Amendment No. 28 is consequential on amendment No. 27. Amendments Nos. 27 and 28 may be taken together. Is that agreed? Agreed.
SECTION 18.
I move amendment No. 27:
In page 18, subsection (1), line 4, to delete "three" and substitute "four".
This amendment revolves around the proportionality argument. There is a view that the representation on the Eastern Health Board from the three new county councils should be increased from the proposed three to four, to bring the representation on the health board in line with that of the other counties. In Wicklow it will be one to 68,000 if the proposals in the Bill remain umamended. In Wicklow at present it is one to about 45,000 and in Kildare one to 33,000 electors. The proposal is to start as we intend to continue and to increase the number of representatives on the Eastern Health Board to four from each council to bring it in line with that of the other councils represented on the Eastern Health Board.
There should be proportionality in relation to these matters. Deputy Doyle is correct, I would not quibble over a couple of thousand. It may be one representative for 43,000 in Wicklow or 32,000 in Kildare, it does not really matter. However, it is proportionately out of scale for the proposed new county councils and I would like the Minister to address that matter which is of great concern for the proposed county councils.
I support the comments by Deputies Doyle and Keogh. The only additional thing I would say is that the Minister received a deputation from the Dún Laoghaire-Rathdown Council and, I presume, from the other councils as well. This was one of the proposals which was forcefully made to the Minister. We spent a lot of time today discussing it, the Minister laid particular emphasis on his desire to respond to the wishes of the members of these councils and to give them the powers of decision on a range of things which we broadly support. There was a strong recommendation from the members that their representation on the health board should be increased and I ask him to accede to that.
As a result of the decisions already taken here the Eastern Health Board will have the highest proportion of elected members of any health authority in the country. The argument can be made on the basis of population comparisons with Kildare and Wicklow, that it might be possible to increase the three counties' membership on the health board from three to four. Members should bear in mind that the geographical size and density of population in the three counties is different from Kildare and Wicklow. However, in the negotiations on this matter, we had to look at the historical situation first. Dún Laoghaire-Rathdown and Dublin County had six members on the health board and that has been increased by 50 per cent to nine members. It is extraordinary that, in making the argument for additional members, my esteemed colleagues have gone west and south but were not prepared to come eastwards to the corporation where a similar population is represented by seven health board members.
This deals with the council——
I know. If you make the argument for an additional three members to 12, I think you should be fair and make the same argument for Dublin Corporation.
We will.
Then, I think you would begin to see where the whole argument is going. Deputy Gilmore is right, that argument was put very strongly to me by the deputation and I responded as positively as I could in circumstances where the membership was increased by 50 per cent from six to nine. Any further deliberations on that matter would be in the remit of another Minister relating to the strategy of how the organisation of health services and regions will be developed for the future. For the purposes of this Bill we have given a fair deal; membership has increased and, as far as we can, we have taken account of the strongly held and genuinely expressed views put forward by local people and their elected representatives. It is not as if we have not responded. A fair deal has been worked out compared to the situation in Kildare, Wicklow or Dublin Corporation.
I do not know how the Minister can say he responded positively. The request was as modest as it could be, to increase the representation from three to four. The only positive response to that request is to agree to it. Anything less than that is a rejection.
There is no such thing as a "half" in this game.
To reject it, as the Minister is doing, and say that he is responding to it as positively as he can, and to put all this language around it, is really an abuse of language.
Flowery language that says "no" at the end of it.
Deputy Doyle, please allow Deputy Gilmore to proceed.
She is a great help Chairman. I have no objection to her interrupting me.
As long as the heckling is positive.
