Eastern Health Board Held on 10Th January, 1980 (1737Kb)

Minutes of the Eastern Health Board held on 10th January, 1980 (1737kb)

Item Type Meetings and Proceedings

Authors Eastern Health Board (EHB)

Rights EHB

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Find this and similar works at - http://www.lenus.ie/hse 1 10/1/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegorman, on Thursday 10th January, 1980 at 6.00 p.m.

Ald. B. Ahern, T.D. Present Dr. D. G. Kelly Dr. J. 0. Behan Cllr. T. Leonard, T.D. Cllr. L. Belton, T.D. Dr. P. McCarthy Cllr. D. Browne Prof. J. McCormick Cllr. M. Carroll Sr. Columba Cllr. J. Connolly, P.C. Mr. M. Matthews Cllr. BJ. Durkan Dr. A. Meade Ald. A. FitzGerald Cllr. M. Freehill Cllr. Mrs. A. Glenn Dr. B. Powell Cllr. A. Groome Dr. B. Sheehan Cllr. T. Hand, P.C. Cllr. E. Stagg Mr. K. Harrington Cllr. J. Sweeney Cllr. P. Hickey, P.C. Cllr. G. Timmins, T.D. Cllr. F. Hynes Dr. J. Walker Cllr. Mrs. M. Waugh

Apologies for Absence

Mr. H. Corrigan and Ms. N. Kearney and Prof.. J. S. Doyle

In the Chair Alderman Alexis FitzGerald

Officers in Attendance'

Mr. J. J. Nolan Mr. J. Doyle Mr. F. Donohue Dr. B. Pigott Mr. T. Keyes Dr. J. O'Mahony Mr. R.N. Lamb Mr. H. Dunne Prof. B. Donnell Mr. A. O'Brien Mr. J. Reynolds Prof. I. Browne Mr. J. Sadlier Mr. M. Cummins Mr. P. I. Lyons Mr. T. Barry Mr. F. Elliott Miss K. Dolan Mr. J. Clarke Miss F. Heaney Mr. P. J. Swords Miss B. Kelly

1/80 CONDOLENCES

The Chairman informed the members that Mrs. E. Sweeney, mother-in-law of Mr. Mansfield Secretary to the Board had died and the members stood in silent prayer as a mark of respect, also with Mr. J. Peidy, Section Officer on the death of his mother. 2

2/1980 CONFIRMATION OF MINUTES

On a proposal by Cllr. J. Sweeney seconded by Cllr. F. Hynes the minutes of the December monthly meeting were adopted.

MATTERS ARISING

Cllr. Durkan asked if a reply had been received from the Minister for Social Welfare in respect of the concern expressed by the Board at the delays in payment of Social Welfare Benefits in the Kildare area. The Chairman undertook to write personally to the Minister on this matter. Cllr. Stagg referred to the decision taken (Page 269 ref 152/79) that Beard members would visit the Health Centres at Kilmeague and Celbridge and it was agreed that a delegation of the 3 members for Kildare and six otter members would make the visits at 'a date which would be arranged within the next 2 weeks by Mr. Donohue. The members of the delegation are: Councillors Ourkan, Groome, Stagg, Alderman A. FitzGerald, Councillors Belton, Browne, Hickey, Hynes and Sweeney.

3/80 PROCEEDINGS OF VISITING COMMITTEES The reports of the following Visiting Committees having been circulated were dealt with as follows:-

(a) No. 1 Visiting Committee meeting held at District Hospital, Baltinglass on 14/12/1979

On a proposal by Cllr. G. Timmins seconded by Cllr. Mrs. M. Waugh the report was noted.

With reference to the Development of the Hospital Services, Cllr. Timmins proposed that the Board should give its approval to the recommendation of the Visiting Committee that an additional 30 beds should be provided at the hospital. Cllr. Hynes seconded this proposal which was unanimously agreed and referred to Mr. Lamb for attention.

(b) No. 2 Visiting Committee meeting held at Central Mental Hospital Dundrum on 15/11/1979

Dr. J. Behan proposed that consideration of the minutes of this meeting should be deferred until the report of the Ad-Hoc Committee on the Psychiatric Services is ready. The members agreed to this proposal.

On a proposal by Cllr. B. J. Durkan, seconded by Cllr. E. Stagg the report was noted.

Cllr. Durkan referred to the accommodation problem at the Out- Patient Department of the hospital. Mr. Sadlier informed him that finances in respect of maintenance and development are fully committed but the accommodation problem in this area is listed as a priority and will be attended to when funds are available.

Cllr. Groome noted that there was a saving in costs resulting from the construction of the new kitchen and dining rooms and Mr. Swords informed him there was an increase of over 50% in the number of meals prepared in the new kitchen.

Cllr. Stagg asked if the Board was going to establish a laboratory at Naas and if so how soon this would be done. Mr. Swords stated that it was hoped to establish a link for pathology services with St. James's Hospital as soon as the new laboratory there was commissioned.

Dr. McCarthy expressed his concern at the failure of Comhairle na nOspideal to approve a permanent post of Surgeon for Kildare where the post has been filled in a temporary capacity for 18 years.

Mr. Nolan shared Dr. McCarthy's concern but pointed out that the temporary appointment was established by the Kildare County Council before 1970 since when the Eastern Health Board had been pressing An Comhairle to consider making the post a permanent one.

(d) No. 3 Visiting Committee meeting held at St. Vincent's Hospital, Athy, on 13/12/1979

On a proposal by Cllr. Durkan, seconded by Cllr. Groome the report was noted.

4/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

The Minutes of the following local (health) committee meetings having been circulated were dealt with as follows:

(a) Dublin City Local (Health) Committee meeting held on 17/12/1979

On a proposal by Cllr. Glenn, seconded by Cllr. Freehill the minutes were noted.

(b) Dublin County Local (Health) Committee Meeting held on 3/12/1979 4

On a proposal by Cllr. Connolly seconded by Cllr. Hickey the minutes were noted.

On a proposal by Cllr. Durkan seconded by Cllr. Stagg the minutes were noted.

Arising from a discussion on the minutes to which Dr. P. McCarthy, Cllr. Stagg, Cllr. Durkan and Cllr. Groome contributed the following motion was proposed by Cllr. Stagg, Seconded by Cllr. Durkan and carried unanimously.

"That this Committee express disappointment at the continuing delay in the appointment of a full-time permanent Consultant Surgeon and physician to the County Hospital Naas and request the Board to press the Minister for Health for immediate approval to the development of the Hospital."

It was also agreed that a copy of the motion should be sent to the Minister for Health and the Chief Officer of Comhairle na nOspideal.

(d) Wicklow Local (Health) Committee meeting held on 21/9/1979

On a proposal by Cllr. Hynes seconded by Cllr. Sweeney the minutes were noted.

(e) Wicklow Local (Health) Committee meeting held on 16/11/1979

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the minutes were noted.

5/80 QUESTION

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes it was agreed that the Chief Executive Officer answer the question lodged:

QUESTION

Councilor M. Freehill:

"How many hours overtime was worked by the nursing staff in St. Ita's Hospital during the month of November and is the Board satisfied that the present number of staff employed is sufficient?" 5 10/1/1980

"I refer to question tabled by you for Board meeting on 10th January regarding overtime by nursing staff at St. Ita's Hospital. The actual number of hours worked by nursing staff during the month of November was 3,268. This represents on average about 12 staff per day. Seventy-five per cent of this overtime was on the male side. I set out hereunder the reasons for this overtime and what is happening in St. Ita's is equally true in our other mental hospitals, i.e. St. Brendan's and St. Loman's.

The total nursing staff including trainees at St. Ita's at this time is 497. Nurses are recruited as trainees through the nurse training school at the hospital and it has been the practice that the intake of trainees is only sufficient to meet the needs of the hospital. It takes, as you know, a minimum period of three years to train a nurse.

Nurses were granted additional holidays about a year ago and this concession was made in a very serious industrial situation. Additional staff were required to implement this decision but it was not possible despite extensive advertising to obtain the necessary trained staff, particularly male trained staff. The only other course open to us was to recruit additional trainees but we managed to obtain only 29 male trainees when in fact we needed 60 for our services. Part of this problem was due undoubtedly to the postal difficulties at that time but we have found that the service is not attractive to male school leavers. There are probably many reasons for this and this- is an aspect, which you might like to discuss later with me.

We have made offers to four post-graduate nurses and 14 male trainees and if all these accept posts and take up duty at the end of this month, it will ease the situation but it will not be fully solved until we have completed the training of all student nurses at present in training.

The question of staffing in psychiatric hospitals will be reported on by the ad hoc committee to the Board but if you wish I could discuss this matter further with you after the Board meeting on 10th January 1980." 6/80 (A) DENTAL SERVICES (DEFERRED FROM DECEMBER 1979 MEETING) (as quoted in Minutes Page 274 ref 154/79) (B) ORGANISATION AND DEVELOPMENT OF ORTHODONTIC SERVICES -Report No. 3/1980 and Circular M 102/471 of 20/12/79 from Dept. of Health, as follows:- "1. The Department of Health's circular M102/471 of 20/12/79 deals with the organisation and development of 6

Orthodontic Services and recommends the creation of a number of Consultant Orthodontic posts, one of which will be in the service of the Eastern Health Board. At present certain less complicated orthodontic conditions are treated by the Board's dental staff in consultation with private Orthodontists. More complex treatment is provided at the Dental Hospital and the Maxillo-Facial Unit of Or. Steevens Hospital. In Kildare and Wick low the services of private Orthodontists are availed of. A sizeable waiting list for complex treatment has developed because of the limited facilities available. Since 1969 the Board has endeavoured to recruit an Orthodonstit but without success. This may have been due to the status of the post. The circular fixes the new posts at Consultant level.

2. The duties of the office specify that the person appointed will provide erthodorniccormfrBrtidn and, where appropriate, specialist treatment for eligible persons referred to him/her and will afford guidance to Public Dental Officers on orthodontic procedures. It is envisaged that the holder of this post will, if required, perform similar duties for the Midland and North Eastern Health Boards, and if required, will undertake teaching duties at University level. He/she if required, will organize and develop a national service for the care of severe cleft palate cases. The post is whole-time, permanent and pensionable, but limited private consultation/practice will be allowed.

3. The Eastern Health Board post will be linked with arrangements to provide a training pathway for future consultants, and the post should have clinical support staff which would provide training opportunities for persons aspiring to consultant status. Clinical support will be provided by the Board's Dental Surgeons and for this additional staff will be required.

4. A base will be required for the Eastern Health Board appointee and this might be in St. James's Hospital which is also the site for the new Dental School in Dublin. Discussions are taking place at present with the Dublin Dental Hospital and the St. James's Hospital Board in regard to the provision at the new Hospital of facilities for the Eastern Health Board's Dental Services, including a base for the Consultant. However, ft will be some years before the new buildings could be provided and in the interim Cornmarket Dental Clinic which is centrally situated may prove a suitable location — but alternative arrangements will have to be made for some of the dental staff working there and for the central dental stores.

5. The proposal is that the Eastern Health Board's Consultant will be involved in the Midland and North Eastern Health Board's services, in the Dental School, in the training 7 10/1/1980 of future Consultants and in the development of a national service for the care of cleft palate cases. This is a very wide remit indeed and would be more appropriate to two Consultant posts than one.

I recommend that —

I. The Consultant post mentioned in the Department's Circular be created and

2. The creation of a second Consultant post be discussed with the Department of Health. A further report will be submitted in relation to the support staff required for the Consultant." Circular M102/471. As you are aware recent years have seen a growing demand for orthodontic services and there is a clear need to expand and develop the orthodontic services provided by health boards.

The Working Party, representative of the Department, the health boards and the Irish Dental Association, which recently submitted its report on dental services to the Minister recommended that the service be developed along the following lines:—

(1) To meet the immediate situation, 5 full-time consultant posts in orthodontics should be created on an appropriate population distribution basis.

(2) Two of these posts should be located in Dublin and Cork respectively. The holder of the Dublin post may be required to develop a national service for the care of severe cleft palate cases and consequently may be required to obtain the necessary expertise in that aspect of orthodontics.

(3) The posts in Dublin and Cork should be linked with arrangements to provide a training pathway for future consultant training. Accordingly, each of these posts should have clinical support staff which would provide training opportunities for persons aspiring to consultant status. Clinical support for the other three orthodontists should be provided in the first instance by health board dentists who have particular aptitude and training in orthodontic procedures. Where such clinical support is not available or is inadequate to meet the demand, consideration should be given to the involvement of private practitioners who possess orthodontic qualifications.

The Minister has indicated that he is prepared to authorise the development of orthodontic services along these lines and would also be prepared to authorise the appointment of 8 health board dental officers as additional clinical support staff in the Eastern and Southern Health Board areas, if circumstances warranted doing so. In this connection a separate Working Group, on which health boards are represented, operating within the framework of the Local Government Staff Negotiations Board has recommended a revised career structure for the public dental service, including a new grade of Senior Clinical Dental Surgeon.

It is envisaged that this grade would be responsible for the provision of clinical support services in a non-training capacity at local level to dental consultants, including orthodontists. The 'pricing' of this career structure is now proceeding to arbitration.

While Orthodontist appointments could be regarded as "hospital" based, the appointees will in reality be traveling officers providing services at various centers throughout their areas. As such, the appointments would be more appropriate to the Community Care programme and it is visualized that the Programme Manager, Community Care, would have responsibility for the services being provided. It is visualised that the five orthodontists would be appointed on the following basis:— Health Head- No. of Fan time Support Staff quarter Board Posts s Eastern Dublin 1 - linked Dental Surgeons on Health with Dental higher training plus Board School dental surgeons of EHB.

Southern Cork 1 - linked Dental Surgeons on Health 3 with Dental higher training plus card School dental surgeons of SHB.

North- Sligo 1 full-time Dental Surgeons 'Western of NWHB. Health Board

South- Waterford 1 — full-time Dental Surgeons Eastern of SEHB. Health Board

Western Galway 1 — full-time Dental Surgeons Health of WHB. Board

Midland Serviced by Dental Surgeons Health EHB of MHB. Board

Mid-Western Serviced by Dental Surgeons Health SHB and WHB of MWHB. Board 9 10/1/1980

Health Head- No. of Fulltime Board quarters. Posts Support Staff

North-Eastern Serviced by Dental Surgeons of Health EHB. NEHB. Board.

It would appear that the Cork, Galway, Sligo and Water-ford posts might be based respectively on the Regional Hospitals, Cork and Galway and on the County Hospital, Sligo and Ardkeen. A decision will need to be taken on the base for the Dublin appointee. He might possibly be based in St. James's which will also be the site for the proposed new Dental School in Dublin.

The question of whether the provisions of Section 62 of the Health Act 1953 will apply to the Cork post will need to be considered.

While the Minister is prepared to authorise the development of orthodontic services along these lines there are problems in relation to real treatment needs which it would be important for health boards to bear in mind.

It has been the experience in many countries that where an orthodontic service is provided free to the recipient or is sub- sidised the demand for treatment exceeds the real need. Unless some element of control is placed on the categories of patients accepted for treatment in an Orthodontic Service the costs tend to escalate beyond acceptable levels. In general, two factors should be taken into account when selecting patients for treatment:—

1. Dental Health Status: Patients should be free of untreated dental caries with all lesions satisfactorily restored. All patients should be free from active gingivitis and/or period densities. Prior to commencing appliance therapy all patients and parents should be assessed to ensure their willingness to cooperate in preventive measures.

2. Orthodontic Status: The fact that a patient does not have a perfectly aligned set of teeth does not necessarily mean that orthodontic treatment is required, many combinations of such deviations are compatible with both acceptable function or aesthetics. Patients accepted for treatment, therefore. in an orthodontic service should only include the following:

A. Function: (i) Patients whose mastication or speech is affected or is likely to be affected because of the presence of a malocclusion. 10

(\\) Patients in whom other structures in the mouth are being damaged or are likely to be damaged because of the presence of a malocclusion.

B. Aesthetics: Patients who claim that, due to malocclusion, they feel at a disadvantage socially or psychologically (socio- psychologically). The fact that the patients appearance is not fully acceptable to the parent(s) should not be a major factor in deciding whether a patient requires orthodontic treatment or not.

Enclosed are suggested draft qualifications, particulars of office and duties for the five posts referred to above. Your observations on the overall scheme as outlined above and on the draft documentation enclosed herewith insofar as it applies to your area would be appreciated. The Local Appointments Commissioners have yet to be consulted on the proposed qualifications.

Copies of this letter and enclosures have been forwarded to the Programme Managers, Community Care. Officers of the Department will, of course, be available to discuss the issues involved with you or the Programme Manager if so desired.

A further letter will be addressed to you in the near future regarding oral surgeons and the other secondary level treatment posts referred to in the Working Party Report."

It was agreed unanimously that item 5 be noted and on a proposal by Dr. Walker, seconded by Mr. Harrington that Item 6, including Report No. 3/1980 be noted and adopted.

Mr. B. Pigott set out for the members the following details in relation to dental and orthodontic services.

"(1) Orthodontic Waiting List. No. on ortho waiting list awaiting assessment — 3,200. Many of these children will have to be assessed before treatment is carried out.

(2) Dental Services Report (Co. Wicklow). Dr. O'Mahony has circulated statistics on treatment provided to the Wicklow members of the Board.

(3) Dr. Harrington's Resolution.

At Meeting of December 6th on the use of fluoride levels. Discussions have been held with Dr. Hill — Regional Analyst on the use of this probe and he will co-operate. These arrangements are in operation for the four major water 11 10/1/1980 supplies to Dublin, Wicklow and Kildare: Liffey; Ballymore Eustace; Ballyboden and Vartry. They will be extended to the smaller supplies in Wicklow and Kildare later.

(4) Working Party Report: Dr. Harrington's Summary. (a) Report emphasises prevention and the Minister recently indicated that he would amend the existing legislation to allow the introduction of auxiliary dental personnel who would be preventive orientated — Dental Hygienists. The importance of prevention cannot be over estimated and Dental Hygienists will be an essential aspect of this. Provision is being made in all new clinics for these auxiliaries.

(b) The Report recommended the transfer of some eligible patients to private dentists — this was the subject of a letter from the Department discussed at Board meeting of December 6th.

This transfer of patients scheme is on an Ad Hoc trial basis for a limited period (31/3/'80) and the financial alloca tion is limited. It provides for basic dental services only and in particular for dentures. The scheme has been in operation since just before Christmas. The following are some statistics:

(1) No. of dentists involved. Dublin...... 142 Kildare...... 9 Wicklow...... 6 (2) No. of patients transferred to Dublin...... 1,170 date Kildare...... 200 Wicklow...... 60 Total ...... 1,430

(3) Categories dealt with Wicklow and Kildare — Adults. Dublin — 24/60 age group and some students (16/18).

(c) The working party report also recommended the creation of a number of posts of consultant status in den tistry. The letter of 20/12/'79 from the Department and the Chief Executive Officer's report of no. 3/1980 refer to the creation of 5 posts in orthodontics with consultant status — one of these is for the Eastern Health Board. The post may be linked with the cleft palate unit in Dr. Steevens Hospital, The University or Royal College of Surgeons of Ireland and also with the Midland Health Board and North Eastern Health Board.

Support staff will be provided through a new grade in the public dental service — Senior clinical dental surgeons and through those employed in the training pathway — House Surgeons, Registrars/Senior Registrars. 12

It is essential that the consultant has an association with a hospital and St. James's Hospital is suggested as a base for him/her.

The wide remit given to this consultant makes it essential that

(I) He/She have adequate support staff and (II) That a second post be created.

The consultant will provide treatment at advanced level, will provide guidance for existing Dental Officers, and will train the Senior Clinical Dental Surgeons who will be working full-time in orthodontics. He will be responsible for the organisation (at clinic level) of the orthodontic services.

He/She will have completed an 8 year training programme before being eligible for appointment."

A discussion to which Doctors Meade, Behan, Walker, Councillors Durkan, Waugh and Alderman FitzGerald contributed followed and the members expressed dissatisfaction with the proposal contained in paragraph 2 of Circular M 102/471 of 20/12/1979 from Department of Health on the Organisation and Development of orthodontic services, to allocate only 1 post of consultant in orthodontics to Dublin. It was considered that the job description for this post which could require the holder to "develop a national service for the care of severe cleft palate cases" was unrealistic as the physical area and population for which the consultant would be responsible was too large to be covered by one person.

The following motion was proposed by Dr. John Walker, seconded by Mr. K. Harrington and carried unanimously

"That this Board view with disappointment and dismay the proposal made by the Department of Health that only one Consultant Orthodontist be appointed to the Eastern Health Board and that this officer will be required to also provide services for the Midland and North-Eastern Health Boards in addition to undertaking a teaching commitment at University level. This Board recommends that at least three Consultant Orthodontists be appointed so as to meet the requirements listed by the Department of Health."

7/80 POST-GRADUATE TRAINING IN GENERAL PRACTICE - REPORT NO. 1/1980

The following report from the Chief Executive Officer was submitted :-

"At its meeting held on 6th July 1978 the Board approved of the provision of a pre-fabricated building at St. James's 13 10/1/1980

Hospital for the encouragement of continuing education of General Practitioners. This development was in accord with the general policy of the Council for Post-graduate Medical and Dental Education in regard to the co-ordination and encouragement of post-graduate education: in approving the provision of this facility the Board noted that three other centres were envisaged in Dublin.

An application for financial assistance in establishing a similar centre on the North side has now been received from the Secretary of the organising committee who is also one of the coordinators for Post-graduate Medical Education appointed by the Council. The centre is to be set up in premises adjoining the Mater Hospital and is being made available by the Hospital which is also prepared to make a contribution towards the cost of conversion. It will serve the North side as a whole pending the provision of purpose-built centres in the new Beaumont and Mater Hospitals. The application is for a grant of £20,000 towards the estimated cost of £25,000 of providing a lecture theatre, seminar/discussion/display facilities, library/reading room, some catering accommodation, offices etc.

The Committee established to set up and operate the centre includes a Director of Community Care and Medical Officer of Health.

I recommend that the Board seek the approval of the Minister for Health to making of a grant of up to £20,000 towards the cost of conversion and renovation of the premises, and the provision of equipment."

On a proposal by Dr. Sheehan seconded by Dr. Powell the report was adopted.

In a discussion which followed and to which Prof. McCormick, Dr. Kelly, Dr. Behan and Dr. Sheehan and Cllr. Connolly contributed the importance of developing contact and interchange of ideas between all the disciplines engaged in providing medical services in hospitals and in the community was stressed. The following motion was proposed by Dr. Kelly seconded by Dr. Sheehan and carried unanimously.

"That £20,000 be requested from the Department of Health towards Post-Graduate education in the South Eastern area of Dubiin and Wicklow."

8/80 SCHEME FOR TRAINING IN GENERAL MEDICAL PRACTICE - REPORT NO 2/1980

The following report from the Chief Executive Officer was submitted. 14

"The Board has been informed, following meetings between representatives of the Faculty of Community Medicine, Royal College of Physicians, and officers of the Department of Health, of a proposal to establish an in-service training programme to enable doctors to obtain membership of the Faculty of Community Medicine.

In that connection it is proposed, subject to the concurrence of the Board, to initiate an experimental training course in the Eastern Health Board's area and to recruit eight trainees for the course.

The Minister for Health has indicated his willingness to approve of the posts and the formal approval of the Board is requested to the creation of eight posts of trainee doctors in community medicine for the purposes of the training programme."

On a proposal by Prof. McCormick seconded by Dr. Walker the report was adopted.

A discussion followed to which Dr. Sheehan, Dr. Behan, Dr. Walker and Prof. McCormick contributed and Mr. Donohue stated that while the precise details of the training programme have not been decided on it was envisaged that the training would be part full-time and part day release. The first part of the training would consist of 1 years academic study followed by experience in general practice and hospitals. This section should take 3 years to complete. In the following 3 years the trainee would prepare a thesis on which he would be admitted to membership.

9/80 FREE FUEL SCHEMES- REPORT NO 4/1980

The following report on the Free Fuel Scheme was submitted :-

"At the December 1979 meeting of the Board members gave some consideration to the differences between the Health Board's Fuel Scheme and the Schemes administered by the Urban Local Authorities in the area. It was agreed that the topic would be on the Agenda again for the January 1980 meeting. A copy of the handout circulated at the December meeting is attached.

The areas of operation of the schemes are as follows:—

Urban Schemes: (a)Dublin City (b)Dun Laoire Borough (c)Balbriggan (d)Bray Urban District (e)Wicklow Urban District 15 10/1/1980 (f ) Arkiow Urban District (g) Urban Authority housing estates outside the urban areas.

Health Board Scheme: All parts of the Board's area other than those covered by the Urban Schemes.

In summary the Local Authority Schemes are more beneficial to those in Group A - as they are automatically eligible regardless of other income or home conditions, (see overleaf).

The Health Board Scheme is more beneficial to Group B — as they are automatically eligible provided that they are "living alone" and have no other income. Persons in this group residing in the areas covered by the Local Authority Schemes are subject to assessment under the norms of the Supplementary Welfare Allowances Act and eligibility is determined on the basis of individual need.

Group C — are automatically entitled under the Local Authority Schemes but are subject to assessment as to individual need under the Health Board Scheme.

The evident variations in eligibility as between the two Schemes derive from the different statutory origins of the Schemes and from differing regulatory guidelines of the Department of Social Welfare. Officers of the Board continue to have regular discussions with officers of the Department and Local Authorities on the operation of the Schemes.

Eastern Health Board/Dublin Corporation and other Local Authorities* Fuel Schemes 1979/1980

Under these schemes a voucher valued £1.50 may be issued to certain categories of recipients each week from October to April (30 weeks) during which eligibility continues. The vouchers may be exchanged for fuel of various types or used in payment of bills for electricity or gas. Only one voucher is issued per household per week. Under the Corporation scheme the voucher may also be exchanged for 50 kg. of turf at a Corporation turf depot if preferred. The Eastern Health Board scheme applies outside those areas covered by the Corporation and other local authority schemes.

The following persons are eligible for vouchers under the scheme concerned: 16

* Local Authority Eastern Health Board Category Scheme Scheme

Group (A) Persons in re Voucher issued auto Vouchers issued monthly ceipt of matically each week by in advance by Com munity Welfare Old Age Pension (Non post offices with pay ment of pension Officers to recipients Con .) t who live alone or with Widow's Pension a dependant spouse or (Cont) child or an incapaci Widow's Pension tated person or are (Non-Cont.) invalided or aged and Blind Pension live withoneothetper- son who provides full- Supplementary Wel Vouchers issued by Com time care AND fare Allowance. munity Welfare Officer who have no other monthly in advance. source of income. Group (B) Persons in re Not automatically ceipt of Old Age pen entitled sion (Cont.). Retirement Pension Deserted Wife's Bene fit Prisoner's Wife's Allow. Single Woman's Allow. Unmarried Mother's Allow. Invalidity Pension Disabled Persons Main. Allow. Infectious Diseases Main. Allow. Garda Widow's Pension Special Allowance from Dept. of Def.

Group (C) Persons in Vouchers issued auto Not automatically receipt of Unemploy matically by Employ entitled. ment Assistance who ment Exchanges each have dependants week with payment of assistance

While persons in Group (B) are not entitled to vouchers under the Corporation scheme and those in Group (C) are not entitled under the Eastern Health Board scheme, never theless any person in these groups or any other person who by reason of financial difficulties, state of health or other relevant circumstances are considered by the Community Welfare Officer to require special assistance towards heating needs, may have such needs met, either by issue of vouchers under the scheme applicable in the area or by such other means as may be appropriate under the Supplementary Welfare Allowances code.

