I move that the Committee agree with the Seanad in amendment No. 1:
Section 6: In page 6 subsection (1), line 4, "as" inserted after "than".
Health Bill, 1969: From the Seanad.
The Dáil went into Committee to consider amendments from the Seanad.
Amendments Nos. 1 and 13 are cognate and will be discussed together.
The amendments are purely of a drafting nature. They distinguish the activities of county councils, sanitary authorities and health authorities.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 2:
Section 8: In page 7, between lines 4 and 5, the following subsection added to the section:—
"(2) Membership of a committee appointed under this section may, with the consent of the Minister, include persons who are not members of the board."
This is an amendment suggested in the Seanad allowing committees appointed under section 8 to include people who are not members of the board, in order to get advice and help from people who might not be members of the board.
This is a very welcome amendment and I should like to say how much we in Fine Gael appreciate that many of the suggestions for comprehensive consultation in relation to health services made by Fine Gael have been accepted by the Minister. This is one in that vein. Frequently people with great experience are unable to give of their services because they are no longer members of a particular authority and this is the kind of amendment which allows our society to avail of the services of such people. I hope the Minister will be able to confirm that such non-members of boards will have the same voting rights on the committee.
If the committee have voting rights, those people would enjoy the same rights, but some of those committees might be of a consultative character — people, say, skilled in the work of domiciliary treatment or planning.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 3:
Section 10: In page 7, before section 10, the following new section inserted:—
"(1) A health board may, with the consent of the Minister, pay an allowance to its chairman in respect of expenses (other than expenses referred to in section 9) incurred by him in relation to the business of the board.
(2) A health board may, with the consent of the Minister, pay an allowance to its vice-chairman in respect of expenses (other than expenses referred to in section 9) incurred by him in relation to the business of the board.
(3) The amount of an allowance under this section and the nature of the expenses in respect of which it may be paid shall be such as may be approved by the Minister."
This arises out of an undertaking given by me on the Seanad Committee Stage to provide for the making of some allowances to the chairmen and vice-chairmen of health boards. I cannot go further than the chairmen and vice-chairmen because it would have very wide implications for members of vocational education committees, county committees of agriculture and all sorts of corporate bodies of one kind or another. This amendment will cover inevitable expenses of an entertainment nature incurred by the chairmen and vice-chairmen. It was pressed on me very strongly by Senators from all sides of the House, and I understand from the Minister for Local Government that he has something in mind in relation to local authorities generally.
We welcome the amendment but I am surprised the Minister has not gone further. I suppose he feels he has gone as far as he can. Local authorities in general are allowed to pay certain expenses to members and there is a very real chance of people who would make excellent local authority members being precluded from such membership by this new legislation simply because they could not afford to be members, being precluded from receiving some compensation. I honestly feel the Minister should have gone a bit further.
I was puzzled when the Minister mentioned vocational education committees and county committees of agriculture because members of these bodies receive travelling expenses. There must be a misunderstanding. Maybe I misunderstood the Minister but if he means what I think he means he is under a misapprehension. I should not like to see people being precluded from membership of such bodies because they could not afford to be members.
I feel sure this matter will arise for consideration in the next two years. The Deputy is aware that members of health boards will have subsistence and travelling allowances as is the case with members of local authorities. This refers to entertainment expenses which chairmen and vice-chairmen will incur. We are not interfering with the system of subsistence and travelling allowances which will apply to health board members. If the Deputy wishes me to introduce through this Bill a completely novel form of payment of allowances to these people, of some specific sum representing disturbance and compensation for losses caused to them in relation to their ordinary work, avocation or job——
What I was suggesting is that in this Bill we are introducing something new.
I think Deputy Tully is making too much of this. All the expenses and all the allowances which hitherto have been paid will be paid in relation to membership of the new boards. That was always my understanding. Now, in addition, a system is proposed which will allow reasonable sums to be paid for necessary entertainment. What happens in the Dublin Health Authority is that, where there is anything in the nature of an official opening or entertainment, the canteen fund is used. I think it is entirely wrong that a fund, built up with the daily pennies and shillings of the workers, should be used for entertainment of this kind. It should be perfectly straightforward and an acceptable item of expenditure that a reasonable sum would be allowed for entertainment. It would raise all kinds of difficulties if, over and above the subsistence expenses, other sums were to be paid. Why, for instance, should it be related to the lowest wage or to the average wage? Why should one person who has substantial means and a substantial income have to forfeit that for the day and accept a lesser sum simply because somebody else is paid less? It would seem to introduce into public bodies a consideration which would be better left out. This is a welcome measure; we should be grateful for it.
