Dáil Éireann díospóireacht -
Tuesday, 5 Dec 1978

Vol. 310 No. 4

Health (Hospital Bodies) Regulations, 1972 (Amendment) Regulations, 1978: Motion.

Minister for Health (Mr. Haughey)

I move:

That Dáil Éireann approves the following Regulations in draft:—

Health (Hospital Bodies) Regulations, 1972 (Amendment) Regulations, 1978, a copy of which Regulations in draft was laid before Dáil Éireann on 21 November 1978.

The motion before the House seeks approval of the draft Health (Hospital Bodies) Regulations, 1972 (Amendment) Regulations, 1978.

The explanatory memorandum which I have circulated with the draft sets out the legal background to these regulations and the necessity for them. Very briefly, the regulations provide for a continuance of the arrangement whereby all the members of Comhairle na nOspidéal are appointed direct by the Minister for Health and for an increase in the total membership from 23 to 27.

The 1972 Regulations provided that all members of Comhairle na nOspidéal would be appointed by the Minister for Health during the period ending on 31 December 1975. The five-year term of office of the members appointed in accordance with those regulations will expire on 31 December next. It is necessary, therefore, to make appropriate legal provisions to enable members to be appointed after that date. This the draft regulations now before the House will do.

The rules in relation to membership of the comhairle are contained in the Second Schedule to the Health Act, 1970. Rule 6 of that schedule provides that members shall be appointed for such term of office not exceeding five years as the Minister for Health may specify. It would be my intention to continue the practice of appointing members for a three-year term of office.

The functions of Comhairle na nOspidéal are set out in section 41 of the Health Act, 1970, and in the explanatory memorandum. One of its main functions is to regulate the number and type of appointments of consultant medical staffs in hospitals engaged in the provision of services under the Act. Since the hospital system is by far the most costly element in the health services, it is essential that advances in medical specialisation should proceed in a rational manner, that over-lapping and possible wasteful expenditure should be avoided and that in general the development of hospital services should be carried out on a controlled basis. The comhairle was established mainly for this purpose. Because of the importance and far-reaching effects of its discharge of these functions, the selection of members for appointment to the comhairle is obviously a matter of serious concern to all involved in the hospital services of the country. The ideal would be to have persons on the comhairle who could speak on behalf of all the interests involved. This is not, of course, capable of being achieved without a very substantial increase in the membership of the comhairle, which in turn would lead to an unmanageable and largely ineffective body. The comhairle has authority to appoint committees for specific purposes and to appoint to such committees persons who are not members of the comhairle. Representations for each and every interest and speciality in the actual membership of the comhairle is not therefore essential for the purpose of securing a completely balanced representation of interests.

I consulted various interests before putting the draft regulations before the House. These included medical and nursing organisations, health boards, voluntary hospitals and medical teaching authorities. Nearly all of the views which I received favoured a continuance of the existing method of appointment to the comhairle, that is, by direct appointment. The draft regulations provide accordingly. It would be my intention, when making the appointments, to take into consideration the names submitted by the various interests concerned of persons willing to act on the comhairle.

The views which I received from the various bodies consulted seem to indicate that some increase in the present membership of 23 would be desirable. It would allow better geographic representation and would enable me to go some way towards meeting requests for greater representation of health board areas and for wider representations generally. These considerations were put forward by many of the bodies consulted, and I have decided to make provision in the regulations for an increase of four in the membership of the comhairle. This increase will bring the total membership to 27, of whom 14 will, as required by the 1970 Act, be hospital consultants. I should like to take this opportunity to express my appreciation of the interest shown by the various bodies which I consulted and of the reasoned and constructive views which they put forward. I am confident that they appreciate the fact that, in an exercise such as this, it is not possible to meet fully the viewpoints of all interests.

I recommend that the House approve of the draft of the Regulations which is before it.

Mr. Boland

These draft regulations allow the Minister the power to increase the membership of Comhairle na nOspidéal in that for ever afterwards a Minister for Health will appoint the members of the comhairle. When the Health Bill was originally going through the House, and afterwards, we heard many suggestions that the selection of the membership of the comhairle ought not to be left entirely to the Minister of the day and that some provision should be made whereby groups involved in the medical and health fields would have the right to appoint members. That is the reason why the present regulations are framed as they are and contain the clause in relation to October 1975. The Minister has decided to remove that clause and give to himself in perpetuity the right to appoint the members of the comhairle. I do not think that is a good thing and the reservations expressed in the early seventies were valid. Events have shown the validity of those reservations.

In many respects the existing comhairle have done a fine job and, from the point of view of Ministers, they have done a useful job in taking the political heat off them. However, in many parts there is a great deal of unhappiness about the way the comhairle have operated and about the fact that the comhairle appears to be somewhat remote from local issues and points of view. There has been a suggestion that it would have been better if the eight health boards had the power to nominate members to the comhairle. That would have meant that local interests and points of view would have been put forward to the comhairle by health board representatives and, in turn, the views of the comhairle and reasons for them wanting to make certain decisions could be conveyed by those representatives. There would have been better communication between the two bodies concerned. The suggestion has been made that such a procedure would eliminate a lot of the disagreement and unhappiness about decisions and recommendations of the comhairle.

The Fine Gael Party considered that point of view carefully in the light of the experience of a number of Members who are also members of health boards and in the light of experience of other Deputies of the operation of the comhairle and decisions taken in relation to hospitals and hospital functions in their constituencies. We decided that it would be proper for the Minister, instead of changing the regulations, to allow the health boards appoint two representatives from its membership to the comhairle, one being the chief executive officer of the board. In that way there would be the combination of administrative interests and membership interests. The views of local boards could then have been conveyed to the comhairle and, in turn, the views of the comhairle conveyed to the health boards. Apparently, that suggestion did not find favour with the Minister. The Minister did not tell us in the course of his speech that those reservations were expressed but told us that the majority of the bodies consulted felt it was right that the Minister should make the appointments. We are most unhappy that no attempt was made to improve the communications between health boards and the comhairle who make remote decisions in Dublin.

I endeavoured to amend the motion before the House, as provided for in Standing Orders, but I was told that I would not be allowed enter amendments. I cannot understand the basis for that decision. That leaves the political groupings in the House in an awkward position because they are invited either to accept the Minister's draft in its entirety or oppose it. We would wish to see the comhairle continue in operation but we are anxious that the membership be appointed in a different way, something which we cannot express in the form of an amendment. The situation is unfortunate. The amendments I intended entering would have sought to increase the membership of the comhairle from 23 to 33 with 16 to be appointed by the eight health boards. I was anxious that the chief executive officer of each board be one of the two nominees from those health boards and that the other person be an ordinary member. That would have ensured a better spread of interest and representation among the membership to the comhairle.

