Dáil Éireann díospóireacht -
Thursday, 18 Jun 1970

Vol. 247 No. 10

Private Business. - Health Boards Regulations, 1970: Motion.

Minister for Health (Mr. Childers)

I move:

That Dáil Éireann approves the following Regulations in draft:

Health Boards Regulations, 1970 a copy of which Regulations in draft was laid before Dáil Éireann on 8 June, 1970.

This motion arises under section 4 of the Health Act, 1970, which requires the Minister for Health to make regulations specifying the number, constitution and functional areas of the health boards which, under that Act, will become responsible for the administration of the health services. For the convenience of the House I have, as undertaken during the debate on the Health Bill, circulated an explanatory memorandum outlining the details of this proposed change in the administration of the health services.

So as to give the whole picture, this explanatory memorandum also refers tentatively to the proposals under the Act for setting up certain other bodies—Comhairle na nOspidéal and the three regional hospital boards —which will be specially concerned in the efficient organisation and development of hospital services. However, the motion before the House now does not relate to these special hospital bodies: separate regulations on them will be submitted later, after the details of their constitution and functions have been the subject of consultation with the hospital authorities, the teaching bodies, and the other interests which will be affected by them. Accordingly, I will not in this statement refer further to them, but will treat solely of the establishment of the new health boards.

The Act requires that, before the regulations setting up the health boards are made, the Minister must consult the Minister for Local Government and also each county council and county borough, corporation and the Dún Laoghaire Corporation. In addition, consultation with the National Health Council is required by section 41 of the Health Act, 1953.

All these statutory consultations on the draft regulations have now been completed and in the case of Dublin City, the formal consultations with the corporation, in the person of the commissioner, were supplemented by informal discussions which I had with some of the Dublin City Deputies. I have also consulted a number of other bodies, including those representing various professional interests. Many bodies and hundreds of persons have taken part in these consultations. I would like to place on record my appreciation of the interest which they have shown in the proposals and the work done by them.

I will present to the House the result of these consultations, but before doing so I should, perhaps, say some general words on the considerations underlying my design of the areas and constitutions of the health boards.

In choosing the functional areas of the health boards, I had to have regard first to what would be a reasonable area for administrative purposes, without having the centre of administration too remote from any large sector of the people served. Clearly, in modern times this requirement can be met by having far larger administrative areas than when transport depended on the horse. There was, of course, no hard and fast rule which we could follow but a practical consideration which was borne in mind was that the areas should be sufficiently compact so that a board member could attend a meeting without an overnight stay and also that staff could travel out from the headquarters to the rest of the area without spending too much time on travelling.

I had also to consider whether county boundaries should be followed in all cases or whether some counties should be split between two boards. Tradition more than logic can be said to govern the lines between counties and there was a strong temptation to be logical in designing the health board areas at the expense of county integrity. North Carlow is, perhaps, orientated most towards Dublin, parts of Kerry and South Tipperary towards Limerick and North Roscommon and the "panhandle" of Cavan might best be administered from Sligo.

On closer study, however, I decided that such apparently logical moves would be unwise. Each county is now a unit in the health services administration and it is better to build by combining these units and accepting whatever anomalies there may be in the boundaries. This has the further decided advantage that it will ease the quite considerable transitional problems affecting the staffs of the present health authorities.

I think that my decision to stick to county boundaries was generally welcomed by the local authorities. Of course, this will not mean that, for hospital services for example, each health board area will have to be self-sufficient. There is nothing to stop arrangements being made for, say, North Roscommon patients to go to Sligo or for Carlow patients to go to Dublin.

In choosing the particular areas set out in the draft regulations, I had regard also to existing regions for other purposes. There are regional systems at present for local government planning, for Bord Fáilte, for the Electricity Supply Board and for some other purposes. In general, the pattern of these indicates that the number which I have chosen, eight, seems about right. In particular, I tried not to depart from the local government planning regions except for very good reasons. In fact, the health board areas differ from the planning regions only in that Roscommon is associated with the west rather than the midlands, that Meath is associated with Louth, Cavan and Monaghan rather than Dublin and that Donegal, instead of forming a separate region, is associated with Sligo and Leitrim.

The proposals for the constitutions of the health boards have, perhaps, given rise to more interest and controversy than the choice of the eight areas —understandable controversy. I should mention, seeing that all involved were anxious to obtain the greatest possible representation. Local authorities wished their members to form a substantial majority on each of the new boards, while the medical profession pressed for strong representation. Representation was sought too by a large number of para-medical groups. If I had agreed to meet fully the wishes of all interests, each board would have blossomed in numbers into a mini-Dáil.

Now, one cannot state a hard and fast rule for the ideal number of members for a board, but a body which is an executive agency, such as the health boards will be, becomes less effective if its membership is too big. I took the pragmatic view, therefore, that if the members of the board were to form an effective body, they should not exceed about 30 in number. This decision meant that I was unable to accede to requests from many quarters for representation or an increase in representation but, after considering the various views expressed on the constitution of the boards, I did manage to make some concessions which I will refer to in my detailed comments on each of the areas.

The National Health Council and a number of the county councils made the point that there should be provision for the professional representation on the board to be spread equitably over the constituent counties. I sympathise with this point of view and intend, in the constitution of the first board and in the regulations governing election to subsequent boards, to see if I can meet it to some extent. However, any exact geographical distribution of professional representation will be difficult to achieve, seeing that, in the appointment of professional representatives, the main endeavour will have to be in getting a good spread of doctors among the different categories of the profession and in securing the professional people best qualified to act on the board. It should be borne in mind, too, that the Minister, in choosing his three nominees to each of the boards, will have a chance to redress or reduce any geographical imbalance which results after the appointment or election of the professional representatives.

I will now refer briefly to the proposals for each of the boards. I should mention that, while the statutory consultations with local authorities took place in the months following the enactment of the Health Bill, I had already had informal contacts with representatives of all the local authorities concerned, before the Bill was passed, on tentative proposals which I had then circulated. What was said during those informal discussions was borne in mind and a number of changes were made in the draft regulations before they were sent out for the purpose of the formal consultations. Hence, the scope for further changes arising from the statutory consultations was limited but I did manage to make some further concessions to local points of view.

The population to be covered by the proposed Eastern Health Board—— 921,000—is by far the largest and the constitution of this board presented, perhaps, the greatest problems. Clearly, if local representation on this board were to be in proportion to population, then Dublin would have had such a preponderant number of members that Kildare and Wicklow would have an insignificant say in the work of the board. In relation to this area and others I took a pragmatic line that representation of each county or borough could not be in simple proportion to its population, but that, where there were big differences in population, the larger authorities should have some additional weighting in their representation.

My original proposal was for a somewhat smaller number of members than the 35 proposed in the draft regulations. I have accepted an increase in the total number beyond what I would regard as the optimum in an endeavour to reach a compromise with the local authorities. I should mention that, in this area, the five authorities concerned took a commendable initiative in meeting to agree among themselves on their representation on the board. They agreed on a total representation of 23. I did not fully accept this and the total local authority representation of 19 which I propose is a compromise between this and my original proposal for a total of 16.

Kildare and Wicklow each pressed very strongly for four members, instead of three. Wicklow County Council mentioned the peculiar geography of the county and thought that their representatives would have to number four if members of the public were to have a reasonable chance to contact them. In refusing these requests, I had regard to the relatively small populations of Kildare and Wicklow Counties when compared with Dublin, and to the fact that each of the counties will have a local committee on which many of the councillors will serve and maintain contact with the operation of the services.

The four county councils concerned in the Midland Health Board—Laois, Longford, Offaly and Westmeath— were reasonably satisfied with the proposed representation, although Westmeath County Council would have preferred to have five nominees on the board, having regard to its expectations of growth in population in that county. The present population of Westmeath is about the same as that of Offaly. If this proportion changes in the future, there could be an adjustment in the representation on the health board but there is no present justification for giving Westmeath higher representation.

In the mid-western area, I had proposed to the local authorities that Clare County Council should nominate four members, Tipperary (North Riding) County Council should nominate four and Limerick City Corporation and County Council three each. Limerick County Council made a strong recommendation that, on the basis of its population vis-à-vis Clare and North Tipperary, it was entitled also to four members. I conceded this, bearing in mind that the total representation of seven from the Limerick area would still be below the total for the other two counties. Clare asked for an additional member also, but I could not see my way to agree to this, bearing in mind the populations served by each of the three county councils concerned.

The four counties concerned with the North-Eastern Health Board— Cavan, Louth, Meath and Monaghan —have expressed themselves as satisfied with the proposals in the draft regulations. This, I might mention, is one of the areas where there is a departure from the local government planning regions. I decided that it was more appropriate that Meath, instead of being associated for health purposes with Dublin, should be associated with Cavan, Monaghan and Louth, particularly having regard to the existence of the major hospital centre in Drogheda. The Meath County Council agree with me in this.

For the North-Western Health Board, it is proposed to allocate six members to the Donegal County Council and four each to the Leitrim and Sligo County Councils. Donegal represented to me that at least 50 per cent of the membership of the board, including the professional and other representatives, should be from Donegal. While this might be justified on the basis of the populations of the three counties—Donegal's population is 109,000, as against a total of 82,000 for Leitrim and Sligo—I do not think that it would be desirable that any one county should have an overall majority in the membership of any board. I accordingly regret that I cannot meet the wishes of Donegal in this respect. Sligo and Leitrim, I should mention, showed uneasiness that, in the selection of professional representatives, Donegal would achieve a preponderance and, as I mentioned in my general comments, I am considering how this could be avoided.

The constitution of the board for the south-eastern area, which includes five counties and the City of Waterford, presented special difficulty.

I should mention that, in the first place, Carlow County Council wished to opt out of this area and be associated with the Eastern Health Board. I met a deputation from the county council on this matter and explained to them that I could not accept this change. The reasons for this were that the population served by the Eastern Health Board as at present proposed was so big that it would be undesirable to add to it, and that Carlow, by reason of its small population, would have very little say if it were in the eastern board. This county is in rather an unusual position, in that the town of Carlow and its environs are at least as convenient to Dublin as they would be to, say, Waterford but, if one rejects the solution of splitting Carlow county, I think that the logical place for it is in the south-east. As I mentioned earlier, there will be nothing to stop an arrangement being made for Carlow patients to continue to go to Dublin hospitals.

In their views on the draft regulations, Carlow County Council indicated that they were agreeable to go into the south-east only on the understanding that the major hospital for the area would be in Kilkenny. I am afraid that I could not give any undertaking about this, as a decision on the major hospital areas in the country must await very full examination of the merits of the different possibilities.

Each of the other local authorities concerned in this area have asked that their representation on the board be increased beyond the figure which I proposed. I have examined their representations very fully but I do not think that the representation for any one authority could be increased without adjusting those for the others and, if they were all adjusted, the total membership of the board would go far above the figure which I regard as the optimum. I have not, therefore, found it possible to make any concession to the views of the local authorities in relation to representation on the board in this area. It is a fact of geography that the south-eastern area as we now propose it is a logical administrative entity; it is accepted as such as a local government region and by Bord Fáilte. The small representation from each county on the health board for the area derives from the fact of there being so many local authorities in it and I can see no way of constituting a viable health board for the area except by having but a few from each county.

The area of the Southern Health Board will cover Cork and Kerry. Kerry County Council had first proposed that there should be two boards, one for each of the counties, but I could not accept this, as I would not regard Kerry County as having a population sufficient to justify its having a health board of its own. Suggestions were also made that it would be more appropriate for North Kerry to be associated with Limerick than with Cork, but I rejected any idea of splitting County Kerry in designing the areas for the health boards. For one thing any such split would have made the proposition for having a large general hospital in Tralee, which is now proceeding, a doubtful one. Looking at the picture as a whole, I think that it is better that the whole of Kerry should be associated with Cork rather than with Limerick. The Tralee hospital must become intimately involved with the large general hospital which is being planned for Cork and this can best be done by having the two counties together within the one health board.

I originally proposed representation on this board of four for Cork Corporation, six for Cork County Council and five for Kerry County Council. This would have given none of the local authorities an absolute majority, but would give Cork city and county which have a population of 340,000 as against Kerry's 113,000, a two-to-one majority on the board. Cork Corporation asked that their representation should be increased from four to five members and Cork County Council requested an increase in representation from six to seven members. Kerry asked that their representation should equal the total for Cork city and county. I have increased the Cork representation to meet the views of the two local authorities there and have increased the Kerry County Council to six so as to keep the proportion of representation the same. I could not agree that Kerry is entitled to equal representation with Cork, having regard to the respective populations. Kerry County Council also asked that the Tralee Urban District Council should be entitled to representation on the board. There is no provision for this in the Act. They asked, too, that four or five of the doctors on the board should come from Kerry. I agree that Kerry should have its fair share of the medical representatives and, as indicated earlier, propose to arrange accordingly, but I see no reason why this county should have a majority of the medical representatives, as the county council have proposed.

The Kerry County Council asked that the chief executive officer of the Southern Health Board should be from Kerry. I would, of course, be in no position to comply with this request, even if I agreed that it was reasonable. The selection of the chief executive officer for the board will be a matter for the Local Appointments Commissioners and Kerry must take its chance on what county the person selected by the commissioners will be from—just as the counties within the area of any other health board must take their chance on whether a person from Kerry or elsewhere is appointed as their chief executive officer.

Following the informal consultations, I had increased the local authority representation on the Western Health Board to six for Galway, five for Mayo and four for Roscommon. Galway and Roscommon accept this but Mayo have asked that they should have six representatives. I do not think that this would be reasonable, seeing that the population of Galway is considerably bigger than Mayo and that it has the major hospital centre of the area. Mayo and Roscommon made some points also in relation to the medical representation on the board. I will bear these in mind.

