minister comments on this again I should like to ask him does he know that the commissioner appointed by the Government to administer the affairs of Dublin Corporation, Mr. Garvin, a man of very long experience of local government administration, agrees with us on this? He agrees absolutely that the system we are advocating in this amendment is the best system possible. Does the Minister realise that he is now proposing to introduce for the seventies a system found inadequate for the thirties? I appeal to the Minister to think very hard and long before he refuses to accept this amendment.
I support what Deputy Clinton has said. I had forgotten that the commissioner, Mr. Garvin, the former secretary of the Department of Local Government, was also present at the health authority meeting when we came to this decision. I, also, appeal to the Minister to accept the amendment on the grounds that this is not a decision of any section of the health authority but a unanimous decision backed up by the commissioner, Mr. Garvin.
I must separate the argument into two parts. I could not accept the concept of the city manager, with all his commitments, however able he may be, being chief executive officer of the eastern health board. That is not a good idea administratively.
Would the Minister say that again? We cannot hear him.
As I read the Bill and I am told by the experts if I accept these amendments, it would mean that the city manager would become the CEO of the eastern health board. Perhaps the Deputy did not intend that?
By way of correction, I stood up and divorced from the amendment the latter part of it where it says: "In the same way as they applied to the Chief Executive Officer under section 18 of the Health Authorities Act, 1960 and shall not apply otherwise". I asked that that should be deleted at the start because when I checked my references I found that was one that applied to delegation by the city manager of certain authority to the CEO.
Leaving out that, I do not want to continue disputing what the Deputy said because I am very anxious to proceed with this Bill or we shall never get it into operation. I wonder whether the new representatives from Wicklow and Kildare, with at least the majority of the professions, meeting together for the first time, months before they have statutory powers—because I propose that these health boards shall be appointed first and given their statutory functions or power to operate some months afterwards—would really want to disturb the executive administration of the Dublin Corporation and Dublin County Council and Dún Laoghaire part of the health administration by taking on an enormous burden of executive work, if that is the case the Deputy states. But if the Deputies have a fear about this I shall make use of subsection (e) by meeting the old Dublin Health Authority before the eastern health board is set up and I shall get a list of the kinds of functions which the Deputies say should be left with the CEO in addition to those under subsection (3) and I shall consider whether these should not be actually determined for a period of six or 12 months after which, I am certain, once the health board has seen how Dublin city health services operate, they would agree to the continuation of these arrangements and that I would remove my authority for these functions and leave it to the eastern health board—I hope the Deputy understands this.
Before the House proceeds further with this debate, the Chair understands that Deputy Clinton mentioned that he understood certain words would be deleted from the Bill or the amendment before the House. The Chair has had no notice of such an amendment, and a deletion of this nature tends to confusion as to what is being done. The Chair wishes to point out that an amendement can be put down again on Report Stage, if the Deputy wishes to do so.
May I say that it does not make the amendment clumsy, but rather tidy, because it deletes the final three lines.
The Chair can only take the amendment before the House as it reads on the Order Paper at the moment. The Chair has had no notice of any change in that and, consequently, cannot accept this change now.
If the Chair feels we cannot continue to discuss the amendment with this deletion I will agree to have it put down on Report Stage if the Minister would prefer it that way. If we were to discuss it as it stands, it does not make the sense I wanted it to make. I did want to ask the Minister a question, even if the amendment is going down again on Report Stage.
The Chair has no objection to that but wishes to point out that, if it is desired to amend any amendment, the usual way to do it is to give due notice or to table the amendment on Report Stage.
I am quite willing to have this amendment discussed again on Report Stage. But I am very anxious to get this Bill through, because there is so much to be done by way of administrative regulations. It is almost impossible, administratively, to inaugurate it in the middle of a financial year and I do not want to have a feeling of uncertainty spread over three years. That would be appalling for everybody concerned.
If I can have a meeting between the city manager, whom I might say has written to me on this general subject of the executive work, and Deputy Clinton and Deputy Burke with the officers of my Department and go through what they have in mind about the functions, between now and the Report Stage, then I am certain we will be able to straighten out this difficulty. My only reservation is that I do not know whether I really ought to transfer these functions permanently. It would be quite sufficient to do so for six or 12 months. I do not know what the functions are. I have not got long enough experience of the detail of the operation of the health services. Will that satisfy the two Deputies? The City Manager will bring a list of the functions which he thinks should be prescribed in some way on the basis that section 16 as a whole is not sufficiently definite for the Dublin Health Authority.
I am very pleased that the Minister proposes to keep an open mind and that he is prepared to meet the people he mentioned. I wonder could he add to this the present CEO and his chief assistant?
The officers of the authority.
That would be Mr. O'Keeffe and Mr. Nolan together with the city manager.
I want to thank the Minister.
Amendment, by leave, withdrawn.
Amendements Nos. 21b, 21c and 21d not moved.
I move amendment No. 22:
In subsection (3) (b), page 11, lines 30 and 31, to delete "receive treatment under, or otherwise avail himself of", and substitute "avail himself of".
This is a very simple and obvious amendment. Its purpose is to avoid the suggestion that a chief executive officer can dictate the form of treatment given by a medical officer in the course of his duties, and to retain the independence of medical officers in prescribing treatment. It is really a drafting amendment.
Amendment agreed to.
Question proposed: "That section 16, as amended, stand part of the Bill".
I should like to ask the Minister a question. Subsection (3) (d) refers to "any function with respect to the control, supervision, service, remuneration, privileges or superannuation of officers and servants of the board." I should like to be assured again—I think it was mentioned earlier—that all those to whom this refers would have a right to appeal to the Minister under the Local Government Act, 1941, if they were dissatisfied.
They would very definitely under other sections of the Bill.
Question put and agreed to.
SECTION 17.
I move amendment No. 22a:
In page 11, lines 46 and 47, to delete "or for continuing as an officer".
My purpose in moving this amendment is to point out to the House and the Minister that this section could be seriously misconstrued in terms of conditions of employment of officers of authorities. I am sure the Minister will give us the required clarification and the required assurance in this matter as the section specifically states:
The qualifications for appointment as an officer, or for continuing as an officer, under a health board shall be approved of or directed by the Minister....
I want to ask the Minister to ensure that no qualifications will be introduced which would have retrospective effect on existing officers in any health authority or any board. I have no objection to any new appointee being informed: "These are the new qualifications for the job and you have to have them if you want to be appointed to the position." The retention of an existing post by an officer should not be in any way held up to what I might call transitional ransom in terms of qualifications.
Therefore, I would hope that section is intended to cover exigencies only such as an officer continuing to be in good health or continuing to be of sound mind. I have no objection if that is the specific construction put on it. I assure the Minister that we would not be prepared to accept a situation in which retrospective qualification application would apply under that section. I would be grateful if the Minister would assure us that the section will not in any way operate to disqualify the holder of office from continuing in that office as and from the introduction of the Bill.
I can assure the Deputy that the legal advisers have indicated to me that it cannot be used in this way, and the Deputy can be assured of this. As he has suggested, certain of the qualifications for officers are such that the person must be required to have them not only when he is a candidate for office but also during the tenure of office. The Deputy gave one example of a suitable state of health. The other example is the case of a woman—she must remain unmarried.
Does the Minister not think that is rather a reactionary provision?
We will not discuss that on this Bill.
We are on health at the moment.
Amendment, by leave, withdrawn.
Section agreed to.
SECTION 18.
Question proposed: "That section 18 stand part of the Bill".
Can the Minister say in what circumstances would he make an order extending the age limit of a person beyond 65 years, and what is the nature of such an order? Has it to be placed before the House?
The only normal case I know of is that of a dispensary officer who is enabled to remain in office until he or she is 70 years. I do not intend to make any changes beyond those which are normally made. The Deputy knows that occasionally 12 or 15 months are given to officers in certain circumstances.
Question put and agreed to.
Section 19 agreed to.
SECTION 20.
Amendment No. 23a is cognate to amendment No. 22b and they may be taken together.