There are those who can afford and those who cannot afford.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 4:
Section 11: Before subsection (2) the following new subsection inserted:—
"(2) Where the Minister makes an order under subsection (1), he shall notify the persons who have been removed from office as members of the board of the making of the order and of his reasons for the removal."
Although there will be a public inquiry in connection with section 11, in relation to the removal of a board, members of the Seanad seem to want me to be very specific: they want the Minister to give stated reasons, in spite of the fact that an inquiry takes place as to why he removes a board from office. I am quite willing to do this. It is only fair that one should state in absolute terms the Minister's conclusions arising from the public inquiry. I hope it will never have to take place. However, I accepted the amendment.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 5:
Section 21: In page 13, the following subsections added to the section:—
"(6) Whenever an officer of a health board is suspended under this section, the chief executive officer may, if he thinks fit, make with the consent of the Minister an ex gratia payment to the suspended officer.
(7) Any sum paid under subsection (6) shall be repayable by the officer to the health board and may be deducted from any moneys payable by the board to him.
(8) Any sum paid under subsection (6) shall not be reckoned as salary or emolument for the purposes of the Local Government (Superannuation) Act, 1956."
This to some extent is an advance on present procedures. Again, I think it is in line with what the Minister for Local Government would agree with. It enables an ex gratia sum to be paid to an officer of a health board who is suspended in circumstances in which it is felt that it would be unfair and wrong not to do so. The payment would be made at the discretion of the CEO, with the consent of the Minister, and, if necessary, would be recoverable later from the recipient, either from remuneration for the period of suspension or, if that is paid, from superannuation benefits or contributions. It is to cover the cases where a person might be suspended and where it would be thought wrong to deprive the officer of all remuneration whatever. I think it is a humane proposal. There will be occasions when it will not be applied. It will be a matter for the CEO and the Minister for Health to decide whether to do it.
We welcome this amendment. In the past, there have been many cases where people under suspension got into very serious financial difficulties, with consequent embarrassment and deep suffering to their families. Sometimes, unfortunately, periods of suspension can be quite lengthy. It is wholly in accordance with natural justice that, until a decision is taken in relation to an officer, adequate means would be paid to that officer so that he and his family might be maintained in a reasonable degree of comfort. This is a very humane proposal and one which is to be welcomed.
I am just wondering whether it is entirely wise to leave this completely and absolutely to the discretion of one person, the CEO. One can think of a case where there might be a clash of personality between the CEO and the person suspended and his case might not get fair consideration from a CEO. I do not know how that could be overcome.
Right of appeal to the Minister.
Could he do that directly?
I should think he could communicate with the Minister. I have never heard of a situation arising where there might be a real personal conflict and where the Minister could not intervene informally one way or the other. I think that no Minister would ever be so stiff as to look through a Bill to see if he could send an officer down to the health board to inquire into alleged gross prejudice on the part of the CEO. I do not see any difficulty in that.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 6:
Section 22: The following subsection added to the section:—
"(5) Removals of officers and servants under this section shall be carried out in accordance with regulations made by the Minister and such regulations shall provide—
(a) that effect shall not be given to any proposal for removal unless prescribed notice has been sent to the officer or servant of the reasons for the proposal, and
(b) that any representations made by him or on his behalf on the proposal which are received within a prescribed period shall be considered.".
This amendment is self-evident. It will be open under the amendment to an officer or servant of a board to request his trade union or representative organisation to make representations on his behalf. My own belief is that he could. Anyway, we have put it in the legislation.
Question put and agreed to.
Perhaps the House could take amendments Nos. 8, 9 and 10 with amendment No. 7 as they are related amendments.
I move that the Committee agree with the Seanad in amendment No. 7:
Section 31: In page 16, subsection (2) (b), line 23, "after consultation with the Minister for Local Government and" inserted after "Minister".
This amendment arises from the discussions in the Dáil and Seanad in regard to the allocation of a local contribution between the contributing local authorities. Section 31 (3), as passed by the Dáil, provided that this would be determined by regulations made by the Minister for Local Government. The point was made during the Dáil debate that it would be preferable to follow the precedent of the Health Authorities Act, 1960, and allow the contributing authorities to agree to the proportion between them, if that were possible, and, in the absence of agreement, to allow the proportion to be determined by a person appointed by the Minister. These amendments are designed to make this change. If the members of the various local councils concerned with the particular health board agree on the basis of allocation, this agreement can come into effect with the consent of the Minister. If they do not agree, then a person will be appointed to make a determination on the allocation of expenses. Pending the making of such an agreement or determination, there will be a provisional allocation, as specified by the Minister, which will be subject to adjustments after the agreement or determination is made. Subsection (6) of the amendment arose from a discussion in the Seanad in which a Senator wished to spell out in detail all the considerations which should be brought to mind by the arbitrator in making his decision. I said that they were of so many and varying kinds that all we could do would be to give a general direction that he would have to consider the relevant factors in relation to this and that these could be mentioned by the Minister for Health and the Minister for Local Government, or specified to him. Such factors will include, for example, the present proportions in which local authorities meet health expenditure; previous systems for divisions of costs, that is, on a valuation basis or in proportion to numbers of patients. Those who have been members of local authorities will know immediately what I mean when I give those as examples of "relevant considerations".