"The local authorities operating fuel schemes in the Eastern Health Board area are:- Dublin Corporation, Dun Laoghaire Corporation, Balbriggan Town Commissioners and Bray, Wicklow and Arklow Urban District Councils."

On.a proposal by Cllr. Connolly seconded by Cllr. Carroll the report was noted. It was agreed that the motion by Cllr. Connolly could be taken at this point. The motion - 17 10/1/1980

'That this committee advises the Eastern Health Board to call on the Minister for Health to provide sufficient funds to increase the weekly payment under the Free Fuel Scheme from the present sum of £1.50 per week to a sum of £5.00 per week, that those eligible receive payments as of right, and that payments be made to those eligible at the start of the year if they have storage facilities and that the scheme operate for 40 weeks for special categories."-

was seconded by Cllr. Carroll and carried unanimously. In a discussion which followed to which Councillors Hickey, Hynes and Groome contributed Mr. Donohue stated that anomalies arising between the two fuel schemes were dis cussed with the Department of Health and that applicants for service must be advised of their right of appeal.

10/80 REVISION OF MEDICAL CARD GUIDELINES - REPORT NO. 5/1980.

The following report No. 5/1980 from the Chief Executive Officer was submitted :-

'The guidelines operative from 1st January, 1979 were based on the Consumer Price Index figures at mid November, 1978. The Consumer Price Index figures for November, 1979 have now become available and, having regard to them, I have revised the guidelines with effect from 1st January, 1980 as shown hereunder.

Current guide- Revised lines (operative guidelines Category from 1 Jan from 1 1979) Jan. 1980

£ £ Single Person living with relatives 24.00 28.00 Single person living alone 28.00 32.50 Husband and Wife 40.50 47.00 Husband. Wife & 1 child 44.50 52.00 " " 2 children 48.50 57.00 " " 3 children 52.50 62.00 " " 4 children 56.50 67.00 " " 5 children 60.50 72.00 " " 6 children 64.50 77.00 For each additional child under 16 years 4.00 5.00 For each child over 16 years with no income and maintained at home by applicant 5.50 6.50 To the Income Guidelines shown above are added: a) Weekly housing outgoings, rent, ground rent, mortgage charges etc.) in excess of 4.00 5.00 b) Exceptional expenses necessarily incurred in travelling to and from work where these create undue hardship. 18

Parsons with no income other tftan:- (a) Old age non-contributory pension (maximum) (b) Old Age (Care) Allowance (c) Deserted Wives Allowance (d) Infectious Disease (Maintenance) Allowance (e) Disabled Persons (Maintenance) Allowance (f) Social Assistance Allowance for unmarried mothers (maximum) (g) Social assistance allowance for single women (maximum) (h) Widows (non-contributory) pension (maximum) (i) Orphans (non-contributory) allowance (maximum) (j) Blind (non-contributory) pension (maximum) (k) Supplementary Welfare Allowance - will be regarded as being eligible for a medical card. Cases of hardship will continue to be dealt with individually on merit." On a proposal by Cllr. Hickey seconded by Cllr. Groome the report was noted. 11/80 LETTER FROM ST. JAMES'S HOSPITAL REQUESTING TRANSFER OF SITES AT GARDEN HILL AND MOUNT BROWN TO FACILITATE DEVELOPMENT OF THE NEW HOSPITAL (TOGETHER WITH COPIES OF RELEVANT EXTRACTS FROM REPORTS No. 22/1978 OF 2nd AUGUST, 1978 AND NO. 35/1978 OF 7th DECEMBER, 1978).

22nd November, 1979. "Mr. James J. Nolan, Chief Executive Officer, Eastern Health Board. Dear Mr. Nolan,

You are aware, in your capacity as a member of the St. James's Hospital Board, of the major development prog ramme envisaged for the Hospital and specifically the pro posals in regard to the envisaged usage of portions of the overall site which do not form a part of the area leased to the Hospital Board. I refer to the Garden Hill and Mount Brown areas.

On behalf of the St. James's Hospital Board, I now submit a formal request to the Eastern Health Board for the trans fer of the areas in question to the Hospital Board. The Hos pital Board presumes that this request will have to be chan nelled in the appropriate way through the Health Board and the Minister and it would be appreciative of your personal efforts to have the matter dealt with as expeditiously as pos sible in the circumstances. I have asked the Project/Technical Services Manager to submit to you a site plan outlining de tails of the additional area which the Hospital Board is now requesting. 19 10/1/1980

I am under advice from the Project/Technical Services Manager that he had made formal application to your Board for wayleave permission on the Garden Hill site for drainage services and no doubt this also will receive your urgent and sympathetic attention.

Yours sincerely,

L. Hogan, Hospital Administrator."

Extract from Report No. 22/1978 of 2/8/78

"GARDEN HILL SITE

When the new St. James's Board was established in 1971, I advised the Eastern Health Board to transfer to the new Hospital Board all the site including the Laundry, Boiler-house and Mortuary areas but excluding a specified area at Garden Hill and the large area between Hospitals 1 and 2 and St. James's Street.

The area at Garden Hill was reserved because of arrangements made since 1969 with University College Dublin Department of Psychiatry, the Irish Foundation for Human Development and the Endocrine Unit, for use of various parts of the site. The situation was summarized in Report No. 12/1976 which was adopted by the Board in March 1976. In the meantime the St. James's Hospital Board have been advised by their Project Team that the Garden Hill site would be required for development of the new Hospital.

A meeting was held in Garden Hill House on July 12th 1978 to consider a proposal from the St. James's Hospital Project Team to utilise the entire site at Garden Hill for the new Boiler house and Workshops. The following attended:-

Prof. D. Howie Mr. T. Keyes Mr. P. Dalton Dr. J. Cullen Mr. P. V. Moloney Dr. J. Behan Mr. J. J. Nolan Mr. T. Harty

The main points of the meeting were:

1. Dr. Cullen assured Dr. Howie of the Foundations wish and intention to co-operate fully with the St. James's Hospital Board but pointed out that the Foundation's needs and current development proposals would also have to be catered for in terms of suitable site area and location.

2. It was agreed that the Foundation would prepare an outline brief of requirements for discussion with the St. James's Design Team representatives as to the possibility 20

of adequate suitable accommodation being available elsewhere on the site.

3. It was also agreed that in the meantime the St. James's Hospital Board should press the Department to sanction the acquisition of the adjoining site of 1.3 acres which would be of great advantage to the new Hospital in any event, but might also be essential in making available an alternative suitable site for the Foundation. The Eastern Health Board would be asked to support the acquisition of the 1.3 acre site.

4. The Endocrine Unit, controlled by Dr. Darragh, on behalf of the Biological and Medical Research Institute, which had hitherto been excluded from any site proposals or arrangements involving the Foundation, would if all parties agreed, be included in a "package" deal involving a new site etc. for the Foundation. The Unit has standard service arrangements with the Eastern Health Board.

5. All matters involved herein would have to be considered by Professor Browne on his return from America and also in due course by the Boards involved. 6. On the assumption that the expected date of June 1979 for starting the Boilerhouse etc was valid, the Foundation, if an alternative acceptable site was guaranteed formally by the St. James's Board, would have no objection to the construction of the Boilerhouse starting on such part of the Garden Hill site as did not involve the activities of the Foundation.

7. A working party was set up consisting of Messrs. Dalton, Moloney, Keyes, Cullen, Behan and Harty to arrange for examination of the Foundation's proposals and the provision by St. James's Board of suitable alternative facilities."

Extract from Report No. 35/1978 of 7/12/1978

"DEVELOPMENT OF ST. JAMES'S HOSPITAL Garden Hill Site, Long-Stay Units, Office Accommodation Board Membership

In my report of 2nd August, 1978 (No. 22/1978) to the Board I informed members of the background to developments at the Garden Hill site, including the request from the St. James's Hospital Project Team to be given the site for the new hospital boilerhouse. In the meantime the joint working party set up to examine the various proposals involved have had several meetings as a result of which more detailed proposals are now available. In the first instance Professor Browne, Dr. Cullen and Dr. Behan have prepared a detailed brief for the planning of a complex to include a full Department 21 10/1/1980 of Psychiatry and the Irish Foundation for Human Development. The brief is in general accord with the broad principles set out in the Ad Hoc Committees Report, except that permanent structures are now proposed, which would naturally cost a lot more than the transfer of existing temporary structures envisaged in the negotiations with the St. James's Board. In order to provide an alternative site for these structures and thereby free Garden Hill for development, the St. James's Board have negotiated with the Department of Health for funds to purchase a site adjoining the Rial to end of the Hospital grounds. This site has been considered by Professor Browne's group including Mr. P. V. Moloney, Architect and they are satisfied that it would provide sufficient ground room, services etc. for the proposals in their brief.

If all the negotiations in relation to the Rialto site are successfully concluded and if the Eastern Health Board consider that the "swop" arrangements are acceptable then the Garden Hill site may be made available to the St. James's Board for development. In that regard the final legal formalities for transfer of the Garden Hill Site to the Foundation are being completed. It should be noted that the Endocrine Unit remains in its present location."

On a proposal by Dr. Behan seconded by Dr. Sheehan the letter with copies of reports 22/1978 and 35/1978 was noted.

A discussion followed in which Dr. Behan stated that the transfer of the site is essential to enable the new St. James's Hospital to be developed. Dr. Walker asked if this proposed move would confer permanence on the 2 other units on the Garden Hill site and Mr. Nolan set out the position as follows:

In the 1960's the Dublin Health Authority consented to the setting up of a biological and medical research unit with a special involvement in endocrinology on a site at Garden Hill in the then St. Kevin's Hospital. This unit was related to the Department of Psychiatry U.C.D. headed by Professor I. Browne, Chief Psychiatrist of the Eastern Health Board whose headquarters and professorial unit are also at Garden Hill. At a later date the Foundation for Human Development was set up also on a site at Garden Hill. This unit which is a separate entity with a psychosomatic orientation has a working relationship with Professor Browne's Department and with the Biological and Medical Research Institute. It was never intended that these groups would be temporary and they hold tenure rights under formal agreements. Negotiations are now proceeding to obtain from the St. James's Board an area of land (approximately equivalent to that at present occupied by the three bodies) to which these bodies 22

may transfer so that the development of the new Hospitals energy etc centre at Garden Hill may not be impeded.

The Chief Executive Officer also emphasised that if the Board's psychiatric service was ever to attain to a significant grade of professional status and acceptance at consultant and service levekthe Chief Psychiatrist would need to be provided as soon as possible with an adequate permanent headquarters complex at Garden Hill. In the interim Professor Browne would be obliged to continue to carry out his functions as Chief Psychiatrist in temporary buildings to be provided by the St. James's Hospital Board and located on the Brookfield site. The following motion was proposed by Dr. Behan, seconded by Cllr. Carroll and carried unanimously:

The Eastern Health Board hereby agree that in order to expedite construction of the new St. James's Hospital and thereby improve considerably the level of health services available to the community, the area at Garden Hill, at present in use by the Foundation for Human Development, the Biological and Medical Research Institute and the administrative, clinical and research department of the Chief Psychiatrist of the Eastern Health Board be transferred as soon as possible to the Hospital Board who will provide for each of the three groups a site, accommodation and related facilities equitably equivalent to the existing sites etc. with appropriate compensation for disturbance where such is a real cost factor.

"The Eastern Health Board also agree to accept in principle the proposals as endorsed by the "ad hoc" committee regarding provision on a permanent basis of buildings, facilities and staff for the Chief Psychiatrist's Department on the Brookfield site provided by the St. James's Hospital Board and to submit them to the Minister for approval, after the necessary schedules and estimated costs have been prepared by the Programme Manager in conjunction with the Chief Psychiatrist and authorised."

It was also agreed that the Board should nominate a small group to meet the Secretary of the Department of Health during the week commencing 21/1/1980 to consider the proposals.

The members of the delegation are:

C. E. O. Mr. J. J. Nolan, Dr. J. J. Behan, Prof. I. Browne, Mr. T. Keyes, Alderman A. FitzGerald, Cllr. D. Browne, Dr. B. Sheehan and one other who would meet beforehand to decide on the form of submission. 23 10/1/1980

Mr. Keyes advised the Board that he has a brief for the meeting in draft form as originally submitted to the Board in 1978.

12/80 ST. COLUMCILLE'S HOSPITAL - DEVELOPMENT OF MATERNITY SERVICES REPORT NO. 6/1980.

The following report No. 6/1980 from the Chief Executive Officer was submitted.

"The Board will be aware for some time past, from reports of the Visiting Committee that there has been a considerable increase in activity at the Maternity Unit, St. Columcille's. During recent years, also, there has been a continuous programme of improvements in facilities and accommodation and with the construction of a new Stores it has been possible to revert a ward area to the Unit, thereby bringing the number of beds available to the original complement of 34.

The number of deliveries during the past 10 years has been

1970 609 1975 598 1971 588 1976 611 1972 582 1977 697 1973 654 1978 816 1974 616 1979 948

It is expected that with the continued growth in population in the area served by the hospital as confirmed in the Preliminary Report of the April, 1979 Census, the upward trend in the number of births will continue.

The unit is fully equipped and has ultra-sound facilities in a comprehensively staffed radiological back-up service. There is also a neo-natal service on a temporary basis including nurseries for well and sick babies. The consultant staff at the moment consists of two Obstetricians whose combined sessions are equal approximately to one whole-time consultant. There are also two Obstetrical Registrars attached to the unit. These staffing arrangements have not been expanded to meet the greatly increased and growing demand on the unit. This restriction was due principally to the reluctance of Comhairle na nOspideal to authorise additional consultant appointments unless we were linked to a large maternity unit. In that regard there have been exploratory discussions during recent months with the National Maternity Hospital and with officers of Comhairle na nOspideal. These discussions have indicated that the consultant staff should be strengthened immediately to provide the* equivalent of two full-time obstetricians. Comhairle has strongly advised that the Unit should be linked on an integrated basis with the 24

National Maternity Hospital. From the viewpoint of service to the public this advice has merit, in so far as the obstetrical services for South Oublin and Wicklow are provided almost entirely by the National Maternity Hospital and by St. Columcille's Hospital. An advantage arising from a linked service would be the provision of uniform standards of staffing and patient care at the highest levels in both hospitals. In addition an adequate consultant-staffed neo-natal service at St Columcille's would also be provided. A further probable advantage would be the introduction of training programmes for medical personnel in St. Columcille's which at the moment is not recognised by the Royal College of Obstetricians for training purposes for M.R.C.O.G.

In the course of the exploratory discussions as to the possibility of a linked relationship, the National Maternity Hospital were agreeable that the existing admission, care and discharge policies of the Eastern Health Board in relation to patients from the South Dublin and Wicklow area would be continued and developed. Related neo-natal facilities would also be considerably improved. All medical staff involved in the joint Obstetrical Unit would be under the control of the Master of the National Maternity Hospital who would be responsible for supplying the necessary number of Registrars, Senior House Officers etc to the St. Columcille's unit Within that situation, special arrangements would have to be made in relation to continuance of our existing consultant staff with full preservation of existing rights and conditions of service. Nursing and ancillary staffs in the Unit would have similar arrangements and safeguards. The position would be similar to that of the Dialysis Unit (in St Mary's Hospital) the activities of which have been under the direct control of Jervis Street Hospital for the past three years.

In the light of the present policy parameters of the Comh-airle which will entail discontinuance of smaller maternity hospitals, I regard it as prudent for the Board to recognise that reality and to seek to preserve and advance the maternity unit at St Columcille's by integrating it with the major hospital, even if in so doing the professional control of the unit passes to the National Maternity Hospital. The existing consultant obstetricians. Doctors Brennan and Gallagher together with Dr. Hanratty, obstetrician to St. James's Hospital, Dr. Malone, Radiologist, Dr. Cusack, Medical Administrator and Sister Angelis, Matron agree, that the real interests of the mothers who come to the St. Columcille's Maternity Unit would be best served by integrating with the National Maternity Hospital.

In effect, if we get a firm commitment that the St. Columcille's unit will be continued and advanced as an active maternity unit and that the National Maternity Hospital will make 25 10/1/1980 available to the unit all necessary resources in staff, equipment and expertise, then integration of the unit with the National Maternity Hospital should be very much to the advantage of the mothers who come to the unit for confinement and to their babies.

In any event, it is quite clear as I have already pointed out to the Board, that we cannot continue to represent ourselves as providing a maternity service at St. Columcille's if we have not got the necessary consultant staff and related facilities.

Although not directly related to the obstetrical unit at St. Columcille's I think it as well, in the general context of hospital developments, to place the following points, also before the Board at this stage. Members are already aware from previous reports and discussions that six major general hospitals are envisaged for the Dublin area viz: St. Vincent's, Mater, Beaumont, St. James's, James Connolly and Tallaght, with continuance of three major separate maternity hospitals viz: Rotunda, Coombe and National Maternity. Smaller general hospitals such as at St. Columcille's, St. Michael's, and Naas, will in accordance with Comhairle policy, have to be linked for consultant appointments with one or more of the major hospitals. St. Michael's already have linked appointments with St. Vincent's (with the approval of Comhairle) and we are continuing our protracted negotiations with St. Vincent's for the same purpose. In the absence of any progress in linking Naas Hospital with St. James's Hospital we have opened negotiations with the Meath Hospital for linked consultant appointments with Naas, in anticipation of the Meath/Adelaide group moving to the new Tallaght Hospital. In that connection it is interesting to note that while the Royal College of Physicians of Ireland nominate St. Michael's as a general hospital recognised for General Professional Training they do not accord similar recognition to St. Columcille's or to Naas Hospitals.

It would also be as well for the Board to start considering at this stage whether the probable continuance of this trend towards integration of these three smaller hospitals with major units may lead inexorably to the evolution eventually, by stages, of a system of joint management for St. Vincent's, St. Columcille's and St. Michael's and for Tallaght and Naas Hospitals."

Mr. Nolan told the members that due to the reluctance of Comhairle na nOspideal to authorise additional consultant appointments at the hospital unless linked with major units the Board had no choice, if it wished to continue providing an adequate service at St. Columcille's, but to seek integrated appointments with larger units. 26

The whole position was considered in detail with unan-mous agreement that the Chief Executive Officer's submission was timely and well-founded and should be endorsed. It was hoped that in the implementation of necessary arrangements, St. Columcille's would continue to be developed as an active acute front-line unit and that any contrary trends would be strongly resisted by the Board.

The representatives from Kildare made strong representations for a special development plan for Naas Hospital and expressed misgivings about any future links with the proposed new Hospital at Taliaght. It was agreed that the working party set up at the meeting on 1st November 1979 (to consider the development of St. Columcille's and Naas Hospitals) should meet as soon as possible to consider the representations made. The members of the party are:—

Ald. A. FitzGerald Cllr. E. Stagg Cllr. P. Hickey Cllr. J. Sweeney Cllr. B. Durkan Prof. J. McCormick Cllr. F. Hynes Cllr. M. Carroll Dr. A. Meade

The following motions were then proposed and carried unanimously

1. Proposed by Cllr. Hickey, Seconded by Cllr. Sweeney

"That the Eastern Health Board in view of the policy of Comhairle na nOspideal that smaller maternity units should be discontinued and having regard to the increasing needs of the community for comprehensive obstetrical services, decide that, in the first instance, the maternity unit at St. Columcille's must be continued and for that purpose all necessary arrangements be initiated with the National Maternity Hospital — if the Charter of that Hospital so permits — for control, operation and staffing of the unit by them on behalf of the Board, subject to the agreement of the Minister for Health."

2. Proposed by Cllr. Hickey, Seconded by Cllr. Waugh.

'That the Eastern Health Board in view of the policy of Comhairle na nOspideal that consultant appointments to smaller general hospitals will only be authorised on the basis of formal linking of such appointments with a large general hospital, hereby decide that the necessary arrangements be made with St. Vincent's Hospital, Elm Park whereby consultant services in medicine, surgery, paediatrics, pathology, radiology and anaesthetics and such other services as may be required will be provided by means of joint appointments in those specialities in both hospitals. All such arrangements must be such as to ensure the continued progress of St. Columcille's as an active acute hospital, serving the community in accordance with 27 10/1/1980

the programmes and policies of the Board, subject to the agreement of the Minister for Health."

13/80 NOTICES OF MOTION

The following motion was proposed by Dr. J. Behan

'That the Board request the Minister to meet a deputation to discuss:

The Tallaght Hospital Establishment Order.

1. Representation on the Planning Board for Tallaght Hospital.

2. And that the Eastern Health Board have representation on the Boards of all voluntary hospitals to assist the Department in ensuring the co-ordination and delivery of an integrated hospital service across both public and private sectors."

Speaking to the motion Dr. Behan said that he wanted the Eastern Health Board to have a vigorous and viable representation on the management and planning boards of Tallaght Hospital. He considered that the management boards of all voluntary hospitals should be representative of the groups who would run the hospital i.e. the staff, the community and the Eastern Health Board and that E.H.B. representation on the boards should be the same as in St. James's Hospital where 50% of the Board of Management are nominated by the Eastern Health Board and this arrangement appears to work satisfactorily. He said that at present the Boards of Management of voluntary hospitals have no public accountability for their affairs and are non-democratic and called for the proper integration of the voluntary hospitals service into the community with one tier operation.

Dr. Behan stated that his proposals were not intended as an attack on religious orders but that there is a two tier health service in operation catering for the private and public sectors respectively and the Eastern Health Board is left with the less attractive end of the service.

The motion was seconded by Dr. B. Sheehan and items 1 and 2 were carried unanimously. At Dr. Behan's request it was agreed to include item 3 on the agenda for the next meeting of the Board.

Dr. Behan also recommended that Dr. Woods Minister for Health should be invited to meet the Board to discuss particular problems of the Public sector Health Service and proposed the following motion which was seconded by Dr. Sheehan and carried unanimously 28

(i) "That the Health Board invite the newly appointed Minister for Health to Meet the Health Board so that he may become acquainted at first hand with the particular problems of the Public Sector Health Service thereby improving his understanding of the Health Board's needs and improving liaison between the Minister and the Health Board.

(ii) It is further proposed that this meeting might best take place by extending an invitation to the Minister to attend the second day of the Board's proposed seminar on its role and function to meet the members and engage in discussions on a structured agenda."

It was agreed that the Minister should be invited to attend at the second day of the seminar for which a structured agenda could be prepared.

It was agreed that the motion tabled by Cllr. Connolly

"That a family planning clinic be set up in the Ballinteer Health Centre."

be deferred to the next meeting.

The following motion was proposed by Cllr. B. J. Durkan seconded by Dr. A. Meade and carried unanimously.

'That this Board would approve the allocation of funds for the acquisition of 6 houses adjacent to Naas Hospital for the purpose of meeting staff accommodation requirements, i.e. 2 houses for doctors, 1 for casualty officer and 3 for other staff."

Mr. Nolan stated that there is no provision in the Capital Programme for the provision of the accommodation recommended in the motion but undertook to have it considered for inclusion in a future programme.

The following motion was proposed by Cllr. M. Freehill

"That immediate steps be taken to alleviate the long delay incurred in the processing of Disabled Persons Maintenance Allowance applications."

Speaking to the motion Cllr. Freehill expressed concern at the hardship which applicants of D.P.M.A. suffered while waiting for approval of their applications.

Mr. Donohue replied that applications for D.P.M.A. dealt with as quickly as possible and where delays occurred the applicant if eligible received financial support by way of a Supplementary Welfare allowance. The Board has a statutory 29 10/1/1980 obligation to examine the means of each applicant and in many cases applications for the allowance were submitted without medical evidence that the applicant was disabled. Added to this there was an accumulation of arrears due to the postal strike. He undertook to have outstanding claims processed and assured Cllr. Freehill that where an applicant could be given interim support by way of a Supplementary Welfare Allowance that this was done.

The motion was seconded by Ald. A. FitzGerald and carried unanimously.

There was no correspondence.

The meeting finished at 10.05 p.m.

Correct. J. J. Nolan Chief Executive Officer.

Signed CHAIRMAN 30 7/2/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Boardroom. St. Brendan's Hospital, Grangegorman, on Thursday 7th February, 1980 at 6 p.m.

PRESENT

Ald. B. Ahem T.D Cllr. F. Hynes Dr. J. D. Behan Ms. N. Kearney Cllr. L. Delton T.D., Dr. D. G. Kelly Cllr. D. Browne Dr. P. McCarthy Cllr. M. Carroll Prof. J. McCormick Cllr. J. Connolly P.C., Sr. Columba Cllr. E. Doyle Mr. M. Matthews Prof. J. S. Doyle Dr. A. Meade Cllr. B. J. Durkan Cllr. M. Freehill Ald. A. FitzGerald Dr. B. Sheehan Cllr. E. Stagg Cllr. Mrs. Glenn Cllr. J. Sweeney Cllr. A. Groome Cllr. G. Timmins T.D., Cllr. T. Hand P.C., Dr. J. Walker Mr. K. Harrington Cllr. P. Hickey P.C.,

APOLOGIES FOR ABSENCE

Mr. H. Corrigan and Cllr. Mrs. M. Waugh

IN THE CHAIR

Alderman Alexis FitzGerald

OFFICERS IN A TTENDANCE

Mr. J. J. Nolan Mr. H. Dunne Mr. F. J. Donohue Mr. J. Doyle Mr. T. Keyes Mr. C. Mansfield Mr. R. N. Lamb Mr. A. O'Brien Mr. J. F. Reynolds Mr. T. Barry Mr. J. Sadlier Mr. M. Cummins Mr. P. J. Swords Miss E. Larkin Mr. F. J. McCullough Miss F. Heaney Prof. I. Browne

14/80 CONDOLENCES

The Chairman informed the Board of the recent deaths of the following, and members stood in silent prayer as a mark of respect — the mother of Miss E. Fulham, Superintendent Public Health Nurse in the Kildare area; Mr. Myles Dockrell, former Psychiatric Nurse and brother of the Board's Fire Officer Mr. Liam Dockrell; Mr. Joe Byrne and Mr. Tom Canavan, former Section Officers of the Board. 31

15/80 On a proposal by Cllr. Sweeney, seconded by Cllr. Hand it was agreed that the meeting would end not later than 9 p.m.

16/80 CONFIRMATION OF MINUTES

On a proposal by Cllr. Freehill, seconded by Cllr. Hand, the Minutes of meeting held on 10th January, 1980 were noted and adopted.

MATTERS ARISING

Mr. Donohue undertook to keep Cllr. Freehill informed of the position from time to time regarding D.P.M.A. applications.

In reply to Cllr. Durkan, the Chairman said that he hoped to meet the Minister next week and would raise with him again the question of delays in Social Welfare payments in the Kildare area. In reply to Cllr. Durkan, Mr. Swords said that the question of appointments at Naas Hospital was still before Comhairle na nOspideal.

In reply to Cllr. Stagg's enquiry about the working party on St. Columcille's and Naas Hospitals, Mr. Nolan said that he had talks with officers of An Comhairle and had an encouraging reaction. It would be necessary to await the outcome of discussions on links with major hospitals in the area before a decision would be made on appointments to the Board's hospitals. In the meantime Mr. Lamb would arrange a meeting of the Working Party dealing with the two hospitals to consider if any further measures were necessary. In that regard it was agreed that Cllr. Eric Doyle should be a member of-the Working Party.