I move amendment No. 22b:
In subsection (1), page 12, line 10, after "Minister" to add "after public local inquiry".
The subsection deals with the suspension and removal of a chief executive officer. It is proposed in the amendment that this power of suspension will operate only after the Minister has held a public local inquiry. The purpose of the amendment is clear. It is to prevent any abuse or any hasty action on the part of the Minister and would enable the chief executive officer to state his case for his conduct—the conduct which, presumably, would cause the Minister to contemplate the suspension. The effect of amendment No. 23a would be to oblige the Minister to have an inquiry held before suspending an officer on the grounds that he is incapable of performing his duties or has misconducted himself. The amendments are simply for the protection of chief executive officers and to ensure that if justice is being done it is also being seen to be done.
We want to have any disciplinary matter made public and not dealt with by the Minister in his office without a public inquiry.
In reply to the two Deputies, I simply could not accept the position of being unable to suspend a person of the importance of a chief executive officer without a public inquiry; obviously he could only be suspended if he had committed some very serious offence such as the misappropriation of a large amount of money. I must be in a position to suspend the chief executive officer immediately; there must be some ultimate discipline in this situation. Equally, it is true that a chief executive officer might not wish to have a public inquiry into his suspension either because he accepted that he should be suspended or had reasonable hope on grounds which he would not want to make public that the suspension would be lifted. There is that human circumstance that enters into it but, again in order to maintain a full understanding with all the Deputies on both sides of the House who wish to take a sort of human attitude towards all this, it does so happen that in this Bill the chief executive officer can be removed without an inquiry, and I shall put in an amendment on Report Stage providing that the chief executive officer cannot be removed as distinct from being suspended until after a local inquiry. Will that suffice?
That seems fair enough. The only thing to which I would draw the Minister's attention is that in the Local Government Act, 1941, there is provision for holding a local inquiry and I thought that since we have a precedent for it, it could reasonably be introduced here.
It is only for a removal.
If that is so, I accept it. I thought it was for suspension as well as removal.
Is the amendment withdrawn?
On the Minister's undertaking to cover the point.
Amendment, by leave, withdrawn.
I move amendment No. 23:
In subsection (2), page 12, line 14, to delete "two-thirds" and substitute "a simple majority" and after "board" in the same line to insert "who were present and".
The purpose of this amendment is to provide that where a health board wishes to suspend a chief executive officer it may do so on a simple majority vote of those present and voting at a meeting of the authority. The Bill as submitted by the Minister would require that the suspension may not take place unless two-thirds of the members voted for the suspension. One can have a situation in which people could stay away from a meeting in order to prevent a suspension taking place, because the Bill does not even confine the two-thirds to members who are present and voting but to two-thirds of the total membership. Therefore, on a health board with 30 people you would need 20 votes in favour of the suspension before suspension could take place. If a majority of the members who take the trouble to attend a meeting are in favour of suspension, then they should be able to suspend. There is no question of a surprise or vexatious suspension taking place, because the subsection provides that the intention to propose a motion of suspension will have at least seven days prior notice which has to be given to every person who is a member of a board. If after notice goes out, people attend a meeting and consider that on the information before them suspension should take place, then that should be sufficient without requiring that there be a two-thirds majority of the total membership.
There could be a variety of reasons for a person's absence. It could be due to the fact that some of the members are also Members of the Dáil, or there may be other good reasons why they are necessarily absent elsewhere. The Minister has power to nullify a suspension and there is ample protection against vexatious use of this. As I say, I do not believe it could be vexatiously used because ample notice would have to be given, and a simple majority ought to be sufficient in the circumstances.
I think I have already shown my willingness not to be compulsively uniform in my approach to this Bill, although I do have to take into account the local government code, and it would be very wrong to depart too far from it unless I had the agreement of the Minister for Local Government and also all the people in the House who are concerned with local government. I think there should be some uniformity in this matter. At this moment county managers can only be suspended by the council of a county by the passing of a resolution on which not less than two-thirds of the members have voted, there being the usual seven days notice. It would be wrong not to give the chief executive officer the same status in that regard. All this is being a little hypothetical because I am very glad to say I remember only one county manager being suspended in the last ten or 20 years. There may have been more but certainly very few.
I cannot remember even one.
I would not like to mention even the one, but I am told there was one since the Management Act.
Obviously they could not get two-thirds of the members.
I do not think that is true. Let us keep the status of the chief executive officer for suspension purposes on the same lines as that of the county managers, which I think is reasonable.
Would the Minister consider even two-thirds of the members present and voting? Some reward should attach to those who go to the trouble of attending. This puts a premium on abstention which can thwart the wishes of members; in other words, those who are prepared to stand up and be counted on a vital matter by attending a meeting and voting are in the same position as those who abstain or stay away in order to avoid embarrassment.
I prefer to keep it exactly the same as it is in the County Management Act, 1940.
The Minister is a conservative.
I have not been too conservative.
Amendment, by leave, withdrawn.
Amendment No. 23a not moved.
Section agreed to.
SECTION 21.
I move amendment No. 23b:
In subsection (1), page 12, line 31, after "may" to insert ", after consultation with the chairman of the health board and the representative organisation concerned".
I am prepared to insert an amendment on Report Stage covering the question of statutory consultation with the chairman or the vice-chairman.
Amendment, by leave, withdrawn.
I move amendment No. 24:
In page 12, to delete subsection (2), lines 35 to 37, and substitute the following:
"(2) The chief executive officer shall notify the Minister forthwith of any suspension under this section."
The purpose of the amendment is quite evident. The Minister should be notified of all suspensions including those for a short term in relation to which the chief executive officer will have to have autonomy in relation to questions of suspension. This is to ensure that the Minister will be aware of any case in which the chief executive officer might be abusing his power of short term suspension.
I move additional amendment to amendment No. 24:
In the second line after "section" to add "and shall state the reasons therefor to the Minister and to the organisation which, in the opinion of the Minister, is representative of the officer or servant concerned".
I do not think it reasonable that the representative organisation be told of the cause of the suspension. The officer suspended should have the option of keeping this information to himself, as he might wish to do in circumstances where his conduct was infamous. If the Deputy so desired we could have a Report Stage amendment making it clear that the Minister and officer concerned would be told of the cause of suspension. I will go that far.
Additional amendment, by leave withdrawn.
Amendment No. 24 agreed to.
I move amendment No. 25:
In subsection (5), page 12, line 46, after "remuneration" to insert "(other than remuneration for a period prior to his suspension)".
The unfortunate man who is suspended should, at least, be paid the remuneration due to him by way of back money while he is suspended.
Amendment agreed to.
I move amendment No. 25a:
"(6) A decision on an inquiry under this section shall be given within a period of three months from the commencement of any suspension".
One can argue about this but I think a limitation period of three months might be to the disadvantage of the suspended officer in some cases. If the suspension arose from the misappropriation of funds, for example, it might continue for a longer period to give the officer an opportunity to make a repayment. I can think of a number of instances in which it might actually help the officer to have a longer period than three months in which to have the matter determined. I think the Deputy should withdraw the amendment.
If an officer was suspended for the misappropriation of funds, would it be the practice to reinstate him after a period of suspension?
No, but during the time of his suspension and the time before his prosecution if he paid up the money while he was still suspended it would make a difference to his future career. Very often a suspended officer might become the subject of Garda investigation and court proceedings, and the Minister could not give a decision to dismiss him within a period because it might prejudice the proceedings against him.
The Minister said in his reply to this amendment that in the case of the misappropriation of moneys it might be to the advantage of the person to have a longer period. On the other hand, there are some circumstances in which a person might be deprived of remuneration over a long period and would consequently have financial difficulties during that time. Would the Minister try to make some distinction?
I am afraid it would be very difficult. This suspension operation is very often a painful one and I do not think any Minister would want to delay the decision too long. I am aware of a case where an officer of the health authority was suspended for a certain offence and gardaí had to search for information and this caused a long delay. I am afraid there is no way out of it.
Amendment, by leave, withdrawn.
Section 21, as amended, agreed to.
SECTION 22.