The Minister spoke about the 50 per cent increase from six members to nine. The figure six was fixed in 1970 when the Health Act came into force. The population of County Dublin has more than doubled since that figure was set. In 1970, the overall population of County Dublin, including Dún Laoghaire, was about 200,000, it is now closer to 600,000 so a 50 per cent increase is not sufficient to cope with that rise in population. We are talking about the delivery of health services but the Minister is passing the buck. This legislation is where the size of representation on the health board is decided, not by the Minister for Health. It is not good enough to pass the buck in this way because we are talking about the delivery of health services to 600,000 people around County Dublin and Dún Laoghaire which is almost one-fifth of the population of the State. It is not unreasonable to ask for such representation for the public who depend on those health services, whether in the form of hospitals or community care services. In County Dublin we are dealing with some of the poorest areas in the country, where people are dependent on services provided by the health board. There probably is a case generally for increasing the public representation on other health boards but there is a particular reason in the case of the Eastern Health Board because of the enormous population it is servicing. With a huge population of 1.5 million people it is not unreasonable to look for an increase.
This was one of the points made very strongly to the Minister by members of the three councils. Going back over this agenda, the Minister has come in repeatedly on amendments dealing with the name and size of councils and said he received no representation from the council. Here is a case where the Minister has received representation from the council and where I would expect him to respond by agreeing to it.
I am looking for clarification from the Minister. The 1991 legislation provided for local elections that year and a continuity of membership with the 78 councillors being transferred to the three new councils. Immediately after that election councillors were elected or nominated to the Eastern Health Board. Arising from this legislation, is there a requirement for existing members of the Eastern Health Board to be re-elected or go forward for re-election at the first meeting of the new county councils, and technically should they resign?
I was going to refer to that point. On the amendment first, the Minister said he reacted as positively as he could. That means he did not say "no" outright at the time. There is a huge difference between saying no and not saying yes. The latter is not positive. The Minister's response at the time was not positive. Although people were of the opinion the Minister would genuinely consider this, representation has not kept pace with the increase in population. The Minister's argument that this will be dealt with by the Minister for Health some time in the future is not relevant. We are talking about a very immediate future, about the beginning of January if this Bill is passed. We are a long way from any health legislation which may affect this. The Minister should reconsider his response to this amendment.
The point Deputy Ryan raised is interesting. Members of the new county councils who have already been appointed to the Eastern Health Board will not necessarily represent the political bias that will exist from the beginning of January. I am not suggesting anyone should resign but I wonder if anyone has considered this. Deputy Ryan's point was raised with me in the course of discussion on this Bill.
In relation to the question raised by Deputy Ryan, in January the three new councils will appoint members to the Eastern Health Board. A total of nine councillors will be appointed, the present county council appointed only six members to the health board. I have been as positive as possible in this matter. This was done following negotiations with the Department of Health, which has primary responsibility for the membership of health boards. We all know that on health boards there is a balance between elected members, members of the medical and paramedical professions and other organisations. This is a particular design of the 1970 Health Act which has to be operated throughout the country.
If we make dramatic changes to this system, we must then allow Dublin Corporation to appoint five more members and allow the medical and other professions to increase their representation on the board. Eventually the Eastern Health Board would have about 78 members. We should be sensible about this. I know there are genuine views about this and there is no unwillingness on my part to consider this proposal but these are the kind of complications involved. I know the situation as well as my colleagues and no cries of fatigue will lead me to believe the situation is otherwise. I am being as positive as I possibly can.
The Minister should discuss this matter with the Minister for Health before Report Stage. It is an important issue. Deputy Ryan's question was not fully answered. Will the six councillors from Dublin County Council and Dún Laoghaire Corporation currently on the Eastern Health Board no longer be members of it from 1 January?
Each of the councils established by section 11 shall, at its inaugural meeting appoint three members to the Eastern Health Board. The said members should come into office on the day following the day of the making of the last such appointment.
Do the existing members remain on the health board or cease to be members?
Until such time as——
The Minister is referring to section 18 (5). It seems there will be an election to the Eastern Health Board.
Yes, that is what I said, at the inaugural meetings of the new councils.
Do the four councillors elected by Dublin County Council and the two elected by Dún Laoghaire Corporation to the Eastern Health Board in July 1991 remain on it?
Yes, until such time as their successors are appointed. They may well be reappointed, I do not know what the councils will decide.
If any of them are not reappointed, will they cease to be members of the health board?
I do not think I have to explain that to anybody.
There is some ambiguity here.
Members may not be aware of this.
They are now.
Some people may be disappointed.
Amendment, by leave, withdrawn.
Section 18 agreed to.