At all times the comhairle have endeavoured to act in what they considered to be in the best interests of the development of the health and hospital services. However, it would be foolish if we did not recognise that their decisions have often provoked a great degree of unhappiness and upset at local level. In some cases it appears as if the decisions of the comhairle were being taken in isolation from local wishes. I do not suggest that we should dwell at length on some of the local issues debated here recently but it is fair to say that some of the aims of the comhairle are little short of utopian. They do not take into account the social, economic or geographic factors within the country. Very often recommendations and decisions appear to have been taken as if all other factors were equal. They did not appear to take into account geographical difficulties or the question of a sparse population spread over a wide area and who have the local services removed with consequential additional travel for relatives of patients.

It is right that Comhairle na nOspidéal should endeavour to achieve the highest possible hospital services but they should also keep in mind a realisation of the special social and geographical factors and the make-up of the country, the way county boundaries are laid out, the difficulties of travel and the hardships incurred by patients and relatives. Sometimes I think it is not a marvellous advancement to have a high level hospital operating to the best level but where the majority of the patients are unhappy. They may be unhappy because they are so far removed from their home environment. They may be upset because their relatives and friends are virtually debarred from visiting them or they may be upset because of the distance they have to travel afterwards on an out-patient basis. They may be upset because their relatives and friends find it can take more than a day to visit them in hospital. All of these factors must be taken into account. Regard must be had to the way the population is distributed, the fact that there is an over-weighting of population along the east coast while in the rest of the country the population is thinly spread. It is not possible simply to say that because there is a certain hospital system operating in another country we will impose that régime here without taking account of the way of life of the Irish people and the geographic and social factors to which I have referred.

I am sorry to say I do not think Comhairle na nOspidéal have given full attention to those factors, other than the achievement of the highest possible medical standards. There should have been an obligation on them to take those factors into account. This was one of the losses suffered in setting up Comhairle na nOspidéal. In the past the Minister of the day was bound always to take account of the social and geographic factors and the wishes of the local community. While he might have been faced with unpalatable decisions, when he took them they were tempered by the local demand and by the real state of the nation rather than having the decisions taken wholly and solely by a group of medical people, sitting together in isolation and trying to impose textbook solutions on an imperfect society. We are an imperfect society and to try to impose a perfect régime on such a society can have worse rather than better consequences.

In his reply the Minister probably will say that he knew of all these things, that Comhairle na nOspidéal take these decisions. That can only prompt us to ask if the Minister was so aware that Comhairle na nOspidéal are the final body in making decisions about the level of services to be provided in hospitals why did he, prior to the last election, make extravagant promises to various sections of the electorate which he knew he could not keep. The Minister is looking quizzical now. Apparently he has suddenly forgotten Roscommon, Monaghan, Mallow, Tullamore and all the other places——

Mr. Haughey

All the promises were kept. All the hospitals Fine Gael tried to close have been kept open.

Mr. Boland

I am sure the people of Roscommon will be pleased to learn this evening that the Minister has managed to persuade Comhairle na nOspidéal to sanction the appointment of an obstetrician/gynaecologist and a paediatrician——

Mr. Haughey

Fine Gael tried to close Tullamore, Monaghan and Mallow hospitals——

Mr. Boland

I am sure the people of Tullamore will be pleased to hear that Tullamore hospital will have a full maternity service staffed in its own right by a gynaecologist and paediatrician——

Mr. Haughey

It is not going to be a geriatric home as Fine Gael wanted.

An Ceann Comhairle

The Deputy should be allowed to make his speech without interruption.

Mr. Boland

I can see that the Government Whip is becoming anxious at the Minister's interruptions and I can understand the reason. It is because of his own local embarrassment in relation to the situation between Tullamore and Portlaoise.

Mr. P. Lalor

I can see the cheer gang are coming in.

Mr. Haughey

Fine Gael wanted one big hospital in Dublin and nothing else. We reversed that policy.

Mr. Boland

I can only suggest that the Minister is endeavouring to mislead the House. The changes introduced by his predecessor in 1975 meant that a great number of additional hospitals that had been scheduled for closure——

Mr. Haughey

Fine Gael tried to close hospitals but they are open now. Deputy Fitzpatrick has just come into the House. He can tell the Deputy that there is a hospital in Cavan now.

Mr. T.J. Fitzpatrick

(Cavan-Monaghan): The Government could not have done otherwise. I signed, sealed and delivered it before the Minister's advent into office.

Mr. Haughey

We are building hospitals in many areas. There has never been such a programme of hospital building in this country before.

Mr. T.J. Fitzpatrick

(Cavan-Monaghan): I think the Minister is trying to wriggle out of it.

Mr. Boland

The Minister was not so cocky with the nurses last week when he hiked off to Brussels to make his statement in absentia.

Mr. Haughey

We have settled the nurses in spite of the Deputy's mischievous attempts to disrupt the health services.

Mr. Boland

"Settled the nurses" might be the truest expression the Minister ever used.

Mr. Haughey

It was done despite the Deputy's mischievous efforts.

Mr. Boland

I am sure the Chair will decide which of us is being mischievous.

An Ceann Comhairle

The Chair would like the House to deal with the motion before it.

Mr. Haughey

I apologise to the Chair and to the Deputy. I will not interrupt further.

Mr. Boland

I doubt if the Minister will be able to resist. Despite the Minister's unhappiness at my reminding the House of the fact, the situation is that before the last election the Minister made extravagant promises to the electors in different parts of the country regarding the appointment of specialists and the upgrading of certain hospitals that he must have known, had he any control of his brief as Shadow Minister, he would be unable to keep within the existing legislation, because those decisions are made by Comhairle na nOspidéal. I am suggesting it was wrong to do that. To use words that the Minister is fond of using, he was either a knave or a fool to have made those promises. Either he did not know that Comhairle na nOspidéal had vested in them the ultimate responsibility for making these decisions——

Mr. Haughey

They have not.

Mr. Boland

——or he knew they had ultimate responsibility and he was deliberately misleading the electors for the sake of short-term political gains.

Mr. Haughey

The Deputy is misleading the House now.

Mr. Boland

The Minister cannot have it both ways. He promised the people of Roscommon that on his party resuming office, on foot of an agreement that provided for a specialist obstetrician being appointed to Roscommon hospital for maternity purposes they would see that agreement implemented.

An Ceann Comhairle

This motion deals with a specific matter and, while I will permit the Deputy to refer to these matters, I do not wish the debate to go into detail on matters generally affecting the whole ambit of the health services.

Mr. Boland

When the Minister assumed office he told the people of Roscommon the decision was not his, that it was a decision for Comhairle na nOspidéal, the body we are discussing on these draft regulations. In view of the Minister's interruption, I want to know whether Comhairle na nOspidéal make the ultimate decisions. Since the election it has been represented by the Minister that Comhairle na nOspidéal were set up under section 41 and make the decisions as to what specialists may be appointed in any area, and the Minister merely provides the finance with the agreement of the Minister for Finance.