I move amendment No. 25b.:
In page 13, lines 10 to 12, to delete subsection (3).
Under section 25 of the Local Government Act, 1941, the Minister has the function of removal from office in all cases of misconduct. In the case of the health board this function will be given to the committee set up under section 23 except as respects absence from duty without leave or without reasonable cause. The reason is that it is not thought necessary to convene the rather elaborate machinery under section 23 in the simple case of an officer who gives up the job and absents himself. The issue in such a case is normally clear-cut and it is desirable to have a simple procedure for declaring the office vacant so that his successor can be appointed. I think that is a reasonable statement.
Amendment, by leave, withdrawn.
Section agreed to.
SECTION 23.
I move amendment No. 26:
In page 13, to delete subsection (2) (b), lines 25 to 32, and substitute the following:
"(b) an even number of other persons of whom—
(i) half shall be selected by the Minister from a panel of persons nominated by such organisation (or organisations) as is (or are), in the opinion of the Minister, representative of the class of officers to which the person belongs or where, in the opinion of the Minister, there is no such organisation or where nominations under this subparagraph have not been made, from such persons as he considers appropriate, and
(ii) half shall be selected by the Minister from a panel of persons nominated by the chief executive officer of the health board."
This amendment provides for the membership of a disciplinary committee in a case where there is no representative organ for the officer concerned or where the representative organ has not made any nomination for membership. As the section stands, there would be no authority to set up a committee in such circumstances and as a consequence no power to carry through a proposal for removal. It is quite evident that it provides a flexible system for the setting up of a disciplinary committee to judge the case where there is no representative organ, in other words, where the trade union or official organisation is lacking in substance and authority.
I move additional amendment No. 1 to amendment No. 26:
In the first and second lines of subparagraph (b) (i), to delete "selected by the Minister from a panel of persons".
The purpose of this amendment is to provide for the organisation which represents the person to have the right of direct nomination rather than what is proposed in the Bill which would require such organisation to nominate a panel of persons from which the Minister would select the people to sit on the committee of inquiry. It is difficult to see why the Minister wants to make a selection from a panel and why he is not prepared to accept the direct nominations of the organisations themselves. I think it would be desirable to allow the organisations to say who they want rather than have a situation where a Minister could have any say in the determination of the personnel. Again, not only must justice be done, it must be seen to be done. I think it is better for the Minister as well as for the person under inquiry that the Minister should have no say in the selection of a person to represent the worker involved.
It has been the good fortune in my career not to have to set up many disciplinary committees. As a result, when I looked at this amendment put down by Deputy Ryan I thought it seemed all right until I began to think about it again. When I began to think about it it became quite evident that the revision of these committees should be such that the Minister can be certain that a close colleague of the person being considered for removal should not be chosen for the committee. That is obvious. You want to make a quite certain that out of the persons nominated you will not have a situation where you might nominate people who were already prejudiced in favour of the person. I think that is quite reasonable. I would ask the Deputy to withdraw his amendment. I think the amendment I have provided is adequate under the circumstances.
Against what the Minister said, it is equally possible to get somebody prejudiced in favour of the Minister by the method that the Minister is selecting. I think it is most unlikely that a trade union or other organisation representing the workers would select somebody who was personally or closely involved with the accused. It would be contrary to wise practice. I think the experience of people who work with trade unions and trade union representatives in disciplinary matters is that the trade unions are just as anxious as anybody else to maintain good standards of conduct on the part of employees and, in fact, it is known that there are cases in which trade unions are even more severe on the workers than are the employers who sometimes might be disposed to forgive and forget but trade unions, very properly, are concerned with maintaining high standards because the misconduct of one of their number could be interpreted as reflecting on the others. I would urge upon the Minister not to seek this power of selection from a panel which he is looking for. I do not think it is necessary and even if what the Minister fears were to come about, there is still the position in which the chairman would be selected by the Minister and there would also be half the composition of the committee from a panel of persons nominated by the chief executive officer of the health board, so that the Minister has a majority who at least are independent of any particular inclination to sympathise with the person involved.
I think we need this amendment as it is. It will enable the committee to be set up more rapidly. I do not think I am prepared to accept the amendment.
I do not think it would be any more rapid. However, I shall not press the amendment.
Additional amendment No. 1, by leave, withdrawn.
On behalf of Deputy Dr. O'Connell, I move additional amendment No. 2 to amendment No. 26:
In the second line of subparagraph (b) (ii), to delete "the chief executive officer of".
This is rather out of line with the general principle that the health board should have no concern with the control of officers under section 16 (3) (d). The Deputy's amendment would mean that the selection on the official side would be the responsibility of the health board and not of the chief executive officer. This function must be reserved to the chief executive officer. He, obviously, and not the board, should therefore be the one to nominate the panel to represent the official side. I could not accept the amendment.
Additional amendment No. 2, by leave, withdrawn.
Amendment No. 26 agreed to.
On behalf of Deputies O'Connell and Desmond I move amendment No. 26a:
Before subsection (3) to insert a new subsection as follows:—
"( ) The panels of persons referred to in the foregoing subsection shall be established for the term of office of the ordinary members of the health board."
I might consider on Report Stage an amendment imposing a statutory requirement for the renewal of the panels from time to time. If I do that, that should satisfy the purpose of the amendment, which is quite reasonable.
Amendment, by leave, withdrawn.
I move amendment No. 27:
In subsection (3), page 13, line 35, to delete "83" and to substitute "86".
This is purely a drafting amendment, with no significance whatever.
Amendment agreed to.
I move amendment No. 27a:
To delete subsection (6).
Acceptance of this amendment would stultify the committee in performing its function. After the committee had heard all the evidence and had sifted it it could be prevented from making a recommendation if a person who did not agree with the majority decision resigned his membership. It would not be any answer to say that the Minister could replace the person who resigned his membership with another member because that member would not have been present at the hearing of the evidence and could not reasonably be expected to contribute to the committee's recommendation. I think the amendment was well intentioned but I do not think it is practicable.
How does the Minister make out that it would stultify the working of the whole section? Could we hear the Minister a little more on that?
If you eliminate subsection (6), if you say they may not act, in other words, if there is a vacancy among its members, then you will have to wait until the vacancy is filled and it might be filled, as I have said, by somebody who had not been present at the hearing of evidence against the official concerned and could not reasonably be expected to contribute to the committee's recommendation unless all the evidence were taken again. I am advised that, from the legal point of view, it is far better to leave the section as it is and if there happens to be a vacancy among the members the members can still act. It is rather a small point but I do think it is important. I do not think it would be a good thing to have vacancies filled by persons who had not heard the evidence in what could be a serious case.
This section 23 is a key section in the whole of the Bill because it specifically relates to the removal of a permanent officer because of misconduct and, as such, it must be taken in a serious manner, not taken as the Minister for Justice took RTE today, if I may say so, quite irrelevantly.
It is certainly completely irrelevant.
I fully accept that. If I may, therefore, refer to the section——
We are discussing the amendment.
I am speaking specifically to the amendment. I may, therefore, point out to the Minister that when any committee of any organisation or body, more particularly, when a regional health board, is meeting to act in a quasi-judicial manner on the question of misconduct of an officer, it is inconceivable, publicly undesirable and, in fact, quite reprehensible, that any such committee should meet and act unless it has a full and total presence of all members.
I may give a case in point to the Minister. Supposing a member is not present at a meeting, supposing a vacancy of a casual nature occurs on a committee designed to question the matter of misconduct and supposing the Minister knows that he has a sympathetic majority on a committee, 70 per cent of whom would be in attendance, I frankly suggest to the Minister that justice would not necessarily be seen to be done fully and effectively unless all members of a disciplinary committee are present. That is an elementary aspect of normal justice. This is like permitting a juror, for instance, to be absent at a key point in court proceedings. Where a permanent official of a health board is likely to be removed from office because of misconduct or unfitness of some kind then the entire disciplinary committee should be present to adjudicate. There should be no casual absences in such a case. If my suggestion is not accepted then, in time, the committee could dwindle from a membership of possibly ten down to three or four. The whole thing would become an administrative farce. This sort of thing has happened in some parts of the country in certain areas of local government. It is not to be recommended.