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 8:
In page 16, subsection (3) deleted and the following substituted:—
"(3) The expenditure of a health board by this Act which is not met by grants under subsection (2) and other receipts shall be contributed by the local authorities required under this Act to appoint members to the board in such proportions as those authorities may agree upon with the consent of the Minister or, failing such agreement being made within a period of six months (or such longer period as may be approved of by the Minister) after the day of the establishment of the health board, in such proportions as may be determined by a person appointed for that purpose by the Minister.
(4) An agreement or determination under subsection (3) shall have effect as from the establishment of the health board to which it relates.
(5) (a) An agreement under subsection (3) may be varied—
(i) by agreement between the local authorities concerned made with the consent of the Minister, or
(ii) by a person whom the Minister, acting at the request of one of the local authorities concerned, appoints to review the agreement.
(b) A determination under subsection (3) may be varied—
(i) by agreement between the local authorities concerned made with the consent of the Minister, or
(ii) by a person whom the Minister, acting either at the request of one of the local authorities concerned or on his own initiative, appoints to review the determination.
(6) A person appointed by the Minister to make or vary a determination under this section shall have regard to such matters as may be specified by the Minister after consultation with the Minister for Local Government.
(7) The making of an agreement under subsection (3) or a request under subsection (5) by a local authority shall be a reserved function for the purpose of the County Management Acts, 1940 to 1955, or the Acts relating to the management of county boroughs, as may be appropriate.
(8) (a) Pending the making of an agreement or determination under subsection (3), the expenditure of a health board which is not met by grants under subsection (2) and other receipts shall be met, in such proportions as may be specified by the Minister, by the local authorities required under this Act to appoint members to the board.
(b) The specification of proportions under paragraph (a) shall be subject to the relevant agreement or determination pursuant to subsection (3) when that agreement or determination has been made, and appropriate adjustments shall be made accordingly."
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 9:
In page 16, subsection (5), lines 34 to 37, deleted.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 10:
In page 16, subsection (7), lines 46 to 51, deleted.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 11:
Section 33: In page 17, subsection (2) (d), lines 25 to 28, deleted and the following substituted:—
"(d) the transfer of the holder of any health office under the dissolved body to an office under the relevant health board which, in the opinion of the Minister, is similar to that health office,
(e) the transfer, with the consent of the Minister for Social Welfare, of the holder of any public assistance office under the dissolved body to an office under the relevant health board or a relevant local authority which, in the opinion of that Minister, is similar to that public assistance office."
This amendment also relates to matters discussed in the Dáil and the Seanad. Virtually everybody on all sides of the House suggested that the administration of home assistance should be carried out by the health authority because of the link between home assistance and hospital services and health services in general. With the proposed delegation to the health boards of responsibility for the day-to-day administration of the assistance services it is clearly preferable that it should be possible to transfer the assistance officers to the health boards instead of to the local authorities, and this is the main purpose of the amendment. The amendment will also make it clear that in the case of health officers the decision on the office to which the person will be transferred will rest with the Minister for Health while, in the case of the public assistance officers, it will rest with the Minister for Social Welfare. It makes it easier to ensure that there is complete co-ordination between the payment of home assistance and the general administration of the health services. The local authorities will also have to move for the delegation of this activity under section 24 of the Bill which we discussed during the Dáil debate and which I made clear would enable this delegation to be effective.
Our only regret is that the Minister did not go the whole way with us and leave the administration of public assistance where it is at present — with the health authorities. What the Minister has now done is to say: "We will take it away from you, give it back to the local authority but they may hand it back to you." This seems an unnecessary exercise and I think it was done primarily out of a desire to discourage health authorities from making representations to the Minister for Health to have public assistance treated as part of the Health Vote and, therefore, entitled to a subvention of at least 50 per cent from the State. It has now been taken out of the hands of health authorities and handed back to the local authorities so that public assistance will in future, as in the past, be treated as something to be paid for entirely out of local rates and not carrying any of the subsidies which health services would carry.
