I move amendment No. 13:
In page 11, to delete lines 12 to 16 and substitute:
"(1) In the performance of their duties, the chief executive officer and the other officers of a health board shall act in accordance with such decisions and directions (whether of a general or a particular nature) as, subject to subsection (3), are conveyed to or through the chief executive officer by the board, and in accordance with any such decisions and directions so conveyed of a committee to which functions have been delegated by the board.
(2) When the chief executive officer or another officer of a health board performs a duty in accordance with subsection (1), he shall be deemed to act on behalf of the board."
This is an interesting amendment. It arises from points made by Dublin Deputies on Committee Stage, and subsequently I met Deputies Paddy Burke, Clinton and Dockrell with the city manager and officers of the Dublin Health Authority. The general tenor of the case made in the House and in my discussions with the Deputies and the local officers was that, because the scale of operations of the eastern health board will be so much greater than that of any of the other health boards, the managerial system which at present applies to the Dublin Health Authority should, for the initial period at any rate, be applied to the new board. Fears were expressed that the administrative system might break down because of the enormous number of decisions that might have to be made by the health board if they operated the Bill in its literal sense and only left to the chief executive officer or any deputy officers the actual matters deliberately reserved in the Bill in relation to control of staff and so on.
Perhaps, I should summarise for the House the management system as it applies in the case of the Dublin Health Authority or in the case of the Cork, Limerick and Waterford Authorities. The County Management Act, 1940, and the City and County Management (Amendment) Act, 1955, contained detailed provisions of how this system operates and how functions are divided between the elected members of a local authority and the manager. The basis of the 1940 Act was that the manager exercises and performs for the council all the executive functions of such council, the executive functions being defined as all the functions of the council not reserved to the members. The second schedule to the 1940 Act listed 22 reserved functions of the elected members. Most of these, however, related to functions which are specific to county councils, such as making bye-laws, appointment of persons as members of other bodies, nominations of persons as candidates in Presidential elections. For the purposes of the Dublin Health Authority and similar bodies, the only important functions actually reserved to the council lie in the preparation, adoption and variation of its estimates and the borrowing of money.
As well as having these functions reserved to them, the elected members had from the beginning powers to control the manager in the performance of the executive functions. These powers were extended and improved under the 1955 Act, which provided that the members may by resolution direct the manager to inform them before he performs any of his functions, and they may, by resolution passed after due notice is given, require him to do anything within his executive powers, but they cannot direct him in the exercise of his powers in relation to the eligibility of individuals or in relation to the control of staff.
In so far as the initiative lies mainly with the manager in the execution of policy, the balance of power in the management system is weighted towards him, as against the members. The fact is that he is liable to be directed by the members in the exercise of most of his functions, as I have already indicated, under the 1955 Act.
We could have written into this legislation the management system as contained in the 1940 and the 1955 Acts. My predecessor discussed the proposed regionalisation of the health services with all the health authorities and they suggested the system that we have now adopted in which the regional health boards have very wide powers other than those clearly indicated in section 16.
The Bill does not depart from the management system to the extent of vesting all functions in the board. It specifically states—in section 16 (3)— that functions relating to decision on eligibility will be reserved to the chief executive officer. It is now intended that the executive functions will be exercised by decisions and directions of the board through its chief executive officer and, under him, its other officers.
Deputies raised two issues on the Committee Stage. The first was whether the Bill was specific enough in establishing the authoritative position of the chief executive officer in relation to the other officers and servants of the board. I do not think there was really much doubt about this in the Bill as circulated because section 12 (1) indicates that the chief executive officer will act as such; section 13 makes it clear that he will determine the conditions of employment and the duties of the other officers and the servants; section 15 provides for him to delegate functions to other officers; section 16 (3), as I have mentioned, reserves specific functions to him and section 30 (2) gives him a special status, analogous to that of the secretary of a Government Department in relation to the financial responsibilities of the board. Now, section 16 (1) was never intended to be interpreted so that the board would by-pass its chief executive officer in issuing decisions and directions but, to remove any temptation for a board to attempt to do this, the amendment now moved substitutes a new subsection making it quite clear that the board's decisions and directions will be conveyed through the chief executive officer in all cases. I am assured that there can be no doubt but that the chief executive officer will be the undisputed administrative head of the board. It is, of course, essential that this should be so for the evolution of a proper management structure.
The other point of concern was whether, under the system proposed in the Bill, the board would become involved in so much detailed executive work that the members would either have to meet very frequently or else the administration would become entirely clogged. This, of course, was never intended. The basis of section 16 of the Bill was that the board would issue general policy decisions and directions and leave it to the chief executive officer and the staff to carry these out. The new subsections proposed to be introduced by this amendment are designed to make this quite clear. They indicate that the board can give either general or particular directions and that, where an officer of the board carries out his duties in accordance with these directions, he will be deemed to act on behalf of the board. It should be clear from this that a board will not be required to consider specific cases to any greater extent than they consider necessary and that, in fact, the section will not stop a board from operating very much as the Dublin Health Authority operates at present.
The essential difference between the provisions in the Bill and the Management Acts is, however, that it would be easier for the members of a board to succumb to the temptation of interfering too much in relation to the performance of detailed executive functions. I do not think that a board, many of whose members will have been used to the operation of the county management system, are likely to do this. It does, however, seem to me to be democratic to leave to the members of the board the freedom, perhaps, to err in this respect and learn by experience what the proper balance should be between themselves and their chief executive officer.
It is planned to establish the health boards next October and to arrange-for them to take over the administration of services the following April. This will give six months for them to settle down and during those six months I propose to have studies done with regard to the best managerial methods for the boards and I shall make the results of these studies available to the boards. The best way of doing this is now being considered.
I am absolutely convinced in the case of a very large board like the Eastern Health Board, that it would be impossible for the board to make all the decisions that they could make if they wanted to make use of their full powers under the Bill. They would be working for hours and hours dealing with minor things. They might, for example, vote an annual sum for the repainting and maintenance of certain dispensaries, and them find that a particular dispensary needed painting more than others. They could well spend hours and hours arguing whether dispensary D needed painting more quickly than dispensary C—and they would get nowhere. In the case of the present Dublin Health Authority this kind of thing is dealt with under a review of dispensaries when all matters regarding them would be discussed.
I hope this amendment will allay the fears of the Dublin Deputies who spoke on the Committee Stage on this issue. I think this is all I can do at the present time. I do have an alternative under section 16 (3) (e) where I could delegate certain functions to the board far and beyond those, but I think the section, with the amendment I have put in, clarifies the position that the whole operation should go smoothly.
I recommend all health boards to get an idea of the work load they will have. I am going to ask every county manager in the country to give me the number of orders he makes that are not orders in relation to what clearly are his reserve functions but are orders in relation to the general running of the health authority so that the regional health boards with the aid and advice of my Department's officers will be able to see what kind of work load they are going to have. This should enable them to do their work effectively without spending an inordinate amount of time at it which will, in turn, give them more time to design, provide and think of the services as a whole. They will deal with matters of prime importance as well as being able to deal in an intelligent way with important complaints that have arisen.