I would like to repeat what I stated during the debate on the Committee Stage of the Health Bill, that, while the county and county borough council representation on the health boards is, of course, democratically sound, I feel certain that, once established, all the members of a board will think collectively for the general good of the whole area served. I confidently expect that the contributions of local authority and professional members alike will be positive and not negative, in the sense of trying to weaken the health structure in any part of the board's area.

The local advisory committees, which will examine the actual record of health services, current and developing in their areas, should be the spurs for any promotional policy required to maintain the principle of fair shares in the development of health policy. I also expect that, through the delegation of day-to-day administrative matters and by the formation of executive committees, the health board's operations will be discharged more efficiently.

This then is a summary of the views expressed by local authorities on the proposals in the regulations. I hope from what I have said that the House will accept that the points made in each area have been very fully considered and that what is now presented in the draft regulations is the best compromise I can offer between the local views and the essential needs of the new administration.

Deputies, I feel sure, will agree with me that almost any appeal for augmenting the number of local authority representatives from one county would be contested by other local authorities in the area and this would result in stalemate.

I can report that the National Health Council, when consulted on the draft regulations, expressed agreement with them. There was also statutory consultation with the Minister for Local Government who has offered no objection to my proposals.

A number of the authorities expressed views on other local matters arising under the Health Act which do not relate to the draft regulations before the House. I have not as yet had an opportunity to consider all of these points but will do so and communicate with the local authorities.

The draft presented represents what I, following the very full consultations which I have outlined above, consider to be the most effective pattern at this point of time for the administration of health services in accordance with the 1970 Act. What is now proposed is not inmutable and, if the administrative needs of the services change, new regulations can be brought in at a later date, when the full effects of the change in administration can be seen in perspective. For the present, I would ask that this House should approve of the draft of the Health Boards Regulations as now presented to it.

Mr. R. Barry

My comments on the Minister's statement will be brief because there are other Members here who, when the 1970 Health Bill was being discussed in the Dáil, made sensible and constructive contributions to that debate and I am sure they wish to speak now.

I do not approve of what the Minister is asking us to do in regard to the health boards regulations. More than once, both inside and outside this House, I have expressed the view that I have a sneaking suspicion of all the take-overs that are occurring all too frequently in this country. Here, another attempt is being made to take away the powers of the local representatives. I believe that the county councils——

Mr. Childers

On a point of order. I had a very agreeable debate with the House on the Committee Stage of this Bill. Surely the principle of the establishment of regional boards has already been accepted by the Dáil and, indeed, welcomed by people from all parties? We could have a debate lasting for days and days if we discussed now the principle of regionalisation. I hope the House will co-operate with me as I co-operated with the House that the debate today should consist in discussing the constitution of the boards the principle having already been accepted. I think that is a reasonable comment on my part and I would ask for your direction on the matter.

An Ceann Comhairle

I would point out to Deputies that the debate is confined to what is contained in the draft regulations before the House. As the Minister has said, there has been a long debate on the Health Bill and we cannot have a repetition of that debate at this stage.

Mr. Ryan

On a point of order, with all due respect to the Minister, the Minister's alleged point of order was a plea; it was not a point of order. Deputy Barry was talking about the number of local authority members under the draft regulations and he was quite within order in doing so.

An Ceann Comhairle

I did not interrupt Deputy Barry.

Mr. Ryan

I know, Sir. I am quite aware of the fact. I am not scolding the Chair; far be it from me to do so. But Deputy Barry is well within order and he is entitled to discuss the number of local representatives on the board and that is what he is doing.

Mr. Childers

Perhaps I misunderstood the Deputy. He started talking about the take-over principle and that has been debated. We will have a majority of representatives from local authorities.

Mr. T.J. Fitzpatrick

(Cavan): If the Minister had listened for a little while longer I am sure he would have got Deputy Barry's point.

Mr. Childers

I am sorry.

Mr. R. Barry

I would have dealt with the matter long ago had the Minister not made a speech. I was referring to the fact that this is not the best way to run the health services. For example, seven members of Cork County Council will be appointed to the southern health board. That board will cover Cork and Kerry. How seven members out of the 46 members of Cork County Council, all sensible, sober, decent men, can effectively account for the people of Cork city and county under the health service regulations is something that puzzles me. I believe this principle to be wrong. You have Dublin and Wicklow comprised in one area, with some 35 members representing nearly 1,000,000 people. The health services involve practically all the community daily one way or another and this is too personal a thing altogether; too few members will be dealing with too many people.

The last sentence in the Minister's opening speech is the most sensible one in it in that he says: "What is now proposed is not immutable ...." Things can be changed. I think time will prove, as many people believe now, that the representation on these boards will not be satisfactory for the efficient running of the health services. I cannot understand why the Minister has decided that he will appoint on the first board all those who are not elected representatives. Is that not what will happen with the first board?

Mr. Childers

No. Perhaps, the Deputy did not understand. We will ask the members of the various professions to nominate members on a non-statutory, informal basis to the first board. I appoint only three. Later, there will be much more elaborate statutory regulations whereby professional representatives will be appointed on a firm legal system. I appoint only whatever numbers are indicated as ministerial nominees. The rest will be appointed in an informal way by the professional organisations concerned within the health board area.

Mr. R. Barry

I accept that, but I think the Minister is asking too much when he reserves the right to himself to appoint three members to each board. Is it not true that all the good medical practitioners and all the good surgeons will be so busy they will not have time to attend meetings of this board which, as good members, they would be expected to attend? Therefore, the best will not find their way on to these boards. These meetings are held in the day time and, therefore, a great many of these people will be unable to attend. They will be prohibited from doing so because of their activities in their professions. The ordinary people will not have the voice they should have in a service for which they are paying so much both directly and indirectly. The time is not far distant when these regulations will have to be changed and, when that day comes. I hope that whatever Government is in power and whatever Minister for Health is in office will not be slow to change the regulations if time proves, as I believe it will, that they should be changed.

I will watch with interest the activities of these boards. I hope all their energies will be directed towards helping those unfortunate people who need health services, some of them daily health services. I hope the boards will set about their work in a most efficient, impartial and honest manner.

Dr. Browne

We welcome the establishment of the regional board. Anybody who has any experience at all of organising services for large population groups knows quite well that the old county boundaries, whatever their origin, can no longer be justified on grounds of administration or efficiency from the point of view of the utilisation of personnel, buildings and equipment. There may be a certain amount of regret because of a loss of local power and local autonomy and the Minister will obviously find a certain amount of resentment on the part of local representatives. I believe, however, that most of them when they get down to thinking about their real function, which is the creation of the most efficient health services possible, will readily understand that these can only be organised through the creation of regional units. In olden days, when communications were very poor, the county hospital building programme was completely justified and not only because of deficiencies in communication but also because of the type of medicine and surgical practice at the time. Things have changed very much now. There are good communications between the various regions in the country, particularly in the arterial roads.

As well as that, the whole practice of medicine and surgery has changed in a very fundamental way in so far as there has been the development of specialisation—specialisation meaning that one simply could not afford to appoint a specialist, per se, to a single county hospital. There has to be the peripatetic consultant who travels around three or four areas serving three or four health authorities in order to get the optimum use from his knowledge and experience and from the very costly equipment he probably will be using—operating theatres, diagnostic and treatment equipment of one kind or another. To get the optimum use, from the community's point of view, from both personnel and equipment, you have to adopt this type of regional grouping system. Again, we are trailing after many countries, particularly Britain. During wartime, the system was that the surgeon travelled around three or four hospitals, visited many clinics, and there was a complete blurring of the county boundaries. We welcome this. We accept the Minister's assurance as to the flexibility of his own attitude to it at the present time. I think he will always have the problem of the overlapping—whether the ambulance should go 200 yards down the road if it belongs to a different county; whether a person has access to a hospital which is almost next door or must go to one 40 miles away which is within his administrative area. These kinds of dilemmas will exist. I should imagine they will greatly be reduced when the regional boards are established.

I hope it will be possible to give the maximum amount of autonomy to these regional boards. One of the sad processes of time here, over the past 50 years, has been the failure to achieve effective devolution of power from the centre. On the contrary, power has gradually percolated back up. Having attempted, away back, to get distribution of power throughout the community and, in that way, to try to educate people into a sense of responsibility for taking decisions in regard to their own affairs in local areas because of reasons which were then sound, I suppose—the fairly high level of inefficiency, failure to accept responsibilities in some of the local authorities for the provision of essential services and sometimes, indeed, corrupt practices of one kind or another—the managerial system was then imposed on the community. I wonder if that phase has not passed now and if we might not attempt to re-educate our community into the establishment of a conscientiousness of group responsibility based on this type of much larger regional area. I think the area where this is most obvious will be the spending of money, the budget. I wonder what the Minister will do about the local budgets of these regional groups. Will he try to achieve a standardisation?

An Ceann Comhairle

I do not think this would arise on these draft regulations.

Dr. Browne

Perhaps the Minister might deal with this? To what extent will the regional authorities have the right to determine the budgets and the spending of the money which he allocates to them? In attempting to establish regional groups, my concern is that, by attempting to keep too close control over them, he will maintain the central authority of the Department of Health which at present persists——

Mr. Childers

The question of the financial control and autonomy was fully dealt with on the Health Bill.

Dr. Browne

We find here that the budgets must be approved by the Minister. To what extent will the Minister examine those budgets in detail or give a global figure and say, in effect: "Spend within that global figure"? That is a very important consideration. Ideally, the regional authority should be trusted with the global figure and then each of them developed in the way which best suits their particular areas. The key to the development of regional autonomy will depend on the attitude the Minister adopts in regard to this matter.

In the making of appointments to the various authorities, Comhairle na nOspidéal will have responsibility for the regulation of the number and types of appointments, the specified qualifications, and so on—presumably, with the consent of the Department. That is not very much changed. But the Minister is going to leave the selection procedure for the appointment of staff to these institutions to the Local Appointments Commission until he has worked out some other procedure. I wonder if he has any further details on the type of procedure he has in mind.

Mr. Childers

The constitution of the regional hospital boards, Comhairle na nOspidéal and the method of appointment will all arise and come before the Oireachtas in November or December when the regulations for these bodies will be the subject of discussion here.

An Ceann Comhairle

The motion before the House does not relate to these special bodies.

Mr. Childers

We had to do it stage by stage. There is a time limit to everything. The most urgent thing is to set up the health boards. They could operate without the regional hospital boards but, in fact, the regional hospital boards and Comhairle na nOspidéal will be set up by 1st April, 1971, and all the matters of which the Deputy speaks can be the subject of full discussion in the Dáil at a later date. Today, we are dealing only with the health boards.

Dr. Browne

It would help us if we had some indication of the way the Minister is thinking in relation to the replacement of the Local Appointments Commission by some other body. In so far as it is referred to here, it seems perfectly permissible for us to ask him these questions. I do not think the Minister should be so impatient of these queries. They are made in relation to the Health Act, by all of us here bona fide in an attempt to help him in his difficult task of trying to establish these regional health boards and not for any other purpose whatsoever.

I am particularly interested in what the Minister proposes to do in regard to making appointments to the voluntary hospitals. I referred to this before and I did not get a satisfactory answer. Will they be covered by the new appointing authority? In relation to the Local Appointments Commission and the appointing of the personnel to the regional boards, I do not know if the Minister knows it but, at present, pending the formation of the regional boards and the appointment of the administrative and managerial personnel, a sense that the existing authorities are unwilling to commit themselves on fundamental decisions on policy has tended to develop. I wonder if the Minister knows that? Secondly, how long does he think it will take if he is appointing either the Civil Service Commission or the Local Appointments Commission to appoint the personnel to these boards? Has he any idea whether he can expedite the formation of these boards, properly constituted, so that there will be the minimum delay in the establishment of these regional authorities? As he probably knows, there are tedious delays in the making of these appointments by the existing methods.

Could I ask the Minister about the Hospitals Commission? What happens to the secretary and the permanent members of the Hospitals Commission? Will they take up a new function, or will they be replaced by any of the proposed boards?

Mr. Childers

That also is dealt with in the Bill. It is also dealt with in paragraph 30 of the Explanatory Memorandum which was circulated.

Dr. Browne

It still does not tell me what will happen to permanent personnel of the Hospitals Commission.

Mr. Childers

The permanent personnel will no doubt be appointed to the staff of the regional hospital boards. They know that.

Dr. Browne

Yes, but I do not know that.

Mr. Childers

I thought I made it clear.

Dr. Browne

Thank you. What happens to the part-time members of the Hospitals Commission? Have they any further rights or do their appointments simply lapse as a result of the creation of the new regional boards? The Minister says that it is not mandatory to take the advice of the advisory boards. They will simply give advice to the regional boards who will not necessarily have to accept it. This is a very important consideration because the responsibility for the spending of money should rest to the greatest possible extent with the local representatives. To that extent no reduction in their powers should be permitted by its dilution by giving to the advisory boards anything other than the right to make recommendations with no power whatsoever to see that those recommendations are carried out.

The control of the Central Mental Hospital in Dundrum leaves the Minister for Health and goes to the eastern regional board. Does the Minister indicate to the eastern regional board what specific function he has in relation to the Central Mental Hospital or does the eastern regional board decide that for itself? What happens to the present inmates of the Central Mental Hospital?

On behalf of the Labour Party I welcome the creation of these regional boards. It is most important that the Dáil should have an opportunity of discussing the proposed procedures fully because, while I know it is a very delicate change, the transition of the voluntary organisations and the voluntary hospitals into the local authority system has taken place over the past 30 or 40 years and, in recent years, has been greatly expedited by the fact that practically all the money going to these places is public money. The old system of appointments to the voluntary hospitals should be overhauled and brought up to the level which we all accept for the making of appointments to local authorities.