If that is not the situation the Minister has not kept his promise to the people of Roscommon although he was capable of keeping it. If that is the situation the Minister misled the people of Roscommon prior to the election. He cannot have it both ways. He could not expect us to discuss the re-appointment of Comhairle na nOispidéal without discussing these matters in the House. They are extremely relevant.

During the most heated part of the debate on Roscommon Hospital, I recall hearing a member of Comhairle na nOispidéal explain why they took their decision on this matter. I accept that the comhairle felt they were operating in the best interests of the general public in Roscommon. The kernel of the argument was that, above all else, they had to take into account the health of the new-born child. I asked was there anybody in the comhairle who tried to take into account the well-being of the mother. Pregnant mothers in Roscommon were expected to travel up to 60 miles in certain cases to attend the maternity hospital which the comhairle felt was the right hospital.

Before the election people were objecting to that and, in that situation, the Minister made the promise he did not keep. Was there nobody in the comhairle to ask about the health of the mother, her physical and mental health, removed from her family, unable to receive regular visits from her family, and worried about what might happen to her if she were taken suddenly ill, was in need of urgent maternity services and was expected to travel up to 60 miles to a maternity hospital? It would be scant consolation for her to know the comhairle made their decision on the basis of the situation prevailing in Denmark.

It would have been far better if the Minister had allowed the health boards to make appointments directly to the comhairle so that the chief executive of the Western Health Board, a member of the board, would be directly represented on the comhairle and would be able to put forward the validly and legitimately held views of the public, and would be in a position on returning to the Western Health Board to give an explanation at first hand as to why the comhairle made whatever recommendation or decision they made. That would have led to a far better operation by the comhairle. That is not my personal decision. It was taken by the entire Fine Gael Parliamentary Party. The composition of the comhairle would have been far better.

The Minister now has complete discretionary power to decide in what area and in whose interest people appointed to the comhairle will serve. During a recent debate, in reply to Deputy Mrs. Burke the Minister said he agreed one female member out of 23 members of the board was far too few. He said that he agreed that there should be more than one in 23. There is nothing in the regulations putting any obligation on the Minister to appoint a greater number of women to the board.

Mr. Haughey

The Deputy does not want the Minister to appoint them at all.

Mr. Boland

There is nothing in the regulations to force the Minister to see to it that the people who comprise almost 50 per cent of the population have better representation than less than 4 per cent.

There is nothing in the regulations to sort out the unhappy situation in which officers of the Department of Health who also serve on the comhairle found themselves recently. This deserves comment as well. A strange situation arises when an officer of the Department serves on what is intended to be an independent body and is serving on that body by virtue of being appointed by the Minister of the day. The question must then be asked: in whose interest does he serve? Does he serve on that independent body as a person with expert advice to offer in his own right? Is he representing the interests of the Department of Health and does he act and vote in accordance with the decisions of the civil servants in the Department of Health? Does he serve and act on that independent body in the interest of the Minister who appointed him? Is he expected to act and vote in accordance with the directives of the Minister of the day? Apparently that is the situation in which civil servants from the Department of Health who were appointed members of Comhairle na nOspidéal found themselves in the recent past in the sorry and distasteful affair of the maternity unit in Roscommon Hospital.

Officials of the Department serving on the comhairle felt unable to attend a meeting of Comhairle na nOspidéal because of the pressure the Minister was putting on them to act in one way. This created a conflict in their own minds because of their anxiety and their personal wish to sit and act and vote in a different way. It is extremely unfair that officials of the Department should have been placed in that position. It should be made very clear in what capacity an official from the Department serves if he is appointed to what is supposed to be, and I understand always has been, an independent body. Any civil servant will carry out the terms of his appointment. If he is appointed to act and vote on behalf of the Minister he will do so. If he is appointed to an independent body because of his knowledge, expertise and skills, he is entitled to make his own decisions on whatever information is available to him as a member of that independent body.

It is not desirable that the new Comhairle na nOspidéal should be set up with some members appointed from amongst the officials of the Department of Health unless the situation is made crystal clear to them, to the general public and to their fellow members of the board. There should be no doubt about how they will act on the comhairle. If the Minister wants to keep the power to appoint members of the comhairle, and if he wants to appoint officials from his Department to the comhairle because of their knowledge, expertise and skills, he should not endeavour to put pressure on those appointed officials to act against their personally held beliefs. That would appear to negate the very reason for which they were appointed in the first place. The fact that that unhappy incident occurred and was used as an excuse to explain away the Minister's incapacity to deal with the local situation in Roscommon is indicative that there is not contained within the membership of Comhairle na nOspidéal a voice to represent the general public and local interests.

Mr. Haughey

The Coalition appointed the present comhairle, not me.

Mr. Boland

I accept that the present comhairle were appointed by the Minister's predecessor, and contained within the regulations that appointed them was a time clause.

Mr. Haughey

If the west is not represented, it is the Coalition's fault.

Mr. Boland

The reason for inserting that clause is given in the explanatory memorandum issued by the Department some weeks ago. It said that the time limitations of article 3 on the method of selection of persons for appointment as members to the comhairle was included because there was disagreement as to whether all the members should be selected by the Minister or whether some should be selected by different bodies. I believe the predecessor of the Coalition's Minister for Health also included that time clause. The fact that the provision to take away from the Minister the power to appoint the comhairle and to allow other bodies to appoint people who would to some degree be representative of the general public and the health boards at a future date was included, clearly indicates that there was a recognition of a need for the public to be represented.

Mr. Haughey

Why did the Coalition not do that?

Mr. Boland

This Minister is now proposing——

Mr. Haughey

The Deputy is trying to ride too many horses.

Mr. Boland

Out of charity I will not reply to that.

Mr. Haughey

The Deputy is trying to ride about six horses at the same time.

Mr. Boland

I never fell off one.

Mr. T.J. Fitzpatrick

(Cavan-Monaghan): Sometimes it is hard enough to ride one.

Mr. Haughey

Deputies should not criticise Deputy Corish in this way.

Mr. Boland

This Minister is proposing to remove from the regulations the clause which allowed the House to consider the idea of inviting other bodies to make direct appointments to the comhairle. That is why I am taking this opportunity to invite the House to consider the idea that health boards should make direct appointments to the comhairle. If your ruling, Sir, had not prevented my amendment from being placed on the Order Paper, it would be before the House by way of an amendment to the Minister's motion, and I prefaced my remarks by explaining that.

If the Minister deliberately chooses to misunderstand the point of view put forward, that is his business, but there is a widely held belief in the country, especially in the Ireland outside Dublin which still represents a large part of Ireland——

Mr. Haughey

They did not think much of Fine Gael.

Mr. Boland

I never suggested what the Fianna Fáil viewpoint behind closed doors might be and I do not think the Minister should concern himself with what the viewpoint of the Fine Gael Party is——

Mr. Haughey

I am not saying that.

