Health (Hospital Bodies) Regulations, 1972: Motion.

I move:

That Seanad Éireann approves the following Regulations in draft:—

Health (Hospital Bodies) Regulations, 1972—a copy of which Regulations in draft was laid before Seanad Éireann on 11th May, 1972.

This motion seeks the approval of the House to a draft of regulations which arises from section 41 of the Health Act, 1970. That section provided for the establishment by regulations of four bodies for the co-ordination and development of the hospital services, one being a national body—Comhairle na nOspidéal—and three regional bodies based on Dublin, Cork and Galway. The draft regulations specify the constitution of the comhairle and the constitution and detailed functions of the three regional hospital boards.

The four bodies referred to were provided for in the Act because of the existence of the two hospital systems, one under the health boards and the other under the various voluntary bodies. About half of the acute hospital beds in the country are within each system. The recent changes in the administration of the health services were based on the fundamental assumption that the voluntary bodies would continue to operate their hospitals and the health boards the hospitals which had been transferred to them from the local authorities. The new bodies are, therefore, intended not to be executive bodies but to work in the co-ordination of the two systems.

Because of the high cost of the hospital services and of the rise in that cost in recent years, it is essential that future planning must avoid unnecessary duplication in the provision of facilities and services. Furthermore, the services are highly labour intensive and must be made as efficient in the use of manpower and womanpower as possible. Developments must therefore be planned in a rational way and the day to day operation of hospitals must be as efficient as practicable.

The function of Comhairle na nOspidéal will lie largely in relation to decisions at the national level on priorities in the development of hospital services. They will do this mainly by their deciding influence on the creation of new consultancies and in their general advisory function for the Minister on development in hospital policies. Within the general pattern evolved through the activities of this central body, each of the three regional hospital boards will coordinate the activities of the different agencies within its region. Article 8 of the draft regulations itemises the functions which the regional hospital boards will perform for this purpose. They will be engaged in broad reviews of hospital facilities within the regions and will be expected to have full regard to local views in their activities.

The list of functions listed for the regional hospital boards is fairly wide-ranging but the stress which each of the boards will put on the different functions may vary. It seems clear too that the boards may not all be in a position to act independently in providing these services. For example, the organisation of management advice, such as on work study and efficiency in hospitals, may have to be arranged jointly for the regional hospital boards, because the skills required in this field are fairly difficult to come by.

The comhairle will consist of 23 members, of whom 12 will be medical consultants. In choosing the members, it will be my aim to have persons who can speak on behalf of most of the major interests involved. This means a difficult choice and I will be aided in it by suggestions made by several bodies concerned in the hospital services and in the medical profession. I would hope to announce the membership of the comhairle very soon after the approval of the draft regulations.

The Dublin Regional Hospital Board will cover the areas of the four health boards on the eastern side of the country; the other regional hospital boards will each cover the areas of two health boards. In accordance with the Act, half of the membership of each regional hospital board will be persons appointed by the health boards. In fact, under the regulations, each health board will nominate four members to a regional hospital board. I will appoint the other members. Again, I will aim to have the boards as representative as possible of the different interests involved and I will be aided in this also by the many suggestions which have been made to me. I would not, I should mention, intend to make my nominations to the regional hospital boards until I have seen the nominations of the health boards to them.

I think that I should make clear to the House the situation as it stands in relation to one important function of Comhairle na nOspidéal, that is in relation to the selection of consultants. Under the Act, functions relating to the selection of consultants both in health board and voluntary hospitals can be given to the comhairle. However, these can be given only by regulations, made after consultation with the comhairle itself. It would not, therefore, have been possible for me to include in the present regulations provisions governing the selection of consultants. Clearly, the comhairle must first be established so that it can be consulted on this. However, the issue of the selection of consultants has been mentioned on a number of occasions and discussed with many interests involved. It is my intention that it will be a priority task of the comhairle to concern itself with a common selection procedure for consultants in all hospitals. This procedure would apply to consultants working in both voluntary and health board hospitals and I would expect that all interests concerned would be involved in working out its details. I think it important to emphasise this in view of statements recently issued which might lead one to think that I have departed in some way from the concept of a common selection procedure for all consultants operated under the comhairle.