The Chairman informed members that the C.E.O. and himself would be meeting the Secretary of the Department the following Tuesday regarding the development of St. James's. The members agreed that Cllr. Groome should join the delegation. Dr. Sheehan asked that he be replaced on the delegation and the members agreed to the' nomination of Cllr. Stagg.

17/80 PROCEEDINGS OF VISITING COMMITTEES

The reports of the following visiting committees having been circulated were dealt with as follows:

(a) No. 1 Visiting Committee meeting held at Verge-mount Hospital, on 11/1/80 — noted on proposal by Cllr. Sweeney seconded by Cllr. Carroll. 32 7/2/1980

Cllr. Sweeney praised the work done on the development of long-stay accommodation at the Hospital. Mr. Nolan said that it had been discovered that the old people admitted to the new unit were more confused and incapacitated than expected showing the heavy burden of such cases yet to be dealt with. He said that the Little Company of Mary had approached the Health Board for a site at the hospital to build accommodation for terminal cases and in endorsing their application for the Board's approval he hoped that the Order might agree to cater for some younger chronically sick.

Mr. D. Kelly referred to possible similar developments at the Royal Hospital, Donnybrook and enquired about the advisability of having two such units. Mr. Nolan replied that practical experience showed that there was still a significant need for such accommodation but that a unit greater than 15 to 20 beds tended to impose too heavy a burden on staff and resources. Cllr. Freehill said there was a number of young chronic sick in Cheshire Homes who did not need nursing, but who could not get accommodation elsewhere. Mr. Nolan said that it was hoped that accommodation would become available in due course for the more independent physically disabled. The Board was prepared to support the Assisi Trust housing project at the Dominican Convent, Navan Road, with this type of problem in mind, but Board priorities in this regard were related at this stage to care of the aged, young chronic sick and terminal cases.

(b) No. 3 Visiting Committee Meeting held at St. Brigid's Home on 17/1/80 noted on a proposal by Cllr. Durkan seconded by Cllr. Hynes.

Cllr. Durkan referred to the maintenance needs of the wooden exteriors of the building and indicated that he would submit a motion for the Estimates Meeting that funds be allocated to undertake speedily the necessary repairs at the Home. Cllr. Hynes enquired if the Fire Officer had examined the building. The Technical Services Officer said that the Dublin Corporation Fire Officer had examined the building some years ago and in addition the Board's Fire Officer visits the Home at least twice a year. He said that as the buildings are at ground level with wide verandahs there are good evacuation arrangements. In addition the floors are concrete and there is at present a scheme in hands for rewiring and installation of fire alarms.

Mr. Nolan referred briefly to the history of the building since its use as a sanatorium and said it was as full as ever and cannot be done without at present The Board has emergency arrangements with the Fire Brigade and the security personnel at night have full instructions as to how to deal with emergencies. On a proposal by the Chairman seconded by Cllr. Hynes it was agreed that the Fire Officer be asked to attend a later meeting and that a report be made available to the members in advance. 33

On a proposal by Dr. McCarthy seconded by Cllr. Stagg it was agreed to suspend standing orders to enable a Visiting Committee meeting held that day at Cherry Orchard to be discussed.

Dr. McCarthy said that at the last Committee meeting at Cherry Orchard the members were advised that finance had been made available by the Department of Health for the provision of an extension to house the two bed isolators that had been purchased but at this visit they found that nothing had been done since the last meeting. Cllr. Groome said it was at least two years since the Isolators had been purchased and if the Department recognised the need to purchase them they should provide the unit for their use. Cllr. Stagg asked that the Board re-examine its stand on the provision of the unit and ask the Department to agree to provide the building. Prof. McCormick said that expert advice should be sought as to whether this unit was needed or not before it was provided. Mr. Nolan said that the Cherry Orchard Hospital was the national infectious diseases centre for the country and while smallpox had virtually disappeared the danger of Lassa fever etc is still present The need to use the unit at Cherry Orchard might never arise but it was considered that in present circumstances, the facilities must be retained. The matter is still being considered by the Department and the Board could consider asking the Department to fulfill the Board's original plans or could agree to accept the Department of Health's alternative proposals. The following motion was proposed by Dr. McCarthy and seconded by Cllr. Stagg:—

"That the original plans to house the two *bed isolators' be implemented."

The motion was passed. Professor McCormick dissenting. It was decided to inform the Department accordingly.

18/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

The minutes of the following local (health) committees having been circulated were dealt with as follows:

(a) Dublin County Local (Health) Committee meeting held on 7/1/80.

On a proposal by Cllr. Hand seconded by Cllr. Carroll the minutes were noted.

(b) Dun Laoghaire Local (Health) Committee meeting held on 8/1/80.

On a proposal by Cllr. Freehill seconded by Cllr. Carroll the minutes were noted. 34 7/2/1980

In reply to Cllr. Freehill Mr. Keyes said he had referred the motion about drug abuse in the area to the Chief Psychiatrist for his report

In reply to Professor Doyle's enquiry about a report on the Rutland Centre, Mr. Keyes said he would ask the Chief Executive Officer to arrange a meeting of the Scientific Committee at which he would have a report available.

19/80 DISPOSAL OF LAND TO DUBLIN COUNTY COUNCIL - (ST. PATRICK'S HOME, NAVAN ROAD)

The following report Nol 7/1980 from the Chief Executive Officer was submitted:—

"In report No. 27/79 the Board was advised of an application by Dublin County Council for approximately 3.6 acres of land at St. Patrick's Home for the purposes of developing playing facilities to meet the needs of an expanding local community. The Board gave its consent to the disposal on the basis of a set off or alternatively at the market value of the site.

The Minister for Health by letter of 11th September, 1979, gave his consent to the disposal on the basis of a set off to avoid the need for either party borrowing capital funds. In the course of recent negotiations with the County Council in regard to the Board's need for sites for Health Centres, Day Nurseries, Welfare Homes and similar, it has been established that the Board will require approximately 20 acres in various locations throughout the county as follows:—

Ctondalkin (a) Deatsrath (b) Booth Road (c) Ronanstown

Tallaght (a) Castletimon (b) Central Area

South County Dublin (a) Stiilorgan (b) Cabinteely (c) Shankill (d) Limekiln (e) Ballyboden (f) Ballinteer

North County Dublin (a) Swords (b) Baldoyle (c) Malahide (d) Portmamock (e) Donabate/Portrane

Also arising from these discussions the County Council has indicated their interest in a further 14 acres approximately at Navan Road being the remainder of the Board's property bordering the canal and railway line at Ashtown and adjacent to the 554 acres which they acquired from the Dublin Health Authority in 1965 for housing. This land is 35 required by the County Council for recreational facilities in the area. The land in question is surplus to the Board's requirements. There will be sufficient land still remaining to preserve the amenities of the Home including privacy.

I recommend that the Board approve of the disposal of the further 14 acres approximately to Dublin County Council for amenity purposes and subject on this occasion also to the provision of adequate boundary walls to restrict access to the remaining lands in the Board's possession and to preserve the privacy of the Home (boundary walls should be approximately 8 feet high). There will still remain 33 acres in the possession of the Board at St Patrick's. In view of the Board's requirements for sites in the County Council area, it is recommended that this disposal also be by way of a set off so as to avoid the necessity for the borrowing of capital monies by the Board.

The lands are held by the Board under a Fee Farm Grant dated 28th April, 1885, subject to an annual rent of £184.65 and became vested in the Board under the provisions of the State Lands (Workhouses) Act, 1962.

This report is submitted in accordance with the requirements of Section 83 of the Local Government Act, 1946.

Section 83 provides that at the first meeting of the Board held after the expiration of ten clear days from the circulation of this report the Board may resolve that the disposal of this property as proposed shall not be carried out or that it shall be carried out in accordance with the terms specified in the resolution.

If the Board resolve that the disposal shall not be carried out it shall not be carried out

On the other hand, if the Board does not pass a resolution as to the manner in which the disposal should be carried out the disposal may, with the consent of the Minister for Health, be carried out in the manner set out above."

On a proposal by Cllr. Carroll seconded by Cllr. Hickey it was unanimously agreed that the proposals outlined in Report No. 7/1980 be adopted.

In reply to Dr. Meade, Mr. Nolan described the arrangements that exist for the exchange of land between the Health Board and Dublin County Council and Dublin Corporation. Mr. Nolan told Cllr. Hynes that it was part of the agreement for the exchange of land that an 8 ft. wall be built to secure the boundary. 36 7/2/1980

Regarding the delay in providing a similar wall at the boundary of lands at St. Clare's the Corporation members indicated that they would be bringing pressure on the Dublin Corporation to provide a wall at that boundary although it was agreed that the itinerant encampment along the road was holding up the provision of this wall.

Mr. Lamb said that the Corporation had now made a Prohibition Order on the site to enable them to remove the itinerants.

20/80 OFFICE OF CHIEF EXECUTIVE OFFICER - APPOINTMENT PER L.A.C. COMPETITION

Mr. Nolan said he was informing the Board officially as a matter of information rather than for discussion that the post of Chief Executive Officer had been advertised by the Local Appointments Commission. The Chairman said he regretted that the L.A.C. and the Department had seen fit to proceed with the advertisement for the position in the circumstances existing. Prof. McCormick, Cllr. Hickey and Drs. Meade and Walker associated themselves with the Chairman's remarks and expressed their complete satisfaction with Mr. Nolan's performance of his duties as C.E.O. and their sincere appreciation of his dedicated service to the Board and to the public in the health and welfare administration.

21/80 LETTER OF 23/1/80 FROM NURSING HOMES ASSOCIATION RE NEED TO INCREASE ALLOWANCES FOR LONG-STAY CASES

The following letter from the Nursing Homes Association (23/1/80) was considered:-

"We understand that active consideration is being given at present to the following:

(a) Increases in the Long Term allowances for patients in Nursing Homes.

(b) Reclassification of the various categories of Nursing Homes.

Regarding (a) — you will recall that a totally inadequate increase of 21.4p per day was allowed to long stay patients in Nursing Homes and hope that in the recommendations you make that ample allowance is made for correction of this anomaly in 1979 and an adequate adjustment also made to take into account the increases that hare recently occurred and those expected to occur again in 1980. 37

We have written to the Minister outlining a case for making the minimum allowance to patients in Nursing Homes of £6.00 per day. From your own costings and from comparisons with other service industries, you will undoubtedly appreciate that even at this figure it is affording a much needed section of our community excellent full time nursing care for a minimum cost

On the question of reclassification, we believe that this is currently being examined. In your letter dated 17th May, 1979 in response to ours of the 2nd April, 1979 you indicated that category 'D' Homes provide nursing care only. However, in the summary of Health Services issued by the Dept of Health you will see that Class C covers 'good quality Homes providing Nursing Care only'. Our Homes more than fulfil this requirement and we see no reason why we should not be in this category.

We have made representations to the Minister for Health on these and other points and look forward to hearing from you favourably in the near future."

Cllr. Timmins recommended the application to the Board and referred to the amount of work undertaken in Bray by these homes which otherwise would become the responsibility of the Board. Prof. McCormick in supporting this said that the work being done was an essential part of the geriatric service. Cllr. Sweeney said that without these homes the Board would be unable to cope with the problem. Mr. Nolan said that the Board has applied for permission to increase to £50 per week (as a maximum in special cases) the Board's support to individuals in private nursing homes.

22/80 LETTER OF 2/1/80 FROM CHAIRMAN SOUTH EASTERN HEALTH BOARD RE PROPOSED ASSOCIATION OF MEMBERS

The following letter from the Chairman of the South Eastern Health Board was considered:—

"Dear Chairman,

At the December monthly meeting of the South Eastern Health Board there was a discussion on a proposal to take steps to have an association formed between the members of the eight health boards in the country in order to further the interests of the Boards and of those whom the Board members represent. Some local authority members referred to the associations which exist for local authorities and which 38

enable members to discuss with their colleagues from other local authorities problems which they would have in common and also enable them to achieve consensus across the country in cases where proposals need to be made jointly to the Minister. The associations in these cases also have an annual opportunity to meet the Minister in person. It was felt that a development of this kind for the eight health boards would be advantageous and the following resolution was passed:—

That a proposal to form an association with the members of the other health boards be approved and put to the membership of those boards; the objective is to hold an annual meeting and a number of working meetings each year to consider matters of common interest and pursue jointly the objectives of the Boards; that this Board take the initiative in arranging an initial meeting with two members from each Board to explore the proposal further and to draft a constitution for the meetings".

Councillor J. Cummins (Waterford City) and the Chairman (Kilkenny) were selected to represent the South Eastern Health Board at the initial meeting.

I should be glad if you would consider having the matter put to the members of your Board and discussed and if a favourable reply is received from each of the Boards I will take the initiative in having arrangements made for the initial exploratory meeting with two members from each Board. The members will be very welcome to come to Kilkenny for this meeting but I am sure it would be more convenient for all travelling to have it held in Dublin and this can be arranged.

I look forward to hearing from you.

Yours sincerely,

M J. McGuinness, M.C.C. Chairman."

While it was agreed that there was a need for such an association it was felt that it would be ineffective if all members of all health boards were to meet. It was agreed that the Chairman and Vice-Chairman would represent the Eastern Health Board, at the initial meeting, and that they would recommend that each health board's membership of the association would be limited to between 6 — 8 members. 39

23/80 LETTER OF 3/12/79 FROM THE SOUTHEASTERN HEALTH BOARD RE VISITING COMMITTEE TO ST. DYMPNA'S HOSPITAL, CAR LOW

The following letter from the Programme Manager, Special Hospital Care, South-Eastem Health Board re appointment of members to Visiting Committee, St. Dympna's Hospital, Carlow was considered:—

"A Visiting Committee of Board members visits St. Dympna's Hospital twice yearly and recently in the course of their visit reference was made to the non-attendance of Board's representatives from the Eastern Health Board in view of the fact that St. Dympna's caters for psychiatric patients from South Kildare.

Has this matter been discussed at your end and what are your views on it? For my part I think it would be a good idea that members from the Eastern Health Board should meet with our visiting committee members on the occasions they visit St Dympna's. If you agree I can arrange to discuss the matter further with you so that details can be ironed out."

On a proposal by Ald. FitzGerald seconded by Mr. Kelly Cllr. Durkan was appointed to the St. Dympna's Hospital Visiting Committee.

24/80 LETTER OF 16/1/80 FROM THE IRISH BREWERS ASSOCN. RE PROGRAMME TO HELP CURB MISUSE OF ALCOHOL

The following letter from the Irish Brewers Association was considered:—

"Dear Mr. Nolan,

You may already be aware that the Irish Brewers' Association launched a public education programme during the past few weeks to help curb the misuse of alcohol in Ireland. The programme reflects our industry's concern with this growing social and health problem and our total commitment to helping prevent the misuse of our own products.

I enclose for your information a broad outline of our programme. Dr. Morris Chafetz, President of the Health Education Foundation in Washington, is at present drawing up a comprehensive education programme. I hope that it will be possible to arrange for you to come and meet with Dr. Chafetz on his next visit to Ireland early this year. 40 7/2/1980

In the meantime, we will keep you informed of further developments in our programme and we look forward to cooperating with you in tackling the problem of alcohol misuse.

Yours sincerely,

G. N. Cairns, Chairman."

Dr. Meade asked to be given a copy of the programme referred to in the letter and it was agreed to ask the Association for a copy for each member. Dr. Behan asked that the matter be discussed at a later meeting. He suggested that the Health Board nominate some persons to join in this education programme. Cllr. Mrs. Glenn asked mat a similar response be sought from the Distillers. On a proposal by Cllr. Connolly the Chairman agreed that the matter be put on the agenda for the next meeting for full discussion.

25/80 NOTICES OF MOTION

(a) The following motion was proposed by Dr. Behan and seconded by Ald. FitzGerald.

'That the Eastern Health Board have representation on the Boards of all voluntary hospitals to assist the Department in ensuring the co- ordination and delivery of an integrated hospital service across both public and private sectors."

Speaking to the motion Dr. Behan said he wanted the Board to have representation on the Boards of hospitals to oversee the provision of a properly integrated hospital service. He felt that the Board had very little say in the development of Hospital Services in its area. While many hospitals are at present in private ownership, the community pays for the bulk of the services provided and these hospitals should be more answerable to the community. At present there was a two tier service, private and public, with two standards of care and two different sets of attitudes. There was, he claimed, a more favourable financial allocation to the private sector which placed constraints on the public sector. His objective was to have one standard of care and democratic representation on the boards of voluntary hospitals.

He felt that the Boards should represent

(1) Owners and Managers (4) Ministerial nominees (2) Elected members of staff (5) Local representatives pos- (3) Nominees of Hearth sibly Directors of Corn- Boards munity Care and G.Ps.

Mr. Kelly said he believed that there was a place for both public and private hospital services and it was very important to have a mixture of the two. He said that the proposed link 41 between St Columcille's and St Vincent's was an example of that type of service which would be of general advantage to the public.

Dr. Behan agreed to a suggestion that the motion be altered to read — 'That the Eastern Health Board seek representation . .." and the motion was agreed as amended. It was considered in that context that the practical application of the terms of the resolution should be considered at the Board's Seminar.

(b) With Cllr. Connolly's permission, Cllr. Freehill moved the motion in his name as follows:—

'That a family planning clinic be set up in the Ballinteer Health Centre."

The motion was seconded by Miss Kearney.

Cllr. Freehill said that a survey had been carried out in the area which showed that 94% were in favour of the Board providing a clinic and of the survey 86.3% were married women between the ages of 21 and 40 years. She said it was an exceptional area because the majority of the population was married couples of child-bearing age. Also the area was a considerable distance from the city centre. In reply, Mr. Donohue said that the Board was not authorised to provide family Planning services until the Family Planning Act was brought into operation and the necessary Regulations were made to indicate the type of service to be provided. Cllr. Freehill suggested that the Minister be asked when he intended to bring the Act into operation and it was agreed that this be done.

'That the Eastern Health Board make provision for a hospital service at Arklow in view of the distance the area is from a general hospital and the very large population and concentration of heavy industry in the area."

Speaking to the motion Cllr. Sweeney said that Arklow was a large expanding town with a population, including the hinterland, of 17,000 approximately. There are about 4,000 employed in industry in the town and the nearest hospital is St Columcille's. The town has no accident facilities other than- G.Ps' surgeries and it needed a hospital or casualty centre.

In support Cllr. Timmins said that a committee from the town was told some years ago that when the Health Centre was provided the Board would examine the question of an accident service further but this has not been done. 42 7/2/1980

Mr. Lamb said that this matter had been before the Board earlier ami mtdleai advice had indicated that a first aid centre would not be workable, and an alternative to an expensive, fully staffed and fully equipped unit is a fast ambulance service. In reply to Cllr. Sweeney's dissatisfaction about the existing ambulance service Mr. J. Sadlier said his aim was to have an ambulance rostered to Arkiow during the daytime hours but this was not always possible. However, he had now made five new employments for the Wicklow area with particular reference to Arklow's needs and he hoped that this would provide a better service.

26/80 OTHER BUSINESS

(a) The Chief Executive Officer advised the members that Canon MacNutt, Church of Ireland Chaplain at St. Mary's Hospital, had recently resigned after 36 years of service and it was agreed that a letter of appreciation would be sent to him.

(b) Mr. Nolan advised members of the recent establishment of an association of Eastern Health Board Pensioners and that he had promised them the Board's practical support in their endeavours.

(c) The Chairman suggested Friday 21st March, as the initial day for the Board's seminar and this was agreed. The seminar will be held at Cherry Orchard Hospital and will commence at 10 a.m. It is intended that it will be a full day and lunch will be provided. Mr. Nolan said that some working papers are being prepared by Mr. Lamb and would be issued to members in advance.

27/80 CORRESPONDENCE

All correspondence had been circulated with the agenda.

The meeting ended at 8.30 p.m.

CORRECT: J.J.Nolan Chief Executive Officer

CHAIRMAN 43 6/3/1980

EASTERN HEALTH BOARD Minutes of Proceedings of Monthly Meeting of Extern Health Board held in the Boardroom, St. Brendan's Hospital, Grange- gorman, on Thursday 6th March 1980 at 6p.m.

Present Ald. B. Ahern T.D., Cllr. P. Hickey P.C., Dr. J. D. Behan Cllr. F. Hynes Cllr. l. Belton T.D., Ms. Noreen Kearney Cllr. D. Browne Dr. D. G. Kelly Cllr. M. Carroll Dr. P. McCarthy Cllr. J. Connolly P.C., Sr. Columba McNamara Prof. J. S. Doyle Mr. M. Matthews Cllr. B. J. Durkan Dr. A. Meade Ald. Alexis FitzGerald Dr. B. Sheehan Cllr. Mrs. A. Glenn Cllr. J. Sweeney Cllr. A. Groome Cllr. G. Timmins T.D., Cllr. T. Hand P.C., Dr. J. Walker Mr. Kevin Harrington Cllr. Mrs. M. Waugh

Apologies for Absence Mr. Hugh Corrigan and Cllr. E. Stagg

In the Chair Ald. Alexis FitzGerald

Officers in Attendance Mr. J. J. Nolan Mr. F.McCullough Mr. F. Donohue Mr. J. Clarke Mr. T. Keyes Mr. P. I. Lyons Mr. J. F. Reynolds Mr. J. Doyle Mr. R. N. Lamb Mr. H. Dunne Mr. J. Sadlier Mr. C. Mansfield Prof. B. O'Donnell Mr. E. Dunphy Mr. P. J. Swords Mr. M. Cummins Prof. I. Browne Miss E. Larkin Miss B. Kelly

28/80 CONDOLENCES

The Chairman informed the members of the recent death of Mrs. Kathleen Sweeney, wife of Mr. Liam Sweeney, Senior Executive Officer, and the members stood in silent prayer as a mark of respect to the deceased.

29/80 CONFIRMATION OF MINUTES

On a proposal by Cllr. M. Carroll seconded by Cllr. B. Durkan, the Minutes of meeting held on 7th February 1980 were noted and adopted. 44

(a) MATTERS ARISING

In reply to Cllr. Durkan the Chairman said that he had written to the Minister for Social Welfare about delays in payments in the Kildare area and he will raise it with the Minister again at his forthcoming meeting. In reply to enquiries from Cllr. Durkan and Cllr. Groome regarding the permanency of appointments at Naas Hospital, Mr. Nolan said that the meeting of the Working Party had been fixed for the 13th March and following this meeting a report would be prepared. On a proposal by Dr. Behan seconded by Cllr. Mrs. Glenn the following motion was agreed:

"That the Chief Executive Officer arrange for the submission of a report to the Board indicating the numbers and categories of staff employed by the Board who are employed in a temporary capacity and outlining the duration for which each such employee has been in a temporary capacity."

The following motion proposed by Cllr. Durkan and seconded by Cllr. Groome was agreed:

'That this Board would use its good offices to arrange an early meeting between the members of Kildare Local Health Committee, a number of whom are also members of this Board, and the Minister for Health, together with representatives of Comhairle na n-Ospideal, to discuss the future development of Naas Hospital, with particular reference to making permanent the positions of the two consultants there."

In reply to a proposal from Cllr. Sweeney that the Chairman of the Local (Health) Committees attend the Board's Seminar, Mr. Nolan said it would be as well if they did not attend the first meeting but that they might be asked to attend later and this was agreed. The Chairman reminded the members that the Seminar would meet on the 21st March 1980.

Dr. Behan asked that the Medical and Allied Research Committee meet to discuss the Research and Psychosomatic Unit and the Rutland Centre separately. Mr. Keyes said that this would be arranged and as he had the report of the Rutland Centre to hand he would arrange a meeting of the committee to discuss that report at an early date.

Dr. Behan said he thought it was appropriate that the Health Board should be represented on the Interview Board to select the new Chief Executive Officer and he proposed the following motion which was seconded by Cllr. Mrs. Glenn and agreed: 45 6/3/1980

'That the Eastern Health Board arrange for a delegation to meet the Minister for Health and for the Public Service, to seek representation for-the Eastern Health Board on the interview panel which will select the next Chief Executive Officer for this Board."

Dr. Behan said that because a motion proposed by him at the January meeting asking the Minister to meet a deputation on the Tallaght Hospital had not been forwarded to the Minister the Board had lost an opportunity of pressing for an increase in its representation on the Tallaght Board as the Minister has since made the Establishment Order on the lines contained in the draft submitted earlier to the Board.

Mr. Nolan told Dr. Behan that the proposal to have Health Board representation on the Boards of all voluntary hospitals would be included in the discussions at the Boards Seminar on March 21st to get the views of the members before making any submission in the matter.

30/80 DEPUTATION FROM WICKLOW LOCAL (HEALTH) COMMITTEE RE ST. COLUMCILLE'S HOSPITAL

The Chairman welcomed the deputation which comprised of Cllr. Miley, Chairman of the Committee, and Dr. W. J. Roche and Cllr. Dr. J. McManus.

Cllr. Miley thanked the Chairman for receiving the deputation and said they were attending on behalf of the Wicklow people to demonstrate their concern about St. Columcille's Hospital, to ask for its continued upgrading and for the purchase of the necessary equipment and in particular to ask for the provision of a paediatric unit. Dr. McManus, making the case for the paediatric unit said that the Committee and all other interested parties were unanimous that this unit would be better sited at St. Columcille's than at St. Vincent's Hospital. There is now up to 1,000 births a year at the hospital and a 24 hour paediatric unit with two full-time paediatricians is a must where there is such a busy maternity unit. Since the Comhairie na nOspideal report was prepared the census figures for the South County Dublin population showed an increase of 53% and the Wicklow population 21%, while in the immediate area served by St. Vincent's Hospital the population has either declined or barely increased and the bulk of the population are elderly. It was considered that a paediatric unit should be where the younger population is and this means locating it at St. Columcille's Hospital. Dr. McManus said his Committee considered that the Comhairie na nOspideal decision was wrong and would like to have it changed. They agreed however with the recommendation that such a paediatric unit should be linked with a childrens hospital. 46

Dr. Roche also spoke and referred to the board's policy in relation to the hospital as a whole. He said it had developed over the years from a workhouse to a first class hospital but latterly the refusal of Comhairle to authorise the replacement of the permanent Surgeons was causing concern to the local population. A Committee had been formed with himself as Chairman, to seek this deputation to the Health Board. While they accepted that the hospital's paediatric section should be linked with a childrens hospital they considered it financially unnecessary to set up a childrens unit at another hospital while such a facility existed at St. Columcille's Hospital for development. He would like to have the assurance of the Board that the hospital would be properly developed and staffed without delay. His committee would not agree that the hospital be handed over to or be linked with other hospitals or consultants if this would result in the consultants doing the bulk of their work in the major hospital at which they worked.

The Chairman thanked the deputation for attending and assured the members that the Board was very much in favour of the development of the hospital and was taking all necessary steps in that regard.

Mr. Nolan said that the Board consistently over the years has fought for the status of St. Columcille's as an acute general hospital and for the development of the maternity and paediatric units. The Board met a major delegation from Comhairle na nOspideal at the Hospital for a full day and made a full and constructive case but the Comhairle refused to authorise the Boards proposals. However the Board were continuing to make representations. The deputation then withdrew.

