Brian Lenihan Jnr (Dublin West, Fianna Fail)

We can return to the issue, but the general directions can be for any purpose relating to this Act or any other enactment or any matter or thing referred to in the Act. The directive power of the Minister is very extensive under section 10. That is as it should be because the Minister is accountable to the Oireachtas. The Oireachtas is exercising the taxing power of raising the funds that fund the service.

I agree with Senator O'Meara that there must be local consultation, and that is also provided for in this legislation. However, the legislation reflects the principle that he who pays the piper calls the tune. That is something those who advocate more local government must address. If they are not prepared to pay for a service at a local level, they are not really entitled to an exclusive say in running it at local level. It is that historical fact of life that has given rise to this legislation, along with the major changes that have taken place in Ireland since 1970.

I agree with all of the Senators who praised the work of the health boards. Many have taken wonderful initiatives. Nobody is taking from that. However, in terms of communications, our country is far more integrated now than it was in 1970 and the speed of communications, the speed of movement between different parts of the country, the technological revolution which has affected medical science as much as any other branch of learning, all point towards the need for a national authority. That is what we are legislating for in this Bill.

I am aware I am revisiting Second Stage but to some extent the discussion so far has tended in that direction and I wanted to reply. It is our strong conviction as a Government that this legislation is very much in the interests of the patient. It is in the interests of the patient that we put an efficient management structure in place.

Senators make the point that local views must be heard and entertained. I do not disagree with that. However, I reject another suggestion, canvassed by Senator O'Meara, that this is part of an agenda to downgrade a particular hospital or to lessen the capacity of a community in any part of Ireland to champion the need for proper services in its hospital. That is not the case. The Bill has nothing to do with that issue. It has to do with providing the best service for the patient. That is the objective, along with getting value for money from the very substantial investment made in health administration. They are very laudable objectives. I do not accept that the Bill is being introduced to in some way affect the rights of persons in local hospitals.

To come back to the central point I made already in this context, he who pays the piper calls the tune. If there are difficulties with the provision of services in local hospitals, it is to do with the allocation of resources. In other cases the difficulties in local hospitals and smaller hospitals have not concerned resources but the recognition of professional qualifications — the observance of professional standards, the maintenance of sufficient numerical levels of staff, and the existence of a sufficient number of patients to justify the provision of a particular service. Those difficulties also exist. However, all these matters can be judged fairly only in the context of who is providing the funds. To interpose a local health board between the fund provider and the service does not add to the debate. Choices must be made in this area and at least the Minister is prepared to come forward and make himself or herself responsible for those choices but needs, given the vast amount of expenditure involved, a technical, well-equipped body to supervise implementation.