asked the Minister for Health if in view of the widespread anxiety throughout the country he will abandon his proposal to reduce the number of health boards with central control of the health service.
16.
Ceisteanna — Questions. Oral Answers. - Health Boards.
10.
asked the Minister for Health if he has any plans to reduce the number of health boards, or if it is intended to restructure them; the plans, if any, he has to ensure that restructured health boards will retain democratic participation of elected public representatives and staff representatives; and if he will make a statement on the matter.
19.
asked the Minister for Health the plans he has to reform the health boards.
I propose to take Questions Nos. 10, 16 and 19 together.
I am convinced of the need for a reorganisation of the health services, including the health board structure. I have recently submitted detailed proposals to Government on these issues. I will announce details as soon as the Government make a decision on my proposals.
Is the Minister aware of the alarm throughout the country at his proposal to reduce the number of health boards? Will the Minister accept that if the number is reduced it will diminish the extent of local democracy and, in terms of the health services, it will mean they will not be as readily available and, if they are, that people will not have easy access to them?
Any alarm is purely contrived and entirely unnecessary. There is a universal feeling there is an urgent and imperative need to reform the structures of the health boards. I am endeavouring to expedite consideration by the Government of this matter and I hope to have the general support of the House.
Does the Minister accept that the proposal is in conflict with the recommendations of the World Health Organisation and in conflict with the policy of the Government who intend devolving more power to local authorities? Is the Minister aware that in the area of education it is intended to establish regional boards? Will the Minister accept that it is in the best interests of the people that there should be a devolved system of administration and that health boards have served the people well?
It has been a source of constant amazement to the World Health Organisation that we have managed in a country of 3½ million people to build up a bureaucracy which is impeding the better development of our health services.
Is it the Minister's intention to retain the representation of elected public representatives and staff representatives on any restructured boards?
There is a need for public representation but I must point out that local authorities who have a majority representation on health boards do not contribute one brass farthing to the budgets of those boards other than the supplementary welfare moneys they owe the health boards and which they will not pay.
Presumably the Minister accepts that elected representatives are put there by the taxpayers who provide all the brass farthings?
Public representatives are incessant in their demands for more health expenditure but are reluctant to raise any money at local level, whether in the form of local taxation or contributions in their health board areas. It is a classic example of the double standards we have here.
Is the Minister aware, as I am, of the wholesale concern at the lack of accountability in health boards and of the lack of responsiveness to the public since those boards are neither accountable to local authorities nor to this House?
There is a great need for reform. For example the Eastern Health Board serve 1.3 million people while other health boards serve between 200,000 and 300,000 people. The structure was brought in in good faith in the early seventies and I supported it at the time but it needs to be changed to reflect the many developments that have taken place since. One change that is needed is the question of accountability. For example, we are only now processing through the House the audited accounts of health boards for the financial year 1982-83 and they do not refer to my period in office.
Will the Minister consider in his plans for reform making the health boards answerable to local authorities? If the Minister adopted that proposal health boards could be called to account for their actions and the chief executive officer could be examined.
My answer, most emphatically, is "no" because local authorities do not raise any money and do not propose to raise any. Any time they were asked to raise money they refused to do so in relation to the health services. Various political parties in this House abolished local health charges and health contributions by local authorities such as the SWA, which are now being paid out of Exchequer funds. Local councillors are demanding the right to run the services at local level but they are not making any resources available towards their financing. That has changed the position dramatically in the last 15 years.
Local democracy is very important.
I am referring to local health boards and that is the point the Minister is missing.
Dr. O'Connell has an important question down and the Minister is talking on so as to avoid answering it.
The Minister never stops talking.
What type of reform of the health boards has the Minister in mind, and when is it proposed to introduce the reform?
He intends to abolish them.
I will give the classic answer: I am precluded from disclosing that information because the Government have not reached a decision on it.
The Minister will not be in office long enough to bring in any reforms.
I will show a little more initiative than Fianna Fáil ever did in their 16 years.
I must now move on to questions nominated for priority.