Dr. Sheehan discussing the deputation said it would be a gross waste of public money to build a new paediatric unit at St. Vincent's when there was already a unit in existence which just needed to be upgraded.

Mr. Kelly described the situation at St. Vincent's where he said there were 60 paediatric beds on the site. He told Dr. McCarthy that these beds however did not belong to St. Vincent's but to Temple Street Hospital.

Cllr. Carroll said it was obvious that the paediatric unit should be at St. Columctlle's and proposed the following motion which was seconded by Cllr. Hickey and agreed:—

"That this Board appoint a deputation to meet the Minister for the purpose of discussing St. Columcille's Hospital and matters appertaining to its use." 47 6/3/1980

On a suggestion by Dr. Behan it was agreed that the deputation to meet the Minister should meet beforehand to prepare its case.

31/80 PROCEEDINGS OF VISITING COMMITTEES

The reports of the following visiting committees having been circulated were dealt with as follows: (a) No. 1 Visiting Committee meeting at Newcastle on 15/2/1980

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the report was noted.

In reply to Miss Kearney's enquiry regarding medical cards Mr. Dunne said that the patient and doctor are each notified in advance before a card is withdrawn.

(b) No. 3 Visiting Committee meeting at Cherry Orchard on 7/2/1980.

On a proposal by Cllr. Hickey seconded by Cllr. Groome the report was noted.

On a proposal by Cllr. Hickey seconded by Cllr. Durkan the report was noted.

The Chairman asked that reports of these visiting committees be brought to the Board as early as possible after the date of the meeting.

32/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

The minutes of the following local (health) committees having been circulated were dealt with as follows:—

(a) Dublin County Local (Health) Committee meeting held on 4/2/1980.

On a proposal by Cllr. Connolly seconded by Cllr. Hickey the minutes were noted.

In reply to Cllr. Carroll Mr.Nolan said that the brief on the mental handicap unit at St. Columcille's Hospital was nearly completed and the consultant team had been appointed. Cllr. Connolly drew the members attention to three motions passed at the local (health) committee meeting regarding 48

visiting hours at mental hospitals, certificates of earnings for medical card applicants and taxi service for medical card holders. It was agreed that reports would be provided to the Committee on these matters.

Regarding the taxi service Dr. Behan said he frequently heard of health board patients being kept waiting for taxis while fare paying passengers were picked up. Mr. J. Sadlier said that very few taxis were used now except in emergencies when the Board's own transport is not available. Because of demand there is at times a delay in mini-bus service and this is difficult to overcome. Cllr. Carroll asked Mr. Sadlier to look into the problem of getting patients to St. James's O.P.D.

(b) Dublin City Local (Health) Committee meeting on 11/2/1980.

On a proposal by Cllr. Glenn seconded by Ms. Kearney the minutes were noted.

Cllr. Glenn expressed her concern over the situation at St. Clare's Home arising from the itinerant encampment and said that there appeared to be great delay in proceeding towards removing the encampment. She was supported by Cllr. Belton who said that the Corporation is claiming it has not formal title to the land as yet. He said the people in the area were very upset over conditions obtaining. The following motion was proposed by Cllr. Glenn seconded by Ms. Kearney and agreed:—

"Deputation to meet Law Agents and officials of E.H.B. and Dublin Corporation to be arranged immediately."

Cllr. Mrs. Glenn also referred to Cllr. Sherwin's motion at the Committee meeting recommending a 'Rodent Week' to tackle the problem of rodent infestation. She was supported by Cllr. Connolly who recommended that this proposal be accepted. Prof. O'Donnell said that the Health Board should give its support.

Ms. Kearney referred to the report at the Committee meeting that over 800 children were in the Health Board's care and said she considered there should be a visiting committee to look after the interests of these children and asked that this be considered at the Seminar. In reply to Miss Kearney's enquiry about Killarney Street Offices, which was also the subject of a motion at the local committee meeting, Mr. Donohue said that the Board's staff were unable to get suitable offices in the area to provide additional facilities for the staff employed. In addition the financial situation requires him to look at the development of the services over the entire board area. He said that at present he had three 49 6/3/1980

new health centres ready but unable to open because telephone lines had not yet been provided.

The Chairman asked that a report be submitted to the next meeting on the office accommodation at Killarney Street.

Regarding the provision of telephones the following motion was proposed by Cllr. Connolly and seconded by Cllr. Mrs. Glenn:—

'That a meeting be arranged with the Minister for Posts and Telegraphs to discuss the telephone problems for E.H.B. Health Centres."

Regarding the motion at the committee meeting on appeals against refusals of medical card applications Dr. Behan said that it was a matter of equity that an applicant would have a right of appeal to someone other than an officer of the Board.

On a proposal by Cllr. Durkan seconded by Cllr. Groome the minutes were noted.

In reply to Cllr. Durkan's enquiry Mr. Sadlier said that the Health Centre at Maynooth would be handed over during this month. Regarding proposals for health centres at Athy and Castledermot and an extension to the Leixlip Centre Mr. Donohue told Cllr. Durkan that he could not say until the capital allocation was received what new starts could be considered for the coming year.

The members agreed at this stage to take the following motion in Cllr. Durkan's name:—

'That this Board would proceed in the current year with the provision of a new Health Centre in Castledermot under the Minor Capital Works programme if the Minister does not make provision for same in the Major Capital Allocation for 1980."

Cllr. Durkan referred to a recent public meeting at Castledermot on the matter and described the total inadequacy of the existing facilities. In view of Mr. Donohue's comment about the current financial position he did not pursue the motion but asked that in allocating whatever funds are available the areas in most need get highest priority. Regarding reference to care of the aged in the report Cllr. Connolly drew attention to the fact that an old man had died in Ballyfermot recently and his death was not known for some days. 50

Regarding the committee's recommendation on coeliac disease the following motion was proposed by Cllr. Durkan and seconded by Cllr. Groome and agreed:—

"That the Board request the Minister to extend the Long Term Illness Scheme to include Coeliac Disease."

Cllr. Durkan raised the matter of anomalies in the rates of pay between health board employees in Kildare as against Dublin City and County areas. He was supported in this by Cllr. Groome.

Mr. Nolan said that while determination of remuneration levels was a matter for the C.E.O. he could appreciate the significance of the point made by Cllr. Durkan. Mr. Lyons, Personnel Officer said that this matter was at present the subject of negotiations at national level and that the outcome of such negotiations, would if the Department agreed, be implemented by the Board. The following motion was proposed by Cllr. Durkan seconded by Cllr. Groome and agreed:—

'That this Board recommends the implementation of a wage structure that will give the service staff of the Eastern Health Board in Co. Kildare, equal remunerative and promotional opportunities with employees in the rest of the Board's administrative area, with particular reference to the catering, maintenance and ambulance sectors."

(d) Kildare Local (Health) Committee meeting on 24/1/1980.

On a proposal by Cllr. Durkan seconded by Cllr. Groome the minutes were noted.

Cllr. Durkan referred again to the delay in making Social Welfare payments and proposed the following motion which was seconded by Cllr. Groome and agreed:—

"That this Board establish an emergency service to deal with applications for Supplementary Welfare Service, at weekends."

The Chairman said that he would like to discuss this further and Cllr. Durkan suggested that the Kildare members meet the Chairman to discuss the health services in their area. The Chairman agreed but asked that a report on the development of the services be made available first. 51 6/3/1980

33/80 TEMPORARY BORROWING - REPORT No. 8/1980.

The following Report No. 8/1980 from the Chief Executive Officer was submitted:—

"At meeting held on 6th December, 1979 the Board consented to the temporary borrowing by way of overdraft up to an overall limit of £1.1 million during the quarter ending on 31st March, 1980.

It is considered that overdraft accommodation up to £1.5 million will be required during the June quarter 1980.

Accordingly, I request that the Board consent to borrowing by way of overdraft during the three months to 30th June 1980 up to a maximum of £1.5 million."

On a proposal by Mr. Harrington seconded by Cllr. Carroll the report was approved and adopted.

34/80 LEASING OF FORMER DISPENSARY AT BALBRIGGAN and TRANSFER OF SITE AT GARDEN HILL TO ST. JAMES'S HOSPITAL BOARD

Dr. Behan drew attention to the requirement that to comply with the provisions of Section 83 of the Local Government Act, 1946 the report Nos. 9/1980 and 10/1980 should have been circulated to the members ten clear days before this meeting to enable them to be disposed of at the meeting. The items were referred to the next monthly meeting of the Board for formal authorisation.

35/80 REVENUE ALLOCATION Report No. 11/1980

The following Report No. 11 /1980 from the Chief Executive Officer was submitted:—

"I have been advised by the Department of Health that this Board's approved level of net expenditure (i.e., gross expenditure less minor income such as receipts from patients etc.) in 1980 is £181.718 millions. The total is made up as follows:— 52

£m (a) Direct expenditure by the Board (including its share of the expenses of the General Medical Services (Payments) Board vii. £12,324 m.) 85.594

(b) Payments in respect of services provided for eligible patients in voluntary hospitals and joint board hospitals. 89.790

Total: 181.718

The allocation does not cover

— expenditure on the commissioning of new units of accommodation

— expenditure on the special scheme introduced last December for the provision of dental and opthalmic services for persons with full eligibility

— expenditure resulting from any revisions of capitation and subvention rates

— expenditures consequential on decisions which may be taken by the Government in conjunction with the Budget.

As this allocation represents a reduction of over £3 million on our original estimated requirement I am considering the position with the Management Team with a view to appropriate adjustments of programme proposals."

The Chairman said that the capital allocation had been conveyed to the Board by letter dated 5th March 1980 and that a separate letter had been sent by the Secretary of the Department to him.

While revenue allocation had been cut by £3.2 million as compared with estimated requirements the only capital allocation of the Board was £200,000 for works at St. Brendan's and St. Ita's Hospitals together with £60,000 for grants to voluntary agencies. It was clear he said that not only new starts but many ongoing services would suffer. In particular, maintenance, which had just been recovering from the 1976 cut-backs, was going to again be severely reduced. He would suggest that the Minister be invited to meet the Board at a later date. 53 6/3/1980

The following motion was proposed by Ald. FitzGerald, seconded by Cllr. Durkan and agreed —

"That the E.H.B. invite the Minister for Health to meet the Board to discuss the implications of the cuts made in the Revenue Allocation to the Board for 1980."

Cllr. Hickey said that there was not much point in discussing the allocation until management provided the information on the budget for 1980. It would be necessary to ensure that sufficient finance was provided to keep the services going and the staff employed. The following motion was proposed by Cllr. Hickey, seconded by Cllr. Groome and agreed —

"That a special meeting of this Board be convened to discuss

(a) the Revenue Allocation

(b) The Capital Allocation

for the current year."

Mr. Reynolds said that the allocation for 1980 was £73 million. Estimates prepared at current prices showed an expenditure of £76 million. The Department had advised the Board that there would be no supplementary allocations and that the budget must take account of anticipated inflation. The non-pay budget is £36 million and because of inflation the Board's shortfall in the year may be as high as £6 million.

Dr. Sheehan said that he believed the health services could be run in a more economical fashion, that there was much waste in the large hospitals and that emphasis on community services could reduce the dependence on hospitals. Cllr. Connolly said it was obvious there would not be enough money to carry on the services and the Minister and the government should be made aware of the seriousness of the situation.

Dr. Behan said that stringent financial controls were being imposed on the Health Board and he would like to be assured at the estimates meeting that equivalent strictures were being placed on the voluntary hospitals. He believed that financial accounts of voluntary hospitals for the last year and a breakdown of their allocation for 1980 should be made available.

The following motion was proposed by Dr. Behan and seconded by Cllr. Hickey and agreed — 54

'That the Board obtain from the Department of Health, in advance of the special estimates meeting, a comprehensive detailed breakdown of the allocation of £89.790 millions to voluntary and joint board hospitals, in view of the disproportionately large sum allocated to voluntary hospitals in comparison to the rest of the health services."

Mr. Reynolds said that these figures will only be available if the Department of Health were prepared to supply them. Mr. Nolan pointed out that under Section 31 of the 1970 Health Act the Chief Executive Officer has the direct onus placed on him to ensure that the Board does not incur expenditure outside the limits imposed by the Minister and he asked for full co-operation in complying with these statutory requirements.

It was agreed that the Estimates meeting would be held at 6 p.m. on the 27th March 1980.

34/80 TALLAGHT HOSPITAL BOARD (ESTABLISHMENT) ORDER

Dr. Behan again referred to the fact that the Board was in danger of losing adequate representation on the Tailaght Hospital Board and he proposed the following motion which was seconded by Cllr. Mrs. Glenn and adopted —

'That the C.E.O. now arrange, as adopted by the Board in Minute 13/80 January 1980, for a delegation to meet the Minister for Health to discuss the Tallaght Hospital Establishment Order and to seek increased representation on the Planning Board for Tallaght General Hospital. It is further proposed that the Board arrange at the same deputation to seek representation for the Health Board on the Boards of all voluntary hospitals."

It was agreed that pending the outcome of a request for a deputation the Board would not supply a panel of names to the Minister and that the Minister would be so informed.

The following motion proposed by Dr. Behan, seconded by Cllr. Connolly was agreed —

'That the Board defer selection of its representatives on the Planning Board of the Tallaght General Hospital until after the delegation from the Board has met with the Minister and sought increased representation." 55 6/3/1980

35/80 IRISH BREWERS ASSOCIATION PROGRAMME TO CURB MISUSE OF ALCOHOL

As requested at the last meeting the Programme from the Irish Brewers Association was circulated to members.

36/80 APPOINTMENT OF NOMINEE TO IRISH PUBLIC BODIES MUTUAL INSURANCES LTD.

On a proposal by Cllr. P. Hickey, seconded by Ald. Fitz-Gerald the following motion was adopted:

'That Cllr. Michael Carroll is hereby selected as nominee to represent Eastern Health Board at meetings of Irish Public Bodies Mutual Insurances Ltd."

37/80 NOTICES OF MOTION

The following motion was proposed by Ald. A. FitzGerald:

'That in view of the extreme housing shortage in Dublin City and in particular the needs of a growing number of 'homeless' that this Board invite representatives of the various hostels to a meeting to consider adequate liaison between them, especially as some facilities seem to be underused."

Speaking to the motion Ald. FitzGerald said there was a lack of co-ordination among the various hostels providing services for the homeless e.g., certain hostels were not open during the day, some close earlier etc. and as a result certain hostels were under utilised, while others were overcrowded. He considered that the managements should be brought together to discuss the overall policy. In reply to an enquiry from Cllr. Carroll Mr. Donohue said that the Directors of Community Care have an interest in this area and visit some of the larger hostels. The motion was seconded by Cllr. Carroll and agreed.

38/80 CORRESPONDENCE

The correspondence having been circulated was taken as read.

The meeting terminated at 9.20 p.m.

CORRECT. J. J. Nolan Chief Executive Officer

Chairman -57- 27/3/1980 EASTERN HEALTH BOARD

Minutes of Proceedings of Special Meeting of the Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegorman on Thursday 27th March 1980 at 6 p.m.

PRESENT

Ald B. Ahern, T.D., Mr. K. Harrington Mr. J. D. Behan Cllr. F. Hynes Cllr. D. Browne Ms. N. Kearney Cllr. M. Carroll Dr. P. McCarthy Cllr. J. Connolly Cllr. M. Freehill Cllr. B. Durkan Dr. B. Sheehan Ald. A. FitzGerald Cllr. J. Sweeney Cllr. Mrs. A. Glenn Cllr. G. Timmins T.D., Cllr. Mrs. M. Waugh APOLOGIES FOR ABSENCE

Mr. H. Corrigan, Prof. J.S. Doyle Cllr. T. Leonard and Dr. A. Meade

IN THE CHAIR

Ald. A. FitzGerald

OFFICERS IN ATTENDANCE

Mr. J. J. Nolan Mr. J. Clarke Mr. T. Keyes Mr. P.J.Swords Mr. F. Donohue Mr. J. Doyle Mr. J. S. Reynolds Mr. H. Dunne Mr. F. Elliott Mr. C. Mansfield Mr. R. N, Lamb Mr. A. O'Brien Mr.. J. Sadlier Mr. M. Cummins Mr. P. I. Lyons Miss F. Heaney Prof. I. Browne Miss E. Larkin

9/80 On a proposal by Cllr. Sweeney seconded by Dr. Behan it was agreed that the meeting would end no later than 9 p.m.

40/80 ALLOCATION FOR NON-CAPITAL EXPENDITURE 1980 and BOOK OF ESTIMATE OF EXPENSES 1980

Mr. Nolan introduced Report No. 12/1980 on the allocation for non-capital expenditure for 1980 and the Budget Estimate for 1980 and the Secretary read the report to the members.

In reply to Cllrs. Carroll and Freehill, Mr. Donohue said that the Board must honour all statutory allowances and hoped to maintain 1979 levels, but if there were any major deviations from the forecasts made for the year it might be necessary to reduce on non statutory services. Cllrs. Glenn, Connolly and Waugh, Ms. Kearney and Dr. Sheehan in discussion warned against cut backs -58-

in the areas of the home nursing, home help and other support services for the elderly indicating that the alternative to such support was expensive hospital treatment.

In reply to Cllr. Browne, Mr Sadlier said that he would report later on suggested priorities in the allocation of the maintenance budget and that St. John's Day Centre in Clontarf had a high priority.

Members expressed great concern about the severe reduction in the alocation for maintenance, having regard to the poor state of the Board's property as seen at visiting committee meetings.

With regard to voluntary bodies, Mr. Donohue told the Chairman that the Board had been asked by the Department when making grants to take account of the 1979 expenditure plus approved increases in staff and materials. However, additional developments and increases in costs such as in oil price rises may give rise to curtailments in expenditure.

The Chairman advised the members that the Chief Executive Officer and himself would be meeting the Minister on Wednesday 2nd April and they would inform the Minister that it was considered untenable that the Eastern Health Board, serving one-third of the population of the country and with many services of national character, was so limited in its allocation of funds. They would press the Minister to recognise the special case of the Eastern Health Board in .elation to the services provided by the Board and its in areas such as its maintenance programme.

Dr. Behan referred to the difficulty facing the Board where the Board has no responsibility or authority over approximately 50% of the Budget for the health services in its area being the part of the Budget allocated to t general voluntary hospitals. It would be necessary for the Board to have access to the Accounts of these hospitals, otherwise the legislation should remove the liability for this service from the Health Board. In relation the psychiatric service, Dr. Behan asked that he be given the breakdown of expenditure incurred by the various agencies providing services for the B in the same way as the Board's own services were shown and he also asked f detailed list of Section 65 Grants paid in the psychiatric area, showing t income and accounts of the organisations receiving the Grants. He also asked for the same information in relation to private psychiatric Mr. Keyes said he would have this information provided. In reply to Dr. Mr. Keyes said that the Minister for Health had removed the responsibility the financial allocation to St. Vincent's Hospital, Fairview, from the He Board to the Board of the Hospital. Dr. Behan commented that this was a f downgrading of the status and role of the Health Board. -59-

Dr. Behan also suggested that the estimated expenditure for maintenance shown under existing individual headings as appropriate to each hospital clinic and not shown as one bulk figure. Dr. Behan said he considered was incorrect that Section 31 of the Health Act imposed a limitation by Minister on the expenditure by the Health Board when such a limitation not apply to other areas for instance the voluntary hospitals.

The following motion was proposed by Dr. Behan and seconded by Dr Freehill:-

"That the Board's legal adviser be requested to obtain Senior Counsel*s opinion as to whether Section 31 of the Health Act, including the penalties for breaching it, are ultra virus the Constitution."

Cllr. Sweeney and Dr. McCarthy objected to the proposal on the grounds t the money is provided by the Minister and he is entitled to exercise control. They said a proper allocation was what was needed.

The motion was then put and agreed, Cllr. G. Timmins dissenting.

Cllr. Durkan referred to the differences in the financial provision or services at Naas Hospital as against St. Coluncille*s Hospital, particularly the areas of catering and medical and surgical supplies. The Chief

Executive Officer said that Mr. Lamb and Mr. Reynolds would examine these headings again and adv:«r; Cllr. Durkan. Cllr. Sweeney referred in particular :o the favourable rate at which the Board is able to cater for elderly people, particularly in the hospital at Rathdrum. He said he would like to see details of costs in the private homes catering for the elderly.

Cllr. Mrs. Glenn referred to the separate allocation made for the Board's share of expenses of the General Medical (Payments) Board and said she believed that this scheme was wasteful and that doctors should be asked to be more realistic in their prescribing. Dr. Sheehan said that while he believed there was considerable waste in provision of the services generally he believed that the services were founded on the wrong principle, that greater emphasis on community care and general practitioner services in particular would help to keep people out of hospital where it is costing £340 a week now to keep a patient. He would like the Board to be in a better position to encourage patients to leave hospital by providing funds to maintain them at home. The following motion was proposed by Cllr. Carroll and seconded by Cllr. Hynes and agreed:- -60-

That if the allocation to the General Medical Services (Payments) Board is insufficient during 1980 any shortfall should as it arises be funded separately by the Department and the allocation should not form part of the Section 31 responsibility of the Eastern Health Board."

Summing up the situation the Finance Officer explained that the allocation for the two hospital programmes for 1980 is 10% to 11% higher than in 1979. In implementing the economies the Community Care Programme was cut back some what less than the other programmes and has been allocated about 15% over 1979. Because the statutory allowances and the terms of such as the Refund Scheme do not vary greatly the programme is not affected by inflation so much as by trends. These can only be estimated at the moment. It was hoped that the measures listed at pages four and five of the report would keep the Board's expenditure within the allocation. However, if early ret showed that expenditure was running beyond the allocation it would be necessary to come back to the Board again.

The Chairman detailed the submissions which would be made to the Minister at the meeting on the 2nd April and it was agreed by the members that these matters be pursued vigorously:-

(1) The need for a minor capital allocation to cater for special works. (2) The need for an allocation for Welfare Homes and Day Centres where the Board's policy is for the provision of 3 per annum, having regard to the economies in the care of the elderly resulting from the provision of this accommodation. (3) The maintenance needs of the Board, particularly in the case of St. Brendan's and St. Ita's Hospitals and the danger that the fabric of the Board's premises will deteriorate beyond repair. (4) The need to continue the special allowances for the dental and ophthalmic schemes for persons with full eligibility. (5) The need to recognise the special role of the Eastern Health Board and its increasing role in national centralised services through such institutions as St. Patrick's and Dundrum and the need for special consideration as the premier health board in the country.

The following motion was proposed by Alderman FitzGerald and seconded by Cllr. Connolly and agreed:-

"Having regard to the terms of the Department's letter of 29th February, 1980 and: having considered the terms of Report No.12/1980, including the measures proposed to contain main expenditure within the limits of the Department's allocation, it is resolved that the said allocation,while totally inadequate for the Board's requirements, be adopted and apportioned as recommended by the Chief Executive Officer and notified to the Minister accordingly as required•" -61-

Dr. Behan asked that representations be made early to the Minister to enable him to consider the Board's position in any future Budget provisions. The Chairman said that it was hoped to meet the Minister at one of the meetings of the Seminar and with the experience of the operation of the revised allocation over a month or two.

The members all joined Mr. Harrington, Cllr. Sweeney and Dr. Behan in complimenting the officers on the preparation of the documentation for the meeting and the information provided for the discussions.

The Chairman proposed that the May meeting of the Board be held in Naas and the June meeting in Wicklow and this was agreed.

The meeting ended at 8.40 p.m.

CORRECT. J. J. Nolan Chief Executive Officer

Signed

CHAIRMAN

62 10/4/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegorman, on Thursday 10th April, 1980 at 6 p.m.

PRESENT Ald. B. Ahern, T.D., Mr. K. Harrington Dr. J. D. Behan Cllr. P. Hickey P.C., Cllr. L. Belton, T.D. Cllr. F. Hynes Cllr. D. Browne Ms. N. Kearney Cllr. M. Carroll Cllr. T. Leonard T.D., Cllr. J. Connolly P.C., Dr. P. McCarthy Cllr. E. Doyle Prof. James McCormick Prof. J. S. Doyle Sr. Columba McNamara Cllr. B. J. Durkan Cllr. E. Stagg Ald. A. FitzGerald Cllr. J. Sweeney Cllr. Mrs. A. Glenn Cllr. G. Timmins T.D., Cllr. A. Groome Dr. J. Walker Cllr. T. Hand P.C., Cllr Mrs. M. Waugh

APOLOGY FOR ABSENCE Mr. H. Corrigan

IN THE CHAIR Ald. A. FitzGerald, Chairman

OFFICERS IN ATTENDANCE Mr. J. J. Nolan Mr. P. J. Swords Mr. F. Donohue Mr. H. Dunne Mr. R. N. Lamb Mr. J. Doyle Mr. F. J. McCullough Mr. C. Mansfield Mr. J. F. Reynolds Mr. T. McManus Mr. F. Elliott Mr. M. Cummins Mr. P. I. Lyons Mr. T. Barry Mr. J. Sadlier Miss E. Larkin Prof. B. O'Donnell Miss B. Kelly Prof. I. Browne

41/80 RETIREMENTS

The Chief Executive Officer Mr. Nolan advised the members that Mr. F. Elliott, Planning and Evaluation Officer and Mr. H. Dunne, Senior Administrative Officer, were retiring from the Board's administrative service on the 30th April and this would be their last Board meeting. He paid a warm personal tribute to both of them. He said he wanted to put on record his thanks on his own behalf and on behalf of the staff for all their years of valuable service. 63

The Chairman associated himself with these remarks and paid a tribute to the enormous contribution by both of these officers. Cllr. Browne also paid tribute to Mr. Elliott and Mr. Dunne and said he hoped that they would continue to be associated with the provision of the health services in some capacity. Cllrs. Carroll and Hickey paid special tribute to Mr. Elliott's association with the Board of James Connolly Memorial Hospital and expressed the hope that Mr. Elliott would continue his association with that hospital. Cllrs. Sweeney, Durkan and Connolly also associated themselves with the previous remarks on behalf of their respective areas and expressed their good wishes.

42/80 MEETING ARRANGEMENTS

Dr. Behan asked the Chairman to advise members that a meeting of the Medical and Allied Research Committee would be held on the 22nd April at 3 p.m. in the Boardroom, also that the Ad Hoc Committee would meet on Wednesday 30th April at 6 p.m. to receive the draft report. On a proposal by Dr. Behan seconded by Alderman FitzGerald it was agreed that the name of this Committee would be changed to the Psychiatric Services Committee.

The members agreed to a special meeting to consider the Care of the Aged report and this was arranged for Thursday 1st May 1980 at 6 p.m. in the Boardroom. The May monthly meeting was deferred to the 8th May 1980, in Naas as arranged.

Prof. McCormick asked that meetings commence at 6 p.m. sharp in the future and this was agreed.

43/80 CONFIRMATION OF MINUTES OF MONTHLY MEETING HELD ON 6th MARCH, 1980

Dr. Behan said he wished it recorded that in referring to the proposed meeting of the Medical and Allied Research Committee mentioned on Page 44 of the Minutes he had asked that the Director of the Psychosomatic Unit withdraw from the meeting after presentation of his report and prior to the report being discussed. On a proposal by Cllr. Durkan seconded by Cllr. Hickey the minutes were noted and adopted.