I hope the Minister will give careful consideration to this matter and bear in mind that the taxpayer or the ratepayer will expect to have certain rights in relation to the ordering and running of these institutions. The voluntary hospitals have rights because they established these institutions in the first place, and provided this service efficiently over the years but, just as the member of the local authority or the country council must accept a certain loss of power and loss of authority in his area, similarly we can expect the same kind of co-operation from the various voluntary hospitals and voluntary health groups who will in the future be helping us to run the local authority services and who will expect to be paid by the local authority for the running of these services.

Mr. Ryan

I am sure the Minister will recall that when the Bill was being discussed in the House, he pleaded with us again and again not to pursue certain lines of discussion because we would have an opportunity later for a full debate on the matters then being discussed. The Minister will understand, therefore, our disappointment this morning on seeing him intervene while Deputy Barry was speaking with the suggestion that we should not have the full discussion which the Minister had promised again and again we would have when the regulations came before the House. While Deputy Dr. Browne was speaking the Minister again assured him that he need not pursue the matter now because we would have an opportunity later for a full discussion. I would ask the Minister to note the contradiction which appears to arise in the assurances which he has given about a fuller discussion later on when, now that we have the first opportunity for a fuller discussion, the Minister seeks to limit the scope of the debate.

In his opening statement the Minister referred to the fact that on his own initiative he had some consultation with some Deputies from the eastern region. The first of these was, unfortunately, called at very limited notice of only three-quarters of an hour and it was impossible for several people who would like to go to avail of such an invitation. I should like to assure the Minister that my absence from the subsequent meeting was not due to any sense of umbrage but apparently there was some failure in communication and I was out of the country at a Council of Europe meeting dealing with drug addiction when the Minister's subsequent meeting took place. I gather that the attendance from my party was small but, apparently, there was some difficulty in communications and I should like to assure the Minister that we intended no offence. We did and do appreciate very much the fact that he extended the courtesy to us of discussing the problem of the eastern region.

The Minister has had to exercise the judgment of Solomon in the distribution of appointments on the new health boards. The Minister will recall that when Solomon pronounced his famous judgment the rightful mother of the child was very displeased and the wrongful claimant was very pleased. This morning I feel that people with the right approach to this matter will fault the Minister's judgment while those with the wrong approach may consider him to be right. The Minister has given representation to the medical profession and the nursing profession and one does not criticise him for doing so. Although he did yield in the course of the debate on the Bill to give a majority to local authority representatives, he has given them a simple majority of one.

Members of local authorities have no right to be on these or any other bodies except in so far as they represent the people who pay the rates and taxes and are entitled to the services. Health services are intended to benefit human beings and they are entitled to adequate representation. It is not a question of satisfying the personal pride of people who have been elected by the people to represent them on local authorities. The status of the people has been downgraded in these new health boards. They are not being given adequate representation and this will result in two shortcomings, one, that the essential personal nature of health services will be overlooked and two, inadequate attention will be given to the provision of health services in the home. The domiciliary end of health services which should be the growing one and the one to receive most attention is likely to be overlooked when our health services are to be supervised by boards which, to a large extent, will draw their membership from people who are concerned with the administration of institutions rather than with the end product of medical services in the homes of hundreds or thousands of people.

In particular we must regard the Eastern Health Board as too big. It has been established by research work abroad that the optimum population for a health region should be 250,000 people. Yet the Minister proposes in his draft regulations to have an Eastern Health Board which, according to the 1966 census, will provide for a population of 921,000, a population which on all the indications before the next census will have reached 979,000 and within a matter of the next five or six years will have gone in excess of the one million mark. The Eastern Health Board has a region of responsibility which is four times greater in population than research workers and enlightened experience elsewhere would regard as desirable. This we consider to be a grave mistake.

Not only has it within its own immediate area or it will have within that area over one million people in the immediate future but it also has the preponderance of hospitals in the country and it draws its patients from all parts of the 32 Counties. So that the responsibility of this health board will be not only for the provision of services for its own one million within its own confines but it will also be to ensure that hospital and other services are maintained in the best condition and run most efficiently to cater for probably 1½ million people who will resort to it from time to time. Therefore, we regret the Minister has not seen the wisdom of dividing the Eastern Health Board region at least in two.

We appreciate that to divide the hospital services, for instance in Dublin city, might not be the best way of providing for the administration of these hospitals but to have two separate health boards within the area of the proposed Eastern Health Board would not deprive either of the opportunity of sending patients from one half of the board area to another. As the Minister has correctly pointed out, the fact that Carlow is to go into the south-eastern health region is no reason why patients from north Carlow would not be sent to Dublin. He expects that will necessarily occur. There certainly would have been every opportunity for ample mobility of patients within the two half-regions of the Eastern Health Board if the Minister had only divided it but he has now created a monster of a health board which is far removed from that which we understood was intended when the Health Bill was being brought into operation. On the Minister's own admission it is nearly four times greater than what he considers to be the suitable figure to attain. We believe he has done a grave disservice to the people who live in Dublin and the adjoining counties of Kildare and Wicklow in creating this giant which, we believe, will not provide the personal services which are very necessary if our health services are to be helpful and meaningful. The new area in the eastern region appears to be trimmed to suit administrative convenience only. It is certainly not suited to the need of the people who live in the east of the country.

The draft regulations provide that the people of Dublin city whose population now exceeds 650,000 shall be represented by only seven representatives. Out of a total population of 921,000 two-thirds of it will have only seven representatives and the adjoining areas with a population only one-third that of Dublin are to have in all 12 representatives. This is not equitable particularly when the financial contribution of the area containing two-thirds of the population is nearly four times that of the remainder. Appreciating all the Minister has said about the difficulty of giving proportionate representation and appreciating that some disadvantage might have to be suffered by the area with the greatest density of population, we consider that the Minister has erred very much against the people of Dublin.

At present the functions of the Right Honourable the Lord Mayor, aldermen and burgesses of Dublin are discharged by a commissioner appointed by the Minister for Local Government. I would ask the Minister to confirm if we are right in interpreting the new Health Act to mean that the commistioner would have power to appoint seven persons to the new Eastern Health Board to represent the Dublin Corporation. The Act provides that in the appointment of members of health boards local authorities may form groups and that groups may nominate members of the local authority for membership of a health board. The Act goes on to say that other persons may be appointed by a local authority by operating the majority system of voting amongst those local authorities who do not form groups for the purpose of making nominations. This would appear to entitle the commissioner to appoint seven persons to the new Eastern Health Board. If we are right in this we would urge that such appointments be made.

Mr. Childers

It may help the Deputy and may also relieve the minds of other Deputies from Dublin if I say I have got agreement from the Minister for Local Government that he will make arrangements under his powers to appoint seven people, and, of course, they will have to be politically on a fair and representative basis. One of the ways of doing it is actually to appoint Deputies. Anyway the Deputy can be assured the Minister for Local Government has agreed that in respect of the Eastern Health Board he will have the power under the relevant Act to appoint some persons to represent Dublin Corporation, and I can assure the House it will be done on a fair and equitable basis from the point of view of the interests concerned.

Mr. Ryan

This is good news and, subject to seeing the Minister's nominees, we welcome this gesture. If a new regional health board is to be successful at all it must have full representation from the very beginning, and it is only proper that those who are in communication with the people in the area through their political activities should have full representation on this board. In making the choice the Minister for Local Government should be guided by the experience of the past and he might, perhaps, consider appointing TDs and TCs who have had experience of the old Dublin Health Authority. There are many TDs and councillors from all parties who have served loyally on the Dublin Health Authority and on the old board of health before that, and I believe they have a great deal to contribute.

As the Minister knows, the commissioner has been unable to devote sufficient time to the workings of the existing Dublin Health Authority which has a smaller area and is a smaller responsibility than that which it is proposed to entrust to the Eastern Health Board. As a result, several members of the presently defunct city council have been invited back to play their part as members of visiting committees. In fact, most of those who were so invited have accepted the appointments and are working. This is a fair indication of the fact that there are in Ireland many people who are prepared to assist the community even though they do not get the recognition of status or the right to wear robes or adopt the other trappings of office in relation to those duties. I would, therefore, renew my appreciation of the fact that it is proposed to appoint to the new regional health board people who will represent the citizens of Dublin. However, I emphasise again they should be people who have served in the past because they will bring the best knowledge to bear on the work for the future and they are in the best position to be of assistance.

I should like to mention briefly the problems which will arise for staffs of the various local authorities. I know the Act provides that no employees may have their conditions of service in any way worsened by reason of the establishment of new health boards, but it does seem to me that a problem will arise for employees of existing health authorities who find themselves transferred to these new super bodies which will have areas of greater extent than local authorities have at the present time. For instance, you could have an employee of the Wexford County Council, who at the moment is liable for transfer only within the borders of Wexford, on the creation of the new south-eastern region, being required to transfer to Waterford, Carlow, Kilkenny, Tipperary (South Riding). There are many who, apart from being direct employees of the local authorities, have appointments in hospitals and have built their homes and their families have set down their roots in particular communities.

Mr. Childers

We went through that in detail on the Bill, and I gave an assurance in that respect. It does not arise on these regulations.

Mr. Ryan

With respect, I say it does arise to this extent. We could argue that all these areas which the Minister is proposing be halved in size in order to lessen the difficulty which could arise by reason of the transfer. Therefore, it is very proper that we should on these draft regulations mention this problem. It is an argument against having bodies which are too big, because, as I mentioned earlier, they have medical disadvantages, social disadvantages and also disadvantages for the staff. We ought to be concerned in the drafting of these regulations to try to reduce these disadvantages, and that was the purport of my remarks.

In the course of the debate on the Bill several Members urged that industrial democracy should operate in the formation of these new health boards, and the argument from many sides of the House was that representation should be given on the new health boards to the non-medical staffs of local authorities. We notice that no representation has been given to these people in appointments which the Minister is proposing to make. It will be open to the Minister, apparently, to select some non-medical person for appointment under the three which he has reserved to himself. We would urge him to do so. It is a pity, however, he has not made arrangements within the regulations themselves to ensure that such representation will be given.

We appreciate that the Minister has a difficult task and that he did his best according to his lights. I have no doubt that were each Member of this House to be given the task each would probably come up with some different choice. It is only in the light of experience that we shall know who is right and who is wrong. One can only hope that wisdom will prevail and that such changes as will be necessary will be made from time to time.

Mr. Clinton

The motion before the House asking that the Health Board Regulations, 1970, be approved arises from the Health Act, 1970, which, as the Minister said, was discussed at considerable length in this House. Many of us took part in those discussions, some of which were quite detailed. We on this side of the House had fundamental objections to that legislation, but that time has gone and the Act is now passed. What we are being asked to do here this morning is to approve of the first move, as we may describe it, in the implementation of the provisions of that Act.

The Minister said that we did not find him unreasonable in the course of the discussions. That is quite true. Unlike any of his colleagues in the Cabinet he came quite a part of the way to meet the views of the Opposition. My opinion is that the legislation has been improved very much because of his attitude and because of the helpful attitude and desire of everybody to get the best possible health services under the circumstances. The Minister referred also to the consultations which have taken place since the Act was passed and, like Deputy Ryan, I want to express my regret in relation to the eastern region that I was not in on these discussions. I do not hold the Minister responsible for that. Something went wrong in the arranging of these meetings and while there were two attempts to do it it was badly done in the finish and some of us who would have liked very much to have been present were not present. Certain compromises have been made, as the Minister said, and these compromises have gone at least some way to meet the objections of the various local authorities in relation to representation and so on.

Deputy Ryan referred to the enormous size of the eastern regional board. This is something we discussed at considerable length but it is no harm to justify again the increase of one in Dublin county and in the Dublin region generally. At the moment the Dublin Health Authority cater for one-quarter of the population and with the added two counties the eastern region will be catering for approximately one-third of the population and it will have approximately 31 per cent of the total budget. When one has regard to the fact that for the Dublin Health Authority the present budget is approximately £14½ milion one gets some idea of the enormous responsibility that is now thrown on to the eastern regional board. I can understand the Minister's great difficulty in acceding to the request of Carlow County Council. They wanted to adhere to the Dublin region. Because of the already enormous size of the Dublin region it was felt that it was already too big. I quoted the advice I got from an American expert who at that time said that the optimum number in a group that should be catered for for health services was 250,000.

We have arrangements well under way in Dublin county alone to provide probably within ten or 15 years for populations in three areas each of which will have a bigger population than Cork. The Minister said that if it was found that the representation is not right for the various areas this can be increased. Can this be increased by ministerial regulation or will it require legislation to make these very necessary adjustments?

Mr. Childers

Regulations can be brought before the House for changing the character of the boards.

Mr. Clinton

That makes it easier because if we had to have fresh legislation we would be having it much sooner than anyone of us would like.

One consolation for many areas is the fact that they can continue to get institutional services on an agency basis regardless of the regions being set up by the Minister. How flexible is that or how favourably will it be regarded? Is it the general intention that as far as possible the institutional services required will be confined to the region in question? Will it be frowned upon if there is a bit too much crossing the border for institutional services on the part of any area?

Mr. Childers

I would expect the position to be more or less as it is at the moment and then the regional hospital boards will naturally be making a survey of what the future should be.

Mr. Clinton

Reference was made in the memorandum circulated by the Minister to the Hospitals Commission. Deputy Dr. Browne asked what would happen to the commission and how would the transfers take place and the Minister said that these people would be transferred and that their position would be guaranteed in the hospital boards. Will all the members of the Hospital Commission have to go before the LAC as the CEO of the Dublin Health Authority is required to do? Indeed, I think the closing date is today. The Minister says that he has not got around to considering all the details, that this is the first move, and that this will come in time. I am sure the Minister has his mind made up already and if it is required that the chief executive officer of the Dublin Health Authority must go before the LAC in fairness there should be the same requirement for people at present employed in the Hospitals Commission.

