Brian Lenihan Jnr (Dublin West, Fianna Fail)

As I outlined in my commentary on the amendment moved by Senator O'Meara, this Bill has nothing to do with eligibility or entitlement under the health legislation. Senator O'Meara made a comment, perhaps it was a stray one, that there was a reduction in rights as a result of this Bill. There is no such reduction in rights. Every entitlement and eligibility that is there for the patient and individual under the health legislation is totally unaffected by this legislation.

This legislation is not addressing issues of eligibility and entitlement. There is a commitment in the health strategy to introduce such legislation and the Department is reviewing the legislation to update and rationalise the entitlement framework. However, that framework is covered by previous legislation and it is not being interfered with by this legislation. This legislation is about management structures, it is not about eligibility and entitlement. I want to make that position clear.

I agree with Senator O'Meara that local communities are concerned, and have every right to be, about the quality of health services in their communities and they have every right to speak out about them. However, we in the Oireachtas have to look at the history and evolution of our health services. The health service executive is a rational response to the fact that the funding for the provision of our health and public social services comes from the central Exchequer.

Prior to the enactment of Health Act in 1970, there was county administration and originally the provision of the health services was funded on the poor law rates that went back to the poor law unions, which I suppose were the original health authorities set up in 1830s and funded exclusively from rates paid by landowners.

There was an evolution after the enactment of the 1898 Act. We had county administration, then county health authorities, again with a significant local contribution. In 1970 it was found that the county framework was too small to plan for the rational evolution of the health and social service. Regional administration was established. There was still an element of local contribution involved. There is no element of local contribution involved nowadays, yet Senator O'Meara argues that local administration should have a decisive role in the administration of these services.

I agree with Senator O'Toole that there is no accountability in that system. There is unaccountability because a board is set up. The boards did much good work and do not want to take from that. The elected representatives on those boards performed their duties with great diligence. We also legislated in the 1970 Act for the direct representation of some of the professional and allied interests on the board. The result of all this was a body that received a lot of money from the Exchequer and a lot of autonomy. There is more control and more democratic accountability under this Bill than there is under the 1970 structure. That is what is at the kernel of this legislation, and we cannot lose sight of that in our discussion.

Senator O'Toole raised the entirely legitimate question of the delivery of services and targets. Under section 10 of this Bill the Minister is given power to do just that and to issue a direction in regard to targets.