(a) Matters arising:

In reply to Cllr. Stagg the Chief Executive Officer agreed that the permanency of the posts in Naas Hospital was not dependent on the outcome of the working party and he said he had written again to the Comhairie in the matter. In reply to Cllr. Durkan the Chief Executive Officer said he had written to the Minister and An Comhairie asking them to 64 10/4/1980

meet a deputation as proposed at the last meeting but a reply had not yet been received. The Chairman told Cllr. Durkan that he had raised with the Minister the question of delays in the Social Welfare payments and the Minister had undertaken to have the new Minister for State in the Department examine the matter.

Mr. Nolan told Dr. Behan that the requested report on temporary staff was being prepared. He also advised Dr. Behan that the Local Appointments Commission regularly asked the Chief Executive Officer to suggest the names of of health board personnel who would be available to act on selection panels: interviews for the post of C.E.O. were at present in progress. Dr. Behan said he considered it a point of principal, however, that the board members be represented on an interview panel selecting a Chief Executive Officer for the Board. It was agreed that the Department and the Commission be so informed.

In reply to Cllr. Durkan, Mr. Lyons said that the Local Government Staff Negotiations Board were committed to negotiating with the unions on a national basis the question of rationalisation of pay to the non-nursing health board staff.

44/80 CONFIRMATION OF MINUTES OF SPECIAL MEETING HELD ON 27th MARCH, 1980

Dr. Behan asked that the minute at the bottom of page 58 be amended by adding that he said that the Minister's decision to remove the responsibility for financial allocation to St. Vincent's Hospital, Fairview, from the health board to the board of the hospital was viewed as an act performed by the Minister of the day for narrow sectarian politican advantage and was not in the interest of the health services.

The Chairman read to the members his statement to the Minister for Health at the meeting which he and the C.E.O. had with the Minister on 2nd April. In the statement he advised the Minister of the need for additional finance for the development of community services and services for the aged: of the special needs for finance for essential maintenance; of the problems created by the increase in population in the Board's area; of the need to recognise the national character of many of the Board's service and of the need for a bias of revenue and capital allocations in the direction of the health board and away from the voluntary hospitals as the year progressed.

Dr. Behan complimented the Chairman on his statement to the Minister. On a proposal by Cllr. Connolly seconded by Prof. Doyle the minutes were noted and adopted. 65

45/80 PROCEEDINGS OF VISITING COMMITTEES

The reports of the following visiting committees having been circulated were dealt with as follows:

(a) No. 1 Visiting Committee meeting held at St. Colman's on 26th February, 1980.

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the report was noted.

Mr. P. J. Swords told the members that the question of the valuation of the land for transfer from the Board to the Wicklow County Council was being dealt with by the Valuer with the County Manager and was proceeding as fast as possible. SUSPENSION OF STANDING ORDERS

On a proposal by Cllr. Sweeney seconded by Cllr. Timmins it was agreed to suspend Standing Orders to discuss a visiting committee meeting held at Wicklow Hospital on the previous day.

Cllr. Sweeney told the members that at the last visiting committee meeting at the hospital in October last the Engineering Officer had advised the members that the electrical installation was dangerous and would need to be replaced but nothing has yet been done. In the following discussion to which Cllrs. Hynes, Doyle, Browne, Waugh, Belton, Dr. Walker, Prof. Doyle contributed, the members told of the dangerous condition of the wiring and that they had been told that the £19,000 required to carry out the necessary work was not available.

The C.E.O. agreed that the work was of an urgent nature but said that this expenditure might lead to excess on the allocation. The following resolution was proposed by Dr. Walker, seconded by Cllr. Hynes and agreed:—

"That the Board, conscious of the fact that the electrical work required at Wicklow Hospital may bring total expenditure outside the Minister's allocation under the terms of Section 31, hereby direct that the work be done forthwith."

(b) No. 1 Visiting Committee meeting at St. Columcille's on 12th March 1980.

On a proposal by Cllr. Sweeney seconded by Cllr. Hand the report was noted. 66 10/4/1980

In reply to Cllr. Sweeney, Mr. Nolan said it was not possible at present to increase the staffing of the intensive care unit but this would be kept under review. Cllr. Durkan said he would like the members to support the view that the Matron's position in the hospital must remain autonomous. Cllrs. Carroll and Hand endorsed this and the C.E.O. said that this was completely in line with the Board's policy regarding the hospital. In reply to Cllr. Durkan's enquiry about consultant staff Mr. Nolan said he had written to the Department of Health for formal approval to the following staff —

2 whole time Surgeons 1 Anaesthetist 2 whole time physicians 1 Radiographer

On a proposal by Cllr.Stagg and seconded by Cllr. Durkan the report was noted.

In reply to Cllr. Stagg and Cllr. Durkan's enquiries about joint geriatric services for Naas and Athy with St. James's Hospital, Mr. Nolan said that as the two Geriatricians at St. James's Hospital and the two at James Connolly Memorial Hospital are not health board staff he can only request their co-operation in the provision of services for Kildare. He had made a case for 10 Geriatricians to cope with the workload in the Eastern Health Board area—to date 5 had been authorised. He hoped that if approval could be got to the appointment of additional staff to St James's Hospital the provision of some service to Kildare could be arranged. Mr. P. J. Swords said that while it may not be possible to provide extra staff at the hospital the full complement of existing employment would be maintained to the maximum extent possible.

(d) Community Care Visiting Committee meeting at Area 4 (Millbrook Lawn) on 22nd January 1980.

On a proposal by Cllr. Dukan seconded by Cllr. Mrs. Waugh the report was noted.

Cllrs. Durkan, Hynes and Doyle drew attention to the totally inadequate security provision at the site of the Health Centre and the grave danger of vandalisation. Mr. Donohue said that the Board's original proposals were for a two-storey building because of the limitations of the site but the Department approved a single storey building which now occupies the total site and leaves no provision for a fence. It is intended to install roller shutters at the entrances. Dr. Walker suggested that the County Council be asked to relocate a footpath which passes by the Health Centre and it was agreed that Cllr. Hickey would enquire about this. 67

Mr. Donohue listed difficulties that have arisen because of the delay in provision of telephone services for this and other Health Centres. The Chairman told members that the Minister for Posts and Telegraphs had already been asked to receive a deputation in this matter as agreed at the previous meeting. Prof. Doyle and Prof. McCormick asked that provisions be made in Health Centres for a general practitioner to participate. Mr. Donohue said that the Board is making provision in the newer Health Centres for general practitioner facilities and has initiated talks with some GPs as to how they would participate. He pointed out that the Board, however, is committed to a policy of group practice in such situations. He said he would prepare a position paper on the subject and present it to a later meeting.

Prof. Doyle suggested that in advance of the provision of a new hospital at Tallaght consideration be given to the inclusion of medical and surgical out-patient sessions in Tallaght area where the consultant would move out, in advance of the Hospital being built to provide services there. Mr. Nolan said that discussions had been initiated in 1979 with the Meath and Adelaide Hospitals with this in view.

(e) Community Care Visiting Committee meeting held in Area 6 on 26th February, 1980.

On a proposal by Cilr. Doyle seconded by Cilr. Mrs. Glenn the report was noted.

In reply to Cilr. Doyle, Mr. Sadlier said that the new tender for Blanchardstown Health Centre was with the Department but had not yet been approved. Also that while he appreciated that the engineering areas would best be co-terminus with Community Care areas the present geographical areas were historically based and redrawing boundaries would mean considerable negotiations with staff but it is being considered.

In relation to the social work service Mr. Donohue told Cilr. Doyle that plans for the reorganisation of the service were being discussed at present.

The Chairman said he considered that the Director of Community Care in an area should be provided with the medical history of families being re-housed into that area on medical grounds and he asked the Dublin Medical Officer if this information could be made available. Prof. O'Donnell explained the present system and said it should be feasible to provide this information.

Mr. Donohue said he would arrange for a report on this matter to the next meeting. 68 10/4/1980

At this point the members agreed to defer item (4) to later in the meeting.

46/80 QUESTIONS

On a proposal by Cllr. Connolly seconded by Alderman FitzGerald it was agreed that the Chief Executive Officer answer the questions lodged.

Question (1) Cllr. J. Connolly.

"Will the Manager give the full list of voluntary organisations who have applied for grants and assistance in 1980."

Answer:

Donnybrook Social Service Council National Association of Widows Department of Social Science, St. Teresa's Day Centre, Seville Place Drumcondra Old Folks Association Mount St. Day Centre for the Handicapped Council for Co-ordination of Social Services Edenmore — Killester — Raheny Rehabilitation Institute for Naas Community Workshop Irish Wheelchair Association Christ the King Day Centre, Cabra Social Service (Tenements) Co. Ltd. Dublin Call and Care Service St. Gabriels Meals Service, Clontarf St. Fintan's Day Care Centre, Deansgrange St. Vincent de Paul Night Shelter, Back Lane I.S.P.C.C. Donnycarney Social Service Council Sancta Maria Day Centre, Cabra Central Remedial Clinic Fr. Laurence Memorial Family Community Centre, Keeper Road Finglas Council of Social Services Terenure — Thursday Luncheon Club Crumlin Social Service Centre, Armagh Road Day Centre for Handicapped, Park House, StiMorgan Voluntary Service International Our Lady's Home, Henrietta Street St. Vincent's Day Centre, Henrietta Street Spina Bifida Association National Association for the Deaf Shankill Old Folks Association Sevenoaks Day Centre, Ballyfermot Irish Women's Aid Ballinteer Community School Cherish Ltd. 69

Skerries Day Centre National Council for the Blind Our Lady's Convent, Sean McDermott Street Ally Loughshinny 'Over 65' Club High Park Convent Little Sisters of the Assumption Ballygall Community Services Milltown Social Service Centre Lourdes Day Centre, Sean McDermott St. Trust Order of Malta, Clyde Road Day Centre Coeliac Society of Ireland Pollen Counting Service, c/o Botany Dept., T.C.D. Beechpark, Stillorgan for Nursing Aides St. Mary's Cabra for Nursing Aides St. Louise's — Tutor Course

Hostels and Services for Travelling Children Don Bosco House Homeless Girls, Sherrard House Hope Los Angeles Sarsfield House Ontaria Tce. St. Mary's Day Centre, Townsend St. Night Shelter, Townsend St. St. Columba's, Gt Strand St. Trudder House and organisations operating Day Nurseries at: Ballyfermot Ballymun Bonnybrook Bray Civics Institute Darndale Dun Laoire Edenmore Finglas Grange/ Kildonagh, Henrietta St. Hollylands, R athfarnham Kilbarrack/Foxfield Kilcullen Killester Kilmore West Liberty Creche, Meath St. Monkstown North William St. Sevenoaks, Ballyfermot Killinarden Naas 70 10/4/1980

Arklow Neilstown Irish Society for the Prevention of Cruelty to Children — General and Social Work services.

Coolock Community Law Centre. St. Francis Xavier Social Service Centre, Sherrard Street St. Mary's Old Folks Club, Ballyfermot Arklow Geriatrics Association Blessington and District Senior Citizens Association Bray Old Folks Association Clonmore Senior Citizens Association Greystones and Delgany Old Folks Association Knockananna Care of the Aged Association Parkbridge Muintir na Tire Rathdrum Senior Citizens Association Wicklow Meals-on-Wheels Committee Aughrim I.C. A. Guild Tinahely I.C.A. Guild Avoca I.C.A. Guild Dunganstown I.C.A. Guild Enniskerry Meals-on-Wheels Committee Kiltegan Care of the Aged Committee Rathdangan Senior Citizens Committee Baltinglass Senior Citizens Committee Dunlavin St. Vincent de Paul Society Athy & District Care of Aged Committee Maynooth Old Folks Committee Newbridge Association for Care of Elderly Monasterevin Old Folks Committee Naas District Care of Aged Committee Castledermot Community Services Committee Celbridge Community Consultative Council Society of St. Vincent de Paul, Leixlip Society of St. Vincent de Paul, Kilcullen Society of St. Vincent de Paul, Kildare Society of St. Vincent de Paul, Naas Society of St. Vincent de Paul, Newbridge Society of St. Vincent de Paul, Ballymore Eustace Kilcock Senior Citizens Welfare Committee Rathangan Parish Welfare Association Kilcullen Old Folks Association Presentation Convent Kildare Newbridge Community Services Irish Wheelchair Association (Athy Branch) Nurney Old Folks Association.

Mental Health Association of Ireland Irish National Council for Alcoholism Social Welfare Centre, Stanhope Street Tolco Limited Irish Foundation for Human Development Irish Society for Autistic Children Rutland Centre Limited 71

Mater Dei Counselling Service Coolmine Limited St. Vincent de Paul Society

KARE St. John of God Co. Wicklow Association Carlow Association Cherry Group Stewart's Hospital Daughters of Charity St. John's School Rudolf Steiner Schools. Aberdeen Rudolf Steiner Schools, Giencraig St. Paul's Hospital, Seaumont Sunbeam House, Bray Sunbeam House Training Centre Camphill Community, Gorey Fingal Workshop Rushton Hall/Condover Hampstead Hospital Peacehaven Sleepy Hollow, Co. Wicklow Medico-Social Research Board

Schizophrenia Association, Dun Laoghaire The Hanley Centre, Dun Laoghaire

The Irish Heart Foundation The Linen Guild Cherry Orchard

Question (2) Cllr. J. Connolly

"Win the Manager say if he has considered the application of ihe Walkinstown Association for Handicapped for an annua5 grant to assist them in their works for the handicapped in the Walkinstown and neighbouring areas and particularly for their new club premises on Long Mile Road, Walkinstown?"

Answer:

"No formal application for an annual grant has been received from the Walkinstown Association for the Handicapped. An invitiation to meet members of the Committee of the Association was extended through Cllr. Connolly and an official of the Board met-the members and discussed with them the Association's wish to extend its activities in such a way as would entitle it to receive a grant from the Health Board. Some advice was offered which the members undertook to consider. 72 10/4/1980

47/80 SUSPENSION OF STANDING ORDERS

On a proposal by Cllr. Mrs. Glenn seconded by Alderman FitzGerald it was agreed to suspend Standing Orders to enable the meeting to discuss the question of the new Assessment Centre at Ballymun.

Cllr. Mrs. Glenn said that there appeared to be some delay in having the Centre opened and urged that the Centre be put into operation without delay. The Chairman said that while finance was available to put the house into order the Corporation was not prepared to spend this money until the staff was provided. Mr. Donohue said he had written to tne Department of Health advising them that the Board needed an extra allocation for the running of the Unit and seeking approval to the necessary staffing. He stated he is in contact with officials of the Departments of Health and Justice and Dublin Corporation in the matter.

It was agreed that Mr. Donohue would report to the next meeting on the situation and that the Chairman would contact the Minister for Health personally to try and expedite a decision.

48/80 LEASING OF FORMER DISPENSARY AT BALBRIGGAN

The following Report No. 9/1980 from the Chief Executive Officer was submitted:—

'The former dispensary premises at High Street, Balbriggan, is held by the Board on lease for 999 years from 1885 at a rent of £1.50 per annum.

When the new Health Centre at Balbriggan was erected in 1964, the former dispensary was let to the Public Health Nurse until its vacation by her in 1977. The property has since been vacant and is surplus to the Board's present requirements.

The Balbriggan Old Age Pensioners Committee, 2 George's Street, Balbriggan, has applied to the Board for the temporary use of the premises as a recreation and social centre for their members.

In accordance with terms tentatively agreed with the Com- mittee, I propose to lease to them the former dispensary premises for a period of 2 years and 9 months at a rent of £5 per month, the Committee to be responsible for internal 73

maintenance and repairs. The lease will also contain the usual clauses and conditions in protection of the Board's interests.

This report is submitted in accordance with the requirements of Section 83 of the Local Government Act, 1946.

Section 83 provides that at the first meeting of the Board held after the expiration of ten clear days from the circulation of this report the Board may resolve that the disposal of this property as proposed shall not be carried out or that It shall be carried out in accordance with the terms specified in the resolution. If the Board resolve that the disposal shall not be carried out it shall not be carried out.

On a proposal by Dr. Behan, seconded by Cllr. Carroll the proposals contained in Report No. 9/1980 were adopted.

49/80 TRANSFER OF SITE AT GARDEN HILL TO ST. JAMES'S HOSPITAL BOARD. CHIEF PSYCHIATRIST'S UNIT AND RESEARCH AND DEVELOPMENT SERVICE

The following Reports Nos. 10/1980 and 10A/1980 were submitted:—

Report No. 10/1980 74 10/4/1980

The site at Garden Hill proposed for the Eastern Health Board's new Ambulance Control Centre can be the subject of a sub-lease of 99 years to the Board from the St. James's Hospital Board. Under the terms of the lease dated 15th April 1974, the Hospital Board seek the consent of the Health Board to sub-leasing of sites at St. James's Hospital to the Federated Dublin Voluntary Hospitals (including the Dublin School of Physiotherapy) to the Medical School of Dublin University and to the Biological and Medical Research Institute Limited.

Arising from the transfer of the Garden Hill site, the St. James's Hospital Board will lease the Brookfield site to the Eastern Health Board and the Foundation for Human Development. It is intended, that subject to Department's approval to the project that the new headquarters unit for the Chief Psychiatrist will be located on the Brookfield site. The teaching etc. requirements of U.C.D. in relation to psychiatry can be provided by Professor Browne, in the interim, at Garden Hill House and subsequently at his new headquarters unit. I have informed the Foundation and the Institute that subject to Board approval they could remain in their existing locations on the Garden Hill site pending completion by the St. James's Hospital Board of the necessary leases involved in the transfer of the site. This arrangement arises because the original agreement governing lettings at Garden Hill expires on 29/2/1980.

This report is submitted in accordance with the requirements of Section 83 of the Local Government Act, 1946.

Report No. 10A/1980.

"Further to Report No. 10/1980 consideration of which was deferred at the March Meeting and which has since been circulated to members in compliance with the requirements of Section 83 of the Local Government Act 1946. I wish to give the Board some additional details regarding the deputation on February 12th 1980 to the Department. 75

A copy of a memorandum by Mr. Keyes of the proceedings at that deputation, a copy of his letter of February 7th 1980 to the Department, and of Professor Browne's letter of 8th February to him together with a copy of the report on the project for a Chief Psychiatrist's Unit and Research and Development Service are circulated separately. Dr. Hensey, Secretary of the Department, agreed that at a meeting in February 1979, the Minister had approved of the project in principle but had expressed reservations about the proposed size of the Unit and its location at St. James's. Dr. Hensey stated that he would have the documents submitted by the Board examined in detail in the Department to determine if the proposed size, cost and location of the Unit were acceptable. The capital and annual revenue (staffing) costs at 1979 prices as set out on Page 13 of the report are £850,000 and £180,000/£230,000 respectively. Dr. Hensey also stated that he would need to know what priority the proposals had in the Board's overall programme. The Board would now need to confirm that the proposals are acceptable and have a high overall priority and that they wish the Minister to be so informed. I have already indicated that Professor Browne as Chief Psychiatrist should be provided as soon as possible with a suitable new permanent unit and with an adequate Research and Development Service.

The compensation required by the Eastern Health Board in respect of the surrender of Garden Hill House is the valuation to be determined by a valuer to be agreed between the Eastern Health Board and the St. James's Hospital Board, including a sum for disturbance etc. This compensation will be used, in due course, towards the cost of providing alternative accommodation, in lieu of Garden Hill House, on the adjoining Brookfield site. If however, the St. James's Hospital Board require possession of Garden Hill House before alternative suitable accommodation on Brookfield site becomes available, and if they can by arrangement with the B.M.R.I, make the unit at present occupied by the B.M.R.I. available to Professor Browne in lieu of Garden Hill House, then such arrangement would be more suitable to Professor Browne and payment of such compensation would not arise at that stage. The Brookfield site should be leased for a term of 99 years to the Eastern Health Board, who in turn will make arrangements to sublease a portion of the site to the Irish Foundation for Human Development, in accordance with previous proposals.

To facilitate Professor Browne's occupation of Garden Hill House during building operations, the St. James's Hospitai Board should undertake to erect a screen wal! at an adequate distance from the House and to take other necessary measures such as double glazing of the windows, etc. If the Board so approve I will continue negotiations with the St. James's Hospital Board and any other bodies concerned. 76 10/4/1980

within the general terms outlined above and in previous reports."

Dr. Behan paid a tribute to the Chief Executive Officer, Programme Manager and members of the deputation to the Minister on the excellent fashion in which they presented the Board's views to the Minister. The Chairman complimented Dr. Behan on all the work he had put into bringing this matter to its present stage. The following motions were proposed by Dr. Behan and seconded by Mr. Harrington and approved:—

(i) "It is proposed that Report No. 10/1980 be adopted including the conditions set out in paragraphs two and three of the Report."

(ii) "It is proposed that Report No. 10A/1980 and the proposals contained therein be adopted and referred v~ the Psychiatric Services (Ad Hoc) Committee to afford it a priority rating which will enable it to be included for planning in the Board's Capital Programme in 1981."

50/80 CAPITAL ALLOCATION 1980

The following Report No. 13/1980 from the Chief Executive Officer was submitted:—

"CAPITAL WORKS

A. At its meeting held on the 6th December, 1979 the Board adopted, with one addition, the programme of new projects plus special provisions for the acquisition of premises and/or sites for Health Centres, Group Homes etc., and for grants to voluntary organisations, as set out in Report 50/ 1979. A sum of £620,000 was sought in respect of the new projects listed for commencement in 1980, if approved, together with £600,000 for premises and/or sites plus grants to voluntary organisations.

By letter dated 5th March, 1980, notification has been received of an allocation of £260,000 to be utilised as follows:

St. Brendan's Hospital — upgrading of facilities £150,000

St. Ita's Hospital — upgrading of facilities £50,000

Grants to voluntary organisations under Section 65 of the Health Act, 1953 £60.000

£260.000 77

The Board is informed that the limits of expenditure indicated should be adhered to and that any of these funds may not be re- allocated to any other project except with the prior approval of the Minister for Health.

The Board is advised also that, in present circumstances, it will not be possible to make an allocation in respect of the current year for minor capital schemes.

B. In notifying the Board of the allocation referred to above, the Department of Health have advised that the total capital allocation for health purposes for 1980 is £28m. which will permit a continuation of work on approved ongoing projects and will meet commitments in respect of the purchase of approved items of equipment which have already been purchased or ordered and payments of professional fees for approved projects in course of planning. In the latter connection, however, it has been stipulated that it will be necessary until further notice to seek the Department's approval to each stage of planning and await specific sanction before proceeding to a further stage.

The Minister has asked for the co-operation of the Board in working within the limits of the restricted capital programme."

In reply to CIIrs. Carroll and Doyle, Mr. Sadlier said that working drawings for the proposed Health Centre at Bally-brack were approved by the Department and the Bills of Quantities were now being prepared. He was asked to press forward as quickly as possible with the project.

Mr. Nolan advised members that this year the Board must go to the Department of Health for sanction at each stage of the planning in capital works and that he would give the Board monthly submission on progress.

In reply to Cllr. Sweeney, Mr. Sadlier said that the contractor for the Wick low Health Centre is at present negotiating a Bond and in regard to Knockanannagh, while tenders were in, the Board might not have the funds to commence work in this year.

On a proposal by Cllr. Sweeney seconded by Cllr. Carroll the following motion was adopted:

"Having regard to the terms of the Department of Health letter of 5th March 1980 and having considered the terms of Report No. 13/1980 it is resolved that the Department's allocation for Capital Works 1980, while totally inadequate for the Board's requirements, be adopted and apportioned as indicated in the above report and that the Minister be notified accordingly." 78

51/80 (A) REPORT OF COMMITTEE ON CARE OF THE AGED

Consideration of Report No. 14/1980 of the Committee on the Care of the Aged was deferred to the Special Meeting arranged earlier.

(B) LETTER FROM ST. JAMES'S BOARD RE REDUCTION OF EXTENDED CARE BEDS AT THE HOSPITAL

Mr. Nolan read the letter and explained that the original brief for the new St. James's Hospital provided for 400 extended care beds. The proposal contained in the letter would mean a reduction to about 300 in the number of these beds. He said he appreciated the difficulties facing St. James's Hospital Board because it was accepted that there was a need for a paediatric presence but a reduction to 300 in the number of long-stay beds was serious enough to have to be considered by the Care of the Aged Committee and he suggested that the matter be referred to that committee. The members agreed to this. Prof. McCormick suggested that pending this consideration the Board welcome in principle a paediatric presence in St. James's Hospital and he was supported by Dr. Behan in this. The following motion was proposed by Prof. McCormick and seconded by Cllr. Carroll and it was agreed :—

'That the Board welcomes in principle the proposal to locate a paediatric unit at the new St. James's Hospital complex but that further consideration be given to the concomitant loss to the Board's Care of the Aged programme of almost 100 extended care beds at the Hospital before a decision is reached."

52/80 NOMINATIONS FOR MEMBERSHIP OF ST. JAMES'S HOSPITAL BOARD The following report No. 15/1980 from the Chief Executive Officer was submitted :-

"The appointments of Mr. F. Donohue and Mr. T. Keyes, Programme Managers, as two of the ten representatives of the Eastern Health Board on the St. James's Hospital Board, terminated on 31st March 1980.

It is now necessarv for the Health Board to nominate two persons to the Minister for Heaith for appointment to represent the Health Board or. the Hospital Board from 1st April 1980 for such period, net exceeding three years, as may be determined by the Health Board."

The following motion was proposed by Dr. Behan seconded by Ald. FitzGerald 79

'That Mr. T. Keyes and Mr. F. Oonohue be re-appointed to the Board of St. James's Hospital."

53/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

Minutes of the following local (health) committees having been circulated were dealt with as follows:—

(a) Dublin County - Meeting held on 3/3/1980

On a proposal by Cllr. Carroll seconded by Cllr. Doyle the minutes were noted.

(b) Dun Laoghaire - Meeting held on 11/3/1980

On a proposal by Cllr. Doyle seconded by Cllr. Mrs. Waugh the minutes were noted.

The Chairman asked that Mr. Keyes write to Cllr. Doyle regarding the Hanley Centre.

On a proposal by Cllr. Durkan seconded by Cllr. Carroll the minutes were noted.

The Chairman said that the matter of representation of staff from the hospital on the working party for Naas and St. Columcfile's Hospitals had been referred to Mr. Lamb who would arrange for their attendance at the appropriate stage.

54/80 QUORUM

At this point Dr. McCarthy advised the Chair that there were less than nine members of the Board present. Only the following members were present at that stage —

Ald. A. FitzGerald Cllr. B. Durkan Cllr. Mrs. Waugh Dr. P. McCarthy Dr. J. Behan Sr. Columba Mr. K. Harrington and the Board rose, the unfinished business standing postponed to the next ordinary meeting.

The meeting ended at 9.20 p.m.

CORRECT. J. J. Nolan

-80-

EASTERN HEALTH BOARD

Minutes of Proceedings of Special Meeting of the Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegoman on Thursday 1st May 1980 at 6 p.m.