I think the Deputy is asking too much of human nature. It would be the greatest miracle since Moses struck the rock if all members of committees of local authorities, for instance, were present at every meeting of every committee.
This is not a local authority committee.
I know that, but the human aspect enters into this. Some members may be ill. Some may have to attend a funeral. Some may be in Strasbourg or New Delhi. The members will be people of integrity who will act conscientiously.
But this will be a disciplinary committee, not an administrative committee. Because it is a disciplinary committee every member should be present. If a vacancy occurs it should be filled.
The Minister will have a panel.
Take a hypothetical case. Take a committee of this House summoned to a meeting in a particular room tonight; the secretary of the committee may find that three members are ill, another gone to a funeral, another abroad somewhere.
Does the Deputy suggest that, out of a disciplinary committee of ten, four or five should be absent?
I am just taking a hypothetical case.
The Deputy is making my case.
I understand this will be an ad hoc committee and, as such, it is unlikely that any members will be missing when they are asked to sit. Before Deputy Desmond came in I suggested that some means should be found to prevent long suspensions which may deprive people of remuneration. The longer the suspension the greater the deprivation. Since this will be an ad hoc committee I do not see any great danger of people being absent from it.
Deputy Dr. Gibbons and Deputy Burke have expressed my point of view. This will be an ad hoc committee chosen from a panel and it should be able to operate satisfactorily even if one member does not turn up to the meeting. If I were to accept the amendment it might only encourage members to leave, perhaps, before the end of the meeting to avoid an unpopular decision. There are two aspects to this. I think Deputy Dr. Gibbons's and Deputy Burke's interpretation is the correct one. I can understand Deputy Desmond's approach.
Would the Minister be prepared on Report Stage to bring in an amendment which would go some way to meet our reservation on this? If, for example, a casual vacancy lasts for more than two months—we will be quite liberal about this—the Minister will take steps to fill it. All we want is a simple amendment stating casual vacancies shall be filled after a period of not more than two months. If that kind of elementary safeguard were brought in, I certainly should be quite prepared to consider withdrawal.
I shall consider whether anything can be done about this. I cannot conceive that this committee would take two months to carry out its function or that there would be a delay of two months.
Committees in Ireland are so self-perpetuating that they have been in existence for years.
I could not give the Deputy any promise.
Amendment, by leave, withdrawn.
Amendment No. 28 has been ruled out of order as it involves a charge on State funds.
Question proposed: "That section 23, as amended, stand part of the Bill."
Take subsection (10), where an appeal is made to the Minister against the decision of the chief executive officer. What would be the procedure? Would the Minister ask for the evidence of the committee before making a decision?
I should have to take a decision on the report of the committee before removing or not removing the officer.
Would the Minister at any stage consider asking his own officer to inquire further into the matter?
The section is quite clear. Where a request is made to the Minister, under subsection (9), the Minister may give to the chief executive officer a direction to remove the officer or a direction not to remove the officer or such other direction as he considers appropriate. In these cases, the committee's report would have to be examined.
Question put and agreed to.
SECTION 24.
Amendment No. 28(a) in the name of Deputy O'Connell has been discussed with Amendment No. 17(b), a cognate amendment.
Amendment No. 28(a) not moved.
Question proposed: "That section 24 stand part of the Bill".
Could the Minister give us some information on what may appear to be a confusion in the allocation of functions—for example, the health inspectors? The section seems somewhat ambiguous in relation to the assignment of duties from the local authority and the health board points of view. The Minister could assist the House by dwelling on the precise functions of some of the officers of local authorities and health boards—the designation of these functions. I get the impression that social welfare officers and health inspectors may find themselves being allocated functions which perhaps they have not bargained for—to give but two examples. This point has been put to me in relation to section 24. There does appear to be some drafting ambiguity in this section. I should like to be proved wrong.
The section does require some explanation. It is the section which enables a medical officer of a health board to spend part of his time doing housing inspection if it is more economic for the housing inspection to be done in an area by the person who is also the medical officer. It simply enables some transfer of functions to be made between local authorities and health boards. There will not be many cases of this kind. I think the principal one would be that, in quite a number of areas, medical officers undertake some inspection of housing and also health inspection. In order not to have to duplicate these officers, they could remain officers of the health board and have the payment of salary divided as between the amount of time they spend doing work for the health board and the amount of time they spend doing work for the local authority. It is quite simple. There is no complication about it.
Question put and agreed to.
SECTION 25.
I move amendment No. 29:
In subsection (1), page 14, line 42, after "conditions" to insert "(which may include provision for superannuation)".
This is rather an interesting amendment. It is to permit arrangements with doctors for the provision of services under the revised general medical services proposed in section 56 of the Bill to include provisions for a superannuation scheme. As the House knows, we propose to have choice of doctor for those with medical cards. Everybody approves of this course. The ordinary provisions referred to in section 19, in relation to officers of health boards, would not be applicable to superannuation of doctors who provide service on a fee basis. We are negotiating with the Medical Association and the Irish Medical Union for a form of superannuation which will be included in the fee for service. Therefore, we have to get away from the formal superannuation code of the local authority as this is something entirely new. That is the purpose of this amendment.
In layman's language, it boils down to this. You might have a situation where a doctor was within the scheme, providing services under the scheme. On reaching a certain age, he would receive a lump sum or pension if he then withdrew from the scheme. Is that the position? Could he withdraw from the scheme and continue in private practice?
In the ordinary way, he would not be retiring until 70. In the case of a doctor taking part in the general practitioner scheme, as distinct from a dispensary doctor, payment for superannuation would be by way of addition to the fees. The only way to work it seems to be to add a certain sum to the fee which would represent the superannuation payments he would otherwise get if he were a permanent officer.
Amendment agreed to.
Section, as amended, agreed to.
SECTION 26.
I move amendment No. 30:
In page 15, lines 5 and 6, to delete "with the consent of the Minister for Finance".
I had a notion that this was one of the amendments which was deemed out of order.
They follow —amendments Nos. 31 and 32— immediately after this one.
I am delighted this amendment was not ruled out of order. Its purpose is to save the Minister the trouble of having his officials running to some officials in the Department of Finance to say what cash books they ought to keep. This is the kind of ridiculous bureaucratic waste of time which leads the public service to think it cannot be as efficient as people in the private sector. If the Department of Health and local health boards cannot work out a proper system of keeping accounts we may as well pack up. I do not believe anything that they devise will be improved by being manhandled in the Department of Finance.
I do not agree with Deputy Ryan about this. I think it is right that the Minister for Finance should be involved in the preparation and presentation of budgets kept by the health boards. It could even redound to the advantage of the health boards if the Minister for Finance had approved of the method of presentation. It might enable the Minister for Health of the day to persuade the Minister for Finance that more money was needed for certain purposes if the accounts were as clearly presented as possible. This also relates to the local accounts as they are presented to the Minister for Local Government. I do not think there is any harm in the section. I could not accept Deputy Ryan's amendment. I do not think it is going to make it more difficult for the Minister for Health or the local authorities to secure the largest amount possible from the Minister for Finance if he is satisfied that the method of preparing and presenting the budget from each health board is good and proper and the accounting procedure as soundly conceived as possible and that the health boards are able to judge what their expenditure and receipts are. I do not see any harm in this at all.
Surely it is a matter for the auditor, rather than for the Department of Finance, to say what books are to be kept and how they are to be kept? I would agree with Deputy Ryan's amendment that this is only putting unnecessary detail on to the board. It is completely unnecessary.
Could the Minister say if this is a new departure or if it is being introduced into legislation for the first time?
It goes back quite a bit.