Mr. Boland

The Minister's hands are full trying to work out what the viewpoint within the Fianna Fáil Party is without getting involved in my party as well——

Mr. Haughey

I am talking about what rural Ireland thinks of Fine Gael. They threw them out. They rejected them. They gave them the greatest trouncing ever.

Mr. Boland

The people exercised their democratic right, as they did outside this House last Wednesday week when there were 4,000 nurses whom the Minister tried unsuccessfully to hoodwink. He now has himself backed into a cul-de-sac. He had to kow-tow and give in to the nurses and in a shamefaced way eventually agree to their fair and legitimate demands.

Mr. Haughey

The Deputy is changing his ground.

Mr. Boland

No amount of heckling will alter the facts that the Minister has decided to keep to himself the power of appointment to the comhairle, that he is not allowing the health boards to appoint directly their chief executive officers or some of their members to the comhairle and that he is not providing specifically in the regulations that there should be a certain number of women members of Comhairle na nOspidéal. He is not suggesting in the regulations that he should appoint to the comhairle nominees from the Medical Council who were set up under the recently passed Medical Practitioners Act, although that might have been a very worth-while suggestion because members of that body are carefully selected to represent different branches of the medical profession. It might have been very appropriate if that council, who also have an educational responsibility, had been nominated as one of the bodies which would have a direct right of appointment to the comhairle.

The Minister has done none of those things. He has merely removed the clause which his predecessors felt was necessary to provide for a reexamination of the workings of the comhairle after it had been set up to see if, in the light of its experience after its first few years of operation, it would have been better if somebody other than the Minister of Health of the day had the right to appoint members to the comhairle. He has done none of those things. He has done what in my view will be the least successful and acceptable thing.

The Minister and I might have different views about what rural Ireland thinks but I hold the view that there are many people in rural Ireland who do not believe that Comhairle na nOspidéal have taken into account the geographic and social factors and local needs and desires in coming to the decision and recommendations——

Mr. Haughey

The Deputy is talking about the Coalition-appointed comhairle?

Mr. Boland

I am not suggesting that the comhairle have acted in anything but the best interests to achieve the best hospital and health service possible. Unfortunately, I find myself having to say again, because of the Minister's apparent inability to grasp what I am saying, that the decisions of the comhairle appear to have been taken in isolation from the real, everyday life of Ireland, that is, Ireland outside Dublin. This has resulted in a great deal of unhappiness and unrest and I believe it is an endeavour to achieve a Utopian medical situation. While I admire the comhairle for trying to see that the best hospital service is provided, I believe there should be an obligation on them to take into account the other factors I have mentioned. I am not sure if that obligation should not have been written into the legislation of the day.

While we may all agree that the comhairle have removed the Minister from the unpalatable decision-making position, which would necessarily have fallen on any Minister for Health during the seventies, nonetheless when he made that decision the social and geographic factors and the desires of the local community bore heavily on his mind because he was made very aware of them by the people themselves and by their elected representatives. While some decisions made by Ministers in regard to the development of the hospital services might not have met with the general approval of a people in an area, at least society could have been happy that the decision had been taken by somebody who had been made aware of the different arguments put forward.

I am afraid that the comhairle, as operated, have chosen to ignore factors other than the strict attainment of the highest possible standards of hospital care provided in the world. I am not sure that the comhairle will achieve those standards unless they take into account the social and geographic factors that make up the fabric of our society. There have been expressions of unrest in different parts of the country and the fact that the Minister's predecessor, who he is so quick to criticise and deride, changed the plan outlined by Mr. Childers, and the fact that the last Minister, Deputy Corish, decided that a number of additional hospitals were to be retained at county level, was indicative of the report that people who were taking into account merely the utopian situation did not always achieve the best possible results. Regardless of how much this Minister may huff and puff there is no doubt that during the term of office of the last Government there was a change and there was an acceptance of the idea that a certain number of additional hospitals should remain to provide services at a county level.

Mr. Haughey

The Coalition tried to turn them into geriatric homes. They tried to close Monaghan, Mallow, Roscommon and Tullamore. That was their policy.

Mr. Boland

This problem of a short memory seems to be endemic within Fianna Fáil. Each of the hospitals which the Minister has outlined in his interruption were detailed for closure by the late Deputy Childers when he was Minister for Health. He was the Minister who introduced the Health Act and set up Comhairle na nOspidéal. If the present Minister knows so little about the development and the evolution of the hospital services not to realise it was the late Deputy Childers who decided to close them, he should consider the situation before coming back to the House.

In addition to those hospitals mentioned by the Minister there were many others that were destined for closure in accordance with the Fianna Fáil plan of the early seventies and in 1975 the then Minister, Deputy Corish, decided that a number of those hospitals should not be closed and he outlined which hospitals should remain. In relation to a number of other hospitals he outlined the development that he considered should occur in regard to them. For instance, in the case of Roscommon, to which the Minister has referred once again in an endeavour to cloud the issue, Deputy Corish restored to that hospital the accident and the surgical services which the late Deputy Childers had had removed.

Mr. Leyden

That is not true.

Mr. Haughey

It is only a tissue of fabrication. Fine Gael's plan was to close county hospitals.

Mr. Boland

In the latter part of October 1975 the present Minister was engaged in a major campaign to reingratiate himself with Fianna Fáil, so perhaps he was too busy then to take note of developments in the health services.

Mr. Haughey

The Deputy is wriggling like a fish.

Mr. Boland

No public relation campaign or no charade on the part of the Minister can change the fact that the hospitals to which he referred as well as many others were destined for closure in the early seventies by the then Fianna Fáil Minister for Health. Some of those hospitals were retained in accordance with what was known as the Corish plan of October, 1975.

Mr. Haughey

The Coalition tried to close Monaghan, Tullamore and so on.

Mr. Boland

During the time that Deputy Corish was Minister there was suggested the setting up of a federation between Roscommon and Portiuncula hospitals on the basis of an agreement to be made between the two authorities. That agreement provided for, for instance, maternity services by way of the engaging of a full-time obstetrician to be based at Roscommon. But the agreement was not implemented prior to the change of Government because of the opposition by Comhairle na nOspidéal. This Minister gave an undertaking that if Fianna Fáil were returned to power he would implement that agreement, but it has not been implemented. I am suggesting that the reason for not implementing it has been that Comhairle na nOspidéal, the body mentioned in these regulations, did not allow the Minister to do so. But I suggest also that at the time of making the promise to implement the agreement, the Minister knew that he did not have the power to do so without changing section 41 of the Health Act. Comhairle na nOspidéal should have within its membership people who are representative of the general public, the general public not only of Roscommon but of every other county.

Mr. Haughey

How can that be done?

Mr. Boland

I have outlined how it can be done.

Mr. Haughey

How can it be done if it is not the wish that the Minister appoint them?