There is another matter related to this, that is, the body with which the consultants should hold their contracts. The FitzGerald Report recommended that this should be the regional hospital boards and provision was made in the Act which could allow for this. However, the discussions relating to the present draft regulations convinced me that it was not essential to make this universal. Therefore, the regulations provide that the regional hospital board will only make the actual contract with the consultant where the bodies managing the hospital or hospitals concerned agree to this. In these circumstances, we can expect that a contract with the regional hospital board would normally be made only where a consultant was needed to serve hospitals under two different managements. The change in my view from the original concept is not really so significant and I would stress again that it does not in any way affect my resolve that the aim of evolving a common selection procedure should be pursued. Indeed, the change in relation to the bodies making the contract could make it easier to achieve a general agreement on selection procedures.

I am aware that, in setting up these new bodies, there are dangers of duplication and doubt in relation to responsibility for particular decisions. It is highly important that, on the one side, it should be quite clear where the functions of the hospital managing bodies—the health boards and the voluntary hospitals end—and those of the regional hospital boards and the comhairle begin and, on the other side, we must similarly be clear as to what is decided in the Department and what is decided within these bodies.

I wish to make it absolutely clear that the success of these boards depends on efficient methods of communication, administrative procedures and co-ordination as between the regional hospital boards, the health boards and the Department of Health.

Equally the same efficient procedures in relation to Comhairle na nOspidéal must be evident. The Minister for Health will have ultimate responsibility in two ways, by the declarations he will make with the consent of the Oireachtas on national health policy and by the financial requirements involved in the integration and co-ordination of the hospital system.

Those institutions should in fact bring more expertise to bear on the problems of providing a modern hospital system but both the staff arrangements and the procedures must in no way result in a triple organisation of the two types of board and the Department causing overlapping and Parkinsonian empire building. We will not be able to afford modern hospital services or attract high class staff if we do not pursue the researches and the consequent decisions based on the growing proportion of specialisation team work and expensive laboratory examination. In about ten years' time the position will have changed very materially.

The same warning applies to the need for more efficient management and for the necessary consultancy service. I am awaiting a report from Messrs. McKinseys, the firm of management consultants which recommended in relation to the health boards and I have stressed to them that, in whatever solution they propose, duplication and lack of clarity in decision-making must be avoided. To achieve this the management consultants may have to come up with some novel recommendations. However, I think that both the new bodies and myself will have to be prepared to examine such recommendations with an open mind. Because, if the new bodies are not seen to have a clear cut function and to work efficiently, this can lead to frustration for all concerned.

I should conclude by saying that the administrative organisation of the health boards will prove in the main to have been correctly formulated. This will not prevent me from watching closely the operation of the new boards and if necessary making changes either administratively or by the consent of the Oireachtas.

Are we adjourning at 9.30?

An Leas-Chathaoirleach

The House has already ordered a debate on the Adjournment which will commence at 9.30.

It does not give very much time. These orders mark a further step towards the organisation of the health services but notwithstanding the Minister's hope, which I think everybody in this House shares, I have grave doubts that he will not, after all, achieve what he would prefer not to achieve. I could do no better than to quote from his words at page 4 of his speech. It sums up his concern for overlapping in regard to the organisation of the hospitals medical services. The Minister said:

These institutions should in fact bring more expertise to bear on the problems of providing a modern hospital system but both the staff arrangements and the procedures must in no way result in a triple organisation of the two types of board and the Department causing overlapping and Parkinsonian empire building. We will not be able to afford modern hospital services or attract high class staff if we do not pursue the researches and the consequent decisions based on the growing proportion of specialisation team work and expensive laboratory examination. In about ten years time the position will have changed very materially.

With the greatest respect to the Minister, I suggest that the bringing into effect of this section of the Act to provide for the establishment of four more bodies is bound to ensure that what the Minister seeks to avoid is in fact going to occur. He is going to have overlapping. There would be general agreement that the national body which the Minister proposes are an essential body and will serve a very useful function in co-ordinating and generally supervising the development of the hospital medical services throughout the country. Like many others who are at present serving on regional hospital boards, I can see no justification whatsoever for the setting up of the three proposed regional hospital boards.

Debate adjourned.