PRESENT

Ald. B. Ahern, T.D. Cllr. F. Hynes Cllr. L. Belton, T.D. Ms. N. Kearney Cllr. D. Browne Dr. P. McCarthy Cllr. M. Carroll Prof. J. McCoraick Cllr. J. Connolly, P.C. Sr. Coluaba McNamara Prof. J.S. Doyle Dr. A. Meade Cllr. B.J. Durkan Cllr. M. Preehill Ald. A. Fitzgerald Cllr. E. Stagg Cllr. Mrs. A. Glenn Cllr. J. Sweeney Cllr. A. Groome Cllr. G. Timmons, TD, Mr. K. Harrington Dr. J. Walker Cllr. P. Rickey, P.C.

APOLOGY FOR ABSENCE

Mr. H. Corrigan and Cllr. Mrs. M. Naugh

IN THE- CHAIR

Ald. A. Fitzgerald

OFFICERS TO ATTENDANCE Mr. J.J. Nolan Mr. P.l. Lyons, Consultants in Geriatric Mr. F.J. Donohue Prof. B. O'Donne11 Medicines Mr. T. Keyes Mr. T. McManus Dr. J. Flanagan Mr. J. Sadlier Mr. C. Mansfield Dr. J. Noel Mr. J.F. Reynolds Mr. A. O'Brien Dr. D. Keating Mr. R.N. Lamb Miss T. Downes Dr. D. Coakley Mr. P.J. Swords Mr. M. Cumins Dr. J. Lavan Mr. F. McCullough Social,Workers Mr. J. Clarke Miss M. Kennedy Mr. J. Doyle Miss M. Borne

1/80 Before the meeting the Chief Executive Officer adrised the aeabers that Minister had agreed to neet a deputation as requested by the Board on 7th 1980. The following deputation was selected on a proposal by Cllr. Hynes seconded by Cllr. Groome-

Dr. J. Behan Cllr. J. Sweeney Cllr. S. Stagg Cllr. J. Connolly Cllr. M. Carroll Cllr. D. Durkan Dr. A. Meade -81-

REPORT ON COMMITTEE ON CARE OF THE AGED

Cllr. Mrs. Glenn who was the Chairman of the Coamittee introduced a report and the Chairman then asked those present for comments.

Prof. McCormick suggested that the Geriatricians be asked to put the summary of main recommendations into a priority order which would permit the maximum use of the limited funds available.

The following comments were made by the Geriatricians.

Dr. J. Flanagan

He said the implementation of the recommendation would cost a great deal of money and it would be best to consider first those that are readily achieveable such as items 8, 21, 22 and 23. These natters could be dealt with at a very early date and would make a great contribution.

Dr. Xoel

He said the first recommendation was by far the most important and every effort must be made to support the elderly at home. This in turn meant supporting the provision of horaehelps, meals on wheels etc. He pointed out that this policy would however mean a lot of elderly infirm people in the Community and this in turn would call for prompt medical care for the elderly when ill and led back to the need for hospital services with adequate assessment facilities for the elderly.

Dr. Lavan

He supported Dr. Noel and said it was essential, to keep the elderly in the Community, to be able to guarantee that hospital facilities would be readily available when needed. He also stressed the role of day hospitals.

Dr. Keating

He emphasised the need for the early provision of beds where there is a dramatic need such as Area C.

He referred to the elderly as falling into two groups - frail elderly who need support and ill elderly who need diagnostic assessment and rehabilitation services. Unless the latter was available the whole service would fall down.

Dr. Coakley

He pointed to the danger of persons being institutionalised in hospitals and emphasised the need for day hospitals with assessment and rehabilitation services where necessary. The aid day centres were also of great use but must have adequate transport facilities available.

Prof. Browne referred to the hundreds of geriatric patients in St. Brendan's Hospital and said that many of these were there only because o one else would take them and that they would have to be considered when the whole problem of geriatrics is being tackled. Dr. Behan agreed that there were hundreds of patients in St. Brendan's and other hospitals not because they were psychiatric but because tney were elderly. He said this only underlined the fact that the public service was not given the resource or the mandate to develop a unified health service. There was need for a comprehensive geriatrics service including psychiatrists ready to enter that service to deal with the psychiatric problems of the elderly. Dr. McCarthy agreed that it would be necessary to ensure that elderly in such nurabers were not admitted to psychiatric hospitals in future and he stressed the importance of financial help to keep the elderly at home. Cllr. Stagg said the -82-

important thing now was to implement the report including putting the recomendations in priority and seeding financing. He considered there should be a special programme for Care of the Aged in the Board covering all categories of elderly and he would make a proposal in this regard.

Prof. McCormick said that from the Committee of which he was Chairman it had become clear that many in extended care throughout the Country were becoming institutionalised in an unsuitable environment. There was he said a clear need for "home" accommodation, sany have no family and cannot remain on their own. He considered that recommendation No. 14 would help to free the syster. but he warned that the Community Care services for the verv disabled sight be more expensive than maintaining that person in an institution. He also said it should be remembered that if the 3oard decides that the Care of the Aged is a high priority the money spent on that service will be at the expense of other areas.

Dr. Behan said that the report makes three points clear:-

(i) The paucity of facilities available for the size of the problem (ii) That facilities are mainly institutional and these are in bad condition (iii) That while the main recommendations relate to the development of Community based services it must be remembered that institutions are part of a balanced service.

He said that the Committee should not only put their proposals in general order of priority but should indicate specific priorities within individual areas setting off the facilities available at present for each area against its requirements. It would then be necessary to state the cost of these proposals and bring this to the Minister and he would he said be making a proposal on these lines.

Referring to the recommendations Cllr. Durkan referred particularly to the tendency for private homes to take patients who didn't want heavy nursing leaving the heavy cases for the geriatric hospitals, causing nursing problems as a result. He considered that the recommendation regarding funds for housing of the elderly should be brought to the attention of all local authorities. He also considered that the recommendations regarding increasing of staff were fundamental to the issue and while he agreed on the need for a campaign of public education he asked that it be more discreet than the last occasion on which such a campaign was mounted.

Ms. Kearney agreed that those matters which could be dealt with immediately should be proceeded with such as the development of the horaehelp service, meals on wheels. There should be no suggestion that these services be cut back in times of financial stringency because they were non statutory.

Prof. J.S. Doyle referred to the work being done by the general hospitals on the Care of the Aged and said that the Voluntary Hospitals had been running a service all along and there should be no question of the diminution of such service to the Community. He stressed the value of the Voluntary Hospital services and asked that they continue to be used. He said he disagreed with the arbitrary age of sixty-five when describing services for the elderlv, that age should be a flexible thing related to the individual person.

Cllr. Connolly said he would like to think that this excellent document would be considered seriously and that recommendations be implemented. He asked the members to consider what they would like to have happen to them in their old age and said he thought everyone would like to live in the Community as long as possible provided the necessary services were available. He agreed that the first need was a survey to know the size of the problem and cost and that the proposals should then be presented to the Minister. The Chairman agreed that the Board's aim must be to try and maintain as many of the old in the Community as possible. For himself he considered recommendation 16 regarding the fostering of housing schemes for the elderly by voluntary agencies was of importance. He said many agencies were willing to help if it were in partnership with the Board or other authority and -83-

would set up schemes of hones of a small intimate nature which would greatly assist the Programme for the elderly.

Dr. Meade pointed to the financial benefit of maintaining people in the Community. He said it costs £8O a week to keep a person in a welfare home and £160 in an institution for the elderly. The Board could well look after a person in the Community for that amount or less and he asked that the recommendations no. 21, 22 and 23 be fully implemented. He also recommended an adequate subvention for elderly in suitable nursing home accommodation. Ke drew attention to the unsuitable nature of a number of such homes and said he considered the geriatricians should be given the power to inspect these premises. He also stressed the need for accommodation which would take ill elderly patients for a short time.

Cllr. Sweeney said it should be remembered that in rural areas it was unlikely that elderly people will let anyone other than their own families look after then. He would like to see accommodation made available to take elderly for a few weeks twice a year to give the families keeping these old people a break.

Referring to nursing homes Dr. Keating said it was difficult to control standards and there were also difficulties regarding admission. Patients had no statutory right of admission to private nursing homes and there was also a financial barrier to many people. This affected the figures shown in the report which while giving numbers of beds available it made no reference to the availability of these in certain categories. In this regard Cllr. Durkan said he was concerned over patients who are self sufficient but are in institutions taking up beds and the provision of more welfare homes would relieve this situation. Cllr. Hynes also said that the financial considerations were very important and many at present in institutions would be taken home if there was a financial incentive. While agreeing with this Dr. Noel said however that after assessment and rehabilitation there i» still a small number of very dependant patients who need high level nursing care and he felt not enough emphasis had been put on this aspect. The care of these patients was a very heavy nursing task and if such patients were concentrated in large units such as St. Mary's there would be difficulties regarding staffing and he suggested that these patients be catered for in smaller units say attached to general hospitals.

At this stage Mr. Nolan referred to the proposal to establish a paediatric unit at St. James's Hospital which would result in the reduction by ICO beds of the long-stay facility and that as instructed by the Board the hospital had been told that while the Board welcomed the development of a paediatric unit at the hospital it was examining the implications for its care of the aged programme of the reduction in the number of long-stay beds.

In relation to the report Dr. Walker said that one of the greatest needs in the Community Care area was for extra staff,medical and nursing particularly, that the staff at present available is mostly absorbed on services for the children. He said also that a director given the task of developing his area could not be subject to cuts particularly in the areas of service to t he elderly such as hooehelps and meals on wheels. He also supported the day hospital idea and while it should ideally be attached to a general hospital he asked that the Board consider providing one in the south west area even without the back up of a general hospital.

The following motion was proposed by Cllr. Stagg and seconded by Cllr. Durkae and agreed:-

That the Board now set up a special programme (section) to organise the care of the aged service in the Community and Institutions*'

Mr. Nolan said that the Board had been considering over the last two years the organisation of the service to meet the need. It would be necessary to keep -84-

together the services which are correlated and this approach night call for a Welfare programme which would include the care of the aged service. On a suggestion fron Cllr. Glenn it was agreed that Mr. Nolan would provide a paper to the oenbers on the matter.

The following motion was proposed by Cllr. Glenn and seconded by Dr. Behan:-

"That the report on the Care of the Aged be adopted and that the Care of Aged Committee formulate the recommendations contained in their report into a priority ordered set of general proposals and a specific five years development programme priority ordered for each of the three areas (Dublin North, Dublin South East and Dublin South West) indicating the costings."

Mr. Lamb thanked those present for their imput to the discussion. He said the point about geriatric patients in the psychiatric hospitals was valid, that the 1968 report suggested that assessment of such patients should be carried out in the same assessment units as other geriatric patients.

He said he would examine Dr. Flanagan's request that the boundaries between Area B and Area C be re-examined.

He said he hoped that the report would be acted on quickly in areas where progress can be achieve without much cost.

The Chairman thanked Cllr. Glenn for the report of the Committee which she hadc^cvCred. He also thanked Mr. Lamb, Mr. McManus and Miss Downes for their assistance in preparing the report and the Geriatricians for their attendance and contribution to t he discussion.

The meeting ended at 7.30.

CORRECT J.J. Nolan Chief Executive Officer

Signed CHAIRMAN

-85-

EASTERW HEALTH BOARD

Minutes of Meeting of Eastern Health Board Committee on St. Brendan's Hospital held on 1st Mar 1980 in the Boardroom, St. Brendan's Hospital, Grangegorman at 7.30 p.m.

PRESENT

Ald. B. Ahern, T.O. Cllr. F. Hynes Cllr. L. Be It or., T.D. Ms. K. Kearney Cllr. D. Browne Dr. P. McCarthy Cllr. M. Carroll Prof. J. McCormick Cllr. J. Connolly, P.C. Sr. Columba McMamara Prof. J.S. Doyle Dr. A. Meade Cllr. B.J. Durkan Cllr. M. Freehill Ald. A. Fi tzgerald Cllr. E. Stagg Cllr. Mrs. A. Glenn Cllr. J. Sweeney Cllr. A. Groome Cllr. G. Timmons, T.D. Mr. H. Harrington Dr. J. Walker Cllr. P. Hickey, P.C.

APOLOGY FOR ABSENCE

Mr. H. Corrigan and Cllr. Mrs. M. Waugh

IN THE CHAIR

Ald. A. Fitzgerald

OFFICERS IN ATTENDANCE

Mr. J.J. Nolan Mr. J. Doyle Mr. F.J. Donohue Mr. P.I. Lyons, Mr. T. Keyes Mr. T. McManus Mr. J. Sadlier Prof. B. O'Donnell Mr. J. F. Reynolds Mr. C. Mansfield Mr. R. I. Lamb Mr. A. O'Brien Mr. F.J. Swords Miss T. Downes Mr. F. McCullough Mr. M. Cummins Mr. J. Clarke

56/80 Mr. McCullough told the members that the Board had taken a policy decision two years ago to Tacate units 2, 4, 7, and 8 in St. Brendan's Hospital holding 140 patients. These units would not be suitable for use again and were to be phased out. Two divisions in the hospital were being renovated to take the patients and work was almost complete and the gradual transfer of patients was starting but the collaspe of the ceiling in unit had accelerated the need for transfer and this had to be done immediately. Because the other units were not fullv ready there was a urgent need for about fiftv beds elsewhere to accommodate some of the patients.

Cllrs. Hynes and Glenn described the conditions seen by the Visiting Committee at the hospital and said that the patients must be transferred out at once. The Chairman asked what other accommodation was available.

Mr. Lamb said that there was not a lot in the Board's own resource, for instance there were only four beds vacant in Crooksling. While there were eleven beds in Bru Chaoimhin there were no facilities for the staff who •86- would be transferred with the patients and they would have to be brought back to St. Brendan's for meals. He was examining the situation in Cherry Orchard but it would not be possible to take bedfast patients there and there were problems because it was a fever hospital.

Dr. Behan said that there was a moral, professional and statutory duty on the Board to evacuate all these patients and it must be done within the next twenty-four hours regardless of where the accommodation must be found otherwise it would be necessary to cease admissions to St. Brendan's Hospital other than certifiable patients or those who constitute a threat to themselves or others.

Mr. Nolan said that in seeking alternative accommodation it must be borne in mind that this was a special type of patient. However, industrial action had now intervened and it was unlikely that it would be possible to transfer patients out of St. Brendan's while it continued. Except for the industrial action staff were willing to go elsewhere with the patients. It would of course only be for a short period as they would come back to St. Brendan's when unit A was ready. As long as it was not possible to move patients because of the industrial action it would be necessary to find accommodation within the hospital itself. Other areas which will be examined would be St. Patrick's Hospital and St. Edmundsbury, the units at Blanchardstown Hospital where the Vietnamese refugees are housed and religious orders who may have empty space in buildings such as Seminaries e.g. the Dominicans in Tallaght and the Christian Brothers at Artane. Mr. Nolan said that the Board's proposals for the use of accommodation at Ballyboden was held up awaiting planning permission and the Chairman asked to be briefed on the situation and said he would contact the City Manager about the problem.

It was agreed that the Chairman would meet Mr. Keyes and his staff the following morning to take steps to implement the Board's decision to evacuate the unsaie premises. If necessary he with Prof. Browne, Mr. Keyes and Dr. Behan could call a special meeting of the Board if this became urgently necessary.

The meeting ended at 9.00 p.m.

CORRECT J.J. Nolan Chief Executive Officer

Signed.- CHAIRMAN 8th May 1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Council Chamber, County Council Offices, St. Mary's, Naas, Co. Kildare on Thursday 8th May, 1980 at 6 p.m.

Present

Ald. B. AhernT.D. Cllr. F. Hynes Dr. J.D. Behan Dr. P. McCarthy Cllr. L. Belton Sr. Columba McNamara T.D. Cllr. D. Browne Dr. A. Meade Cllr. M. Carroll Cllr. M. Freehill Cllr. E. Doyle Cilr. E. Stagg Cllr. B.J. Durkan Cilr. J. Sweeney Ald. A. FitzGerald Cllr. G. Timmins T.D. Cllr. T. Hand P.C. Dr. J.Walker Mr. K. Harrington

Apologies for Absence

Cilr. J.Connolly P.C. Ms. N. Kearney Mr. H. Corrigan Prof. J. McCormick Prof. J.S. Doyle Dr. B. Sheehan Cllr. Mrs. A. Glenn Cllr. Mrs. M.Waugh

In the Chair Ald. Alexis FitzGerald

Officers in Attendance Mr. J.J. Nolan Dr. L. Murphy Mr. R.N. Lamb Mr. J. Doyle Mr. F. Donohue Mr. A. O'Brien Mr. T. Keyes Dr. B. Matthews Mr. J. Reynolds Mr. C. Mansfield Mr. J. Clarke Mr. M. Cummins Mr. P.I. Lyons Mr. T. Barry Mr. J. Sadlier Miss R. Browne Prof. I. Browne Miss A. McCabe Prof. T. Lynch Miss M. Curtis Mr. P.J. Swords Miss F. Heaney Mr. F. McCullough

57/80

At the commencement of the meeting Cllr. Durkan welcomed the members to Co. Kildare for the meeting. Cllr. Carroll on behalf of the members thanked Matron and the Catering Staff of the Hospital for their hospitality. It was agreed that a letter be sent to Matron and Catering Superintendent thanking them on behalf of the Board. 88

58/80 CONFIRMATION OF MINUTES

On a proposal by Cllr. Sweeney seconded by Cllr. Durkan the minutes of the monthly meeting of the Board held on 10th April, 1980 were adopted.

(a) Matters arising

In reply to Cllr. Stagg's enquiry about geriatric facilities for Kildare Mr. Nolan said that Drs. Noel and Lavin would be asked to discuss this matter with Drs. Flanagan and Coakley with a view to working out a possible temporary rota which would provide an interim service for the area. It is hoped that the provision of an extra geriatrician later will allow for more permanent arrangements.

In reply to Cllr. Doyle, Mr. Sadlier said that drawings were being prepared for the electrical wiring of Wicklow Hospital. With regard to the resolution passed at the April meeting Mr. Nolan said that he would not know until later in the year whether the expenditure on Wicklow Hospital would be a factor in bringing Board expenditure over the allocation.

In reply to Cllr. Durkan, Mr. Lyons reiterated the policy to have equal pay for non-nursing staff throughout the Board's area and that negotiations towards this were being conducted at national level. In reply to Cllr. Hand, Mr. Nolan said he was considering with the Programme Managers, the temporary use of Unit 3 at Vergemount Hospital for patients who had to be evacuated from St. Brendan's Hospital but following which the unit would be converted for use by the elderly. It was agreed that the question of the new Health Centre and Offices at Wicklow would be placed on the Agenda for the June meeting. Also that the Programme Manager Community Care would put a report before the members at the June meeting regarding applications for Disabled Persons Maintenance Allowances.

In reply to Cllr. Doyle, Mr. Keyes said he understood that the Minister had sanctioned a grant of £12,000 to the Hanley Centre.

59/80 REPORTS OF VISITING COMMITTEES

The reports of the following Visiting Committees having been circulated were dealt with as follows:

(a) No. 1 Visiting Committee meeting held at District Hospital Wicklow on 9/4/80

Cllr. Doyle asked that it be recorded that he attended the above meeting. On a proposal by Cllr. Timmins, seconded by Cllr. Hynes the report was noted. The Technical Services 89 8th May 1980

Officer was asked to examine the position regarding attendance of maintenance staff at Wicklow Hospital and to submit a report to the members.

(b) Community Care Visiting Committee held in Area 7 on 25/3/1980

On a proposal by Cllr. Hynes seconded by Ald. FitzGerald the report was noted.

Mr. Donohue told Cllr. Doyle that a number of nurses were in training for public health work and on their return to the Board's service in June he would be discussing with the Directors the assignment of these nurses to the various areas.

60/80 PROCEEDINGS OF MEETINGS OF LOCAL (HEALTH) COMMITTEES

The minutes of the following meetings of local (health) committees having been circulated were dealt with as follows:

(a) Kildare Local (Health) Committee meeting held on 20/3/1980

On a proposal by Cllr. Durkan seconded by Cllr. Sweeney the minutes were noted. Regarding the motion passed at the Committee meeting on the membership of the Working Party on Naas Hospital, Mr. Lamb said that the staff of the hospital would be asked to attend the meetings as required.

Cllr. Stagg referred to the Winter Fuel Scheme in Kildare and said he believed that the method of payment of Supplementary Welfare Allowances to recipients of free fuel was not standard throughout the Board's area. Mr. Donohue said he would examine the position. Cllrs. Durkan and Stagg referred to the acceptance of long-stay cases from the Kildare area into St. Mary's Hospital and said that they understood that the Medical Superintendent would be agreeable. Mr. Nolan in reply said that while the Consultants retain the right of admission on their clinical judgments admissions were also limited on the basis of catchment areas and because of nursing staff shortages in the hospital. He agreed however to ask Dr. Godfrey if some beds reserved for pulmonary function cases could be allocated for long-stay patients.

(b) Wicklow Local (Health) Committee meeting held on 21st March 1980

On a proposal by Cllr. Timmins seconded by Cllr. Carroll the minutes were noted. It was agreed that the reference in the Minutes to the qualifications of consultant staff and unrest amongst the staff at St. Columcille's Hospital was inaccurate 90

and unfortunate. In reply to Cllr. Browne Mr. Sadlier said said that tenders for the completion of the work at Shillelagh were expected to be received within the next week.

61/80 CHAIRMAN'S BUSINESS

The Chairman reported to the meeting about the position at (1) St. Brendan's Hospital and (2) the nursing dispute. Regarding the evacuation of patients from St. Brendan's Hospital the Chairman said he had spoken to the Planning Authority regarding the premises at Ballyboden. Other suggestions were being examined, such as the use of Religious Houses as accommodation for those patients. Or. Behan referred to his request at the meeting of the Board in Committee on 1st May that the staff be authorised to evacuate that part of the ward area in St. Brendan's which could be considered dangerous. The Chairman said that he had met the next day with the Programme Manager and Professor Browne and discussed the matter at length. It was considered that the intervention of the industrial dispute had made the movement of patients impracticable at present. It was agreed that it would not serve any purpose to discuss the matter in detail while the dispute continued but that an immediate meeting of the visiting committee would be called when the dispute was settled. Prof. Browne said he was hopeful of accommodating the patients who must be transferred within the Board's own resources. The Chief Executive Officer said that following discussions at the Management Team it was hoped that when conditions allowed it would be possible to make interim arrangements for accommodating the patients concerned pending completion of works at Unit A. etc. in St. Brendan's.

Or. Behan said that the position the Board found itself in now was the result of a cumulative shortage of funds to maintain buildings. It was agreed that the Department would be advised of the Board's views in this matter.

62/80 QUESTIONS

On a proposal by Cllr. Sweeney seconded by Cllr. Carroll it was agreed that the Chief Executive Officer answer the questions lodged.

DR. J.D. BEHAN 1. "Would the Chief Executive Officer please state the extent and degree of overcrowding in the Board's Psychiatric, Geriatric and Mental Handicap institutions, homes and hostels both currently and during the proceeding twelve months, indicating the criteria, guidelines and regulations used to determine such overcrowding and the penalties, if any, for breaches of such regulations?" 91 8th May 1980

2. "Would the Chief Executive Officer please state what, in the opinion of the Board's Health Inspectorate, Fire Officer and Law Agent, are the respective liability of this Board and of the Minister for Health in the event of a fire or other disaster occurring in an overcrowded institution particularly when such overcrowding has already been brought to the attention of the Board and Minister?"

3. "Would the Chief Executive Officer please indicate what is the proposed distribution of the Department of Health's Capital Allocation for 1980 with, for purpose of comparison, details of the proposed distribution of the Department's Capital Allocation in each of the proceeding five years together with a statement of the actual ultimate distribution of capital in each of those five years?"

The Chief Executive Officer advised Dr. Behan it was not possible to have information for all the questions at the meeting but that replies would be delivered to him as soon as they were available.

63/80 DISPOSAL OF LAND AT KILGOBBIN DISPENSARY RESIDENCE Report No. 16/1980

The following Report No. 16/1980 was submitted by the Chief Executive Officer:—

'The Dispensary Residence and the Dispensary (both under the same roof) at Kilgobbin, are held by the Board for ever, and discharged fromard indemnified against the payment of all rent. The original area of land attached to the residence was 2.25 acres statute.

On the 2nd May, 1974, the Board consented to the disposal to the Department of Posts and Telegraphs of 0.825 acres of the land. The transfer of the 0.825 acres has been effected and payment of the agreed price of £4,000 has been made to the Board by the Department of Posts and Telegraphs.

The Department of Posts and Telegraphs has now applied to the Board for a further 70 M2 of land to enable the Department to comply with a planning requirement to provide a separate entrance to their site. This land is not required for any of the Board's purposes. The Board's Valuer has reported that the value of the freehold interest of the 70 M2 is £250.

I propose, subject to the approval of the Board and to the sanction of the Minister for Health, to dispose of 70 M2 of the land at Kilgobbin to the Minister for Posts and Telegraphs for the sum of £250. 92

This report is submitted in accordance with the requirements of Section 83 of the Local Government Act, 1946.

Section 83 provides that at the first meeting of the Board held after the expiration of ten clear days from the circulation of this report, the Board may resolve that the disposal of this property as proposed shall not be carried out or that it shall be carried out in accordance with the terms specified in the resolution. If the Board resolve that the disposal shall not be carried out, it shall not be carried out.

On a proposal by Cllr. Carroll seconded by Cllr. Doyle the report was approved.

64/80 GARDEN HILL - ARRANGEMENTS FOR TRANSFER OF SITE TO ST. JAMES'S HOSPITAL BOARD Report No. 17/1980

The following Report No. 17/1980 was submitted by the Chief Executive Officer:—

"At the Board Meeting on 10th April, 1980 the Board adopted Reports Nos. 10 and 10(A), thereby in effect authorising the leasing of the Garden Hill site to the St. James's Hospital Board in return for the leasing to the Eastern Health Board of the Brookfield site and the leasing to the B.M.R.I. of a site at the south west corner of the Hospital grounds.

At the monthly meeting of the Hospital Board on 25th April, 1980 the transfer proposals were approved subject to agreement by the Department of Health and to continuance of the Eastern Health Board as lesser to the B.M.R.I. in respect of the site mentioned above. The revised arrangements mean that the Hospital Board will lease (a) the Brookfield site and (b) the site at the south west corner of the grounds, to the Eastern Health Board who will sub- lease portion of (a) to the Irish Foundation for Human Development and sub-lease (b) to the B.M.R.I. The site required for the Eastern Health Board Ambulance Control Centre can, depending on legal procedures, be excluded from the Garden Hill site transfer or can if such transfer is effected be leased to the Eastern Health Board by the Hospital Board, as in the case of the two sites above.

I propose, subject to Board approval, to request the agreement of the Minister for Health to the arrangements set out in this Report and in previous Reports, in order to expedite 93 8th May 1980

commencement of the new Hospital project. I also propose to arrange for our Law Agent to have the necessary legal formalities completed as soon as possible."

On a proposal by Dr. McCarthy seconded by Cllr. Hynes the report was noted.

65/80 CAPITAL PROGRAMME - PROJECTS COMMENCED AND APPROVED Report No. 18/1980

The following Report No. 18/1980 was submitted by the Chief Executive Officer:—

"At the April Meeting of the Board, Report No. 13/1980 was submitted giving details of the allocation for 1980. As the greatly reduced allocation imposes very severe restrictions on the Board's development programme, I agreed to inform the Board each month of progress. In order to give members a base-line for an integrated programme over the next 5 years, coupled with a comprehensive view of our ongoing and projected developments, I attach herewith a schedule of major works, with a very approximate estimate of costs at current prices of £90 million. As the need for new and/or restored buildings and the condition of existing structures are so closely inter-related I wish to draw the Board's attention to Mr. Sadlier's estimate of £20 million for restoration of existing retainable buildings to a condition meriting retention and preservation by regular adequate maintenance.