Mr. Boland

It could be done by the simple expedient of allowing the eight health boards who are charged with the provision of health services to appoint two members each to the comhairle, one to be the chief executive officer of the board and the other from among the membership in each case. Members of the health boards are elected in various ways and all of them have the duty of representing the general public at health board level. If they were serving also as members of Comhairle na nOspidéal they could put forward the validly held point of view—regardless of whether we would agree in any instance—of the general public in those areas. But if the Minister did not wish to do that he should have put into these regulations, as was the case in respect of the Medical Practitioners Act regarding the setting up of the Medical Council, a provision that a certain number of the members of the comhairle should be persons who in the opinion of the Minister represent the interests of the general public.

Mr. Haughey

But the Deputy does not wish me to appoint them.

Mr. Boland

The Minister seems to have great difficulty in following a simple contribution this evening. He is fighting with the health boards——

Mr. Haughey

I am not fighting with anybody.

Mr. Boland

——as well as with everybody else. If he had not wished to allow the health boards to appoint the members, he could have appointed them himself by putting into the regulations a stipulation that a certain number of the members of Comhairle na nOspidéal should be appointed by the Minister on the grounds that they represent the interests of the general public. There should also be the stipulation that a certain number of the members be women so that the female viewpoint would be represented in relation to decisions regarding hospital development especially in respect of maternity hospitals. In the regulations, too, power should be given to the Medical Council to make appointments because of their specialist knowledge and expertise. There are many different ways in which the composition of Comhairle na nOspidéal could have been improved but there is only one way in which it could have been disimproved: to remove from the existing regulations the onus placed on the Minister of the day to consider, as was suggested in the first regulation, the idea of Comhairle na nOspidéal members being appointed from a number of different sources other than merely by the Minister for Health. However, the Minister chose to take the easy way out and this was the worst way.

Mr. Haughey

It was what my predecessor did.

Mr. Boland

Why is the Minister being so obtuse today? His predecessor imposed an obligation on himself or on whoever might succeed him to examine the situation. Presumably, if he had known who was to be his predecessor he would have imposed even greater strictures.

Mr. Haughey

Surely the Deputy means his successor. The Deputy is trying to ride too many different horses.

Mr. Boland

I have warned the Minister before against referring to riding horses. I have yet to fall off one.

Mr. Haughey

The Deputy is galloping madly in different directions.

Mr. Boland

I did not have to present a prize from the Health Education Bureau of something that was named after a tobacco firm. Things are not going well for the Minister.

Mr. Haughey

They have never been better.

Mr. Boland

The Minister is regarded as being a fair man when it comes to wielding a political knife; but when he reaches a situation when he cannot get to a tape first with a scissors, the situation is not auguring well for his continuation in political life. His predecessor placed an obligation on the Minister to examine the situation of the hospitals in the light of the disagreement that prevailed at the time on the question of whether the Minister should appoint all the members of the comhairle. The suggestion at the time of the setting up of Comhairle na nOspidéal was that they should be allowed operate on foot of being appointed by the Minister for a number of years and that after the expiry of those years, in other words after the council appointed in 1975 completed their term of office, the situation should be examined in the light of the operation of the comhairle to see whether they might operate better if they were appointed by a number of different bodies and contained appointees of the Minister. That is what the Minister's predecessor set out to do and that is what the Minister has decided not to do. The last few years have seen public protest marches, demonstrations, acres of newspaper comments and editorials, the passing of resolutions by local authorities, health boards and local district health committees, all calling on Comhairle na nOspidéal, on the Minister and on different people to change the operation of the comhairle. If ever there was proof of the wisdom of the decision that the composition of and method of appointment to the comhairle should be examined in a number of years after commencement of their operation, that proof is there in the record of public authorities engaged in the provision of health services and in the files of newspapers and journals.

The health boards should be allowed the right to appoint roughly half the membership of the comhairle, but I am not suggesting that they should be given the right to appoint members without any type of restriction. One of each of the two health board nominees should be the CEO of the health board who might fairly be expected to convey the overall viewpoint of his board to the comhairle and to convey back in turn the viewpoint of the comhairle to the health board. That would have represented an improvement in the operation of the comhairle and in their relations with the health boards, and the general public. It would be silly to suggest that Comhairle na nOspidéal have good relations or are held in high esteem in certain parts of the country. It is regrettable that the comhairle are not held in high esteem. The way the comhairle are working and trying to achieve the best possible hospital service would be better understood if among their members were people from each of the eight health boards. The Minister has not chosen to provide for that or to put the restriction upon himself to appoint women or people who would be representative of the general public.

Following examination of the regulations and what they were setting out to do, my party have expressed unhappiness about the changes the Minister is making in these regulations and the fact that he is not taking into account the often repeated exhortations to change the method in which the comhairle are appointed. I am confident that the comhairle will continue to make decisions based on what they believe to be the attainment of the highest possible hospital service. Those decisions would be better taken if there were more people on the comhairle representing local interests and Irish life, lay as well as medical.

Dr. O'Connell

I am not going to delay the House unnecessarily on this motion. When Comhairle na nOspidéal were established I had grave reservations about them. I thought they had power exceeding that of the Minister for Health. The charter setting up the comhairle was such that they seemed to have unlimited power. The purpose in setting them up was praiseworthy but there was a saying with a great element of truth in it prior to the setting up of the comhairle and applying particularly to voluntary hospitals, that if your aunt was the Reverend Mother you could be assured of a consultant appointment in a hospital. That was not as funny as it sounded. There was a great deal of nepotism in the appointment of consultants to hospitals which was contrary to normal, decent practice. Merit did not count for much. We still have evidence in voluntary hospitals, particularly in this city, of a great deal of nepotism, and merit is of secondary consideration.

The setting up of Comhairle na nOspidéal indicated a great attempt to rid this country of nepotism in hospital appointments. How far this has succeeded is another matter. There are a number of loopholes still. Comhairle na nOspidéal do not have the final decision and the hospital can overrule their recommendations with regard to appointments. The former Minister for Health, the late Mr. Childers, admitted that the hospital would have the final say. I was disappointed in that.

I have said that the comhairle had power exceeding that of the Minister himself. One wonders whether such a body should have unlimited power. It could be argued that this gets the Minister off the hook because it gives power and authority to a body to make decisions, perhaps political decisions. The big dilemma facing the Minister for Health is whether he should allow a body to take decisions of such importance in relation not only to the appointments to hospitals but also to the setting up and location of major hospitals.

I intend no disrespect to Deputy Boland, but having listened to him I was confused. I wondered whether he wanted the Minister or Comhairle na nOspidéal to have the power. Is the power to be taken away from the Minister and given to an autonomous body the constitution of which, with regard to the members, is rather one-sided? Another criticism of the comhairle is that they are Dublin-orientated. I recognise that the membership of the comhairle must contain a certain number of consultants, but I wonder whether the composition should not be much more balanced. Who should make the final decision? Should Comhairle na nOspidéal merely take unto themselves the task of deciding the manpower requirements in hospital services? Should they rationalise this? Should they make the political decisions as to where hospitals should be located? These are the big arguments we must consider in relation to Comhairle na nOspidéal.