To go back again to the figures for the various representations. I remember when arguing for an increase in the representation for Dublin county I pointed out that the midland region had a population of 178,000 people and had a membership of 12. At that time it was proposed to give Dublin county three representatives for a population of 174,000. That has since been increased to four but it is still, even ignoring the enormous growth of the area, very much below what one would regard as a proper representation for the area. I can see the Minister's difficulties are great. One difficulty is the already very large size of the board. Of course all of us have had experience of working on these boards and rarely do we have anything like a full attendance. I was pleased to hear the Minister tell the House that it is now possible to have Dublin Corporation represented on the board from the beginning. As Deputy Ryan said, it is no harm to draw the Minister's attention to the fact that before the council was abolished the members of the health authority were selected in accordance with political strengths in the corporation and regard should be had to this when the appointments are being made from the corporation. They cannot be made in the way they are being made in every other local authority.

The Minister when moving this motion gave the type of advice with which all of us on this side of the House would very readily agree. We have the legislation now, whether we agree with it or not. Of course, there is an immense amount to be said for the regionalisation of the institutional services. Large boards will now be set up comprising persons from a variety of local authority areas. They will represent many different people, for instance, the nursing services, and various sections. It is the duty of everybody serving on these boards to regard their responsibility as being collective responsibility for the entire area. There is a natural tendency to have a parochial outlook and to misplace loyalties. I agree with the Minister that people should forget they represent a particular section or area and, instead, should have regard to the overall improvement of the health services in the entire region. This is extremely important and I hope it will work in this way.

There is also the question of the speed with which these boards will be set up and the time scheduled for putting into operation the new legislation. Deputy Dr. Browne referred to the slowness in making appointments through the various means and asked the Minister if anything could be done to expedite the procedure so that the legislation could be put into operation as quickly as possible. Perhaps he was expressing the sentiments of all of us in this matter. Certainly, the Minister cannot be held responsible for any delay in the implementation of the legislation. Neither can Members of the House be held responsible because there was not any undue delay in the passage of the Bill through the House. We can only wish it well in the future.

Mr. Treacy

It is right and proper that we should have a full and frank discussion on this important matter concerning the radical changes that are about to take place in the health services with particular reference to the establishment of health boards. We cannot fault the Minister or his Department in respect of the amount of information available. Information has been readily forthcoming from them in this regard. This is to be welcomed because the changes that are envisaged are a matter of great concern for all our people.

It is anticipated, I understand, that the majority if not all of the changes provided for in the legislation will be implemented by April of next year. Therefore, there is not much time left for us to bring home to the Minister and his Department the kind of changes that we desire in this regard. We welcome many of the changes in the main and that is why we support the Minister today and assist him as best we can to get the motion through the Dáil as speedily as possible.

We are primarily concerned in these draft regulations with representation on the health boards. It is to be observed that the number of public representatives has been kept to a minimum. We appreciate the Minister's difficulty that to increase the numbers from any given local authority might cause reaction from other authorities, or stalemate, but we should not allow a situation to develop where the existing county council or health authorities and the public they represent might consider themselves to be too far removed from participation in the affairs of the boards.

We must consider the close relationship that has existed between county councils and health authorities and the hospitals and health services which they provided in the past. One can readily imagine the radical changes involved in separating these county councils from the future health services pertaining to the people they represent. We all owe a deep debt of gratitude to public representatives, public officials and managers of health authorities for their dedication to duty and, in particular, for their contributions towards improving the hospital services in their respective areas. We must appreciate the amount of energy, time and money that was expended in transforming an archaic and outmoded health service and in bringing institutions into line with modern standards. We must not forget the part played by these county councils and all who were involved in that transformation.

Those of us who serve on public bodies have witnessed the change from the old workhouse, the old barracks or county home which we inherited from the British regime to modern buildings where our people are cared for in sickness and in health and where excellent standards are maintained.

The most important feature of these local institutions is the friendly atmosphere and the individual attention provided in an environment where people can feel they are amongst friends. This will go to a large extent in the creation of the health boards. Those of us who are members of local authorities are about to witness the loss of autonomy and control of our local hospitals and health institutions generally. These powers are being ceded to a larger autonomous body that will comprise a conglomeration of counties. In the process, it is fair to suggest that much of the intimate relationship and personal attention that we lavished on our local institutions will probably be lost for ever. While it may not be relevant on this motion, there is concern about the future of these hospital services and the health services generally when they are transferred to the larger health bodies.

Mr. Childers

The future of the health services was dealt with at length on the Health Bill.

Mr. Treacy

It is a matter for the Chair to intervene as to whether a Deputy is in order and the Minister has no right to intervene in such a manner.

Mr. Childers

On a point of order, then.

Mr. Treacy

I do not intend to deal with the matter at any length but it is only fair——

An Leas-Cheann Comhairle

The Deputy will appreciate that we are dealing with the composition of the boards that are being set up. This is the matter before the House.

Mr. Treacy

I was making a comparison between the composition of these boards about which we are now talking and the boards which had responsibility for our health services up to now. It is a fair comparison to make without going into detail. It is difficult to see what effective "say" representatives from county council areas would have on the larger boards. In my own south-eastern region there will be three members on the board out of a total of 31. It is difficult to understand how those three representatives from South Tipperary can have an effective voice in maintaining a particular standpoint for, say, the retention of a hospital or an effective say in the future use of the services in the area or anything else. They can clearly be outvoted by the members from the other counties combined with the representatives from the various professions in the health services, doctors, dentists, pharmacists, nurses et cetera. I would, therefore, ask the Minister if he would elaborate on what he considers to be the functions of the local health committees. We would like to maintain the closest possible liaison between the existing public representatives, the local health committee and the health boards we are now proposing to establish. What functions will those local boards have? Will they have any effective say in determining who will be granted medical cards?

Mr. Childers

I dealt with that in detail before. I elaborated on this in reply to questions.

An Leas-Cheann Comhairle

This does not arise. It is completely out of order to relate those other boards with the boards now about to be established.

Mr. Treacy

I thought it was relevant to relate the functions of the health boards to the boards proper. However, the Minister seems to be in an aggravated mood today and does not feel I should refer to them.

Mr. Childers

I gave great amplification on this.

Mr. Treacy

We would wish to ensure that the staff of our present health authorities are safeguarded in the transfers which are about to take place. Are those staffs likely to become redundant and, if so, what is to become of them? Can they expect preference in respect of the new appointments which will be created? Much controversy will centre on the location of the headquarters of the health boards.

An Leas-Cheann Comhairle

Again, the Chair would point out to the Deputy that the draft regulations are solely concerned with the setting up of the boards and with the membership of the boards. There will be other regulations at a future stage dealing with those other matters. The present regulations are confined to the setting up of those boards.

Mr. Childers

I dealt with the health boards and staffs during the debate on the Health Act.

Mr. Treacy

I appreciate the Chair's ruling but it would be a pity if any attempt were made to frustrate or inhibit public representatives from eliciting further information or, indeed, broadening the scope of the debate to some extent. I am sure the Minister would wish for the co-operation and understanding of all of us in public life in bringing about this transformation with the least possible disruption or anxiety on the part of all concerned. If the debate is to be restricted very considerably people may well get the wrong impression. There is a lot at stake in this. The health of our people and the services which we are to provide for them in the future are involved. The role played by all of us in public life with regard to those health boards will have a great bearing on the matter.

An Leas-Cheann Comhairle

The Chair is not inhibiting the Deputy in the matter before the House. The only matter before the House is the draft regulations dealing with the setting up of those boards and the membership of them.

Mr. Treacy

The Minister's remarks in respect of the south-eastern region are rather brief. He mentioned the difficulties experienced by Carlow County Council which felt it should be merged with the south-eastern region. He has been careful to avoid the pertinent points put to him at the meeting of the public representatives in those various county councils. I do not know if it is prudent to go into that matter here. Perhaps we will get another opportunity of dealing with it. I express the hope, therefore, that in the establishment of those boards the utmost liaison will be maintained and that it will be seen that the representatives, however small in number, will have an effective say on those larger bodies in maintaining and improving the health services for the people of our respective areas. That is as much as one can hope to say on a restrictive measure of this kind.

Mr. H.P. Dockrell

I do not propose to speak at very great length on the regulations. The Minister in drafting the regulations has been obsessed to ensure that the boards would not be too large and as a result the various local authorities are under-represented. If I talk about Dún Laoghaire Corporation having only two members to be appointed to this the Minister will reply that that was agreed to by Dún Laoghaire Corporation. I know Dún Laoghaire Corporation did, in fact, agree to two but I did not agree with that. I thought it should be more. I do not want to take the Minister on a tour of Dún Laoghaire but I must point out that it is almost impossible for the two Dún Laoghaire representatives to be available to all the people in the area.

The function of the representatives on this board is to be available to the people as they should be. I do not want to talk about the increased bus fares and so forth the people will have to meet in order to get to their public representatives in Dún Laoghaire. With four for the county Dublin is under-represented. It is impossible so to site the four County Dublin representatives that they will be available to the people.

I was glad to hear the Minister say that the representation can be increased in the future by an amendment of the regulations. As has already been pointed out by Deputy Clinton, there will be a large increase in the population of County Dublin in the next few years. In regard to the Dublin city representation of seven, certain ex-members of the Dublin Health Authority have come back to the authority and are at present on sub-committees of that authority. Those representatives should be the persons whom the Minister will appoint as the Dublin Corporation representatives. Reference was made during this debate to the chief executive officer of the Dublin Health Authority. It was said that he would have to go before the Local Appointments Commission. There was an inquiry as to the position regarding persons employed by the Hospitals Commission. I agree that the Minister should not make fish of one and flesh of another and I feel that the employees of the Hospitals Commission should also go before the Local Appointments Commission.

Mr. Childers

That does not arise on these regulations. I dealt with it on the Bill.

Mr. H.P. Dockrell

Yesterday I had the pleasure of meeting a number of Swedish doctors and public representatives. Apparently in Sweden social welfare and health are divorced. One of their problems in Sweden at the moment is to bring them together. I feel that under these regulations the Minister is tending to destroy any liaison which there is between health and social welfare.

Reference was also made to employees of various health authorities being taken over by the new bodies. I want to impress on the Minister that those employees should be at least as well provided for as they are at present. They should not be moved from where they have bought houses and settled down unless it is absolutely necessary.

Mr. Childers

I dealt with that fully on the Bill.

Mr. H.P. Dockrell

I do not agree with the overall position in these regulations whereby the public representatives have only a bare majority of one over the medical representation. The medical and other representatives will be representatives without taxation. While I know the Minister can say that public representatives are not being taxed directly they at least have to meet the ratepayers once every five years and give an account of what they have done and how they have spent the local authority's money. The medical representatives would never have to do that. That is possibly a retrograde step especially in view of the fact that the representation for the medical profession and others is so high compared with the local authority representation. These are the few matters I should like to bring to the attention of the Minister.

Dr. O'Donovan

I have a serious matter which I want to direct to the Minister's attention. This matter is germane to the regulations. I appeal to the Minister in this matter. Firstly, I want to thank the Minister. It is only fair that this view should be expressed in the House. I do not think any piece of legislation has ever been more thoroughly documented in this House. Everyone appreciates the way the Minister worked on the Bill before Christmas. The Minister seems to think we are taking a long time to discuss these regulations. We are not; I think we will have them today and that is not too bad.

I will not go as far as my colleagues in the two parties who have said that the local authorities' representatives are being badly treated. That is not so. They are in a majority of one in every one of these boards, so far as I can see. All they have to do is attend and, if there is a serious matter which they feel vitally affects their people, I do not think the representatives of, say, County Kerry—since that county has not been mentioned—would have any difficulty in persuading the representatives of, say, County Cork to join in with them.

I hope the city commissioner who will have a share in appointing the representatives of the abstract figures of the Lord Mayor and Burgesses of Dublin will appoint people who are already on the health board here. I will make only a brief reference to this matter but I think that in the case of the city of Dublin there is something seriously wrong when one finds that only 15 per cent of the people have medical cards, and in the county of Dublin only 8 per cent of the people have these cards, as against 40 per cent of the people in County Limerick who have them. County Limerick is being subsidised to the tune of £25 million or £30 million for the dairying industry. That is all I want to say about it, but there is something seriously wrong.

I want to put a serious idea to the Minister about a matter which I raised on the Bill and on which the Minister made me a promise. I take it that the Minister did not fulfil this promise for good reasons, but he did not even mention it. I appeal to the Minister, when appointing his three representatives on each of these boards, to appoint one person from among the ordinary working staffs of some hospitals or some part of the institutions in each of these areas. The Minister clearly misunderstood what I had in mind in view of what he read out in his brief about it. I was not thinking of the conditions of employment of these people. I was thinking of the kind of contribution that can be made by the most ordinary man on an occasion like this. It has been said correctly "To the people is given judgment". One can get as good a piece of judgment, and often better, from an ambulance driver than from a highly qualified surgeon and it is judgment that will be involved here.

The Minister appoints three persons. The Minister did not mention this in the Seanad. I trust he considered it, since he promised me he would, but I again appeal to him to appoint one of these people. There are thousands of ordinary workers employed in these services and everybody else gets representation. In spite of all the talk we have heard this morning from people who are on county councils about the county councils not being adequately represented I want to be honest—it behoves politicians to be honest on occasions—and say that there is majority representation for the local authorities on each of these boards.

Mr. T.J. Fitzpatrick

(Cavan): Only just.