This is unfair. At present between 64 per cent and 77 per cent of people who are in receipt of home assistance are people who are receiving some other welfare benefit from the State and they do not receive public assistance unless they are unable to provide, by their own industry or other lawful means, the necessaries of life. Here we have a situation in which local rates are clearly being used to subsidise what are statutorily recognised as being totally inadequate State welfare payments. Instead of treating these as we ought, as health subsidies, we are putting them back to be handled as part of the sanitary expenses of the local authority, as part of the expenses which must be paid in order to relieve the community of the diseases which are associated with poverty and destitution. This is an entirely wrong concept and, while we accept the bona fides of the amendment, we are sorry it is something that has to be done because of this totally erroneous approach to the whole problem of relieving destitution and misery in our midst.
A substantial portion of home assistance in the Dublin region, as much as 30 per cent, is in respect of what are health services — the provision of meals-on-wheels, home help, the provision of many aids for elderly and disabled people living on their own. Surely these are health charges and should be carried as such and should rank as health services with equal status as institutional services? However, this is not being done; they are to be regarded as sanitary services, matters for the local authority which may then delegate them back to the health authority and because of that we have to go through this extraordinary Gilbertian procedure of transferring a health service to a sanitary authority and then allowing the sanitary authority to declare that the health authority may conduct it in future.
There could be complications in this. If, as Deputy Ryan says, it subsequently goes back to the health authority the question of whether they qualify for the grants will come into it again. As it stands, there is one thing which possibly might support leaving it with the local authority and that is the question of local knowledge of people who require assistance. All members of local authorities are aware of the occasions on which people have asked for public assistance and have pointed out that though they asked for it they did not get it or they did not get enough. Occasionally representations have been made by local authority members which have resulted in this being rectified but what is likely to happen if this passes completely from the local authority is difficult to visualise at this stage.
In connection with the grants made last year for the assistance of bodies dealing strictly with old people and which will be in operation again this year, can the Minister tell me how it is proposed to deal with those; are they being taken over by the new health authority or will they be left to the local authority? I am not too happy about the whole set-up because it appears where there is dual responsibility somebody goes to the wall and it is usually the person who has the least amount of money and who needs help.
Under the 1953 Act, which is being continued as altered in this Bill, the health boards will pay the boards responsible for paying organisations dealing with poor people and old people. The health boards will look after that situation.
Will the 100 per cent grant at present being given by the Department of Health be continued?
Whatever the grant was before can still be given on the same basis.
Or a greater grant?
Yes. In regard to what Deputy Ryan said, I have already told the House that the Minister for Social Welfare is examining the whole of the social assistance code in relation to an examination of the operations of the Department of Social Welfare. We have also to examine the Devlin Report which proposes very much closer co-ordination between the Departments of Social Welfare and Health. I could not possibly have taken the action suggested by Deputy Ryan at this stage but I think the whole operation can proceed smoothly as a result of the use of section 24 of the Bill and these two amendments.
Perhaps the Minister would clarify paragraph (d):
the transfer of the holder of any health office under the dissolved body to an office under the relevant health boards which, in the opinion of the Minister, is similar to that health office,
Does the Minister, for instance, consider that the new post of CEO of the Dublin Regional Health Board would be similar to that which previously existed in the Dublin Health Authority?
It would be open to permit such a transfer. I have made it absolutely clear that I intended to have all these positions filled by the Local Appointments Commission.
There is a lot of uneasiness among employees of the present health authorities as to what is their position with regard to transfer just as there was uneasiness when it was suggested that the Land Commission should go to Castlebar. Can the Minister say if it is likely that an effort will be made to transfer these people to wherever the new health board is centred?
A certain number of them will have to be transferred but compensation will be paid to them to cover the cost of moving. When they took office it was quite clearly stated in their terms of service that they were likely to be transferred, as in the case of civil servants.
The employees of local authorities are only transferred at their own request. This is a different matter.
I understand that under the relevant Acts they can be transferred, and I made that absolutely clear both in the Dáil and Seanad, but a joint consultative council will be appointed when the health boards are being organised. I anticipate that, in relation to, for example, clerical officers, who do local authority work and those doing health authority work, it will be possible in many cases to find out who would prefer to be transferred and who would not. It will be possible to re-allocate their duties in the case of clerical officers. The joint consultative council will examine all these matters. Many of them will have to remain wherever they are because of the general decentralisation of health services everywhere and the whole arrangement can be carried out without undue dissatisfaction. We promise that nobody's conditions should be worsened as a result of the change.
The usual practice in local authorities is that officials switch from one section to another in order to gain experience in the different sections. Can I take it that, if there is, for instance, somebody dealing with roads who would be prepared to transfer to another section, he can switch with a person who is dealing with health?
That is possible, but it requires negotiation.
Did I understand the Minister to say that such a transfer could only take place from clerical officer grade down and that it would not apply to those who were staff officers?
It would apply to any grade.