One of the worst reasons for continuing to do a bad thing is to be doing so because it was always done. There are hunks of stuff in this Bill which should be cut out with a scissors. This is one of them. A local government auditor will be appointed by the Minister for Health after consultation with the Minister for Local Government. What is his purpose? Is it just to check the figures after someone has prepared them? If it is, this is just a peculiar way of employing a local government auditor, who should be concerned with all sorts of things like the preparation of accounts. The whole thing is simply wasting time and money. It is wasted effort, duplication, multiplication and quadruplication, of one official chasing after another, consulting each other about the type of books which should be prepared and the type of accounts to be kept. The Minister says this is justified because somebody in the Department of Finance will be impressed by the excellent way in which someone is doing his bookkeeping. It is unmitigated hogwash. It is wholly unnecessary. You may as well say that a private company should insist that their auditor consult every year with the Department of Finance, and the Department of Local Government, and the Department of Industry and Commerce regarding the preparation of the accounts. Already they have to consult with the Revenue Commissioners.
The Minister may say we should not hold up this Health Bill on points like this and that this could be discussed on another occasion. I feel this is one of the occasions when Parliament can do something about this. It is outrageous that stuff like this should be written into a Bill. If the Minister wants to do it as a matter of practice, let it be done as a matter of practice, but do not write it into the Bill in this day and age as a statutory obligation so that some junior official in the Department of Finance can rush up to the Minister for Finance and say: "We have caught the boys in the Department of Health. They did not submit the accounts as required by section 26 of the Health Act, 1970," as it probably will be.
Are the accounts submitted?
Section 26 requires that the accounts should be kept in a form and made up at such times and in respect of such periods as may be prescribed by the Minister for Health with the consent of the Minister for Finance.
The same provision is in section 9 and the Deputy has accepted it.
No. All along the line we have tabled amendments of this self-same kind. A number have been ruled out because they imposed a charge on the Exchequer, it apparently being the notion that a Minister for Health goes wild and misspends public money unless the Minister for Finance puts a brake on him. It is not considered that money will be wasted in this regard. This is the kind of verbiage which brings the draftsman, the parliamentarians and the legislators into well-deserved disrepute. I urge on the Minister to remove it or to agree at this stage to our amendment. If he is rapped on the knuckles by the Minister for Finance he can put it back again on the Report Stage of the Bill.
I would not recommend that course of action to the Minister. It is a tragedy that Fine Gael have advanced in social legislation good causes for quite the wrong reasons. This is a classic example. Fine Gael have repeatedly advocated to this House the principle of public accountability. We have crucified every State-sponsored body in Ireland with the need for uniformity of accountability and the need for general supervision and overall national supervision of the strategy of national expenditure. It would be inconsistent to advocate that the Minister for Finance, at Cabinet level, should not have a fairly substantial finger in this pie. I would draw attention to an elementary aspect which I would hope to see in the near future. It is necessary that the whole accounting system of health services should, in the not too distant future, be completely computerised. I would not like to see the Department of Health or the Department of Local Government or any other section of the Government having a series of ad hoc administrative areas and financial accounting. On that basis it is necessary to have common budgetary systems in operation in any Government Department. I would remind the Fine Gael Party, as the advocates of some of our strongest reports of the Committee of Public Accounts, that all Government Departments are responsible on a common basis to the Committee of Public Accounts of this House. All State-sponsored bodies should be equally accountable. The Minister for Finance cannot be denied what we demand for ourselves in this House. So long as this House is to have a Budget every year—and we have the bad situation in Health of having annual budgets instead of budgeting on a five-year basis as an absolute minimum—we must regard ourselves as being accountable nationally. The only person who, in the long term, is utterly responsible is the Minister for Finance. On that basis, much as one abhors bureaucracy in a small island such as this and much as one deplores Departmental inefficiency— and I do not believe that Departments are as inefficient as some public representatives think—much as one would wish to see greater effectiveness, I do not think this is the way to go about it, by knocking out “with the consent of the Minister for Finance”. It rather reminds me of some of the statements made by the late Deputy Donogh O'Malley who took decisions first and the Minister for Finance had subsequently to find the money.
I have no doubt the present Minister would act with much more conservative aplomb and circumspection in terms of State expenditure but nevertheless I feel that this is an elementary overall provision. For example, if it stated: "with the consent of the Houses of the Oireachtas" I could not see any objection on the part of the Deputy but simply because the Minister for Finance is mentioned we all seem to go berserk. I do not think the proposition is worthy of support.
We have gone many times from the Dublin Health Authority to Ministers for Health looking for more money. When we go we try to make the best case we can. We bring our CEO with us and the accountant and the secretary and the assistant CEO. We do this for one purpose—to make a case.
And the greatest sum of money you ever got was when I led the deputation.
Such a backscratching operation!
Surely it would be a great asset to any Minister for Health to have this provision. Every Minister is trying to get as much money as he can for the Department he is administering. I suppose we will be going to the Minister for Health again when it comes to striking a rate. What other weapon has the Minister for Health than a case made direct to the Minister for Finance? I do not see anything wrong with it.
I do not know why Deputy Desmond deliberately set out to misrepresent what Deputy Ryan is saying about all this. Deputy Ryan has no objection to the standardisation of accounts. I am sure he feels with all of us that it would be a good exercise to standardise the accounts and the form in which they are presented because this would enable the Minister for Health to compare the expenditure of different boards and different institutions and of the various departments of the various boards and institutions Anybody can see why it would be very desirable to have this standardised form of accounting. That is not what Deputy Ryan is objecting to. Deputy Ryan is objecting to the fact that the Minister for Health would not be in control of his own Department, that he will have the Minister for Finance breathing down his neck and telling him what he should do, when he should do it and the particular method he should adopt. The only concern the Minister for Finance should have is how much money is spent.
He gets so much money every year.
His only concern is that the audited accounts are properly audited and that the expenditure is in order. As Deputy Desmond said, there is a certain amount of money that he can spend and apportion but according to this legislation the Minister for Finance will prescribe everything, tell the health boards exactly the amounts they can spend in any given year.
Go away out of that. It is getting late at night now.
That is quite specific in a later section, section 31. I am surprised at Deputy Desmond. He obviously did not read the later sections in the Bill.
I am referring you to them.
Deputy Lenihan too. Our objection is that the Minister for Health is not being allowed to be boss in his own house and he should be and he should have no Minister for Finance breathing down his neck in this fashion.
I am interested in the discussion and I like most of all Deputy Desmond's talk about the computer and the idea that the Minister for Finance should be terrified of the supreme programmer of the computer. I would like to have some part in the decision about how the computer should be programmed. That is not a bad idea at all.
In regard to this section, first of all it does not relate to the question of how the health boards raise their money. That comes later in the Bill. I can look back to the last three Ministers for Finance, during the period when health expenditure was absolutely booming. May I remind the House again that, eliminating all inflationary costs of wages, salaries and costs of material, the total cost of the health services is twice what it was in 1958 as against an increase in the volume of production of 1958 values of 50 per cent. In other words, my Government, no doubt pushed by the Opposition who always want to spend more than we can afford, have enormously increased the cost of the health services. Nobody can say that there has not been a great increase, far beyond the maintenance of what is supposed to be the golden rule, that you increase the cost of social services as far as you can in relation to the amount by which production has gone up. We have far exceeded that and rightly so.
I want to say now something that is absolutely true. I have studied this question enough to know. If one reads the World Health Organisation's annual report which I got yesterday one will see that health services are a bottomless financial pit to every Minister of every country, including those that up to now had a far greater income per head than we have. It is an absolutely bottomless pit. Even in the United States they do not know how they will find the money to do all they are supposed to do. Looking back on the last three Ministers for Finance I do not think it will hurt my interests if the health boards keep accounts in a form which is satisfactory to the Minister for Finance. I would like to feel that the Minister for Finance understood the methods of budgeting, understood the classifications of expenditure, accepted fully how we divide the cost of contributions to voluntary hospitals, the relationship of those to the deficits paid from the Hospitals Trust, the cost of the medical services, the cost of operating different district hospitals and different schemes.