Dr. O'Donovan

I take the point, but it is there and on a serious matter there is no question but that they will vote together and will, therefore, be able to carry any matter.

The Minister will have no difficulty in finding a suitable person. I appeal to him to appoint one of these people. We all know that one of the most distinguished Ministers we ever had in this House was Deputy Tim Murphy, who was Minister for Local Government. He was a postman early in life. If anybody suggests to me that such people are not often very much better than specialists, I will not accept it from him. Therefore, I make this appeal to the Minister. I am not interested in the conditions of employment of ambulance drivers or people who sweep the wards in this matter, how much a week they are paid. I am concerned that when every other kind of person is being represented on these boards they should be represented by at least one person.

The answer I got from the Minister on the Bill was that this would be broadening the boards. Some of these boards have 32, 33 and even 35 members. They are probably too big already from an administrative point of view, and that is a defect, but one extra person will make no difference. I want to make a genuine appeal to the Minister to put one person on each of these boards who can speak for the ordinary workers in the services.

Mr. Hogan

I do not agree with the arguments put up by the last speaker. I submit that the medical representation on these boards is there for a specific purpose. They are not there in a trade union capacity; they are there in an advisory capacity. Our hospital services, as developed over the last 20 or 30 years, are deplorable. They would be the laugh of any administrative body in the world if they were examined. This is not the time to go into that subject but, if the Deputy wishes to cast his mind back—and I will discuss this with him at any time —to how things have developed here and looks at the situation at which we have now arrived, which is partly historical but also due to our own mismanagement, he will see that it has derived in great measure from the fact that we did not have proper medical advice. This is the first attempt that has been made to secure this advice. I do not want to be misrepresented here. We did not have that medical advice in the Department of Local Government or in the Department of Health or indeed we did not pay sufficient salaries to secure the standard of service in our Departments to get proper advice.

Dr. O'Donovan

Too many temporaries.

Mr. Hogan

The Deputy has pleaded for the ordinary man. We have in every county council 22, 23, 24, 25, or 26 ordinary men who have operated our county council services for a number of years, and we see what that ordinary man's advice has given us. The result has been a hotch-potch hospital service which we are now trying to put into order; and it will cost a huge amount of money and many years of endeavour to bring some order out of the chaos.

The criticism I have to make of this regulation is not of the regulation per se. We accept the principle of specialisation. We must accept that in a modern world, or else go into the backwaters altogether. Therefore, we must accept a measure of decentralisation or regionalisation. One cannot bring a specialised service to every crossroads; all one can do is bring every crossroads to a specialised service. The essential thinking behind the Bill and on which these regulations are drafted is to achieve that purpose, and we, on this side of the House, accept that in principle.

However, these regulations are being introduced in a piecemeal fashion. With all due respect to the Minister, I feel he should have tried to avoid that because we are inhibited a little bit in getting a global picture of how he intends to proceed. He has not disclosed everything he has at the back of his mind. Even in regard to these simple regulations he says that the non-elected members will be in the first instance appointed on an informal basis and later on appointed on a more formal basis based on regulations. This is a small matter. I do not see why these regulations should have been left to be dealt with later, with, perhaps, another discussion here. The Minister has already submitted that there will be five or six doctors, a chemist, a pharmacist, general nurses, psychiatric nurses and so on on a board. That is the general format of the non-elected members on these health boards.

Dr. O'Donovan

Some are more equal than others.

Mr. Hogan

I am not suggesting that there is any ulterior motive but I do not know why he has deferred this.

I have another criticism which is not so much a criticism of the regulations as of the Bill. These regulations will dilute local authority but there is no evidence in these regulations or in the parent Bill that there will be any dilution of the local demand made upon the taxpayers.

Mr. Childers

Is that on the Bill?

An Ceann Comhairle

That matter has been dealt with already. It does not arise.

Mr. Hogan

The Minister has dealt with financial aspects of the Bill but he has not mentioned any dilution of local demands beyond the two shillings he spoke about some months ago.

Mr. Childers

I even gave a picture of the eight boards so that the House knew at the time roughly how many boards there would be. I gave an exact description of the financial arrangements.

Mr. Hogan

Does the Minister not agree there will be a dilution of local authority power on these boards?

Mr. Childers

I dealt in full with that on the Health Bill.

Mr. Hogan

The point I am making is that there will be a dilution of local authority power on these new boards but there is no corresponding reduction in local taxation. I believe there should be a parallel between local representation and the local demand. If there is going to be a centralisation of authority, there should also be a centralisation of payment. If the Government want to regionalise or centralise health administration they must be prepared to make increasing subventions from the Exchequer to meet these payments. That is only justice and commonsense. That is my second criticism of these regulations but, as I said at the beginning, it is more a criticism of the parent Bill itself than the regulations.

My third criticsm is on the question of piecemeal regulations. A Deputy from the Labour Party thanked the Minister for being very informative. As far as the Act is concerned, that is so; but he is strangely coy about the hospital board regulations which he is going to introduce later. It seems to me that, while he is going to great lengths to meet local sentiments in respect of these regional boards and has conceded that the majority of one would be allowed to local elected representatives——

Mr. Childers

It varies from one to three.

Mr. Hogan

——we do not know exactly how these hospital boards are going to evolve because we do not have before us the regulations dealing with them. I understand the hospital boards will be less democratically constituted.

Mr. Childers

I have made it clear that this was going to come before the House at a later stage. We could actually go ahead with the regional health boards, which could operate on their own, and we would never appoint regional hospital boards or Comhairle na nOspidéal. These are additional bodies which will be considered in the autumn.

An Ceann Comhairle

We cannot discuss the question of hospital boards on this measure.

Sir Anthony Esmonde

Surely one must be complementary to the other?

An Ceann Comhairle

The Minister has pointed out that there will be a debate on this matter in due course.

Sir Anthony Esmonde

With respect, I submit that there must be some association between the health boards and the hospital boards. Surely it is in order to discuss them en passant or are we to confine ourselves entirely to the health boards—I know that is the Minister's wish? The Minister has told us he is going to bring in other regulations but as we are discussing the health boards which, after all, are the parent boards, surely it is in order to mention the others and try to find out what is in the Minister's mind?

An Ceann Comhairle

The motion before the House does not relate to these special hospital bodies.

Mr. Childers

I have given a general picture of the regional hospital boards and Comhairle na nOspidéal. I said there were to be eight health boards and the House knows that. If Deputies look up the reference they will find sufficient information about the regional hospital boards and Comhairle na nOspidéal to enable them to deal with these regulations. There will be a further debate on it later.

Sir Anthony Esmonde

As the hospital boards operate in an advisory capacity to the health boards, they must have some connection with each other.

Mr. T.J. Fitzpatrick

(Cavan): This committee type of debate is delaying the passing of the regulations.

Sir Anthony Esmonde

That may be so, but there is no reason why the Minister should intervene every five minutes.

An Ceann Comhairle

We are dealing with the establishment of the new health boards and a debate will be held at a later stage on the question of the special hospital bodies.

Mr. Hogan

The criticism I am making is that the Minister has not seen fit to present these regulations simultaneously with the regional hospital board regulations. There must be some correlation between them. They cannot be put in separate watertight compartments. We cannot adequately discuss these regulations without having some idea what the hospital board regulations are, unless we are to have two watertight health compartments in the country. Health is like wealth; it is indivisible. We cannot discuss the regulations dealing with the health boards without discussing the regulations dealing with the hospital boards.

Mr. Childers

Paragraphs 26 to 39, inclusive, of the White Paper give the general background of the regional hospital board construction and the general functions of Comhairle na nOspidéal. I have repeated in this White Paper all I said in the Dáil so that when Deputies are considering the constitution of the health boards they should not be in the dark. In fact, Deputies have as much general information as I can possibly give about these other boards. The resolutions in relation to the functions and set-up of these boards will come before the House in November.

Sir Anthony Esmonde

Are we not allowed to discuss it?

An Ceann Comhairle

There is nothing before the House on these lines. We cannot discuss regulations which are not before the House.

Sir Anthony Esmonde

The Minister talked about it in his opening speech.

An Ceann Comhairle

The Minister informed the House that it would have an opportunity of discussing these regulations in November.

Mr. Hogan

I should like to know what has prevented the Minister from presenting these regulations today if he has all that background information.

Mr. Childers

It was quite impossible to do it. I had to consult with too many people.

Mr. Hogan

The Minister had to consult with the hospital authorities, the teaching bodies and the universities, but there has been ample time for these discussions. I realise they are of a more important nature than the discussions which took place with local authorities, but the Minister has had ample time to have these discussions carried out and present us with a comprehensive picture.

Mr. Childers

I cannot be ten people.

Mr. Hogan

We do not know what the functions of the health board will be as regards the hospital boards.

Mr. Childers

The general functions of the regional hospital boards are clearly indicated in the White Paper. They were indicated in the House as well during the Health Bill.

Mr. Hogan

It seems to me that there is the possibility of an overlap of functions here. What are the functions of the regional hospital boards vis-à-vis the local hospitals?

An Ceann Comhairle

We cannot go on to discuss a matter which is not before the House and is not included in this motion.

Mr. Childers

Paragraphs 31 and 32 of the White Paper give the functions of the hospital boards.

Mr. Hogan

We do not know, for instance, in respect of the hospital boards, how they will be elected. All we suspect is that they will be less democratically elected than the regional boards.

Mr. Childers

The proposed election of the regional boards is referred to in paragraph 27 of the White Paper.

Sir Anthony Esmonde

This is a most unusual debate. Whenever anybody tries to say something the Minister reacts with wild indignation.

Mr. Childers

I have already gone into great detail on this matter. I was enormously patient with the House on the Health Bill. I listened and gave endless information and I am quite right to resent the fact that somebody gets up in the Dáil at this stage and says there is no indication on the proposed election of the members of the regional hospital boards when an approximate concept of this is given in paragraph 27.

Mr. Hogan

White Papers and regulations that come before this House are two different matters. The White Paper is a relatively informal document and is entirely different from what is written into legislation and regulations and the Minister is perfectly aware of this fact.

As regards the administrative areas, the brief from the Minister is quite limited. He deals with the design of local board areas and also with that very sensitive area at present: collective responsibility. I do not know that existing geographical areas and various functional units have ever been uniform or coterminous. The Minister mentioned that he has been thinking on the lines of local government and Bord Fáilte regional areas. I do not know whether the areas he has laid down will stand the test of time. He is right to say he is leaving it flexible and that the position is not immutable. Various bodies, such as the Land Commission, Post Office and the Revenue Commissioners, devise their areas on a functional basis; and, although the Minister is adhering to county boundaries, it may evolve that in some cases he will have to depart from this practice. Our county boundaries were drawn up many years ago and they were not designed to conform with the most appropriate functional areas for health purposes. Therefore, I welcome the Minister's flexible approach and his reference to this in his speech.

For some purposes, particularly in the matter of election to the Dáil, it might be desirable to have county boundaries and constituencies coterminous, but a case could be made for a departure from county boundaries where health administration is concerned. The Minister mentioned County Carlow as an example. He could also have mentioned County Clare, which I understand goes in with the southern region. Parts of that county are within 20 miles of the university city of Galway and there are probably many areas which would be better put in with another county for administrative purposes.

I adhere to my viewpoint that we should have had hospital board regulations before us when discussing health board regulations in general because the hospital boards will ultimately become the dominant body in health administration. They will be less democratically elected and there will be an increasing centralisation of authority. While some centralisation is desirable, one must draw the line somewhere.

With increasing centralisation there will be an increase in officialdom and the principles of democratic authority and responsibility will be diluted. That is the reason I consider we should know exactly where we are going and be aware of the entire position as regards regulations. This piecemeal introduction of regulations was too smooth. The Minister got very hot under the collar on this matter. He said he had not time, that he had to consult with many bodies. The Minister may have a point here but I am also entitled to my viewpoint that we should have had these regulations submitted with the health board regulations so that we could know how far and how fast the bureaucratic approach to health administration was evolving.

Mr. Kavanagh

I want to voice the disappointment and disapproval of many people in County Wicklow at the refusal of the Minister to accept the proposal of local authority representatives in Wicklow to increase their representation from three to four members on the Eastern Health Board. I am sure representatives from County Kildare are equally disappointed at the refusal of the Minister likewise to increase their representation.

In his original proposal the Minister considered that 16 local representatives were sufficient to represent the Eastern Health Board area, and, of that number, six were from the Wicklow-Kildare area and ten from the Dublin area. I agree with the Minister that the Eastern Health Board presents the greatest problem for him. On a population basis or an area basis, it is a difficult board to administer. Undoubtedly, the bulk of the people in this area live in the city and county of Dublin and on that basis one might consider that people in Dublin city and county should have representation which would largely outweigh that of the two other counties. However, there is another side to the story and the Minister has admitted that he has taken into account not only the population but also the size of the area. Of the three counties, County Wicklow is the largest, and yet it only rates three representatives. In his original proposal the Minister decided that County Wicklow should have three representatives out of 16 but we are now being given three representatives out of a total of 19, which reduces proportionately the voice of my constituency and county on the Eastern Health Board.

The board will have 35 members. Looking at the composition of the board from the point of view of other members, medical practitioners, dentists, pharmacists and so on, it is reasonable to assume that the vast majority will live or be based in Dublin city or county. These people will have just as much say as local authority members and they will represent the city and county of Dublin, as well as their professions.

It could eventually turn out that Kildare and Wicklow would have six representatives on the Eastern Health Board whereas the city and county of Dublin would have as many as 29. I do not say this will happen, but it could be the evolution. It is unlikely that dentists, pharmacists and nurses, for instance, will elect a member from the Wicklow or Kildare areas because of the vast numbers in these professions in the Dublin area. The request by Wicklow and Kildare for an extra member on the board from both these counties was a reasonable one, remembering the number on the board and the likelihood that most of the other representatives, apart from local authority representatives, will be based in or around the city of Dublin.