One other point. With the three present health regional authorities being brought into one, could the Minister say if there is any likelihood of redundancy occurring because of the possibility of inability to absorb the officers under the administration of the local authorities?
We have already said there will be no redundancy. If there is too little work for some people the changes will have to be effected by wastage, retirement and death, but I have made it perfectly clear that we have not provided redundancy compensation in this case because nobody will be made redundant.
Would the Minister explain his real reason for paragraph (e) of this amendment because he has not given a convincing reason up to now for the transfer from his Department of responsibility for public assistance officers?
The home assistance officers will now come under the auspices of the Department of Social Welfare and it was in order to make it possible to effect their transfer to the health boards that we put in these two amendments.
That is not the position in the Dublin Health Authority. The home assistance officers in the Dublin Health Authority are under the health authority.
It is the Minister for Social Welfare who is responsible for officers in the Dublin Health Authority and not the Minister for Health.
Since they are employed by the Dublin Health Authority, this is an extraordinary situation. Would the Minister not accept that it would be more rational and reasonable to keep these people completely under his wing and not to move them backwards and forwards? It is a most extraordinary piece of legislation.
I made this agreement with the Minister for Social Welfare and I cannot go any further except to say that it will not cause any trouble in the Dublin Health Authority. The Minister for Social Welfare is absolutely willing to have this co-ordination maintained and effected and I do not anticipate any difficulty.
It is divided responsibility.
Is it not the present position that employees of Dublin Health Authority who are engaged in home assistance are employees of Dublin Health Authority but under this Act they will become employees of Dublin Corporation? Therefore, it will be possible for these people to be seconded from the corporation back to the health authority.
This is only a matter of an arrangement with the Minister for Social Welfare and I do not believe he will insist on carrying out this operation.
It is the need for this that is difficult to understand.
I do not envy the Minister who will have to explain this when drafting his White Paper.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 12:
In page 17, subsection (5), lines 50 and 55, "1959" deleted and "1968" substituted.
This is purely a drafting amendment to include Acts that were omitted previously and to which the Health Bill refers.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 13:
Section 35: In page 18, subsection (1), line 36, "as" inserted after "than".
No. 13 has been discussed with No. 1.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 14:
Section 40: In page 22, subsection (1), line 3, before "shall" the following inserted:—
", after consultation with such bodies representative of persons concerned with the provision of hospital services and such other bodies (including bodies engaged in medical education) as he considers appropriate,".
This amendment arises out of an undertaking I gave on Committee Stage in the Seanad which would leave it open to the Minister for Health to decide with what bodies he should consult in regard to any particular aspect of the regulations which he would be framing under section 40 with regard to Comhairle na nOspidéal. There is separate provision for consultation with various bodies on the establishment of the regional hospital boards and I agreed to make it clear, through this amendment, that I would naturally consult with bodies representative of persons concerned with provision of hospital services, medical education and so on, before framing the regulations for Comhairle na nOspidéal. That will come before the Dáil later for discussion.
Can we take it that the regional hospital boards will cover the same areas as the regional health boards?
There are three regional hospital boards: one in Cork, one in Galway and one in Dublin. The Dublin regional hospital board covers the entire area from Waterford to Louth, Monaghan and Cavan and all the way up the east coast.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 15.
In page 22, subsection (1) (b) (vi), line 26, "cognate" inserted after "other".
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 16.
In page 22, between lines 27 and 28, the following paragraphs inserted:—
"(c) Before making a decision in pursuance of paragraph (b) (i) in relation to an appointment, the duties in relation to which involve the teaching of clinical medicine or the conduct of medical research under the direction of one or more than one college, the Council shall consult each such college.
(d) A function in relation to the selection of a person for an appointment, the holder of which is a full-time or whole-time professor in a college, shall not be prescribed under paragraph (b) (v) save with the consent of that college.
(e) In this subsection ‘college' means a college which awards a qualifying diploma mentioned in the Second Schedule to the Medical Practitioners Act, 1927, or a college of a university which awards such a diploma.
Perhaps the Minister will clarify this?
This is a very obvious amendment. In relation to the operations of Comhairle na nOspidéal we had consultations with the authorities of University College and Trinity College in relation to teaching appointments in the Dublin hospitals and the teaching authorities are anxious that their position should be safeguarded. They agreed that the proposals in the present amendment would meet their requirements. The effect will be that Comhairle na nOspidéal must consult the teaching authorities before regulating the number and type of teaching appointments and that they cannot be given functions on the selection of consultants who are whole-time professionals except with the consent of the relevant teaching body. It was decided that Comhairle na nOspidéal would decide on the number of consultants and the type to be appointed in order to get integration in relation to the provision of specialists, but that it would be wrong if this could automatically apply to teaching appointments where there were full-time professionals to be appointed, that that would be transferring too much of the administration of the medical schools of the universities. We have put in this amendment very enthusiastically. It is entirely reasonable.