I would like to be satisfied that the Minister for Finance felt that this method of budgeting was, first of all, uniform throughout the country and that he did not think there was anything bogus about it, that he did not think that in some way we were getting away with financial statements that were not entirely acceptable to him. When I think of the increase in health expenditure in the last ten years, paid for partly by the ratepayers, partly by the taxpayers and partly by the Hospitals Trust Fund, I do not think Members of the House can say that the Minister for Finance will use this section to increase the amount of purely bureaucratic work that has to be done by the health boards or to prevent me from getting funds.
I have only been Minister for Health for a short time but I am considering, with the officers of the Department, whether we need some kind of consultancy body to help the health boards to be as efficient as possible. Whether that would take the form of a work study unit within my Department or a work study unit recruited in some other way I do not know. I do think it would be a good thing if more local authorities engaged in this kind of work. I realise that it is most important that anybody who does this work should have had considerable experience of a local authority as distinct from a commercial company. It is also absolutely important to assure the staff that any saving should be effected by retirement or wastage. In the case of local authorities where people have very special responsibilities, one could not do it any other way unless there was some system of retirement at an early age where certain people wanted to receive satisfactory superannuation terms. Therefore, I think we need a great deal of study with management over a period with those people so that that can be done with the consent of the whole board in an agreeable way. For that purpose it is good to have the Minister for Finance approve some of the accounts and I think in the long run we will gain the confidence of the Minister for Finance as far as we can to provide the necessary amount of money. That is my sincere belief about it.
I think the Minister and the House have misunderstood the purpose of my amendment. I do not believe anything worthwhile will be achieved by the Minister for Health submitting a draft of the proposed accounts to the Minister for Finance other than to give statutory sanction to the operation of Parkinson's Law. Here we are saying to a group of people that it is a waste of time writing letters to another group of people who will waste time examining what they have drafted and will waste time writing memoranda and so forth to them. No private company, no trade union, nobody in the sane world would operate their business like Departments of State. Instead of getting away from this farcical situation, which the Minister thinks we might cure by bringing in outside consultants, we propose once again to bring it into legislation. I am disappointed to hear Deputy Desmond's reaction to this. It is entirely at variance with the reaction of his colleague, Deputy Dr. O'Donovan, who enthusiastically supported similar amendments by us.
It is the difference in age.
Maybe it is the good company which he at one time kept, I do not mean in the Department of Finance but in Fine Gael. He was in the Department of Finance and can speak from his own personal experience of the stupidity of exercises of this kind. It is quite ridiculous and you may as well say that no function shall be exercised by the Minister for Health under this Bill save with the consent of the Government. Nobody likes that because nobody assumes the Minister for Health in this or any other Government will go berserk and act contrary to the wishes of his colleagues in the Government.
I would also say that it is unnecessary to insert into a Bill this particular section only to do something with the consent of the Minister for Finance. There is an assumption at law that Ministers act reasonably. Mind you, I would say it is a legal assumption and there are many people who doubt it. It is there and I am prepared to assume the Minister for Health, his successors, the Department of Health, the officials in local government and the local health boards will act reasonably. It does not need this type of stupid restriction on the exercise of their colleagues' wisdom in order to ensure that public money is not wasted. It is quite the reverse. This will waste time and effort and will lead to delays which could be avoided if you trusted those men. In the Department of Local Government there are financial experts, there is to be a local government auditor to audit the accounts and there will be qualified officers and accountants in the various health boards but apparently this legislature is being asked not to trust those people but to say that some junior clerk in the Department of Finance must be consulted before those people in their collective wisdom can say this is the way it should be done. This is ludicrous, it is Gilbertian and it would need a Jonathan Swift to do credit to it. Again, apparently I am unable to persuade the Minister to see my thinking in the matter.
Deputy Ryan is certainly making a lot of noise. Sections 29 and 30 clearly give full authority to the Minister for Health in the preparation of estimates for expenditure and section 26 simply says the accounts are to be kept in such a form. It is only the form of the accounts which is mentioned.
I know quite well what Deputy Ryan means but in actual fact the form in which those accounts shall be made out and the periods for which they will be made up will be prescribed by me as Minister with the consent of the Minister for Finance. I refuse to believe the Minister for Finance would insist on changing it the whole time. The normal practice would be for a single set of regulations covering the whole accounts of all the health boards in the same way to be in operation for a period of years, perhaps, unless it was found right, not only for the purpose of correct budgetary procedure but for making comparisons of a social kind in relation to social examination or examination of total social expenditure. The Minister for Finance might ask to have this document slightly amended so as to differentiate between certain expenditures in order that the whole of the social health expenditure and social welfare expenditure could be analysed in a certain way. In the ordinary way there will be one book of regulations and it will not be changed every year.
I want to comment on what the Minister said about budgeting. The greatest upsetters are budgets. Those upsets were caused on many occasions by the Minister for Finance followed by the Minister for Health. I would say in the last three years in succession we got out our estimates, got them sanctioned and all the rest of it. Two weeks later the Minister gave an enormous increase in the capitation rates to voluntary hospitals. Our accounts went up some hundreds of thousands and that had to be carried on into the next year. I assume the Minister for Health sanctioned that with the agreement of the Minister for Finance. That upset the budget. The Minister cannot make a case in relation to budgets being upset because if there is an election budgets are upset and the Minister for Finance can go on living.
Amendment, by leave, withdrawn.
Section agreed to.
Sections 27 and 28 agreed to.
SECTION 29.
Question proposed: "That section 29 stand part of the Bill."
This section requires that:
A health board shall submit estimates of receipts and expenditure to the Minister in such form, in respect of such periods, and at such times as he may direct, and shall furnish to the Minister any information which he requires in relation to such estimates.
May I express my delight that the form in this case seems to be contrary to what is required in the other section?
It follows section 26 obviously.
Section 26 deals with accounts and section 29 deals with estimates which are hypothetical. They are a matter of prophecy. Accounts are concerned with facts. These are estimates of future receipts and expenditure. Apparently we have no prophets in the Department of Finance and there is no point in consulting the Minister in that regard. It is good to see apparently that somebody's mind was not overcome with the conservative ideas that what our grandfathers did was good enough for us when we came to section 29.
The Bill, as drafted, proposes to remove from health boards the tremendous scope which they had in relation to the preparation of estimates and the improvement of the health schemes which they could suggest. Section 29 is surrendering a great deal of the freedom, a great deal of the authority, a great deal of the responsibility which health authorities previously had.
The Bill gives to health boards an obligation to prepare and to notify estimates to the Department, but under section 29 let them be aware of the fact that it sounds the death knell of the responsibility which health authorities had up to now and which was responsible for having health schemes trimmed to the needs of their respective localities. From now on the health authorities will not have any say in the determination of the services in relation to their own communities.
Surely the local members will have the usual say in administration?
Look at sections 30 and 31.
The Minister will decide it.
They will be free to prepare their estimates.
Will we not be free to prepare our estimates? Are we to say that we cannot, for instance, look after the Jones family or the Burke family in such and such a townland who have fallen on bad times?
The Minister can say you cannot look after them.
We had that discretion in the Dublin Health Authority. As far as I understand it, there will not be any power taken from the members concerning the making of regulations.
If Deputy Burke looked at section 29 he certainly has not read sections 30 and 31 which make it obvious that decisions on estimates of expenditure——
At this stage we are discussing section 29.
Section 29 relates to health board estimates. Under it, they may certainly produce estimates but it could be a useless exercise in so far as the Minister can say they may not spend that much, or they may spend more—he is more likely to say the former. The Minister will have the right to make that positive decision despite the fact that in the Dublin Health Authority area he provided only 46 per cent of the total expenditure. Surely, then, the right to say what should and should not be spent should be shared between the Minister and the health boards. That would be the fairest way.
Look at sections 6 and 32.
Question put and agreed to.
SECTION 30.
Question proposed: "That section 30 stand part of the Bill."
At present a health authority have a discretion——
——to provide services over and above those sanctioned by the Minister for health. In cases where the health authority exercise that discretion they may well have to pay for the services so provided entirely out of the rates and they may do so in the knowledge that they will have to face the full bill themselves. Health authorities may at present incur expenditure for services which they consider to be highly desirable needs, including looking after the Joneses and the Burkes who have fallen on lean times.