GENERAL HOSPITALS SPECIAL HOSPITALS COMMUNITY CARE MAJOR PROJECTS Day Hospital at St. James's Health Centre at Tallaght COMPLETED IN 1979/1980 Hospital 23 bed unit at St. Health Centre at Ballinteer Loman's Hospital Health Centre at Coolock Community Care team MAJOR PROJECTS Legion of Mary Hostels - Improvements - St. headquarters, Coolock UNDER CONSTRUCTION Improvements Brendan's Hospital Health Centre, Finglas Lifts installation, Bru Chaoimhin Hostel at Woodvilla House -Conversion New 22 bed unit and day Male chronic block and centre, St. Colman's mental handicap hostels, St. Hospital, Rathdrum Ita's Hospital - Reconstruction Health Centre and Day Nursery, Blanchardstown MAJOR PROJECTS FOR New Youth development WHICH TENDERS HAVE centre, Central Mental Health Centre and BEEN RECEIVED Hospital Community Care team headquarters, Wieklow Boilerhouse centralisation, St. Health Centre, Kilbarrack Brendan's Hospital Health Centre, Knockananna Health Centre, Shillelagn

MAJOR PROJECTS BEING Fire precautions, St. Fire precautions etc. , St. Health centre and Loman's Hospital community care room PLANNED Brigitt's Home headquarters, Naas Extension of psychiatric Fire precautions, St. clinic Vergemount Extension of Mary's Hospital (Stage community care team 1) accommodation. Dun Laoghaire

Isolation Unit, Cherry Day hospital, Finglas Health Centre, Athy Orchard Hospital Mechanical services, St. Columcille's Hospital Day Hospital, St. Loman's Health Centre, Swords Hospital Development (Stage 3), St. Vincent's Athy Extension of St. Welfare Home, Harold's Cross Dympna's Alcoholism Unit Health Centre and Day Upgrading of Units V & W, Nursery, Ballybrack St. Ita's Hospital Health Centre and Day Nursery, Rowlagh Health Centre, Blessington Child psychiatric centre, Cherry Orchard Mental handicap centre, Loughlinstown Maintenance workshop, St. Brendan's Hospital

PROJECTS FOR WHICH AN Fire precaution works, St. Central Pharmacy at St. Headquarters for ALLOCATION FROM THE Mary's Hospital (Stage 2) Brendan's Hospital community care team, DEPARTMENT OF HEALTH A5 WAS APPLIED FOR WITH A Extended earn hods, St. Reconstruction of kitchens plus VIEW TO INCLUSION IN 1980 Patrick's Home room Health Centre, Barndarrig repairs plus further PROGRAMME (Utter dated upgrading ofpatient accommodation, St. Brendan's 12/9/1979) Hospital

Fire precautions and Replacement of electrical Health Centre, telephones District mains installation, renewal Leixlip Hospital, Baltinglass ol roofs, male and female (extension) chronic blocks, steam boiler and water pump, St. Ita's Hospital Upgrading of a third Unit Upgrading of laundry, St. Ita Health Centre, Kilmeague at Vergemount Hospital for s Hospital geriatric patients

Ward improvements, Kitchen equipment, Extension to 2 Welfare Cherry Orchard Newcastle Hospital homes to provide staff flat Hospital Renewal of Roof, Health Centre, Bride Upgrading of services, Newcastle Hospital Street (extension) District Hospital, Wicklow Fire precautions and Day and residential Day room, District upgrading of accommodation for Hospital, Baltinglass accommodation Hostel, children related in Mount Pleasant, Ranalagh particular to new housing areas Workshop, Central Mental Hospital 'Decided by Board at meeting on 10th April, 1980 that the Chief Executive Officer should authorise the immediate expenditure (of £50,000) to meet the costs of electrical rewiring which had been included in the draft Minor Capital programme lor 1980 but lor which no allocation was received.

PROJECTS FOR WHICH Geriatric assessment unit, Day Hospital, Welfare Home, Dalkey APPROVAL TO PROCEED etc. Co. Hospital, Naas WITH FORWARD PLANNING Clontarf IN 1980 WAS APPLIED FOR Geriatric assessment unit, Health Centre and FROM THE DEPARTMENT OF etc. St. Columcille's headquarters for HEALTH (letter dated 12th Hospital 50 bed psychiatric unit, Bloomfield Community Care team, September, 1979) Terenure 60 extended care beds, St. Clare's Home 2 additional Welfare Homes Health Centre, Castledermot Additional accommodation for women and children particularly in new housing areas N.B. In addition, particular emphasis was laid in letter dated 12/9/1979 to the Department, on the pressing need for progress with the planning of new offices for headquarters staffs. The Brief for an office building to be constructed on a section of the lands at St. Brendan's Hospital was lodged with the Department in July, 1979. ADDITIONAL DEVELOPMENT The foregoing lists do not include additional development proposals, e.g. new health Centres and the up- PROPOSALS grading of a number of existing facilities; the balance of the Welfare Homes programme; the replacement of certain geriatric beds and a significant increase in their number; further residential and day cart facilities which may arise from the mental health development report currently being prepared; accommodation for the proposed Chief Psychiatrist's Unit and Research and Development Service at St. James's Hospital for which approval In principle has already been given by the Board and discussed with the Department of Health (Report 10/1980). Approval to proceed with the forward planning of these and other projects listed on the following pages will be requested from the Minister for Health in due course.

GENERAL HOSPITALS SPECIAL HOSPITALS COMMUNITY CARE PROJECTS FOR WHICH Provision for homeless Projects approved by the Welfare Homes - 21 further APPROVAL TO PROCEED WITH women and children Board on 30.3.1978 as part of homes at various locations FORWARD PLANNING IN 1981 a general development incl. Ballybrack, Raheny, AND SUBSEQUENT YEARS Staff changing programme, submitted in Monks town, Ballinteer, WILL BE REQUESTED FROM accommodation, staff March 1978 by Board Ballyboden, Tallaght, THE MINISTER FOR HEALTH IN quarters, theatre, adminis- Committee including - Inchicore, Clondalkin, DUE COURSE tration, patient reception Hostels/Group Homes in Blanchardstown, Clontarf, laboratory, new boilerhouse, various centres (320 Skerries, Swords, Baldoyle, Co. Hospital, Naas places) 20 bed Acute Unit, Naas, Athy, Maynooth, Tallaght 50 Day Wicklow, Arklow. Leundry, St. Vincent's Care/Workshop places - Hospital, Athy Dublin S.E. Additional accommodation Day Hospital, Dundrum area for community care teams at Development of laundry and Day Hospital, Dublin North Clonskeagh, North Strand, P.A.B.X. at Cherry Orchard -Central Tallaght and Hospital Day Hospital, Kildare North Blanchardstown. Day Hospital, Kildare Replacement of Central Day Hospital, Health Centres at Clondalkin accommodation for the Tallaght Acute Unit, Dublin (3), Portmarnock, aged, St. Brigid's N.E. 2 Units for Adolescents Ballyfermot (extension), Child Care Centres at Tallaght (2), Blanchardstown Crumlin, (2), Edenmore,

GENERAL SPECIAL COMMUNITY HOSPITALS HOSPITALS CARE

40 extra extended care Coolock and Tallaght Inchicore, Larkhlll (extension), beds at St. Clare's, Unit for severely disturbed, Lucan (extension), Dundrum Ballymun dangerous children (extension), Hostel for patients Darndale.Cabinteely, Shan kill, 50 extended care beds, suffering from Limekiln Lane (extension), Baltinglass Hospital Alcoholism (12) Malahide, Stlllorgan, Pearse St. Acute Un It, Naas Donnybrook, Ballyboden, 2 Day Hospitals Medium Stay Skerries (extension), Howth, Accommodation, Marino (extension), Portrane/Donabate, Balbrlggan New kitchen, St. Mary's Oun Laoghaire/S.E. Dublin (28) (extension), Ballyogan, Navan Hospital Medium Stay Road, Celbrldgo, Newbridge, Accommodation Clene, Calverstown, Kill Staff quarters, St. Dublin S.E. (40) (extension), Ballytora, Colli Colman's Hospital Oay Care/Workshops (290 Dubh, Straffan, Leixlip, places) Prosperous, Narraghmore, $ Replacement Unit E, Medium/Long Stay Unit, Allenwood, Sail ins, Kildengen, Clonskeagh Hospital Nurney, Roberts-town, Kildare Rethmore, Caragh, Browns Provide new Central Central (28) town, Levittstown, Kllcullen, Stores at Cherry Orchard Medium/Long Stay Unit, Oreystones, Carnew (ext.), to replace building vacated Dublin Donard, Stratford, Hollywood, in James's Street South Central (60) Balllnaclash, Ballyknockan, Child Service — Residential Newtownmountkennedy, Adapt Units at Cherry Units (extension), Kilcoole (20/28 places each) - (extension). Orchard for alternative Residential Units to replace usage Wards Further accommodation for in St. Brendan's Hospital children (including day centres, Medium/Long Stay Unit, day nurseries and residential) at Tallaght various locations related in (20) particular to new housing Occupational Therapy Unit centres. (Forensic Service) Residential Units, Forensic Service (150 beds) 99 8th May 1980

The foregoing lists relate only to works under the direct control of the Eastern Health Board and do not include capital projects undertaken by or related to Voluntary bodies etc such as St. John of God Brothers, Daughters of Charity, Stewarts Hospital, St. Vincent's Hospital, Fairview, voluntary general hospitals including James Connolly Memorial Hospital, Rehabilitation Institute, Cheeverstown etc. Neither is provision made therein for any separate major developments at St. Brendan's Hospital which are not already designated and which might arise on the basis of Messrs. V. Kelly & Associates' Report of April, 1980 to the Programme Manager.

A very approximate estimate at to-day's prices, of the capital expenditure involved in the foregoing list of Eastern Health Board projects is £70 million. In addition we estimate that approximately £20 million, at to-day's prices, is required to bring existing Eastern Health Board buildings to an acceptable standard of accommodation."

On a proposal by Cllr. Carroll seconded by Cllr. Hand the report was noted. Mr. Nolan said he was placing before the Board a schedule of major works which require to be done to ensure continuation of the Board's services including maintenance requirements. He referred in particular to the proposed new office block for headquarters staff and the unit for the Chief Psychiatrist's department with research and development facilities. In the schedule he was trying to foresee all future development needed over the next number of years. It would be necessary for the Board to determine the order and rating of priority for every project included in the schedule and thereafter only the Board, by agreement, could alter that order of priority. Cllr. Browne thanked the Chief Executive Officer for submitting such a comprehensive schedule and asked in particular that the Board ensure, even though it must be accepted that all the work listed cannot be tackled straight away, that all the essential and necessary work be carried out.

Cllr. Stagg supporting this said that the list was an indictment on administrations past and present where the Board is relying on central government for funds and is left unable to carry out its statutory obligations. The Chairman said that this case would be put to the Minister. The prestige of the Board is diminished as funds are denied to it and this could not be allowed to continue.

Cllr. Durkan said it was important to stress that this schedule only represented the Board's minimum requirements and if spending could not be undertaken now the Board would ultimately be overcome by the accumulated lack of investment in new premises and in maintenance. 100

Agreeing with the speakers Dr. Behan thanked the Chief Executive Officer for preparing the schedule and said that it represented the lack of consideration given to the Board's requirements over the years. Unless the Board gets the funds to meet its obligations it would be better if the legislative responsibility for running the service were removed from the Board. He also referred to the lack of press cover given to the meetings of the Board and the Chairman undertook to have the Medical Correspondants of the daily papers appreciate the importance of the Health Board's deliberations on the delivery of health care in the region. Cllr. Hand asked if he could be told how long it would take to spend the 20 million pounds which it was estimated would be required to bring our present premises up to a reasonable standard. Mr. Sadlier said that on the basis of existing building capacity it would take about ten years to spend that much money. Cllr. Stagg asked if the comparable costs per bed in the voluntary hospitals and the health board hospitals could be compiled for use in any dialogue with the Minister regarding the cost and effectiveness of the different institutions. Mr. Lamb and Mr. Reynolds undertook to see if this information would be available.

66/80 JAMES CONNOLLY MEMORIAL HOSPITAL BOARD APPOINTMENT OF REPRESENTATIVE TO BOARD

The following Report No. 19/1980 was submitted by the Chief Executive Officer:

"Mr. F. Elliott, former Planning and Evaluation Officer, Eastern Health Board, was appointed to the Board of the James Connolly Memorial Hospital as an Eastern Health Board representative, but in his capacity as an officer of the Health Board. Mr. Elliott ceased to hold office on 30th April 1980 and in accordance with the terms of the Establishment Order he ceased to be a member of the Hospital Board on that date but he may be re-appointed by the Board for a term up to three years."

Cllr. Carroll proposed that Mr. F. Elliott the outgoing member be re-elected and this was seconded by Cllr. Sweeney and agreed unanimously.

67/80 LETTER OF 25/4/80 FROM DUBLIN CORPORATION RE ESTABLISHMENT OF JOINT COMMITTEE TO CONSIDER HYGIENE STANDARDS AND RELATED MATTERS

The Secretary read the following letter from the Corporation:

"I refer to your letter of the 17th January, 1980 concerning a resolution passed by the Eastern Health Board at its 101 8th May 1980

meeting on the 6th December, 1979 that a Joint Committee of Dublin Corporation and the Eastern Health Board be established to consider hygiene standards and other matters.

The City Council at its meeting on the 14th April, 1980 agreed that a Joint Committee be set up along the lines suggested by your Board.

The Corporations' representatives on the Joint Committee wil! be chosen by a Selection Committee. Before referring the matter to the Selection Committee I should be obliged to know what is the proposed total membership of the Joint Committee and how many of the members will be drawn from Dublin Corporation. I should also be glad if you would confirm that the proposed Joint Committee will be serviced by officials of the Eastern Health Board."

The Chairman said that the proposal to have a joint committee of the Board and the Corporation had been approved by the City Council. A major purpose of the Committee was to look into the standards of houses in multiple occupation and to revise these standards if necessary by up-dating Bye-Laws. It was hoped that the Committee would also examine environmental pollution problems and food hygiene in general. It would be proposed that Dublin Corporation and Health Board officials would provide back-up services. The Committee would confine its activities to the city area of the Health Board. The members agreed that there should be eight members from the Board and eight members from the Corporation on the Committee. The following were selected to represent the Health Board:

Drs. Walker and McCarthy, Ald. FitzGerald, Cllrs. Freehill, Belton, Browne, Glenn and Ms. Kearney.

68/80 NOTICES OF MOTION

(a) The following motion was proposed by Cllrs. Durkan and Stagg:—

'That every effort be made to make available sufficient funds to undertake the work on the provision of the proposed new Health Centre in Castledermot."

Speaking to the motion Cllr. Durkan said that while he realised the constraints on the Board it was vitally important in the current year to make every effort to proceed towards the provision of a health centre at Castledermot because of the great needs in the area. 102

Cllr. Stagg referred to the local disappointment that there would be delay in providing a Health Centre at Castledermot and pressed the Board to put the proposal to the Department of Health.

Mr. Nolan said he had sympathy with the members' request. While his report on capital plans carried recognition of the needs of the area the Board would have to decide the priorities over the total requirements. With that reservation he was, he said, prepared to accept by notice of motion any proposal that any item take precedence once it was understood that this would displace other items in order of precedence.

In reply to Cllr. Doyle's question as to the effect of motions to change the order of precedence the Chief Executive Officer said that the major projects listed first in the schedule take precedence over those listed later. Castledermot could only be in the area of planning and even for this the Department would have to agree. As matters stand the Board can only proceed in 1980 with work on St. Brendan's and St. Ita's to the amount allocated by the Department.

It was agreed that all members would examine the lists and that the proposals would be placed on a future agenda for the members to decide priorities.

(b) The following motion was proposed by Cllr. Durkan:

'That provision be made to proceed with the proposed new Health Centre at Celbridge and the extension on the existing Health Centre at Leixlip."

Speaking to the motion Cllr. Durkan said that the situation in Leixlip was the same as in the previous case. The motion was seconded by Cllr. Stagg and agreed on the basis of a selective priority rating as already discussed.

"That the necessary funds be allocated to undertake the urgently required repairs at St. Brigid's Home, Crooksling."

Cllr. Durkan said that this motion arose from an earlier Visiting Committee meeting. He hoped that the necessary work could be carried out. The motion was seconded by Cllr. Hynes and agreed and the Technical Services Officer said he hoped to do some work out of this year's maintenance allocation.

(d) The following motion was proposed by CIIr. Carroll and Hand: 103 8th May 1980

"In view of the increased cost of Patented Drugs to the Health Boards this Board views with alarm the Government's intention of early ratification of the European Patent Convention, which is designed to facilitate the multi-national Drug Companies and calls on the Government to refuse to ratify the said Convention."

At the request of Cllrs. Carroll and Hand, this motion was deferred to the June meeting.

(e) As Cllr. Connolly was not present the motion in his name was not put to the meeting.

(f) The following motion was proposed by Ald. A. Fitzgerald.

'That a report be prepared by the Chief Medical Officer on present delays and numbers awaiting treatment for orthopedic surgery in the various hospitals in the Eastern Health Board area."

The motion was seconded by Cllr. Sweeney and agreed.

The following three motions were proposed by Dr. Behan:

(g) 'That the Chief Executive Officer be requested to obtain Senior Counsel's opinion as to the liability in law of the Minister for Health, the Department of Health and this Health Board in respect of a situation where the Board has admitted a patient for a specific treatment when, in fact, due to the inadequate facilities available to the Board, such treatment is not, and cannot be made available."

(h) 'That the Chief Executive Officer be requested to obtain Senior Counsel's opinion as to whether or not the psychiatrically ill person, the elderly infirm or ill "geriatric" patient and the mentally handicapped person has a constitutional, statutory or other legal right to the provision by the state of adequate and effective facilities for the care and treatment of their debility or infirmity."

(i) 'That the Chief Executive Officer be requested to obtain Senior Counsel's opinion as to whether the distribution of available resources by the State in an imbalanced and inequitable manner in favour of any one sector of the Health Services or community to the detriment of equally if not more necessitous sectors of the Health Service, thereby neglecting and discriminating against vulnerable, weak and underprivileged sectors of the community, is repugnant to the Constitution or infringes any statutory or other legal duty including those imposed on the state by the Treaty of Rome and the European Court of Human Rights." 104

The first motion was seconded by Dr. K. Harrington and on Dr. Behan obtaining the members' permission to take all three motions together, the second and third motions were seconded by Dr. Meade.

Speaking to the motions Dr. Behan said that his three Questions and three motions before the meeting was mainly about what can undoubtedly be described as the three Cinderella services of the Board, i.e.. Psychiatry, Geriatrics and Mental Handicap.

They can be taken together as an overall enquiry into the present state of this Health Board's functioning. Commencing with a question enquiring about the distribution of Capital Resources in the Health field over the past several years, they will also highlight the existence and responsibility for treatment facilities which are not alone seriously deficient but overcrowded. Further, and of far reaching significance, he said, they will seek to identify the rights, if any, of the individual patient to the provision of adequate levels of treatment facilities and services. On the other side of the coin, they will also seek to identify the true nature of the State's obligations and duties to provide these facilities and treatment, if indeed it has any.

The overall objective of his Motions and Questions is to establish the total context under which this Health Board is operating and more specifically, to define the level at which it is permitted to function by the Department of Health since it took over from the Dublin Health Authority ten years ago. The establishment order of the Health Board would suggest that the Health Board is the statutory body responsible for the planning and co-ordination of an integrated Health Service in this region on behalf of the Minister. However the reality is very different. Despite the fact that 'de jure' the Health Board has the statutory responsibility for the provision of the overall Health Service of this region and for the total financial allocation, de facto it has neither the control nor the responsibility for effective Policy Making, for planning and developing or for allocating resources.

Dr. Behan said that the resultant reality is that there is a two tier Health Service in existence. The top tier is the Private Sector which is prestigious, fashionable, elitist, well resourced and, thanks to assured funds from a direct relationship with the Department of Health, the private sector is effectively independent to the point of having autonomy without open public accountability and scrutiny. Conversely, there is the bottom tier represented by the Public Sector, which, under resourced and often coping with those patients rejected by the Private Sector, is the poor cousin of the Private Sector statutorily forced to provide a second class service for patients who are relegated to second class citizens 105 8th May 1980 in second class poor law institutions. The outcome he said is an official acceptance and institutionalization of two standards of attitudes and two standards of allocation of resources leading to two standards of care for different classes of citizens.

Or. Behan said since the Health Board took over from the Dublin Health Authority there has been a progressive diminution and erosion in the role and efficacy of the Health Board by the process of centralisation of policy making along with the simultaneous exclusion of the Board from participation in proceedings and organisations which directly affect the statutory functions of the Board.

Ultimately it is the Central Agency of the Department of Health who, in effect, decide policy for the Health Board by controlling the purse strings of the Financial Allocation. Consideration of the financial facts both revenue and capita! proves this. Of a revenue allocation of approximately £180 million 50% is allocated by the central agency of the Department directly to the Private Sector Voluntary Hospitals for about 15% of the illness which occurs in the population and which is treated by high technology bed- oriented medicine. In contrast the other 50% of the Budget is allocated to all the other services put together with, including Psychiatry, Geriatrics, Mental Handicap, Community Care and General Practise, amount to about 85% of the illness in the population.

He pointed out that consideration of the allocation of capital resources illustrates the same imbalance. Out of a total Capital allocation of £28 million in 1980 the Eastern Health Board Public Sector gets two hundred thousand pounds (£200,000) with several million pounds going to the Private Sector. And if that is not evidence enough this Health Board has just been informed that the estimated cost of bringing our existing physically deficient institutions up to the acceptable level in which the Dublin Health Authority handed them over is a staggering £20 million pounds, representing the bill for a cumulative legacy of neglect before we even get to planning new facilities and he doubted if this includes the £10 million bill for St. Brendan's alone.

What is required he said is the utilization of available resources for the balanced development of the Health Service based on the principles of social justice and equity with a true partnership evolving between the Public and Private Sector rather than, as currently, the suppression of one to meet the needs of the other.

It's a matter of regret he said that the Board has to have before it such serious and legally oriented motions. Members might be interested to know what finally inspired their intro- 106

duction. When drafting the revised Development Plan for the Psychiatric Services it seemed appropriate that the first page of this Plan should carry a single quotation which would help focus the minds of Board Members, Department Officials, and Politicians on the nature of the problem facing the Board. What, one could ask, could be more appropriate to highlight the deficiencies in the Psychiatric Service than a simple restatement of that Article of the Constitution which undertakes to cherish all the children of the Nation equally. There turned out to be but one problem — to an amateur, and at first read, there seems to be no such Article in our Constitution.

Hence these Motions tabled by him which constitute a deliberate attempt to establish the legal facts and to identify the legal responsibilities and implications arising from them. The conclusions will enable the members of the Board to know whether individual people and patients have constitutional rights or not and, concurrently, does the Minister, his Department and this Health Board have a constitutional obligation to provide an adequate and effective level of treatment facilities and services. He considered that the consequences of an answer in the affirmative are staggering in that it would constitute an invitation to the Public to request the Courts to direct Government to perform the functions for which it was elected.

He said that the consequences of a negative reply to the effect that an individual possesses no Constitutional or other Legal rights to provision of adequate facilities and levels of treatment services and that, conversely, there are no obligations of a Constitutional or other nature on Government to develop the Health Services in a balanced and equitable fashion is equally profound. It means that the utilisation of financial resources in the provision of Health Services is a gift in the hands of politicians and the evidence so far, based on the treatment of this Board and our citizens, is that the financial resources in the field of health are used by politicians for the purpose of gaining political advantage rather than for the development of a balanced Health Service based on the principles of Social Justice and equity.

In conclusion Dr. Behan said that if it turns out that the development of the Health Service is no more than a political football then this Board must review its position. If there is a gap in the Constitution this Board should take the initiative in seeking to have the Constitution and the Health Acts appropriately amended and not resign itself to being little more than a talking shop and a mere window dressing for democracy conveniently used by the Minister of the day and his Department to obscure the real source and nature of the use of power and patronage in the Health Services field. 107 8th May 1980

Supporting the motion Cllr. Stagg said it was frightening to think that 50% of the financial resources were being spent without any reference to the Health Board and on only one aspect of the service while the Board itself was being starved of funds while having to provide statutory services and in a situation where even its own hospitals were being run down.

The Chairman thanked Dr. Behan for the motions proposed but considered that Dr. Behan's remarks about politicians were a bit too severe, the Civil Service and indeed the medical profession itself had been also responsible for the neglect of the Eastern Health Board services over the years. The motions were agreed and the Chairman asked that the necessary advice be obtained.

The Chairman thanked the Kildare County Council and the County Manager for kindly providing the facilities for the meeting and Cllr. Stagg thanked all those members who had travelled to Naas for the meeting.

The meeting ended at 8.45 pm.

CORRECT: J.J.Nolan

Chief Executive Officer

CHAIRMAN 108 5/6/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in St. Colman's Hospital, Rathdrum, Co. Wicklow on Thursday 5th June, 1980 at 6 p.m.

PRESENT Dr. J. 0. Behan Sr. Columba McNamara Cllr. J. Connolly Mr. M. Matthews Cllr. E. Doyle Cllr. Mary Freehill Ald. A. FitzGerald Cllr. E. Stagg Cllr. Mrs. A. Glenn Cllr. J. Sweeney Cllr. F. Hynes Cllr. G. Timmins T.D. Cllr. Mrs. M. Waugh

APOLOGIES FOR ABSENCE Ald. B.Ahern, T.D. Cllr. B. Durkan Cllr. M. Carroll Dr. A. Meade Mr. H. Corrigan Dr. B. Powell Dr. J. Walker

IN THE CHAIR Ald. Alexis FitzGerald

OFFICERS IN A TTENDANCE Mr. J. J. Nolan Mr. P. J. Swords Mr. T. Keyes Mr. J. Doyle Mr. F. Donohue Mr. C. Mansfield Mr. J. Reynolds Mr. M. Cummins Mr. R. N. Lamb Mr. A. O'Brien Mr. J. Sadlier Miss E. Larkin Mr. P. I. Lyons Miss B. Kelly Mr. J. Clarke Mr. P. Byrne

69/80 Clir. Sweeney and Cllr. Hynes welcomed the Chairman, the members and officers to the meeting which was being held in Wicklow for the second time. The Chairman thanked the Councillors and expressed his appreciation on behalf of himself, the members and officers for The hospitality extended to them by the hospital staff. Clir Connolly also joined in the expression of thanks to Matron and her staff. He also suggested that the meeting be finished by 9 p.m. and this was agreed.

The Chairman advised the members of the recent death of the mother of Miss Aine Flanagan, Senior Administrative Officer, Community Care. The members stood in silence as a mark of respect and the Chairman asked that a letter of sympathy be sent to Miss Flanagan. 109

On a proposal by Cllr. Waugh seconded by Cllr. Sweeney it was agreed that the Annual Meeting of the Board would be held at 6 p.m. on Thursday 3rd July 1980 to be followed by the July monthly meeting at 6.30 p.m.