We regard this as a very wholesome and necessary amendment. The fact that the Bill was debated so long without its being inserted is a very sound reminder to us of the wisdom of having a Second Chamber to ensure that something as vital as this is not overlooked in such a comprehensive measure as this Health Bill. The teaching colleges are entirely justified in the representations they have made. The Minister has welcomed the representations he has received and I am glad he has seen his way to include this very necessary amendment in the Bill.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 17:
In page 23, subsection 3 (d), line 6, ", 16 (1) and (3)" deleted.
This amendment is consequential on No. 19 and the two amendments may be discussed together.
This amendment is really consequential on amendment No. 30 which compels the health boards to have at least 12 meetings in each year. I did this with some reservations because I felt they would have the necessary number of meetings but there are a great many things in this Bill where you can take the pragmatic view that people will do the right thing or you can take the view that there must be certain minimum provisions. Therefore, having agreed that the health boards should meet 12 times a year I could not possibly insist that Comhairle na nOspidéal and the regional hospital boards would meet on a specific number of occasions in the year. Amendments Nos. 17 and 19 will exclude them from the general provision in regard to the regional health boards.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 18:
In page 23, subsection (3) (d), line 6, "30" deleted and "32" substituted.
This is purely a drafting amendment.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 19:
In page 23, between lines 10 and 11, the following inserted:—
"(4) The first meeting of a body established under this section shall be held on a day to be appointed by the Minister and the body shall hold such other meetings as may be necessary for the performance of its functions.".
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 20:
In subsection (4) (a), page 23, line 13, "of that body" added after "vice-chairman".
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 21:
In page 23, subsection (8), line 46, "provision" deleted and "provisions" substituted.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 22:
In subsection (9) (a), line 60, "sections 12, 13, 15 and 16" deleted and "sections 12, 13, 15, 16, 21 and 22" substituted.
Would the Minister explain this?
Sections 21 and 22 of the Bill deal with the suspension and removal of officers under certain conditions by the chief executive officer of the health board. There will be no chief executive officer of the regional hospital board and so the amendment has to be introduced to make that clear.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 23:
In page 24, between lines 12 and 13, the following subsection inserted:
"(12) A body established under this section may accept a gift of money, land or other property on such trusts and conditions as may be specified by the person making the gift, but shall not accept a gift if any conditions attached to the acceptance thereof are inconsistent with the functions of the body.".
What gifts has the Minister in mind for bodies of this kind?
Senator Alexis FitzGerald, in the course of his life, must have dealt with a number of bequests and gifts. He had the optimistic view that Comhairle na nOspidéal might be given gifts by some generous person, so I was willing to put in the amendment that Comhairle na nOspidéal could accept a gift.
We could not accept the gift of a chain of office in Dublin County Council.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 24:
Section 48: In subsection (1), lines 1 and 2, "for the purposes of this section" deleted.
This is a drafting amendment.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 25:
Section 58: In subsection (2), line 54, "by the Minister" deleted and "by the Minister," substituted.
I am at a loss to understand the purpose of this amendment. Perhaps it is only a typographical error.
If you read it with the comma it reads better than without it. There is no precedent for inserting just a comma into an amendment and so some of the words must be put back again.
The comma escaped our attention.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 26:
Section 65: In page 30, lines 33 and 34, "provides elementary education but" deleted.
This is to allow health boards in their discretion and at the request of the governing body to extend to post-primary schools the school health examination service. I want to make it clear that within the next three or four years there will be only a pilot scheme in connection with this, if we have one at all, because all the expert advice I can get is in regard to having better pre-school services and more selective primary school services. It will take all our time to get these services organised and to get the necessary additional staff. However, I agreed to put in the amendment thinking that as the years go by we might wish to extend the primary school type of examination to secondary schools.
Without opening a debate on the success or failure of the school medical service, we welcome this section. It does seem entirely wrong that we should be as of now apparently depriving children between the ages of 12 and 14, and shortly between the ages of 12 and 15, of a school examination which they would have if they remained in the national school and of which they are deprived because they proceed to another establishment. This the Minister tells us, and so we understood, will allow health boards to provide the medical examination in schools other than national schools. We appreciate the problems there would be about recruiting staff and in providing facilities for the minimum examination and the new scheme which the Minister has in mind, but let us hope this will be fulfilled and that they will then be able to extend into the regions where children are now being deprived of facilities where at one time they were not so deprived.