The Ryans are on lean times, but the same cannot be said of the Burkes. This immense responsibility which was exercised by health authorities, particularly that of Dublin, is going. I can recall one case in recent times when the Dublin Health Authority became aware that a hostel was about to be put on the open market for sale by a charitable organisation who were abandoning it. The health authority wanted to acquire it so that it could be made available as a halfway house, so to speak, for people who had been in mental institutions, had been cured and were on the way back into society but who had not homes of their own to go to. It was recommended by the authority's chief psychiatrist that such a halfway house should be established as an intermediate stage in the final treatment and rehabilitation——
What happened was that the Dublin Health Authority were unable at the critical time to get sanction for that proposal. Had they not had the discretion to say that not-withstanding the failure of the Minister for Health to approve the scheme they would go ahead anyway, they would have lost the opportunity to buy this building at an attractive price and they would have lost the opportunity of providing at a fair cost this most desirable accommodation for those unfortunate people. Ministerial sanction came only after the health authority had decided to pay the sum necessary out of their own funds to provide this vital need. That freedom is going because section 30 sets out clearly:
A health board shall not, save with the Minister's consent, incur expenditure for any service or purpose within any period in excess of such sums as may be specified by the Minister in respect of that period.
What will happen in the financial year 1971-72 is that the Minister shall say: "You shall spend £X and no more." It will be no longer open to the health authority to have supplementary estimates. They must keep within targets already set by the Minister.
This is an undesirable development, and Deputy Burke knows it because I can see tears falling down his kindly face when he thinks of what will happen to the Joneses and the Burkes who will have to wait until the following year before the health authority can come to their aid.
It might occur when an authority become involved in a big project like the building or the extension of a hospital costing the authority a lot of money. In the everyday running of the authority's affairs, the Minister would not interfere.
That is the pity of it, that this section, and the whole Bill as devised, is on the basis of fixing limits beyond which a health authority may not go no matter what new emergency may arise.
Does the Deputy think that is good?
It is not on an annual basis. It says within any period, which could be five years.
It could be five years or three months but the periods are to be such as may be prescribed by the Minister with the consent of the Minister for Finance, and surely nobody anticipates that somebody in the Department of Finance will be aware of the possibility of a hostel coming on the market to cater for former mental patients. Anybody with any experience of a health authority knows that it deals with a multitude of unpredictable human problems, and if a health authority has not in the future the discretion it enjoyed in the past, a great deal of the humanitarian work and financial saving which health authorities were able to effect in the past, will be prevented. That is a retrograde step and something nobody with a progressive outlook and an understanding of the problems of health authorities would welcome.
I do not agree with the Deputy because my interpretation of section 30 is that it is intended to deal with something bigger than the ordinary everyday running of affairs. While I made a hypothetical case, jokingly, a few moments ago, I did not take it seriously because the discretionary clause in the old Health Act was a great boon to all concerned. It gave every councillor or member of a board and the executive officer and the Minister the right to apply discretion when it came to a deserving case. We had cases of people in receipt of £1,000 or £2,000 a year who lived up to it and then became ill and went to hospital. We found in a short time we had to look after their wives and families. Without the discretionary clause in the Health Act we could not do that. It was a great humanitarian clause. We do not want to see anybody in our society hungry or in want no matter what it will cost the State. For that reason I imagine section 30 is intended to deal with bigger things involving the spending of thousands of pounds on hospital buildings. However, the Minister will no doubt interpret it later.
Has the Minister anything to say? Am I right in believing that this discretionary power which health authorities had hithterto to bring in supplementary estimates and provide for certain expenditure entirely out of their own resources is going under this Bill?
I do not think so. If the health board propose some supplementary expenditure during the year and are willing to raise it purely from the rates it will be up to me to see they get the money one way or another and, if necessary, that the rates for the ensuing year will be raised to cover the deficiency.
As the House knows, expenditure for people with medical cards and the middle income groups is to a very considerable degree open ended. That is one of the difficulties the Minister for Finance faces. Unemployment benefit and social welfare assistance are open ended and money has to be found either by supplementary estimate or in some other way. The House is fully aware that these two services I have mentioned, the medical card payments and middle income payments, are open ended and if the number of people with medical cards happened to increase over what was reasonably estimated when the health board sent their estimates of health expenditure forward, there is nothing the Minister for Finance or I could do about it. If there happened to be a very severe epidemic of 'flu or any other malady in the community, however, as this section reads I cannot say to the health board: "You cannot spend any more even though people are having 'flu with complications." It is open ended.
I do not think Deputies need worry about this. The strictness provided for in these sections is at least basically reasonable. It is not a good thing to have a loose form of budgeting in advance in which there is not full understanding between the health board, the Minister for Health and the Minister for Finance. I do not think that would encourage the Minister for Finance to provide more funds but I can see an inevitable and reasonable flexibility in this, as I have described. As the House is aware, there are new services which must come out of funds provided by the Minister and not from the rates. When the Health Bill passes and the various sections are put intc operation there will be expanding health services. I shall not go into them now; that has been done already: these must be met out of taxation if we are ever to find a satisfactory solution to the contribution problem by a combination of both rates and taxes I cannot concede in the future that health expenditure will be limited frozen or cut down through any fell plot arising out of some dreadful interpretation of a section of this Bill.
The functions which Deputy Ryan states Dublin Health Authority now have would, I believe, be functions of the local authorities throughout the country. No doubt those local authorities would repay on those cards. In other words, Dublin Corporation or the county council, if they so wished, could buy a hospital with their own funds and the Department of Health would have no say about it.
Arising from something Deputy Burke said, suppose the local health board write off hospital accounts which at the end of the year amount to say £5,000, will they have to get sanction from the Department for this or does this function lie with the executive officer? In fact this would be an extra expenditure by the health board and I expect the CEO could make his decision without referring back to the Minister or the Department of Health.
In reply to Deputy Gibbons, Dublin Corporation could not at present buy a hospital for use for health purposes because under the legislation establishing that health authority this is a function of the health authority, which is a separate statutory body. In any area where there is a separate health authority as distinct from the local authority, which in many regions is the health authority, the health authority has the health function and the local authority does not come into it except that at present the local authority receive a demand from the health authority to produce the money to pay for the services which the health authority have decided should be provided. Dublin Corporation, for instance, cannot say to Dublin Health Authority: "You may not render such a service" or "You may not make a certain purchase." All the corporation may say is: "We do not think you should do it" or "We think you should do it" but they may not say: "You shall not do it." They must provide the money. This legislation proposes that what has hitherto operated in the Dublin Health Authority area and in other areas where there are health authorities like Limerick, Cork and Waterford, will apply all over the country. So Roscommon County Council, for example, as a county council will no longer be the body which will decide what should be done but it will be the health board for the region in which Roscommon is situated that will make such decisions.
The Minister makes light of my worries and, while I know he is an optimist—I am too—I think we must look at the realities. A chief executive officer is in the situation that if, at any time, he is of opinion that a decision, or a proposed decision, of the board would incur expenditure by the board in contravention of the section, he shall so inform the board and the Minister. A chief executive officer may not do anything which would add one halfpenny beyond that which had previously been authorised.
My concern is that, with the best will in the world, and with the most expeditious system of administration, there will be gaps between the time that members of health boards decide that a certain expenditure is desirable and the receipt of approval from the Minister. This is a mandatory section which absolutely prohibits the incurring of any expenditure beyond that which is already prescribed. There is no room for manoeuvre. There is no opportunity available to anybody to exercise discretion. No one may even take a chance that consent will be forthcoming because something is such an obvious need. No one can even say that there is a mandatory obligation on us, in other sections and regulations made by the Minister, to offer service to particular people.
That obligation may be there but we are not in a position to carry it out because section 30 says we cannot go beyond the money already prescribed for us, and that is that. Knowing many of the good public officials that I do, and other Members of the House know, it is certain that they will not go beyond what they are permitted to expend under section 30, no matter how desirable the object or how humanitarian it may be.