Did Deputy Boland want the Minister to have the power to appoint to the comhairle or did he want them somewhat on the lines of the new medical council? Should there be more lay representation on the comhairle? Should there be nominating bodies with powers of nominating to the comhairle? If that is the case, do we take away the power completely from the Minister and is he then merely a figurehead in the Department of Health? We must decide whether the location of hospitals should be a political decision or one taken by a body such as the comhairle.

We will never get a consensus on this. No matter what Comhairle na nOspidéal do in their present form and no matter what decisions they take, they will be criticised. If it takes a decision in relation to Mayo, Sligo will criticise it as indeed will Galway and Roscommon. If it takes a decision in relation to Monaghan, Cavan will criticise it and there will be an editorial in the Cavan Anglo-Celt criticising it. I recognise that. In a situation such as this a political decision will have to be taken in respect of the location of hospitals and it may have to be an unpopular decision.

Is the Minister, in expanding the membership of the comhairle, doing it so that he can make political decisions and overide the powers of the comhairle? Does he want to put his own name on it so that a political decision can be taken by him? I put these questions because the Minister has not said that he will arrange for the new appointees to be representative of various areas. Should they come from the western area or the north-western area? Of the four additional members proposed should there be one representing two health boards? There is no arrangement for this in the appointments which the Minister envisages.

I would not agree with Deputy Boland that the late Mr. Childers made the decision originally. The first attempt to rationalise our hospital services was made in the Fitzgerald Report in the late sixties. The Minister was presented with this report and it was a fair attempt to rationalise our hospital services. Perhaps the working party which examined the situation was Dublin-orientated and did not understand the local problems of the various areas. But no matter what the recommendations of the report, I dare say they would have been criticised. I remember in 1969 I went to a meeting in Athlone and I came up against a very irate group of people who were objecting to the downgrading of their hospital. I often felt that the Department of Health did not go to enough trouble to explain the purposes of the recommendations in the Fitzgerald Report because when I explained the position to them in terms of a person whose child might be admitted to the hospital for what might be an apparently simple symptom demanding surgical intervention but during the course of the operation it turned out to be a much more complicated thing which required expertise beyond the capacity of a particular hospital, the public were not irate at all and they saw the logic and they were prepared to make certain sacrifices in the interests of patients. The Fitzgerald Report was too unbalanced in so far as it was too Dublin-orientated. It was a pity that it started off on the wrong foot. It was a sincere attempt to rationalise our hospital services. It was a good report, perhaps a little ahead of its time in its thinking. If it had been more balanced in its representation of various rural areas it might have achieved a lot more.

The nettle has to be grasped by the Minister. There was a lot of political expediency since in deciding on hospitals. I saw evidence of political expediency some years ago and a Minister for Health who will decide on where hospitals should be will have to be unpopular; he will have to take a decision in consultation with the comhairle which will, perhaps, be unpopular with members of his own party. They will be unpopular decisions but it will be a brave man who will take them and he is going to have to take them. He is not going to have a consensus about the location of hospitals. If the Minister favours Tullamore he will come into conflict with his representatives in Portlaoise, and vice versa. We cannot retain all our hospitals. If we try to do this we will be diluting the service too much. The cost of hospitals and hospital services is an enormous burden at the moment. We will have to make unpalatable decisions but right decisions in the interests of the country.

The dilemma the Minister faces is a serious one. It is a big decision he will have to make. It is suggested that the Minister in attempting to expand it is attempting to gain a political power over the comhairle so that he will be able to make political decisions in favour of particular hospitals. I am not saying that he is but it has been suggested to me that he is. Perhaps it is true; maybe he wants to make political decisions but I would like him to do it taking into account all aspects of it, all factors involved and primarily he should remember that it must be in the interests of the people and not his vested interest in an area.

Perhaps I took an unpopular line in regard to Roscommon so far as my own party were concerned but I felt at the time, and I still do, that sometimes one has to be unpopular in the interests of the people as a whole. The people in Roscommon were talked to and had the situation explained to them properly. No mother will object to a little inconvenience in the interests of her baby. I feel strongly about that and I believe that most mothers who have any sense of feeling for their unborn child would be prepared to suffer the inconvenience. Everyone knows mothers who have suffered more than mere inconvenience. Our biggest problem is that we have not taken the trouble to explain the position properly to people. We get involved in this political wrangling all the time and it is very wrong and we lose credibility. We do ourselves harm and the public lose respect for us. I will say frankly, at the risk of offending someone, that I admire the Minister for admitting that he had made a mistake. He admitted he was wrong. Maybe he was ill-advised but I think it is good that anyone can say he is wrong. I have been wrong many times.

Mr. Boland

There was no provision for giving back the thousands of votes.

(Interruptions.)

Mr. Quinn

The Deputy might not recognise honesty when he sees it.

(Interruptions.)

Dr. O'Connell

It is important to admit that we are wrong at times when we are wrong and the Minister said he was wrong and I admire him for that. It is a good man who says that. As I have said, I could not in conscience support the Roscommon maternity unit in preference to the Portiuncula unit. If I did I would be doing an injustice to the people. We have to make decisions bearing in mind all factors in the situation. Sometimes it is unpopular to do so. There is a dilemma in regard to Comhairle na nOspidéal where they are not totally representative whether to give them this full power to make decisions. That is the only thing I find wrong; I would like to see the comhairle more representative. How does one do it? Maybe the time will come in the next few years, when a new body is being appointed, when the Minister will get around to making them a fully representative body without making them too cumbersome a body. There is always the great risk that a body will become too cumbersome when this is done. Perhaps increasing the membership by four will not do that.

The comhairle have done an enormous amount of work. I have to admit I was critical from the beginning but I have to admire the work they have done. Before Comhairle na nOspidéal came into being we had no statistics on what was available here or on our manpower requirements. We were making appointments without any regard to any of these things. There were duplications all over the place and there was an appalling state of chaos. Comhairle na nOspidéal have done a wonderful job in trying to rationalise the position and in bringing about order out of this terrible chaos in regard to consultant services. We need to do this in the interests of the economy because we could not withstand this waste any longer and Comhairle na nOspidéal have done this and have done it admirably. They have done a great job and we can be proud of the work they have done because their members are very busy people.

It is often said that the person to appoint to a body such as this is a very busy person. All of them have been very busy. Their attendance has been very high. They have had committee meetings and have done a wonderful job. We might find the chaos worse without them. In deciding the medical manpower requirements, we should seriously consider asking them to take into account the medical student intake to universities and medical schools. If we are considering our medical manpower requirements we must take into account the number we will permit in our medical schools. It is not in accordance with the facts to say that we might be making our contribution to the Third World by allowing unlimited admission to medical schools because the graduates from our medical schools do not usually go to the Third World; they go to the rich, prosperous countries. We are not fulfilling any obligation to the Third World by having unlimited acceptance in our medical schools.