Under the present school medical inspection system children can get one inspection, perhaps two or three or none at all. Does this amendment cover the case where a child has an inspection before leaving primary school and certain defects are discovered? Normally such children would be dealt with but because they go to a secondary school they are not dealt with unless the parents are prepared to pay. Is that covered in the new proposals or will those children fall between two stools again?
If defects are discovered and treatment is necessary they will be included in the scheme.
Under the present system they are excluded.
That is covered.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 27:
Section 70: In page 31, between lines 28 and 29, the following new section inserted:—
() (1) The Minister may make arrangements for the dissemination of information and advice on matters relating to health and health services.
(2) A health board shall make arrangements for the dissemination of information and advice on matters relating to health and health services.".
There was a time when this question of the Minister for Health giving advice on health matters would have raised turmoil in our community. We are glad that day has gone.
Yes, it certainly has.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 28:
Section 74: The following subsection added to the section:—
"(3) Before laying the draft of an order under this section before each House of the Oireachtas, the Minister shall consult the Commissioners of Charitable Donations and Bequests for Ireland.".
What is the purpose of this?
A Senator made the observation that if a private hospital was changing its charter the Commissioners of Charitable Donations and Bequests might have been making available a very valuable endowment fund to this hospital. If the functions of the hospital were to be altered in a particular way the commissioners might be satisfied and might continue the bequest but if a very drastic change were to be made the governing body of the hospital would know the views of the charitable commissioners as to whether certain bequests would continue. For example, if a hospital which engaged entirely in looking after dying people changed its functions and started looking after a number of different classes of patients they should at least ask the charitable commissioners whether the gift was to be used only to help dying people or whether it could be used to help anyone else. This is a matter of law about which I know very little. Anyway, there is no reason why they should not consult with the commissioners.
I am delighted with this amendment.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 29.
First Schedule: In page 35, column (3) opposite the reference in column (2) to the Health Act, 1947 "99," inserted before "102".
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 30.
Second Schedule: In page 38, line 18, "at least twelve meetings in each year and" inserted after "hold".
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 31:
In page 38, line 32, the following inserted after "board":—
"by a resolution, for which not less than two-thirds of the members of the board voted and of the intention to propose which not less than seven days' notice was given to every person who was a member of the board when the notice was given,".
This amendment makes it clear that the chairman of a board cannot be removed from office save by a resolution of the board when at least two-thirds of the members have voted. This makes the position of the chairman more assured and it avoids any difficulties which might arise regarding the casting vote of the chairman should the determination of his position depend on a simple majority that relates to Rule 29 of the Schedule. The amendment arises out of a number of points made on Committee Stage.
Does that mean the number voting or the number present and voting?
The number present and voting. It is a pragmatic situation whether or not a health board would really have the nerve to remove the chairman if there were only a few members present, but I accepted this amendment as being necessary.
The amendment requires seven days' prior notice to be given.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 32:
In page 38, line 48, "or, in his absence, the vice-chairman" inserted before "of" where it first occurs.
A number of people asked me to give the vice-chairman a more specific role and status and I think they are quite right. The vice-chairman is almost completely forgotten in a great deal of legislation.
It strikes me that as well as putting in the vice-chairman it should also be said in his absence the acting-chairman or the chairman for the time being.
We might have added "chairman for the time being".
Question put and agreed to.
I move that the Committee agree with the Seanad in Amendment No. 33.
In page 38, line 49, "or, in his absence, the vice-chairman" inserted after "chairman".
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 34.
In page 39, lines 1 and 8, "or vice-chairman" inserted after "chairman".
Question put and agreed to.
I move that the Committee agree with the Seanad in Amendment No. 35.
In page 39, after Rule 29, the following new Rule inserted:—
"(30) A member of the board who has —
(a) any interest in any company or concern with which the board proposes to make any contract, or
(b) any interest in any contract which the board proposes to make.
shall disclose to the board the fact of the interest and the nature thereof and shall take no part in any deliberation or decision of the board relating to the contract, and any such disclosure shall be recorded in the minutes of the board.".
This was a really good point made by a Senator. This section had been left out, when, in fact, it should have been put in.
What is it?
It means that a member of the board who has an interest in the company must not take part in any decision relating to that company.
Does it say what the penalty is, if he does take part, because in other legislation where this type of provision is made I do not think any provision is made for a penalty either to the member or to the contract? It is a rather interesting position. It is like some of the sporting rules which give an offence without a penalty. What happens if he does this?
We have inherited this from other legislation. I am afraid the person has to act reasonably; there is no penalty on a person who does not act reasonably.
This simply means that a decent person will not take part but that a person who takes part is not decent anyway and he does not mind.
I hope the other members of the health board will be tough on this subject. I cannot do more than this anyway.
I have come across such a situation before.
