asked the Minister for Health if he has any plans to change the administration of the health services and, in particular, if he will consider the abolition of the health boards and the reconstitution of the local health authorities.
Ceisteanna—Questions. Oral Answers. - Health Services Administration.
2.
I have no plans to abolish the health boards and to reconstitute local health authorities. It is proposed, however, to review the operation of the health boards from the point of view of performance, constitution, and overall responsibilities.
What does the Minister mean by reform of the constitution of the health boards?
Of course the constitution of the health boards is to be revised from 1 June next. I have no proposals at this stage — lest the Deputy is wondering about that aspect — to alter their constitution in that sense, in terms of the boards themselves. But the work and operations of the boards constitute the first priority in such review.
I should have used the word `review' rather than `reform'. Is the Minister satisfied with the present workings of health boards in general?
The position in relation to the health boards is that they have grown enormously since their formation ten or 12 years ago. As a result of that growth many changes have taken place in their kinds and volume of activities and even the volume of personnel. This growth has itself brought problems. What I plan to do at this stage is to review the organisation and arrangements for dealing with the work of the boards given the new situation in which there has been so much growth. The first area with which we shall be dealing is that of community care which has grown very considerably. It is anticipated that there will be further growth in that area as a result — to give one instance — of the Task Force on Child Care.
Is the Minister aware that their administrative costs have risen to an astronomical level? Is he aware also that it now costs £79 per day to keep a person in a public ward in a general hospital? Surely the Minister must see the necessity to reform the present constitution of the health boards and the running of the health system generally.
In that respect, one step I am taking at present is the setting up of a new research unit within the Department of Health to examine the costs and financial procedures within health boards and within hospitals funded by the Vote of my Department. Therefore, I shall certainly be looking into those questions.
Could the Minister indicate what changes he envisages in the community care schemes as a result of the task force report and in particular whether legislation will be introduced in this House in relation to such changes?
We are talking here of the performance, administration and administrative changes which may be necessary. When I was Minister for Health previously I initiated a review of the community care organisation and structure in consultation with the staff. The report on that review was concluded very recently only and is at present being circulated. Basically it was intended to consider the existing organisation and to quantify and study that organisation as it stands. The second phase was to ascertain what changes and organisation were needed to meet future requirements in that community care area.
A Cheann Comhairle——
I have allowed five supplementaries already.
With respect, I have been allowed only one and, arising out of the Minister's replies, there are a number of serious matters that should be dealt with. I shall be as brief as possible.
We shall have the Estimate for the Department of Health when the Deputy can discuss those matters at length.
I appreciate that, but this arises directly from the replies of the Minister. The Minister has not actually clarified the action he is taking in relation to the community care scheme. Is he proposing merely internal administrative changes or the introduction of legislation to give them a statutory basis? Is he doing this in the light of the dissatisfaction of many members of the community care scheme at the manner in which the teams at present operate? Could he give the House a more substantial indication of what his thinking is in this area?
I should like to refute the Deputy's allegations that the community care schemes are not giving a first-class service to the community. I prefaced my remarks by saying that there has been considerable growth particularly in the area of community care and in view of the growth that has taken place I considered it necessary to have a review of the organisation of community care. The decisions which will be taken on that review will follow on the conclusion of the review. In addition we will have to consider some of the implications of the Task Force on Child Care in relation to that same review. When these matters have been studied—they are being studied at present — we will come forward with our proposals.
Would the Minister not agree that the task force report was published approximately two years ago and that it is reasonable for the Minister at this stage to let us have his views as to what action should be taken? Could the Minister indicate whether he has reached any conclusions as to the implementation of any of the recommendations contained in the task force report, in particular in the area of the operation of the community care scheme vis-à-vis the problems of children and children's services?
First, this question is not about the Task Force on Child Care. Secondly, I wish to make clear that the Task Force Report was concluded approximately a year ago, I had that report in effect concluded at that time, the work having gone on for some seven years before that. I assure the Deputy that on resuming office I now will be quite concerned to implement as much as is feasible of the Task Force Report within the scope of the resources available.
In the review of the health board system, does the Minister intend to ensure that local representatives have a greater role to play, because there is an obvious erosion of responsibility and the authority is now vested mainly in the officials?
Yes, I would be anxious to ensure that the community care teams were as closely related as possible to the community and those concerned directly in it.
In the light of——
We could go on for ever like this. If the Deputy likes we will have an adjournment debate on it. Question No. 3.