Geographically, Wicklow is a difficult county to represent because of the difficulty in travelling from east to west and from north to south and those wishing to bring their problems to the notice of the health board will have difficulty from the point of view of travel. The bus services are confined to the eastern and western sides of the county. It is difficult to travel from east to west or vice versa. If the three representatives were to come from the more densely populated areas those in the west and south would have difficulty in meeting these representatives without travelling long distances from the outlying areas. There is no problem in Dublin because constituencies change with a changing population and a representative on the regional health board would not necessarily have to coincide with the constituency area. Perhaps the Minister would have another look at this and appreciate the merit of the case made for increasing representation for both Wicklow and Kildare.

Since the dissolution of the Dublin and Bray local authorities consultation with these bodies is impossible. The people in Bray have had no council since the Bill was introduced. It would be logical to have one member on the health board selected from the Bray area. There is a heavy concentration of people in Bray and, for that reason alone, I would ask the Minister to appoint an extra member for that particular area. The dissolution of the council has left problems in that the people have had no voice. Their only public representatives are the members of Wicklow County Council. The people have had no opportunity of showing how they feel about the health boards.

Again, representation is inadequate from the point of view of the number of medical card holders in Wicklow as compared with Dún Laoghaire or Dublin county. Only 7 per cent or 8 per cent of the population of Dublin are covered by medical cards whereas 30 per cent of the population of Wicklow are covered by medical cards. Almost 20,000 are covered by medical cards. They should have larger representation on the health board. As things stand, there will be only three representatives. I appeal to the Minister to have another look at the representation from the Wicklow area, bearing in mind that the board will be based in Dublin and that those constituting it will more than likely live in Dublin. I ask the Minister to increase the number from Wicklow and Kildare from three to four. That was the original suggestion.

Sir Anthony Esmonde

I accept without question the fact that the Minister has put an amount of work into this. We had a long discussion here on the Bill and the Minister issued a very informative White Paper. I do not, however, accept his attitude that we should not discuss this. This is a most important matter. We are talking about the regionalisation of health services and their implementation by regional health boards. It is unfortunate that the Minister is not prepared to listen and that he should constantly intervene to shout down those who are putting their particular points of view.

For the Minister's information, as far as the Fine Gael Party are concerned, we spent a long time yesterday in our health committee, of which I happen to be the chairman, discussing the matter and the regulations here before us this morning. It is the duty of the House to discuss these regulations, if necessary, at length. We are taking a very vital step in setting up these health boards and in regionalising health services. Everybody is entitled to express his view. It would be much better for the Minister to listen quietly instead of intervening every five minutes to explain that so-and-so is out of order.

With regard to regionalisation, by and large the division is probably a fairly sound one, but there are some criticisms I should like to make in regard to it. It would have been much better to have left Dublin on its own. Dublin is a colossus and it will swallow the others. Deputy Kavanagh made a very reasonable case and, having listened to him, I cannot help feeling that, even if the Minister were to accede to his request and give Wicklow and Kildare extra representation, that would still not give them parity with Dublin. It would have been better if the Minister had dovetailed both Kildare and Wicklow into one of the other regional boards. However, I have no doubt he has done what he has done after consultation with all concerned and on the advice of his officials.

The old principle of no taxation without representation should be adhered to. If I lived in Wicklow or Kildare, which I do not, and if I were representing either of these two counties, which I do not, I would feel that I was getting a raw deal because those whom I represented were not having a full say in the management of their own affairs. These regulations should not be the be-all and end-all. There should be flexibility. One may work hard, one may listen to arguments in a lengthy debate, and so on, but that does not mean one is always right. The purpose of Dáil Éireann is to debate and discuss. The Minister would be well advised to listen to the suggestions of Deputies about these regulations.

I am also not very clear, on the regional health board question, as to what exactly will happen. With respect, I think this is a point the Minister should fully clarify to the House for the purpose of those who will constitute, shall we say, the background or the civil service of the regional boards. In every county at present— we know a health authority which is going to be dissolved and to disappear —there are officials who are specifically dealing with health matters such as medical cards and with disability awards, which were always conducted by the Minister's Department, and many other facets of, shall we say, medical administration and politics. Let me come to my own area down Wexford way which I think is called east central. It seems to me that the administrative centre under the regional board will be based in Kilkenny. For that matter, it seems quite obvious that there must be a transfer of officials from their existing establishment into Kilkenny unless it is envisaged that these officials would be allowed to remain in their original area and travel each day and get travelling expenses, but that does not seem practical.

Mr. Childers

I dealt in detail on the Bill with what the Deputy is speaking about—the question of the transfer of staffs.

Sir Anthony Esmonde

The Minister said there would be no worsening of the conditions. That means nothing.

Mr. Childers

I would point out to the Chair that, on the Bill——

Sir Anthony Esmonde

Am I not entitled to express an opinion? I am elected a Deputy, the same as the Minister.

Mr. Childers

I ask for a direction.

An Ceann Comhairle

If the Deputy is dealing with regional hospital boards, the matter does not arise on these regulations. Even if the Minister wanted to refer to it, he also would be out of order in discussing it here.

Sir Anthony Esmonde

What else am I discussing but regional health boards?

Mr. Childers

It was dealt with on the Bill.

Sir Anthony Esmonde

I am entitled to express my opinion, and that is that. I propose to do so. I will not be dictated to by the Minister for Health. If the Minister does not like a long debate that is not my fault. It is my right to discuss regional health boards and I propose to do it. I had been mentioning officials. Officials have approached me. Surely I am entitled to cite their case here? I am not a member of the local authority and I shall not have an opportunity of doing it in the future——

Mr. Childers

I appointed a council to deal with all the matters suggested by the Deputy. It was published in the newspapers.

Sir Anthony Esmonde

The Minister would not even allow me to finish what I was going to say. I say that there are certain people who are dealing with health in County Wexford— and I am sure in County Waterford, County Carlow, and so on—and they will have to be transferred somewhere else. I want the Minister to clarify the position as to what arrangements are envisaged with regard to it.

Mr. Childers

I have dealt with this matter on the Bill.

Sir Anthony Esmonde

If you set up a regional health board and they suddenly find themselves with a lot of staff on hands and with nowhere to accommodate them, who is going to deal with that?

Mr. Childers

The Deputy will find it all in the debate on the Health Bill.

Mr. T.J. Fitzpatrick

(Cavan): I respectfully submit that, in discussing the establishment of these health boards, the duties and functions of the health boards are relevant notwithstanding the fact that they may previously have been dealt with. We are now setting up health boards. Surely we can discuss their duties, responsibilities, functions and what they are going to do? If we cannot, we might as well not be here.

Mr. Childers

That was all discussed on the Health Bill, too.

Mr. T.J. Fitzpatrick

(Cavan): The Minister seems to be obsessed with the fact that, because there was a general discussion on the Health Bill, these matters are not relevant now.

Mr. Childers

A detailed discussion.

Sir Anthony Esmonde

I might add that, since the Health Bill was discussed here at length, on the strength of that, the officials concerned, for whom I am speaking now, wrote to me and said that the Minister had stated in the debate that their conditions would not be worsened but they wanted to know their position. Surely the Minister for Health, who is the overall operating Minister, must have some overall plan? Surely I am entitled to ask him to give particulars of that plan to the House in relation to the setting-up of the regional boards? If I am not entitled to do that, I am not entitled to say anything here. I might as well leave the House. This is what Dáil Éireann is for. It is for the purpose of discussing those things. My question is very simple.

An Ceann Comhairle

The question of staff does not arise on the health boards regulations.

Sir Anthony Esmonde

What does arise?

Mr. T.J. Fitzpatrick

(Cavan): On a point of order. When I refer to the White Paper I see “A health board and its committees will act through its chief executive officer and, under him, its other officers issuing for this purpose such decisions and directions. The board will thus not have to concern itself with details of day to day administration.” Surely we are entitled to discuss that? That seems to be absolutely relevant in this debate.

Mr. Childers

It was all discussed on the Health Bill.

Mr. T.J. Fitzpatrick

(Cavan): That may very well be. I refer to paragraph 19 of the White Paper.

Mr. Childers

It covers other matters.

Sir Anthony Esmonde

Would the Chair please give me a ruling? Am I not allowed to say anything or to discuss anything in relation to the regional health boards that was discussed on the Health Bill? Will the Chair please give a ruling here? Then perhaps I shall be allowed to continue without interruption.

An Ceann Comhairle

The Deputy is entitled to refer to the Health Boards Regulations, 1970, now before the House. Anything outside that would not be in order.

Mr. T.J. Fitzpatrick

(Cavan): Might I clarify——

An Ceann Comhairle

Is Deputy Esmonde in possession or is Deputy Fitzpatrick in possession?

Mr. T.J. Fitzpatrick

(Cavan): On a point of order. Surely we are entitled to discuss what these health boards will do? We are asked here by the Minister to give him authority to establish health boards. I want a ruling from the Chair as to whether or not we are entitled to discuss what these health boards will do. I most emphatically suggest we are entitled to discuss that.

Mr. Childers

I submit that I spent eight days describing in detail what the health boards would do and the conditions of service in relation to the employees, how they would be protected, the arrangements for responsibility for staffing and conditions. Even at the time the Health Bill was going through. I gave an indication that there would be eight boards. I even published the major parts of the constitution of the boards. The only thing in this is some change in numbers of representatives of each county and the professions. Marginal changes in the numbers were made. Otherwise, everything was known even including how these health boards would be set up in the sense of their size and composition. I discussed this whole matter in the greatest detail. I gave a complete picture of the function of the health boards. The sections in the Health Act clearly indicate the functions of the health boards.

Sir Anthony Esmonde

According to the Minister's argument, if he has already given the delineation of the health boards when the Health Bill was being discussed here, we are not even allowed to discuss that. The Minister's attitude is absolutely beyond me. If I may say so with respect, I think it is a puerile attitude for a responsible Minister to adopt, for the Tánaiste, No. 2 in the Irish Government, to come in here to try to muzzle everybody who tries to express an opinion.

On the matters that the regional health boards will decide for themselves I have another query for the Minister. There have been certain recommendations with regard to the setting up of these regional health boards and in regard to the siting of hospitals. I now want to ask the Minister something which will no doubt send him off the deep end straight away. I cannot help that. He should try to be patient. The question is: who will decide where the hospitals will be sited and what the general overall hospital policy will be? Will it be decided by the regional health boards, or by the Minister, or by the hospital boards? We want to find this out.

My difficulty is that I will not have an opportunity of speaking on this anywhere again. I am not a member of the local authority and therefore I will not have any say on the regional board, not that I particularly want to have it. I want to find out what the functions of the regional board are. Deputies and Senators will have to meet their local representatives and put before them, in as clear words as possible, what the exact position is. Therefore, I am asking the Minister two specific questions. One has caused quite a row, or a furore, or a storm in his breast. That is the simple question of what exactly will be the position of the health officers who now function in my county when he sets up the regional health board in Kilkenny. Apart from a long diatribe saying that he had explained it all previously, the only thing he said was there would be no worsening of their conditions.

My other question is with regard to the siting of the hospitals, which is most important to the people who live in the area. They are interested in that question. The Minister has given no definite decision on this, nor has he indicated who will give the decision. Will this decision be taken by the regional health boards or by whom will it be taken?

An Ceann Comhairle

May I point out to the Deputy that we are not discussing the regional hospital boards. The House will have an opportunity of dealing with that matter when it comes before us again. We cannot anticipate the debate on that measure.

Sir Anthony Esmonde

I am simply trying to find out who takes the decision with regard to the siting of hospitals. Surely the siting of the hospitals is most important in relation to the setting up of regional health boards? You cannot run a regional health board unless you have full knowledge of the overall administrative plan. I take it that the regional health board will be the controlling administrative body. I think I am right in that. I do not think that even the Minister would disagree with that. It may be the only thing with which he agrees in what I have said here this morning.

I take it that the regional health boards represent a decentralisation from central control. The officials of the Department of Health know that I have never been a great advocate of central control but this is a decentralisation and a regionalisation. Is the Minister giving that function to the regional health boards or is he not? I have no doubt that the Minister will answer that question for me with all the courtesy he can command when he gets up to reply.

There is another matter which interests me. The regional health boards will take over the functions of the Hospitals Commission which is to be dissolved. As I understand the position, the function of the Hospitals Commission was to decide for what purpose the different funds allocated to them from the Hospitals Trust were utilised. They acted in an advisory capacity. It seems to me that they acted in a national advisory capacity. The Minister has said that there can be interchange between the different health boards. He mentioned commuters. That seems to be a small matter and to relate only to two regions along side each other.

Formerly the Hospitals Commission allocated the funds on a national basis. My query is: when they go out of existence and are superseded by these regional boards how will they carry out the function of the Hospitals Commission because they are individual regional boards? Does the Minister intend to carry out that function himself, or does he intend to hand it over to the regional boards?

Mr. Childers

The Minister does it. The Minister takes the national decision from the recommendation of the three regional hospital boards.

Sir Anthony Esmonde

It is not a matter for the three regional boards. Surely there are six or seven boards?

Mr. Childers

There are three regional hospital boards, as the Deputy will find in paragraph 31 of the White Paper. They are being charged with the general organisation and development of hospital services. They will be studying the needs of the hospitals and the requests of the hospitals both in relation to consultants and to improvements in hospitals and I will have to correlate the needs of the three regional hospital boards.

Sir Anthony Esmonde

Therefore it is not a matter for a regional board at all?

Mr. Childers

The health boards are responsible for the day to day running of the hospitals.