I recognise the unique position of the Royal College of Surgeons in relation to this. They have graduated their fees so that they charge lower fees to medical students from the Third World. I would like to see the comhairle look at this aspect of it, because it is an important point. We cannot consider medical manpower requirements for this country without considering medical student intake. The Minister has an unenviable task in deciding whether we should give them the power or whether he should retain it. I would like to see a wedding of both, consultation with the Minister and the last word with him. I do not begrudge him the right to do this. Sometimes political decisions have to be taken after consultation with the experts. A weak Minister would like to shake the matter off and not have it because it is an unpopular thing to do. He will face enormous political pressures, which I hope he will resist. I hope he will take into account the basic requirements and overlook the fact that vested interests may be applying pressure.

When the Minister comes to make the appointments I hope he will be big enough not to take in political appointees. I am not casting any reflection on him. I hope he will be able to say "I want this to work right; I want this body to operate well. I will appoint people whom I feel will do a good job and I will see, where possible, that the representation is as wise as possible". If the Minister does this he will do a very good job in regard to the appointments. It might change his whole thinking on medical personnel and medical requirements if he gave a little time to reading a book called Doctors on Trial, which will shortly be published.

Mr. Haughey

I have.

Dr. O'Connell

That is good. It is not published officially yet. It is worth reading and it may change the Minister's thinking on the medical profession and the health requirements of the country.

Minister for Health (Mr. Haughey)

I would like to deal with a number of points made by the two representatives of the Opposition parties during the course of this discussion. First of all, I want to make it clear that in extending the membership of the comhairle it is my hope that the increased membership will enable me to provide a better regional basis for the new comhairle. I want to assure Deputy O'Connell that I will endeavour to avail of the power of appointment which the regulations give me to ensure that the best possible comhairle comes into being with the widest spectrum of representation in the professional and in the regional capacity.

I, like Deputy O'Connell, was quite confused as to what exactly Deputy Boland was suggesting to me in regard to the constitution of the new comhairle. Most of his criticism in regard to the existing comhairle should not be directed at me at all because the existing comhairle was almost exclusively appointed by my predecessor. My predecessor, Deputy Corish, as Minister for Health, decided he would retain for himself the power of appointment. I do not criticise that, but it is not very fair of Deputy Boland to attempt to criticise me for retaining that power of appointment on the very flimsy ground that I am now deleting the termination date for the Minister's power of appointment.

As far as I am concerned in the situation that we are confronted with in this area the only way out is for the Minister to make the appointments. I assure Deputy Boland that I have carried out a very wide range of consultations in this connection. The overwhelming view of all those concerned is that the Minister should retain the power of appointment. Because of all the diverse interests that have to be represented on the comhairle the only practical way is for the Minister to receive lists of nominations and make the appointments himself. Deputy Boland, with his customary attempt to court popularity here and there, tied himself up in a number of knots. He wanted to criticise me for retaining this power of appointment. He said that the Fine Gael Party had discussed this and they had decided that the Minister should not retain this power of appointment. Every Minister so far who has had to deal with this matter has decided that the only practical, sensible compromise in the approach is for the Minister to make the appointments. I do not think I can be criticised on political grounds for retaining this power of appointment. If the Fine Gael Party do not agree with that it is just another indication of how out of touch they can become with reality in those areas.

Another petard on which Deputy Boland hoisted himself was that, on the one hand, he said I should not retain this power of appointment and, on the other hand, he demanded certain things which I can give only if I retain the power of appointment. He wanted a certain amount of reflection of public interest and opinion on the new comhairle and his way of achieving that would be to nominate the eight CEOs from the health boards. Surely that is a totally ludicrous proposition. The CEOs are not elected. Excellent officials though they may be, nobody would attempt to suggest that they represent or reflect public opinion in their areas.

Mr. Callanan

They certainly do not.

Mr. Haughey

I have to accept Deputy Boland's word that what he put before us represents the crystalised wisdom of the Fine Gael Party. I will not dispute that but I am very surprised that the Fine Gael Party are suggesting to us that Comhairle na nOspidéal in a very significant element of their membership should consist of the CEOs. As I understand popular opinion among Deputies in this House who are interested in health matters, it is that the criticism of the health boards which should be made is that the CEOs have too much authority and power, that far too many matters are decided by the CEOs without reference to public opinion and popular requirements and demands. Deputy Boland and the Fine Gael Party want to extend that undesirable situation into Comhairle na nOspidéal. If Deputy Boland attempts to ameliorate that ludicrous proposal by saying that he also suggests there should be two from each health board, that is getting into even more absurd ground. If there were two from each health board, 16 members out of a total of 23 or 27 would come from the health boards. They would have a complete majority on the comhairle. Whatever element of flexibility and response to public demand there is in the comhairle at present, there certainly would be none then.

I want to say quite categorically that the only way to bring the comhairle into being with the right sort of mix in the membership is for the Minister to receive proposals from as wide a spectrum of organisations as possible and then make the appointments, trying to reconcile all the different conflicting interests involved. If Deputy Boland takes away from me the appointment of the members, how can I ensure that there is reasonable representation of women? I gather that Deputy Boland puts a high priority on the adequate representation of women on the new comhairle. The only way I can ensure that is by having the power of appointment.

Lots of the things Deputy Boland said in pursuing what Deputy O'Connell referred to as "the political wrangling advantage" led him into very contradictory positions. I do not want to rehash the old business of Roscommon and the closure of this or that hospital. It was my policy put before the people at the election in the Fianna Fáil manifesto that we would retain the county hospital. In so far as the manifesto received the approval of the people, it received it with that element included in our health policy. I believe the retention of the county hospitals is necessary in our circumstances, having regard to our population structures and our social strata. At some time in the future it may be that we will be able to do away with the county hospital but that day is far removed from practical politics at present. In every part of the country there is overcrowding in our hospitals. We find people in corridors and wards chock-a-block with beds to the point where staff can hardly move around. How can we contemplate at this stage or in the forseeable future closing down some of these valuable county hospitals which are providing an acute service for the people in their areas? It would not make economic or social sense.

In pursuance of that policy which I put openly in the Fianna Fáil manifesto before the general election, I am now endeavouring as far as possible to retain the county hospitals for the benefit of the people of those areas. Whether or not any Deputy likes to contradict this in points of detail, the fact is that Monaghan hospital has been kept open and preserved as a full-scale county general hospital. The same applies in Tullamore, Mallow and Roscommon. It is my policy to maintain these as county hospitals providing an acute general service. I have indicated to the comhairle that this is my policy and asked them to staff these hospitals as required. They have done that.

I want to make it absolutely clear where the line of demarcation comes. Sometimes there may be a slight overlap but broadly speaking the line of demarcation is as follows. It is my decision, as Minister for Health answerable to this House, as to what general hospital policy should be. It is my decision whether there should be an acute general hospital here or there. When I have taken that decision, it is the responsibility of the comhairle to decide on the level of staff. I do not find any particular difficulty working with the comhairle along those general lines of policy and I do not think there will be any difficulty with the new comhairle.