The Minister mentioned that social welfare assistance is open-ended. It is so open-ended, and the Minister is so aware that it is open-ended, that he has transferred the assistance activities from the health authorities and handed them back to the local authorities. This is something with which people in urban areas with health authority as distinct from local authorities are familiar. Dublin Health Authority operate home assistance. Under the home assistance service they operate "meals on wheels" and other ancillary aids to give domiciliary care particularly to elderly people, all of which has had a dramatic effect in reducing the cost of maintaining elderly and disabled people in institutions.
This, of course, has been quite a considerable burden and, in fact, is one of the main reasons for increases in rates, because the State has not carried any share of this increased assistance burden. While it was the responsibility of the health authority it was open to deputations to urge the Minister to persuade the Minister for Finance to treat them as health matters. I am sure my colleagues on the Dublin Health Authority, Deputy Burke and Deputy Clinton and our present distinguished chairman, Deputy Dockrell, and others, will verify that this has often been urged and that we have gone on deputations to the Minister for Health in the Custom House and have received from successive Ministers every encouragement that the day would come when these assistance services would be treated as proper health matters and receive, as a consequence, assistance under the Health Vote.
What is proposed here is to take these open-ended services away from the health boards lest they should cause difficulty in relation to section 30. This is an alarming section. We are entirely justified in saying we oppose section 30 because it is so repugnant to the kind of activity which health authorities should be free to engage in. It will cause difficulties. I do not like being a prophet of gloom, and it will be no consolation to any member of the Fine Gael Party to say whenever difficulties arise: "We told you so." We do not want to be in a position to say that, or even be tempted to say it. That is why we urge the Minister between now and Report Stage to endeavour to provide some degree of flexibility for the health boards, even if the price of exercising that discretion is that the total cost of exercising it has to be recovered out of the local rates.
That is an immense break. I have known of desirable schemes which members of the Dublin Health Authority wanted to adopt but the fact that they had to pay for them entirely out of the rates without any assistance from central Government caused them no little anguish in deciding whether they should be provided. Even that measure of discretion, if left, would provide room for manoeuvre so that consultations could continue after the expenditure arose, if it was necessary to do so in the absence of the consent of the Minister. That is the way to get around this difficulty and avoid the pitfalls which we believe are inevitable otherwise.
You have to read section 30 as following on section 29. I am open to correction, but my reading is this: The health authority prepare their estimates. They are sent to the Minister. The Minister gives a global OK. They are specified under various headings. There is an open-ended element in this and that is the element of the health cards. That is as open-ended as social welfare. The health authority make their estimate based on their experience during the year. That goes to the Minister and under section 30 he gives a global OK. We do it every year in the county council. We strike a rate and we say that we will produce no proposal during the year which would mean the spending of another penny. That is what the Minister is telling the health authority under section 30, they having produced the figure under section 29. That is the way I read it.
I think Deputy Lenihan is overlooking the fact that at the moment the local authority have discretion to bring in a supplementary estimate for additional expenditure which becomes necessary. That power will not be available to a health board. It is stuck to a figure, and may not go beyond it. It may go back to the Minister and the Minister may consider whether he will give it to the health authority. He may say we can be certain that it will always be given in relation to medical cards particularly under this Act as they will become a statutory right for certain classes of people in any event; but there are other forms of expenditure and they will not be tolerated because the power which a local authority has to bring in a supplementary estimate will not be available to the new health boards.
I am assured—and I do not believe I am breaking any confidence in saying this—by a number of people who work in local government that with section 30 as it stands at the moment they would not spend one penny beyond the figure permitted even if it meant that some person had to wait for necessary medical attention. It just could not be done and they would not do it because, if they did, they could be surcharged.
That is not true, because in the middle of the year if I chose to I could provide for an increase.
But the health authority would have to go back to the Minister and get his sanction. There have been cases in the past where there has been legitimate disagreement but there has been power for the health authority to say: "All right, we will do it and we will pay for it ourselves." That is going.
Mr. J. Lenehan
It has never been refused.
They no longer have permission to say they will do it and pay for it themselves.
Mr. J. Lenehan
I think this is a case of Deputy Ryan trying to prove that black is white.
I have been at a meeting which the Minister attended and the three counties concerned were fully represented. To my amazement they came to absolute agreement in about one-tenth of the time I thought it would take to come to agreement, and I am sure there was no man more amazed than the Minister when it happened. I should like to point out to Deputy Ryan that no matter how bad the service may be under this new scheme it cannot be any worse than it is at the moment. It is for that reason we are backing it. If Deputy Ryan feels that the public representatives in Dublin are justified in keeping somebody out of hospital or without medical attention simply because money was not passed before the 31st of the previous March, that is not a proper approach. These health boards will be legally bound to provide this service and whether they be paid in that year or in the next year there should be no serious problem involved. I certainly hope that there will be no law case over this as there was over the fluoridation of the water some time ago.
I was wondering when the dirt was going to be drawn in.
Question: "That section 30 stand part of the Bill" put and declared carried.
SECTION 31.
Amendments Nos. 31 and 32 in the name of Deputy Ryan have been ruled out of order.
Question proposed: "That section 31 stand part of the Bill."
The amendments which I tabled on behalf of Fine Gael were for the purpose of getting a change which is most desired in Ireland in relation to our health services, that is, a change in the method of financing them. We believe it is wrong that we should continue to operate a system whereby the State accepts responsibility for only one half of the cost of health services, and that is the only statutory obligation which the Fianna Fáil Party are accepting under this much vaunted piece of legislation. It was introduced at the end of a decade of long debates on the issue of whether or not the health services should be paid for out of the rates. The Government's own White Paper which was produced after many agonising years of inactivity acknowledged that rates were not a proper form for the financing of health services and undertook that the contribution to the cost of health services as of 1966 would be maintained at that figure and that any increase would be paid for by the State. If the Government had honoured their obligation in that regard the Government would now be defraying 70 per cent of the cost of health services. On the Government's own figures they are defraying only 56 per cent of the cost of the health services so that on their own undertaking in their own White Paper three years ago the Government are defaulting to the extent of 14 per cent of the cost.
It is acknowledged on all sides of the House that the Bill is taking many powers from local authorities. It is taking away discretion which local authorities previously had to provide services beyond those sanctioned by the Minister. There is hardly anything which health boards may do in future which has not received the prior sanction of the Minister for Health. There is hardly anything which can be done save in accordance with rules and regulations prescribed by the Minister for Health. More and more power is taken away from the local authorities, from those who represent the people who are being called upon through the rates to pay for half the cost of the health services. Then at the end of it all, after the Government's own acknowledgment that rates should not be used to finance health services, the Government are proposing to crystallise in this legislation the thing which they admit is wrong.
This is a deplorable admission of failure. It is a confidence trick. They paraded themselves as the great reformers who were going to clean up the in justice of making rates pay so much for health services, and then this Bill which is still being vaunted as a piece of social progress, which is still being paraded as providing relief, will do no more than maintain the thing which is accepted as the most glaring injustice of our present health services.
This section 31 will also take away from local authorities the power which is now a reserved function of a local authority, a power which is conferred on the local authority and not on the manager, that is, the power to strike the rate. As far as the health services are concerned, it is the Minister for Local Government who will strike the rate in future and the Minister for Local Government will send the bill, for the health services for which the Government will not pay, to the local authorities. Then it will have to be paid, and the reason for doing this is quite clearly to prevent any other local authority taking the courageous stand which was taken earlier this year by Dublin Corporation and by the Bray Urban District Council. In future it will not even be open to a local authority to refuse to be a party to a system which it knows to be unjust; it will no longer be open to a local authority to say to the Government: "You acknowledged in the White Paper your policy was wrong and we insist, now that you have admitted you were wrong, that you live up to what you have undertaken to do," because in future the bill will go to the local authority who will receive it from the Minister for Health who will have processed it through the hands of the Department of Finance. This is one of the most objectionable sections of this very disappointing Bill because it is only maintaining what has been admitted to being so unjust.
Progress reported; Committee to sit again.