Sir Anthony Esmonde

I read in the White Paper that that function of the Hospitals Commission was being taken over by the regional boards.

Mr. Childers

By the regional hospital boards, not the health boards. That is clearly indicated in the White Paper and it was also explained during the debate in the Dáil.

Sir Anthony Esmonde

I know everything was explained during the debate. We had a little difficulty, Sir, before you took the Chair. The Minister feels that anything that was discussed during the debate on the Health Bill should not be mentioned now, even though it is relevant to the regional health boards which I have been discussing amid considerable interruptions from the Minister. However, the matter has been settled amicably and I think the Minister has decided to desist.

I want to express the same view as my colleague, Deputy Hogan. We expressed our view yesterday at a party meeting that it was unfortunate that the Minister saw fit to bring in these regulations piecemeal. My recollection is that the implication in the debate to which the Minister has referred so often today was that these regulations would be brought in together. If the Minister had seen fit to bring in all these regulations at the same time this House would have a much clearer picture of the situation than we have at present. We have a piecemeal picture at the moment of what will happen. I appreciate that the Minister wants the health boards to function as soon as possible. The establishment date he mentioned was 1st October so that they would be functioning by 1st April, 1971. I note from the explanatory memorandum that the setting up of the hospital board will be on 1st April, 1971 and the effective implementation of the regional board itself will be on the same date. It does not seem to be a very tidy way of doing the job that the regional health boards should go into full functioning on 1st April, 1971 when the auxiliary bodies inextricably associated with them are not even being set up, I think, until 1st April, 1971. I, therefore, join with Deputy Hogan in saying that I think it would have been tidier to bring in all the regulations together rather than do a piecemeal job as the Minister has done.

It is extremely unfortunate that a Minister such as the Minister for Health who has possibly enhanced his prestige somewhat, at least beside his own colleagues, in this health legislation and has tried to do the best he can in letting us have all the information possible—something I personally appreciate—should have tried in this debate to stifle discussion. It is no credit to him. I think it is the first time in 20 years in this House that I have had to listen to a continuous attempt to interrupt and stifle debate. I sincerely hope that as long as I am here we shall not have to listen to it again.

Dr. O'Connell

I am impressed by the Minister's efforts to ensure that the Health Act will be in operation by 1971. We must pay tribute to him because in the year he has been in office he has certainly applied himself very diligently to every aspect of the measure to ensure that the Act will be functioning by 1971.

There was a very logical approach in the formulation of the health boards. While I am naturally very concerned with our own board, the Eastern Health Board, in general I can find no fault with the functional areas outlined. I have looked through these regulations and I see the Minister has been very generous to the medical profession. He has considered them fully and the medical profession have every reason to be thankful to the Minister because he has ensured that throughout the country they will have 25 per cent representation on the health boards. That is a very generous gesture to the medical profession especially when you consider that there are only 2,500 doctors in the country and nearly three million people.

I discussed informally with the Minister a short time ago the composition of the Eastern Health Board. The only thing I am disappointed about is that he has not seen fit to give Dublin City greater representation on this board. There are three-quarters of a million people in Dublin city and, on a population basis, Dublin City Council would have approximately 15 members on the board. Instead, we find there are only seven representatives of Dublin city. As far as I can see the Minister acceded to the request of members of Dublin County Council to increase their representation but may I ask now what was the Minister's proposal originally in respect of representation for Dublin County Council?

Mr. Childers

Six. We increased it by one.

Dr. O'Connell

In regard to the nine persons appointed by election by registered medical practitioners practising in the functional area of the board, I should like it be conveyed to the bodies representing the medical profession that the nine persons to be appointed by them should be from areas not essentially in Dublin City but that they should be located in various parts of the functional area of the Eastern Health Board. This would ensure that they would then act also as citizens of their areas and not necessarily only in their capacity as medical practitioners. This might offset the imbalance at present on this board with representatives of the medical profession. I speak as a doctor but also as a citizen in saying I should like to see this happen. Perhaps the Minister would bring this to their attention and suggest that the medical practitioners appointed to the board should be from areas not necessarily confined to Dublin City.

I should have thought that we might have more than one person appointed by the nursing profession. One as against nine in the case of the doctors seems a little unfair.

Mr. Childers

There are two in fact.

Dr. O'Connell

I am sorry. There are two, one general and one psychiatric. That is a good idea. I overlooked that. I should imagine that the representatives from Wicklow and Kildare might feel somewhat perturbed at having only three members each. It would be understandable if they felt this to be a little unfair to them. I agree that, if there are too many members, the board would be unwieldy and unable to act properly. Because of that I am loath to complain about the representation for Dublin City. I think that 35 members is sufficient on a health board; to exceed that number would perhaps be abnormal. I hope the members of the board will not be there solely representing their local interests but will act as members of a board not just taking care of vested or local interests but in the common interest. If this principle were remembered by them and perhaps by Members of the House we might see the logic of the representation.

I had hoped the Minister would have brought in the regulations regarding Comhairle na nOspidéal and the three regional hospital boards at the same time. That would have given us a better picture, perhaps, and we could have discussed all these together. Probably there is a reason for not doing so.

I am glad the Minister has mentioned the point that this does not mean that the hospital services of each health board will have to be self-sufficient. There is nothing to stop arrangements being made for, say, North Roscommon patients to come to Sligo or Carlow patients to come to Dublin. What would happen if, say, North Roscommon patients had to come to Dublin?

Mr. Childers

That can also be arranged.

Dr. O'Connell

It can be arranged and it will?

Mr. Childers

Under the Health Act. Sections in the 1953 Act enabling transfer between health authorities have not been repealed. The health boards now represent the health authorities and under the 1953 Act transfers can be made from one health board to another.

Dr. O'Connell

With the Dublin city council dissolved and with the health boards regulations coming into effect so soon, I wonder how the Eastern Health Board will be represented and who will replace the seven members who were appointed by the Right Honourable Lord Mayor, aldermen and burgesses of Dublin. I would hope that the city commissioner would not solely represent these seven members.

Mr. Childers

The Deputy was not here when I explained that the Minister for Local Government has agreed to make arrangements for the appointment of seven persons who more than likely will be Deputies from the area in political proportion to what their representation should be.

Dr. O'Connell

Would it be in political proportion to their representation in the Dáil or in proportion to what the representation was on the city council prior to the dissolution?

Mr. Childers

I cannot give the Deputy the details. All I can say is that, as far as I am concerned, it will not be a distorted representation but will be fair and reasonable.

Dr. O'Connell

I hope that will be done, and this is a very good idea in the absence of the Dublin city council. Perhaps, the Minister for Health would also discuss with his colleague the Minister for Local Government the possibility of having another city council elected in time for the operation of the Eastern Health Board.

Mr. Childers

That does not arise on these regulations.

Dr. O'Connell

That might be considered. Other than hoping the Minister might have considered an extra member from Dublin city, I have no fault to find with the composition of the health boards. Let me repeat what I said earlier, that the medical profession have every reason to feel thankful to the Minister for the ample representation he has granted to them.

Mr. T.J. Fitzpatrick

(Cavan): The Health Act, 1970, will operate to a large extent through a number of boards to be established by regulations made by the Minister. For some time past I have been noticing a trend under which legislation which was passed in this House operates largely through regulations or statutory instruments made by the Minister. In some cases that is inevitable, but it is of the utmost importance that, in the case of the Health Act, where it has been specifically provided that these regulations shall be brought before the House and passed by the House before they become law, that provision be treated seriously.

Like Sir Anthony Esmonde and some other Deputies, I noticed the Minister was somewhat impatient about any detailed discussion on these regulations. The Minister has the reputation of being a reasonable and polite man, a man who believes in full and frank discussion in the House. It is a pity that he has adopted the attitude he has adopted here today, and if I had any doubt as to whether or not I should speak on this motion, I had no difficulty in making up my mind when I noticed the Minister's impatience. We are handing over here to the Minister in these regulations a very powerful weapon, and it is our duty as Members of this House to read these regulations, to discuss them, to put forward our views on them and to get such information from the Minister as we require. I trust the debate will continue on the basis that we are doing something of importance here. Section 4 of the Act, while it imposes responsibility on the Minister, also imposes responsibility on the Members of this House to see that what the Minister is doing coincides with the wishes of the House and is in accordance with the Act.

I believe that the establishment of these regional health boards and regional hospital boards is the beginning of the regionalisation of local government. Following the regional planning boards and the regional boards under which Bord Fáilte operate, it is, perhaps, a gentle and a good way of doing it. It is gratifying to see that in deciding the regions, after some consideration the Minister decided to respect the integrity of county boundaries. I hope I shall be excused for saying in passing that I only wish I could have convinced the former Minister for Local Government that he should adopt a similar attitude when he was defining constituencies. I wish I could have convinced him that he should preserve and respect the county boundaries of Leitrim, for example, but all the persuasion at my disposal was not able to do that.

These boards will either succeed or fail during the first few years of their existence. That imposes a very serious obligation on the Minister because he has taken responsibility for appointing something less than 50 per cent of the entire personnel of these regional boards. Perhaps, the local authority will appoint a majority, but the members who would normally be appointed by the medical practitioners, the dentists and so forth in the area will be appointed by the Minister.

Mr. Childers

On nomination.

Mr. T.J. Fitzpatrick

(Cavan): Yes, on the nomination of such people as he thinks represent certain interests.

Mr. Childers

I do not appoint them.

Mr. T.J. Fitzpatrick

(Cavan): The Minister gets three nominations and he appoints one. Is that the idea?

Mr. Childers

I get only one.

Mr. T.J. Fitzpatrick

(Cavan): The Minister has a fairly wide discretion under the Act because it says: “ ... shall include appointments made on the nomination of bodies which in the opinion of the Minister are representative of the medical and ancillary professions or of particular branches thereof.” Therefore, the Minister will decide who will make the nominations. Is that not correct?

Mr. Childers

That is right, but I meant the actual practices. The associations I may ask are the medical associations.

Mr. T.J. Fitzpatrick

(Cavan): I approve of that. It is not as in the case of the Association of Municipal Authorities: they send up three and the Minister appoints one. That will not happen here. If the Minister asks a certain professional body to put forward a nomination he must appoint that nomination. I approve of that. Nevertheless, I would ask the Minister to embrace as many of these professional bodies as possible, any of them with any organisation within the region, to make sure that these boards are as broadly based as possible and will get off to a good start. If the first boards do not inspire the confidence of the people whom they are to serve, the confidence of the medical and other professions who think they are entitled to representation on them, they will be a failure.

Something which strikes me on reading the regulations in conjunction with the Act is in regard to section 4 (2)(a) which says:

Membership of a health board shall consist of—

(i) persons appointed by the relevant local authorities.

We go then to the Schedule to the Act and we find that there are two ways by which local authorities may appoint members. One is that a group within the county council, say, can get together for the purpose of appointing a member. That is a good thing because in a county council where one party might have an overall majority they might be tempted to be unfair and this ensures that the minority will at least have some representation. It appears to me, however, that the group are bound to appoint a councillor and they cannot appoint anybody else. The Schedule says:

Any group of councillors comprising the necessary number of councillors may nominate a councillor to be a member of the board and he shall be appointed on that nomination without any voting.

The other appointees of the local authority may be members of the council or may not be members of the council. I should like the Minister to tell me if that is so, if my interpretation is correct and also if that is the intention, or is it merely accidental.

Mr. Childers

Yes, the Deputy is right. County councils will appoint county councillors.

Mr. T.J. Fitzpatrick

(Cavan): The Schedule also states:

The remainder of the members of the board shall be appointed successively by a majority of the votes of the councillors who are not members of any group of councilors ...

But if we go back to section 4 the county council may appoint councillors or non-councillors. We could interpret section 4, if it stood alone, as meaning that a county council could appoint members of a county council or people who are not members of a county council. It does not mean anything else.

Mr. Childers

I am afraid that is not the intention.

Mr. T.J. Fitzpatrick

(Cavan): Section 4 (2) (a) does not say “members of relevant local authorities appointed by said authorities”, it says “persons appointed by the relevant local authorities”. When we go to the Schedule it seems to say that the group system of appointing is confined to members of the council. The Minister should look into this because it may lead to confusion later on.

Mr. Childers

The Act is so long that I can never remember the whole of it, but if the Deputy looks at section 5 he will find under subsection (1) (d) a paragraph which seems to get us over the difficulty to which he refers, this apparent anomaly.

Mr. T.J. Fitzpatrick

(Cavan): The paragraph reads:

notwithstanding anything contained in any other Act, the members of the board who are appointed by the council of a county shall be members of that council and the members of the board who are appointed by the corporation of a county or other borough shall be members of the city or borough council for that borough;

Mr. Childers

That sets it out.

Mr. T.J. Fitzpatrick

(Cavan): That seems to put it beyond doubt but certainly reading section 4 (2) (a) as it stands one could come to the other conclusion. The functions of the regional hospital boards are defined in the memorandum and while I know we are not discussing that it does say that the ownership and management of hospitals will remain respectively with the health boards. The health boards we are now setting up will continue to own and manage hospitals within their functional areas but who will decide where these hospitals are to be located? Will it be the Minister?

Mr. Childers

The regional hospital boards will conduct inquiries and it will be a ministerial decision. Where the new general hospitals proposed under the FitzGerald Report will be sited will be my function.

Mr. T.J. Fitzpatrick

(Cavan): Who will confirm that the north-eastern hospital will be in Cavan?

Mr. Childers

That will have to be an archangel and that is not included in the Act.

Mr. T.J. Fitzpatrick

(Cavan): Is it the regional hospital board who will decide that?

Mr. Childers

The three hospital boards will do long-term planning. They will be given the FitzGerald Report and told to look at it, and equally Comhairle na nOspidéal will have something to say about consultants. Finally only the Minister can make the decision and as the Deputy knows we have to have an inquiry before the function of a hospital will be changed—in the case of any change in the function of a hospital.