It will do no good to rehash the Roscommon situation. It is a difficult matter. Perhaps Deputy Boland and Deputy Burke would now acknowledge that they have got all the political advantage they can get from that situation.

Mr. T.J. Fitzpatrick

(Cavan-Monaghan): And the Minister's party got all the votes they could get out of it.

Mr. Haughey

Let us leave political advantage aside. I have been perfectly open and frank with this House in regard to Roscommon.

Mr. Boland

The Minister was not so open and frank with the electorate of Roscommon.

Mr. Haughey

When I came into office there was a stalemate in regard to Roscommon. Nothing was happening. I asked a senior official of my Department to bring all the parties together, to start consultations again and to try to work out a federation which would work. We did that and a reasonable compromise proposal was put forward which, as far as I could see, met the situation reasonably accurately. Unfortunately, that proposal has been rejected, not by Comhairle na nOspidéal but by the Western Health Board. Those federation proposals could now be in operation as to 90 per cent of their content were it not for the fact that the Western Health Board rejected them because they did not go all the way they wanted. I have given an undertaking before and I repeat it now that I will keep working on the Roscommon situation until we can devise some solution which will meet the social and community demands of the people of Roscommon. As Deputy O'Connell has clearly and honestly outlined, whatever the political disadvantage to himself might be, the solution devised must meet the medical requirements: the overriding need for us to provide the right sort of maternity service for the mothers and children in future. These two things must in some way be brought together in some sort of intelligent sensible proposal in the Roscommon situation. In so far as my undertaking in regard to Roscommon is concerned, the county hospital will be retained as a county hospital to provide the level of services in the area and I intend to continue that situation to the best of my ability.

The comhairle will have very important functions and an important role, as outlined by Deputy O'Connell, in trying to keep some rationalisation in the system of hospital appointments and in making sure that the right balance and structure is preserved so that there is no overlapping and no shortages and that the right number of appointments is made throughout the whole hospital structure. That is a very important function in so far as it is delegated to the comhairle by statute. I will not interfere with their decisions or try to influence them in any way. I will make my policy clear to them in regard to hospital development and, having done that, it will be their function to implement that policy so far as the staff are concerned.

There need be no particular difficulty about our continuing to operate along these lines. I am following along the path charted by my predecessors. If the House agrees that I should continue to have the appointments of the members and that I should increase the number to 27, I will endeavour to provide the best possible comhairle I can, an independently minded comhairle which will make decisions strictly on the merits of the situation, objectively and impartially—a comhairle which, as far as I can ensure, will have a good representation of all the regions throughout the country and will be able to reflect all the problems and aspects that arise in the different areas and at the same time will by and large continue to do the task that the existing comhairle has done fairly successfully, and which, but for the odd instance here and there, the comhairle has done to the general satisfaction of the people interested in health matters.

I avail of this opportunity to pay tribute to the existing comhairle, to the chairman and the members. As I said in a reply to a criticism by Deputy Boland I did not appoint them; they were appointed by my predecessor. But in so far as I found them there when I came into office, I have absolutely no complaint about the comhairle. They went about their statutory functions honestly and diligently and I fully subscribe to what Deputy O'Connell said about them. The amount of work they put into their task is quite extraordinary. They have been very assiduous and very comprehensive in their approach to the task they were allocated by statute. Whether we agree or disagree with particular decisions of theirs, we would all agree that the comhairle now going out of office have served us very well indeed.

Mr. T.J. Fitzpatrick

(Cavan-Monaghan): I do not think Deputy Leyden shared the Minister's views.

Mr. Haughey

Every Deputy is entitled to his own opinion. I am giving the House the benefit of what I think, as the responsible Minister. The existing comhairle have done a very good job and have devoted an awful lot of time and dedication to their statutory function. I hope that the new comhairle which will come into being next year will be able to provide the structure of staff throughout the hospital service which will best serve the people which, as Deputy O'Connell pointed out, is the ultimate objective of the new comhairle.

Mr. Boland

Deputy Leyden said that he would get the Minister to abolish the comhairle.

An Leas-Cheann Comhairle

Is the motion agreed?

Mr. Boland

No.

Question put.

The Dáil divided: Tá, 58; Nil, 26.

Tá

• Ahern, Bertie.
• Ahern, Kit.
• Andrews, David.
• Andrews, Niall.
• Aylward, Liam.
• Barrett, Sylvester.
• Brady, Gerard.
• Briscoe, Ben.
• Brosnan, Seán.
• Browne, Seán.
• Burke, Raphael P.
• Callanan, John.
• Cogan, Barry.
• Colley, George.
• Conaghan, Hugh.
• Connolly, Gerard.
• Cowen, Bernard.
• Daly, Brendan.
• Davern, Noel.
• de Valera, Sile.
• Faulkner, Pádraig.
• Filgate, Eddie.
• Fitzgerald, Gene.
• Fitzsimons, James N.
• Flynn, Pádraig.
• Fox, Christopher J.
• Smith, Michael.
• Tunney, Jim.
• Walsh, Joe.
• Geoghegan-Quinn, Máire.
• Gibbons, Jim.
• Haughey, Charles J.
• Herbert, Michael.
• Hussey, Thomas.
• Kenneally, William.
• Killeen, Tim.
• Killilea, Mark.
• Lalor, Patrick J.
• Lawlor, Liam.
• Lemass, Eileen.
• Leonard, Jimmy.
• Leonard, Tom.
• Leyden, Terry.
• McCreevy, Charlie.
• McEllistrim, Thomas.
• Molloy, Robert.
• Moore, Seán.
• Morley, P.J.
• Murphy, Ciarán P.
• Nolan, Tom.
• O'Connor, Timothy C.
• O'Hanlon, Rory.
• O'Leary, John.
• O'Malley, Desmond.
• Power, Paddy.
• Walsh, Seán.
• Wilson, John P.
• Wyse, Pearse.

Níl

• Barry, Richard.
• Begley, Michael.
• Belton, Luke.
• Boland, John.
• Bruton, John.
• Burke, Joan.
• Clinton, Mark.
• Collins, Edward.
• Cosgrave, Liam.
• Cosgrave, Michael J.
• Creed, Donal.
• D'Arcy, Michael J.
• Deasv, Martin A.
• Donnellan, John F.
• Fitzpatrick, Tom (Cavan-Monaghan).
• Harte, Patrick D.
• Kenny, Enda.
• L'Estrange, Gerry.
• McMahon, Larry.
• Mannion, John M.
• Mitchell, Jim.
• O'Brien, Fergus.
• O'Donnell, Tom.
• O'Toole, Paddy.
• Taylor, Frank.
• Timmins, Godfrey.

Tellers: Tá, Deputies P. Lalor and Briscoe; Níl, Deputies Creed and McMahon.

Question declared carried.