It does not matter greatly unless the decision is carried by the vote of the person who has an interest. It seems to me that if a resolution was carried by the vote of a person who has an interest the vote would be invalid.
But it does not say that.
What it says is, "...shall take no part in any deliberation or decision of the board relating to the contract". The decision would be an invalid decision if the person took part.
I have heard that before and it just does not work that way unless it is written in that the contract would be debarred or the member disqualified. We had the case of a person who sold land and his vote carried the sale of the land to the local authority.
It would be a very brave member of a board who would risk the possibility of being a defendant in legal proceedings.
There are no legal proceedings because there is no penalty.
It is probably very hard to determine.
I think this is a case where we should decide what is to happen if a member breaks this section.
If the vote of a member of the board sanctioned the contract which would not otherwise have been sanctioned I think the chairman can declare the proceedings to be invalid. I am sure there is sufficient precedent.
There is not; that is the unfortunate thing. It does not state what will happen if he does this.
It must happen very rarely that a person is present when a contract is awarded in which he has an interest.
No, it happens all the time. Normally, there is no harm at all because it is usually a contract supplied on a competition basis but occasionally it is really serious.
We shall have to consider it for the next Health Bill.
This is a matter which should apply to all local authorities and not just to a health bill. If the position is as unsatisfactory as Deputy Tully has said it seems to be a wholly undesirable situation and one which should not be permitted to continue. It is unlikely that people would abuse their interest or their knowledge in these matters but the sure way of preventing it would be to provide very severe penalties.
All you have to do is make it illegal. If a member does this he should be debarred from future membership of the board; that is the obvious solution.
It is quite possible that a person may consider that to be a relief well worth getting.
This does not happen when tenders are supplied, as they are properly examined by a board. It must happen infrequently when a piece of valuable property is being purchased that the presence of a member would ensure that the board would decide to buy it rather than not buy it.
Not infrequently. I am aware of one case where a piece of property owned by a member was, in fact, bought against the vote of the minority of the council. It was held that it would not have been bought but for the fact that this man being a member got the support of fellow members of his party to carry the day. This should not happen. There is no provision to punish a member for doing this.
I never came across anything like this in the city or county of Dublin.
There is no such thing as buying land at exorbitant prices; you are terribly honest in Dublin. I can assure the House it did not happen in Meath County Council either.
Question put and agreed to.
I move that the Committee agree with the Seanad in amendment No. 36:
In page 40, before Rule 30, the following new Rule inserted:—
"() The board may make standing orders for the regulation of its proceedings, other than proceedings the regulation of which is provided for by or under statute (including this Act), and may amend or revoke such standing orders.".
This is self-evident, enabling health boards to have power to make standing orders governing their procedure in so far as it is not already indicated in the rules in the Schedule.
Question put and agreed to.
Before the Minister closes his file, could he venture a guess as to the timing of the stages of the Bill now that it has been passed? He has done his best to give us as much information as he could but could he give us any information as to when we are likely to have the various stages of the Bill in operation? We have some approximate dates.
There is one matter that has to be attended to with the consent of all the parties concerned. In order to spend sums on some of the provisions in this new Bill, the Esti- mate for my Department for 1970-71 will have to be taken in April and so the Parliamentary Secretary to the Taoiseach will ask the Opposition to agree to take the past Estimate immediately, knowing that there will be a full debate on health policy immediately after Easter, so that I can get provision for sums to be spent on the payment of the chief executive officers and other new services. Secondly, I think about May or June, I will introduce the resolutions for the final formation of the regional health boards, hospital boards and Comhairle na nOspidéal and if we can get those through, then, by October, the chief executive officers will have been appointed by the Local Appointments Commission and the health boards will start to meet to plan their work without having any legal power and to plan the whole formation of the board; and then the final arrangements for giving the health boards and the other boards full authority should commence on 1st April, 1971. I am crossing my fingers but I think we are really keeping up with the schedule fairly well. Administratively and financially, it would be almost impossible to introduce the health board administration in the middle of a financial year, as anybody who knows anything about accountancy in a local authority will appreciate.
I thank the Minister. There is one aspect of this about which we are all anxious for information. Where exactly does the Minister think choice of doctor will fit into the schedule?
It could not possibly begin until 1st April, 1971.
Does the Minister think it may start pretty soon after that?
I would say so, yes. I would hope so.
When does the Minister think he will be in a position to give us an indication as to when he will introduce regulations to define entitlement to the blue cards?
That would have to be done prior to 1st April.
I omitted that. These standards will be introduced about November.
Of this year?
It is not a debate I am going to enjoy because there is nothing that I can suggest that would please almost anybody in the House but I will have to live with that.
Amendments reported and agreed to.