Mr. T.J. Fitzpatrick

(Cavan): I take it that the FitzGerald Report is still the leading authority on the subject?

Mr. Childers

Yes, but it will take some years before any decision will be made. The Deputy need not worry, within the ambit of these regulations, as to whether any decision is going to be taken on the appalling question of whether Monaghan or Cavan should be the centre of a general hospital at the moment.

Mr. T.J. Fitzpatrick

(Cavan): If rumours are right the Minister may find himself in a fix. All sorts of rumours have been going about the area recently about various transfers, changes, representations of Deputies, and so on.

Mr. Childers

That is why I referred to the archangel.

Mr. T.J. Fitzpatrick

(Cavan): In a way it was a pity not to have declared Dublin a special region. I agree with other speakers that it is an immense area which should have been left to itself and Wicklow and Kildare should have been fitted into some other regions. That is all I wish to say. I spoke mainly to establish the principle that we are entitled to discuss these regulations and we would be in breach of our duty to our constituents, to the House and to democracy if we did not do so.

Mr. Malone

I want to express very great disappointment that the Minister could not see his way to accede to the recommendation made by members of the local authorities in the proposed eastern region that greater representation than is envisaged should be given. The Deputy from Wicklow made the case that Wicklow and Kildare were entitled to greater representation than they are getting because of the size of the area involved. I can sympathise with the Minister in his task of making out the various apportionments in this region, having regard to the size of the population of the City of Dublin and even of the county of Dublin and the borough of Dún Laoghaire. I am sure he must have given some consideration to the fact that these are reasonably compact areas.

While we in Kildare and Wicklow may orientate towards Dublin to some degree—parts of Wicklow and north County Kildare—I fail to see how the southern portions of either of those counties could be regarded as orientating entirely towards the city of Dublin. I have no grouse with the Minister in regard to the professional representation on the board but I am worried that the representation given to Counties Kildare and Wicklow is insufficient to meet the demands that will be made on the members when the boards are finally set up.

Let us take County Kildare as an example. I wonder if the Minister gave any thought to the fact that if one was to base the representation on electoral areas—there are four such areas in Kildare—we could possibly have three representatives on the board from the one area. Anybody familiar with rural areas will be aware that the people in those areas cherish the personal contact they have with their representatives. They like to know that they have a representative living near hand and to whom they can bring their problems but this might very well not be the case in Counties Kildare or Wicklow. I am sure that when the councillors meet they will see to it that representation is spread out as much as possible and as fairly as possible.

There is also the possibility that the Minister may have in mind the political representations on those county councils where one representative would be chosen from Fianna Fáil, one from Fine Gael and one from Labour but what would be done if we had Independents? What are we to do if the board do not represent a fair distribution of the representatives in the various counties? Perhaps, the Minister will have a look at this matter and see if it will be at all possible to give an additional representative to Counties Kildare and Wicklow. As I have said, we tend to orientate towards Dublin but there is a fear that Kildare and Wicklow would become the poor relations on the board. Let me give an example. The boards would concentrate more on the city of Dublin than on the rural areas. We in Kildare have sent a proposal to the Minister's Department to have a psychiatric unit attached to the hospital at Naas but this proposal has not been accepted.

Mr. Childers

That does not arise in discussing these regulations.

Mr. Malone

I am trying to make a case that should the representation be completely lopsided, the city of Dublin would be the attraction rather than the rural areas and that in order to ensure the rural areas are properly looked after in Counties Kildare and Wicklow, we should have a fourth representative on the board.

Dr. Byrne

During the debate on the Health Act, the Minister promised us a chance of discussing the setting up of the regional health boards and I wish to discuss very briefly the motion before the House. The Minister gave us a very informative brief. Under section 4 of the Health Act, 1970 the Minister for Health is required to make regulations specifying the number, constitution and functional areas of the health boards which, under the Act, will become responsible for the administration of the health services.

The first comment I should like to make is in relation to the actual constitution of the health boards. When speaking on the Health Act, I referred to the composition of the health boards and I may have given the impression at that time that I was in favour of there being a majority representation of the medical profession on the boards. I should like to make it clear that while I am in favour of a majority of medical representatives, I wish to make it clear also that, if at all possible, there should be representation from the local authorities. By this I mean that if there are people on local authorities of medical standing or background or with para-medical associations the Minister should request that such people be appointed to the boards; I have in mind a person such as Deputy Hogan who is a member of a county council. It would be far more efficient to have someone with a medical or para-medical background as the local authority representative rather than a lay person. Efficiency is what we are aiming at.

Of course, this could not always be possible nor could the Minister legislate for it but, perhaps, he could recommend to the local authorities that if there must be a choice between, say, Jack and Tom and if Jack has medical experience, he should be selected if at all possible. I would be grateful for the Minister's comments on the feasibility of this suggestion being implemented in some form or other. Are we establishing health boards with a majority of people who have no specialised knowledge of what the health services are about? If we take a cross section of people who will probably comprise the majority of the health boards, we know that these will be representatives who have been elected by the people to local authorities.

Mr. Childers

Again, I point out that the general principle of the constitution of the boards was discussed at length on the Health Act and this included everything of which the Deputy has spoken.

Dr. Byrne

The Minister assured us that we would have an opportunity of discussing this when the regulations were before the House.

Mr. Childers

The regulations refer only to the number of persons.

Dr. Byrne

It refers to numbers, consultation and functional areas, according to the Minister's brief.

An Leas-Cheann Comhairle

What we are dealing with in these regulations are the health boards themselves, not the quality of the personel. What we are dealing with here are the constitution and the functional area of the health boards. We cannot go back to a discussion of the quality of membership or back to the provisions of the Health Act regarding this matter or arguments which were put forward on the Bill.

Dr. Byrne

I would be grateful, Sir, for your interpretation of what the word "constitution" means in this context: whether it is the constitution of the actual health boards, the membership of the boards, or whether it is some document which will be drawn up?

An Leas-Cheann Comhairle

If the Deputy consults the regulations which he has in front of him he will see the constitution is laid out in certain ways. Certain members will be elected by local authorities and certain other members will be elected by registered medical practitioners and so on.

Dr. Byrne

Exactly. That is the impression I was under. The constitution, in other words, is the membership of the new health boards, eight in number. If it is in order to discuss the constitution of the health boards, then I wish to discuss the constitution of the health boards, but not the quality of the members on them.

An Leas-Cheann Comhairle

The Deputy would seem to be making an argument that those from the county councils should be of a certain type.

Dr. Byrne

I will accept the Chair's ruling but I am merely making the point——

An Leas-Cheann Comhairle

What the Deputy must avoid at this stage is going back to argue that the Act must be different now in regard to those regulations. The Act is the Act now.

Dr. Byrne

I accept that. I will not dwell on this any longer. I merely mention to the Minister that the constitution or membership of the health boards will comprise local authority representatives and professional medical people. I should like the Minister to recommend to the local authorities to have people of medical background or para-medical experience appointed to those boards.

Mr. Childers

I have no power under the Act to do that.

Dr. Byrne

The Minister states he has no power. He may not have statutory power to do this but he could possibly make an unofficial recommendation. I will merely make one comment concerning the Eastern Health Board, which takes in the Dublin area. The Minister rightly stated that this is the largest health board area in the country. Unfortunately, in Dublin city there are no local authority elected representatives with whom the Minister can discuss the matter. He has had consultations with the city commissioner, supplemented by informal discussions with some city Deputies. The Minister has made a fair effort to find out the feelings of city Deputies regarding the type of representation they would require on the Eastern Health Board.

When the Minister was setting up the Eastern Health Board, being aware of the fact that he could not have what we might term proportional representation of local elected representatives, he said he would endeavour to compensate for this on a much fairer basis. I congratulate the Minister on this. Comparing the populations of Wicklow and Kildare with the very large population in Dublin city, the result could be a fantastic majority of the local elected representatives on the health board, without giving the people of Wicklow or Kildare a fair or reasonable representation.

This would be a fine thing if the Minister were consistent. Unfortunately, he has not been consistent, and I do not know why. He has been inconsistent because, when we come to the establishment of the Southern Health Board, we find the Minister has apparently agreed to some more equitable form of representation for the population of these areas. This is the health board which will cover Cork and Kerry. Kerry County Council at first proposed two boards. The Minister stated we did not want too many areas to administer and that there would be only eight health boards in the country. Kerry County Council, after a discussion, agreed they would go in with Cork county and form the Southern Health Board. The Minister has not been consistent in dealing with the representation on this health board.

In regard to the Eastern Health Board, the Minister stated that representation could not be strictly in proportion to population. In the case of the Southern Health Board, however, we find that he initially proposed four representatives for Cork Corporation, six for Cork County Council and five for Kerry County Council. He said that this would not give any of the local authorities an absolute majority. That is quite true, but it would give Cork city and county, with a population of 340,000 as against Kerry's 113,000, a two to one majority on the board. Here we have an example where the population has very definitely been taken into consideration. On a strict population basis, Cork city and county would have a majority of three to one on the board—that would be 300,000 against 100,000. The Minister has not kept to that strict representation, but he has given Cork County Council and Cork Corporation an absolute majority here neither of them as separate bodies getting individual majority. In the Southern Health Board we proposed that there should be ten members from Cork and five members from Kerry. Following representations which the Minister received from the local authorities it seems from the Minister's brief that he overruled all the professional interests and all medical groups as regards their representation. The Minister has concentrated on local authority representation. He has increased Cork representation to meet the views of the two local authorities there. Cork Corporation representation has been increased from four to five members and Cork County Council representation from six to seven members, giving them a total of 12 members. This gives one additional representative to the Kerry County Council, giving them a total of six members which is still 50 per cent but still no one of the individual bodies has an overall majority. I feel that is why the Minister could not have agreed to the proposal put forward by the Kerry people who went to see him and who said that he should give some form of recognition to the Tralee Urban District Council.

Mr. Childers

I cannot do this under the Act.

Dr. Byrne

I concede that. With regard to the eastern region the Minister has specified that there should not be strict adherence to the concept of local authority representation being in line with the number of people in an area. Under the Act the Minister could not have done this, but could have increased the representation of Kerry County Council on this board. The Minister could have given consideration to this point. We know that the people in Kerry have been bullied under the new Health Act. They have been pushed from Billy to Jack; matters have gone from logicality to illogicality. From what the Minister said earlier we know that tradition rather than logic can be said to govern the lines between counties. There was a strong temptation to be logical in designing the health board areas at the expense of county integrity. Kerry County Council made representations to have a health board of their own. Why should they not have one? They have been divided into two or three parts. They are now in line with Cork. With Cork County they form the Southern Health Board. They do not appear to have sufficient representation on this board compared with the representation of the Cork Corporation and the Cork County Council. I would not accept the local authority representation on the Southern Health Board. I would vote against it. Kerry County Council have a very difficult job because of the terrain and the distances involved in the county.

The Minister referred earlier to the factors involved in the establishment of an efficient health board and to the fact that travel has now become so much easier. The health board could cover a far wider area. The Minister said that there was no hard and fast rule which could be followed but that practical considerations must be borne in mind. Areas should be sufficiently compact so that board members should be able to visit the areas of administration freely. The area of the Southern Health Board as proposed by the Minister includes County Kerry where the terrain is unusual. There is a population of 113,000 spread over a large area. I speak from personal experience as a man who is familiar with the position and has practised there. I am familiar with the front line movements of the medical health services as they exist in a county like Kerry where an outlying district may be several miles from the nearest hospital. I appeal to the Minister to increase the representation of the Kerry County Council on the Southern Health Board.

There was no obligation on the Minister to give us so much detailed information. The Minister must be commended for doing this. The Minister informed us that the Kerry County Council had asked that the majority of the medical representatives on the health board should be from the Kerry area. The Minister said this was not a valid recommendation. The Minister should give careful consideration to this proposal. The Minister has given consideration throughout the whole discussion to the needs of the patients, and has shown concern for the elderly person and the young child. He is anxious that the service to these people should be very efficient. This is the aim of the health boards.

A chain is as strong as its weakest link and we do not want the weakest link of our health services to be at the tip of the Dingle Peninsula or in the Kerry mountains. We wish to see a strong and efficient health service. That is why I ask the Minister to consider increasing the representation of the Kerry County Council on the Southern Health Board. I am pleased to note from the Minister's brief that he has, in fact, apparently given unofficial sanction to the hospital in Tralee. It is mentioned in the Minister's brief as being a full general hospital.

Mr. Childers

That does not arise on the regulations. The question does not arise as to where the hospitals will be.

Dr. Byrne

It is in the brief.

Mr. Childers

That does not arise on the regulations.

Mr. Donegan

Is it in order for one Member of the House to discuss something and for another Member not to discuss it? If the Minister mentioned something in his brief, and was allowed to do so, surely it is in order for an ordinary Member to discuss the same thing?

An Ceann Comhairle

I am not aware that the Minister discussed these matters.

Dr. Byrne

In regard to the Southern Health Board the Minister stated that it is important for the local authorities in Kerry and Cork to co-operate because there will be a great need for good communication between the general hospital in Cork and the Tralee hospital in order to provide an efficient service. Why should we victimise Kerry in this matter? Why should Kerry be the poor relation under our new Health Act? Why should it be the weakest link in the chain of our health services? I can only say that I will vote against this motion because of the fact that Kerry has not been given sufficient representation on the Southern Health Board.

Debate adjourned.

Mr. Donegan

I wish to raise on the Adjournment the subject matter of Question No. 53 of Tuesday 19th May.

An Ceann Comhairle

The Chair will communicate with Deputy Donegan.