70/80 CONFIRMATION OF MINUTES

Cllr. Staggsaid that it had been agreed at the previous meeting on the proposal of Cllr. Durkan that there would be consultations with the Matron of Naas Hospital regarding domestic staff and also that there would be consultations with Dr. Murphy the Director in the Kildare area regarding minimum needs for the Health Centre at Castledermot. It was agreed that the minutes would be amended to include these items.

The minutes as amended were signed on a proposal by Cllr. Sweeney seconded by Cllr. Hynes.

SPECIAL MEETINGS HELD ON 1st MAY 1980

Dr. Behan's name was ommitted inadvertantly from the list of members in attendance.

Cllr. Mrs. Glenn told the members that the Committee on the services for the elderly was considering the Board's request for a priority order to the recommendations. They were meeting on the 26th June and would submit their recommendations formally to the Board thereafter. Mr. Keyes said that the report of the Psychiatric Sub-committee would be available for consideration at the same Board meeting.

The minutes were adopted on a proposal by Cllr. Sweeney seconded by Cllr. Timmins.

71/80 REPORTS OF VISITING COMMITTEES

The reports of the following Visiting Committees having been circulated were dealt with as follows:—

(a) No. 1 Visiting Committee meeting held at St. Colman's hospital on 17/5/80.

On a proposal by Cllr. Timmins seconded by Cllr. Sweeney the report was noted. Cllr. Sweeney thanked all those who came to the hospital on this special occasion.

(b) No. 1 Visiting Committee meeting held at Baltinglass Hospital on 20/5/80.

On a proposal by Cllr. Timmins seconded by Cllr. Hynes the report was noted. 110 5/6/1980

On a proposal by Dr. Behan seconded by Cllr. Connolly the report was noted.

(d) No. 3 Visiting Committee meeting held at St. Ita's Hos pital on 17/4/80.

On a proposal by Mr. Matthews seconded by Cllr. Hynes the report was noted.

Cllr. Stagg said that he found things so wrong on that visit that he wrote personally to the Minister regarding conditions at the Hospital. He said he believed the matters that he had drawn attention to were now improved but he still didn't regard the situation as satisfactory at the hospital. The committee was having a further meeting at the hospital next week. Mr. Keyes said he considered the function of a visiting committee was to visit a hospital and report on their findings to the Board. When the R.M.S. and himself got such reports he would investigate any complaints made. Matters arising locally in the hospital should be dealt with by the R.M.S. Cllr. Hynes expressed the view that the Board should have seen and corrected the faults at the hospital before the visiting committee drew attention to them. Mr. Matthews said he had drawn the Board's attention previously to various faults at the hospital in particular when the representatives of the nursing staff met with the Ad-hoc Committee late last year and drew attention to the conditions at the hospital at that time. He said that there was no statement of duties for ward staff and this made it difficult to assign work to Attendants and Cleaning Staff. Mr. Keyes pointed out that it was a job of the nurse in charge to use the ward staff to carry out all duties necessary to run the ward efficiently. At Mr. Matthews request it was agreed that the Visiting Committee at their next meeting at the hospital would meet a deputation from the nurses.

In reply to the Chairman's enquiry Mr. Keyes said that when the R.M.S. is absent from the hospital there is always a deputy standing in for him.

In reply to Cllr. Stagg's enquiry regarding the installation of laundry equipment Mr. Sadlier said he hoped to place a contract for the work shortly.

(e) No. 4 Visiting Committee Meeting held at St. Mary's Hospital on 30/4/80.

On a proposal by Cllr. Glenn seconded by Cllr. Hynes the report was noted. 111

(f) No. 4 Visiting Committee Meeting held at Legion of Mary Hostel, Brunswick Street on 14/5/80.

On a proposal by Cllr. Hynes seconded by Cllr. Sweeney the report was noted.

Cllr. Glenn referred to the tremendous voluntary effort made by the Legion at the Hostel and the consequent saving to the Board by their good work there. Cllr. Hynes associated himself with these remarks. It was agreed that the Legion would be advised of the Board's appreciation of the work that they were doing at the hostel.

72/80 QUESTIONS

On a proposal by Cllr. Sweeney seconded by Dr. Behan it was agreed that the Chief Executive Officer answer the questions lodged.

QUESTION 1: Mr. K.Harrington "Would the Chief Executive Officer please state the terms of present leases to the Irish Foundation of Human Development and the B.M.R.I, as regards:- a) length of tenure, when renewable and any other pertinent conditions b) length of tenure, when renewable and any changes in or additional conditions or advantages envisaged under the proposed new lease c) what grant is given by the Board to the Foundation of Human Development?

ANSWER: In May 1966 a Day Centre and School for autistic and emotionally disturbed children was established in Garden Hill House which was the former residence of the R.M.S. of St. Kevin's Hospital. With the increasing number of children, the accommodation eventually proved inadequate and was vacated in 1973: it was then allocated to Professor Browne as an interim headquarters unit.

On foot of an agreement dated 1st July, 1969 made between Professor Browne and the Biological and Medical Research Institute a psycho-endocrine research centre was established, for which a site of under an acre at Garden Hill was provided by the Dublin Health Authority in an agreement dated 7th July, 1970. The cost of building, equipping and staffing the laboratory at Garden Hill was undertaken by the institute without any cost to the Board. The lease was for an initial term of 5 years from 1st March, 1970 subject to renewal at a nominal rent of 50p per annum. Subsequently the Authority at its meeting on 25/3/1971 consented to the endorsement of the original lease to include an extra half acre of ground and 112 5/6/1980

the extension of the original term to 1st March 1980 with a similar renewable commitment. The additional area was needed to allow for the enlargement of the research unit and development of further research and service programmes. This Garden Hill site was excluded from the area leased to the St. James's Hospital Board under indenture dated 15th April. 1974.

In 1973 the Foundation for Man, later incorporated as the Irish Foundation for Human Development was established at Garden Hill on the recommendation of Professor Browne. The Foundation was to provide and equip a Demonstration Health Care and Psychosomatic Unit, with links to the Department of Psychiatry U.C.D. which was to operate in association with a Centre for Community Studies to be established in the Garden Hill premises. At its meeting on 11th July, 1974, the Eastern Health Board agreed to make a grant to the Foundation and to meet the operating costs of the unit by way of annual grant. The following sums have been paid Unit by the Board to the Foundation on foot of an arrangement with the Department of Health as confirmed in their letter of 24/5/1977:-

£ 1974 Nil 1975 15,000.00 1976 Nil 1977 30,000.00 1978 58,283.00 1979 103,600.00 1980 27,500.00 £234,383.00

(a) £40,000 of this amount was a special payment from the Department of Health in respect of services to Eastern Health Board patients provided by Dr. D. FitzGerald of the Angiology Department in St. Mary's Hospital, Phoenix Park, over a period of years to 31/12/1979.

(Paragraphs 13/73, 75/74 and 85/74 of the Minutes refer).

Later the Board approved a proposal for the establishment of a Mental Health Centre at the Garden Hill premises from which a mental health service for the Tallaght area would be developed. (Paragraphs 83/75 and 99/75 of the Boards Minutes refer) pending building of a new hospital at Tallaght. With the expansion of the activities of the Foundation, it was proposed in Report 12/77 and confirmed at a Board Meeting on 14/4/1977, to lease, with the consent of U.C.D. the entire site at Garden Hill to the Foundation excluding Garden Hill House, the Animal House and the B.M.R.I. premises with immediate surrounds in each case. The lease was on the same 113 terms as for the Department of Psychiatry, i.e. on a 5 year renewable basis from. 1/3/1970. The transfer was notified to the Department of Health on 20/4/1977 and was incorporated in an agreement dated 30/8/1977 between U.C.D., B.M.R.I. and the Foundation. Under this agreement U.C.D. surrender their lease to the Foundation, while the Endocrine Research Unit becomes part of the B.M.R.I. with continuance of title. The Department of Angiology under Dr. Dermot Fitzgerald remains part of the Foundation and the teaching involvement with U.C.D. continues.

Subsequently in order to comply with a Government direction that native fuels should be used in the boilerhouse for the new Hospital, the St. James's Hospital Design Team decided that the only suitable area for a gravity-feed fuel-supply plant was at the Garden Hill site. Very complicated negotiations have since been proceeding during the past two years involving the Department of Health, the Eastern Health Board, St. James's Hospital Board, B.M.R.I., U.C.D.. the Foundation, the owners of the Brookfield site and the Corporation Planning Department. Agreement has been reached on almost all major issues and it is hoped to have the transfer documents completed by the various legal advisors very soon. Full, details of the proposals were contained in Reports Nosi 10/1980, 10A/1980 and 17/1980 to the Eastern Health Board at its meetings in March, April and May, 1980. In their letter of 22/5/1980 to St. James's Hospital, the Department accept in principle, the proposals in respect of the Biological and Medical Research Institute and the Irish Foundation for Human Development.

Pertinent conditions in the existing lease include a provision that the site and the buildings erected thereon shall be used solely for the purposes of the clinical research unit and shall be kept in good order and condition. If the premises cease to be used as a research unit then vacant possession thereof shall be surrendered to the Board at an agreed valuation. The only change proposed in the new agreements is to have a standard term of 99 years or a balance thereof, in respect of all leases between the Board, the Hospital, B.M.R.I. and the Foundation. Stability of tenure is essential to encourage continuance of the in-f low of development and research funds from finance/ trust organisations such as the Bank of Ireland, Carrolls, Irish Cancer Society, A.I.B., Commission des Communautes Europeans Brussels, Gulbenkian Foundation, Guinness Ltd., Waterford Glass, etc., as well as to safeguard the Boards interests in the concern. Security and viability of the work programme is also necessary to attract and hold research and service staffs. No grants are paid by the Board to the B.M.R.I. to whom payments for services given to eligible Eastern Health Board patients are made under the normal sessional arrangements. 114 5/6/1980

QUESTION 2: Cllr. M. Freehill "How many people are in receipt of Mobility Allowance and how many applications were turned down since the scheme started".

ANSWER: at 31.5.1980 Number of Persons in receipt of allowance — 99 Number of applications refused — 104

73/80 DISPOSAL OF LAND TO WICKLOW COUNTY COUNCIL Report No. 20/1980

The following Report No. 20/1980 was submitted by the Chief Executive Officer.

"The Board will be aware from reports of the Visiting Committee that proposals have been under consideration with Wicklow County Council for the disposal of 5.7 acres of land at St. Colman's Rathdrum, which is surplus to the Board's requirements. This land forms part of the lands amounting to approximately 18.5 acres transferred to the Eastern Health Board at the establishment of the Board in 1970. The lands which are mainly part of the former Workhouse Lands are held on a leasehold basis from the Fitzwilliam Estate and are subject to an annual rent of £14.93. The Board's Valuer has recommended and the County Council has accepted that the purchase be on the following terms:—

1. That the sale price in full and final settlement shall be the sum of IR £32,000 (thirty-two thousand pounds). 2. That the land comprising 5.7 acres or thereabouts shall be conveyed to the Council in fee simple, with vacant possession. 3. That the Council shall take in charge the foul sewer which traverses the site. 4. That the Council shall erect a suitable boundary on the line of severance. 5. That each party shall be responsible for its own respective costs of the transaction.

The County Council proposes to use part of this land for the provision of sheltered housing and so provide on the St. Colman's site an integrated service for the care of the aged.

I recommend that the Board approve of the disposal of 5.7 acres approximately to Wicklow County Council in accordance with the terms negotiated by the Valuer. 115

This report is submitted in accordance with the requirements of Section 83 of the Local Government Act 1946.

If the Board resolve that the disposal shall not be carried out it shall not be carried out.

On a proposal by Cllr. Hynes seconded by Cllr. Timmins it was unanimously agreed to adopt the proposals contained in report No. 20/1980.

74/80 FUTURE OF ST. BRENDAN'S HOSPITAL Report No. 21/1980

The following Report No. 21/1980 was submitted by the Chief Executive Officer.

"As members are aware, the question of the future of St. Brendan's Hospital has been the subject of examination and debate for some considerable time. The report of the Psychiatric Services (Ad Hoc) sub-committee adopted by the Board in March, 1978, recommended, inter alia:—

1. The development of a comprehensive community psychiatric service and the scaling down of the large psychiatric hospitals including St. Brendan's Hospital. 2. The making of effective provision for the maintenance of an acceptable level of care and accommodation for remaining long- stay patients during the transitional scaling down period.

More recently the Management Team requested a Design Team under the leadership of Mr. J. Inglis, Architect, to undertake a survey of the hospital and submit their report thereon. This report has now been received and has been examined by the Technical Services Officer and Management Team as a result of which certain recommendations have been put to the Psychiatric Services sub- committee. 116 5/6/1980

The report, generally emphasises the magnitude of the task which would confront the Board if this hospital were to be brought up to an acceptable standard, highlights the very poor conditions of most of the buildings and services and makes the point that safety is at a low level because of such factors as structural instability, overloaded and dangerous electrical installations, unreliable and ineffective steam generation plant and heating and water services and inadequate fire protection measures. The total cost involved if this report were implemented in full is estimated at a figure in excess of £9 million.

The psychiatric services sub-committee is at present engaged in updating its report of March, 1978 and the up-dated report will incorporate recommendations in relation to St. Brendan's Hospital set in the context of the development of the Psychiatric service as a whole. It is expected that the up-dated report will include, inter alia, recommendations providing for (1) a significant reduction in size in the hospital and in the number of in-patient places provided therein, (2) the provision of approximately 75 replacement beds in the various catchment areas on a phased basis and (3) the implementation of a programme designed to maintain all buildings at an acceptable level during the transitional period.

It is expected that the sub-committee report will be placed before the Board for consideration during the coming months".

Presenting the report Mr. Keyes advised members that the requirements for replacement beds at (2) in the second last paragraph of the report should read 750.

Referring to the report on the hospital buildings prepared by Consultants for the Board Mr. Keyes said that it was now clear that the life of the hospital buildings was extremely limited and that any accommodation required for the future would have to be built. The report of the Psychiatric Services Sub-committee would be dealing with the various aspects of the proposals for the future of the hospital and this report would be presented to the Board shortly. Regarding the moves made necessary recently by structural defects Mr. Keyes said that with the co-operation of the General Hospitals Programme 20 patients had been moved to a unit at Verge-mount Hospital and the unit at Cherry Orchard was being made ready for more of the patients who must be moved. In addition Mr. Keyes said a further unit at the Hospital needs to be vacated and the Psychiatric Committee will deal with this and refer to it in their report

Dr. Behan endorsing what Mr. Keyes said confirmed that the Psychiatric Sub-committee would report shortly to the Board. Cllr. Connolly expressed his concern at the amount of 117

money apparently involved in the future of the hospital and asked would it be forthcoming. Mr. Keyes said the situation was that there were 1,000 in the hospital living in accommodation that must be replaced and this would have to be considered a priority of the Board.

Mr. Nolan referred to further items on the agenda at Nos. 8, 18 and 21 all relating to Capital Projects and said that in the context of St. Brendan's and St. Ita's Hospitals and the Board's other institutions the members would appreciate in relation to these reports that the needs of those two hospitals could absorb all capital monies available. As however that level of priority for St. Brendan's and St. Ita's would deprive the other Programmes of all capital funds the Board would probably decide that a special claim be made to the Minister for these particular works.

Dr. Behan said that as a result of the most recent meeting with the Department Officers he believed that the Minister and the Department of Health were now aware of the needs of the Board's services. In his view the Board should formulate its requirements to advance its services on all fronts particularly in relation to the care of the aged and the psychiatric services and place these demands with the Minister and the Department.

It was agreed that further discussion be deferred until the reports of the Psyciatric Services Committee and the Committee on services for the elderly were available.

75/80 TEMPORARY BORROWING Report No. 22/1980

The following report No. 22/1980 was submitted by the Chief Executive Officer.

"At meeting held on 6th March 1980 the Board consented to the temporary borrowing by way of overdraft up to an overall limit of £1.5 million during the quarter ending on 30th June 1980.

It is considered that similar overdraft accommodation will be required during the September quarter 1980.

Accordingly, I request that the Board consent to borrowing by way of overdraft during the three months to 30th September 1980 up to a maximum of £1.5 million".

On a proposal by Cllr. Sweeney seconded by Cllr. Timmins the following motion was adopted unanimously. 118 5/6/1980

"That the Eastern Health Board consent to the Temporary Borrowing by way of overdraft as outlined in Report 22/1980".

76/80 1980 BUDGET ALLOCATION - LIMITATIONS ON EXPENDITURE Report No. 23/1980

The following report No. 23/1980 was submitted by the Chief Executive Officer.

(1) "Health Services Revenue Expenditure A review of revenue expenditure to 30th April 1980 has disclosed that the allocation provided for the medicine schemes in the Community Care Programme is likely to be exceeded by £1.06 million.

The relevant details are: Col.(1) Col. (2) Col. (3) Col. (4) Col. (5) Out- Budget Expen. Estimated Excess turn Allocation to 30/4/80 Expen. 1979 1980 1980 £000 £000 £000 £000 £000 Medicines 1.898.9 2,150.0 1.030.0 3,090.0 940.0 Refund Scheme Long-term illness 1.268.2 1.400.0 507.8 1.523.4 123.4 medicines

The number of persons availing of the medicines Refund Scheme in 1980 is much greater than in 1979 as the following figures relating to the Dublin area show. Month 1979 1980

No. of claims Average Cost No. of claims Average Cost per month per claim per month per claim

January 8.467 12.82 12.171 16.42 February 6.909 15.73 13.400 16.41 March 4.920 18.13 14.761 15.93 April 5.362 17.74 11.424 16.78

The projected expenditure for the year (Col. 4) does not provide for the possibility of a steeper increase in the trend in the numbers availing of these schemes or for increasing costs per claims. The excess expenditure for both schemes will certainly be greater than the £1 million now estimated. 119

The medicine schemes are open-ended in that the Board has no control over the number of persons availing of them or the cost of the medicines prescribed.

The attention of the Department of Health has been drawn to this matter in a letter dated 29th May 1980.

The expenditure on the Board's other services (hospitals etc.) is running slightly over the allocation at the end of April.

It is not possible at this stage to say whether this trend will be maintained and/or accentuated. Certain costs such as heating, and lighting are higher in the early months of the year.

Expenditure on other items such as furniture, equipment, ambulances, section 65 grants represent annual costs. The picture will become clearer at the end of June when we shall have six months expenditure on which to base estimates for the remaining portion of the year.

Every effort is continuing to be made to keep expenditure within the budget allocation, without at the moment imposing .cuts in any of the principal services. A further report will be submitted to the July meeting.

(2) Supplementary Welfare Allowances Expenditure 1980 The Department of Social Welfare has been informed in a letter dated 22nd May 1980 that the allocation approved for this service will not be sufficient to meet the Board's costs in 1980. The relevant figures are:—

Allocation from Department of Social Welfare £2,742,612 Estimated Net Expenditure £3,759,869 Shortfall £1,035,257

The estimated net expenditure is based on the actual expenditure and on known commitments to 30th April, 1980. There is no provision in it for: i) Any general increase in demand for the service ii) Any appreciable level of industrial unrest Hi) Any increase in cost of materials such as beds, bedding, etc. which may occur in the remaining months of the year.

The Department has been requested to review the matter".

Mr. Nolan said that this report was the first warning signal of serious upward trends in spending. It was obvious from the returns from January to April that the Board would exceed its budget considerably especially under headings where it 120 5/6/1980

had no control over the amount of claims made, for instance the drug refund scheme and the long-term illness scheme. The budgetary figures for May might show whether the economies that the Board has introduced are having effect but if there is not a considerable improvement in the situation it may be necessary to inform the Minister that the Board would be unable to stay within its allocation.

The Chairman referred to a recent deputation to the Minister at which the deputation advised him that although the Board appreciated the need for economy they were concerned at the effect the cuts were having on the services. Cllr. Stagg said that while the extent of the economies may not be reflected in the figures presented to the Board because of inflationary trends the cut' backs were certainly hitting the service to the public and hoped that there would be no further cut backs especially in areas such as Supplementary Welfare Allowances.

Dr. Behan said that the Board should consider seeking in future a fixed budget for the services which can be estimated in advance and asked that the services which are on a demand basis be provided for on a flexible budget.

77/80 NOMINATION OF MEMBER TO CENTRAL COUNCIL OF FEDERATED DUBLIN VOLUNTARY HOSPITALS (Report No. 24/1980)

The following report No. 24/1980 was submitted by the Chief Executive Officer.

At the July, 1979 marital/ meeting of the Board Dr. C. McNamara was appointed to represent the Board on the Central Council of the Federated Dublin Voluntary Hospitals. Dr. McNamara has now submitted his resignation which has been accepted by the Council. It is now necessary for the Board to appoint a representative to the Central Council of the Federated Dublin Voluntary Hospitals to replace Dr. McNamara.

Mr. Nolan told members that as Dr. McNamara had resigned the members would now have to appoint a replacement member to the Council.

Dr. Behan was nominated for appointment by Cllr. Freehill. The Chairman seconded this nomination and it was agreed unanimously. 121

78/80 REPORT OF BOARD SEMINAR HELD AT CHERRY ORCHARD ON 21/3/1980 Report No. 25/1980

The following Report No. 25/1980 was submitted by the Chief Executive Officer.

PRESENT

Ald. A. FitzGerald Cllr. B. J. Durkan Dr. J. Behan Sr. Columba McNamara Mr. K. Harrington Prof. J. McCormick Dr. J. Walker Cllr. G. Timmins Dr. B. Sheehan Cllr. J. Sweeney Dr. P. McCarthy Cllr. F. Hynes

Cllr. A. Groome Cllr. M. Freeh ill

OFFICERS IN ATTENDANCE

Mr. J. J. Nolan Mr. P. I. Lyons Mr. T. Keyes Mr. J. Sadlier Mr. F. J. Donohue Mr. J. Clarke Prof. B. O'Donnell Mr. J. Doyle Mr. J. F. Reynolds Mr. C. Mansfield Mr. R. N. Lamb Mr. M. Cummins

MATTERS DISCUSSED:

Cllr. Freehill asked that more information be given on: National Rehabilitation Institute National Health Council Dublin Regional Hospital Board

Dr. Behan said he felt the Board should have a more structured involvement in consideration of new legislation and asked did the Minister for Health seek the views of the Health Board when legislation was being drafted. Professor McCormick said the Board should be in a position to make representations for change rather than waiting for change to be initiated by the Minister.

Cllr. Durkan asked that members be advised on how Boards established under the Health (Corporate Bodies) Act and the Voluntary Agencies listed related to the Health Board in the provision of services and what assistance they gave.

Dr. Behan said that the Health Board should be represented on the Boards of Voluntary Hospitals and bodies such as Comhairle na nOispideal. The Health Board should see the minutes of their meetings and their Annual Reports and Annual Accounts. Unless the Health Board could have some control over Voluntary Hospitals expenditure it would be better if responsibility for patients in those hospitals was 122 5/6/1980

removed from the Health Board. Cllr. Sweeney and Dr. McCarthy said that it was necessary to seek a change in the Comhairle, it was too hospital orientated at present. Professor McCormick said national bodies were needed in Health Planning and while an Comhairle had faults it also served a good purpose. Referring to the Dublin Regional Hospital Board he said he considered an Eastern Regional Authority should be established to take over functions of the Regional Board and other health functions. He said the Board itself should also invest more in Planning and Evaluation of services.

Dr. Sheehan said he felt many of the bodies set up under the Corporate Bodies Act did not reflect the requirements of the Community. Medical education was hospital orientated and General Practitioners were not as a rule represented on such Boards. Neither old General Practitioners have an adequate say in the organisation of Community Services at Community Care Area level. Professor McCormick suggested that the General Practitioners who were members of the Health Board and the Local Committees in the Board's area should form a Committee to present their views.

Sr. Columba and Cllr. Durkan referred to indiscriminate prescribing of drugs and the role of the Drug Advisory Board, General Medical Services (Payments) Board. Professor McCormick said the Drug Advisory Board was a responsible and efficient body which advised on drug inter-action and side effects and also advised on the control or prohibition of drugs. It might be that the Health Board should consider National Drug Pruchasing as practiced in Norway. Regarding prescribing the Committee of General Practitioners suggested by him might advise. Dr. Walker asked that the Board's views on over-prescribing be got over to the medical organisations. Dr. Sheehan said that the Health Education Bureau had done a good job in this matter but a greater response from Doctors was needed. Mr. Harrington said that the limits on repeat prescriptions should be examined.

Mr. Donohue said that the main dissatisfaction among Doctors with the General Medical Services scheme was lack of representation on the Payments Board and slowness in making payments. The scheme was costly however, the average cost was £796 per 100 patients seen during the month of November 1979 while the cost for one particular Doctor was £1952 per 100 patients seen. The scheme did not have the hoped for effect of keeping people out of hospital, admissions to general hospitals had increased by 100% since 1961 while the population only increased by 19%. Dr. Sheehan defending the scheme pointed out that 85% of illness was managed at General Practitioner level at a cost of £30 million through the General Medical Services white the hospital service for 15% of the population cost £500 — 600 million per annum. He did not take the view that General Practitioners only should be asked to economise. 123

He would welcome a control of hospital admissions also. He pointed out that 45% of hospital admissions came from their casualty departments, manned by junior doctors, while only 35% came from General Practitioners. Dr. McCarthy said he thought there should be a statistic combining visiting with the cost of drugs dispensed to give the cost of caring for a patient. He pointed out that the visiting rates would be higher where there is no convenient hospital with a casualty department and more domiciliary visits in Country areas where travelling was difficult. Cllr. Durkan referred to the disadvantage of a person in a rural area who had no choice of the Doctor attending and what could be done where treatment was unsatisfactory. Professor McCormick said that such a situation could only be met by a complaint to the Medical Council.

Speaking on the subject of Finance Professor McCormick said that instead of the proposed gradual devolution of autonomy envisaged under McKinsay the opposite was happening. Boards had very little say on their allocation and the services were generally so labour intensive that there was very little scope for discretionary expenditure. Over the last 10 years there had been 1000% increase in health expenditure. In some years there had been considerable investment in health services over and above the actual needs. This won't happen again in the foreseeable future and to make the most of discretionary expenditure the Board must increase its Evaluation and Research functions. Dr. Behan said he felt that the exhaustive type of audit carried out on Health Boards accounts should be extended to the Voluntary Hospitals.

Cllr. Durkan-said there was considerable opinion that it was not in the best interests of small rural populations to be governed by the same body as that for the large urban areas. The Local Committee members would not accept that the needs of the Board are the same overall and that priorities are Board-wide. Ald. Fitzgerald said that there may be seen to be an absence of a role for the Local Committees which should be identified. It was agreed that discussion of the Local Committees would be deferred to the next meeting.

The meeting ended at 4.30 p.m. It was decided that the next meeting would be an evening meeting starting at 6 p.m. and that the small Committee appointed by the Board to advise on an agenda for the Seminar would meet to structure the form which the next meeting would take. It was agreed that the Minister for Health would be invited to attend."

Cllr. Freehill asked that the first paragraph be altered to read that she had asked for information on the National Rehabilitation Board not "Institute" as recorded. 124 5/6/1980

Mr. Nolan said that the minute was a summary of what had been discussed at the first meeting of the seminar which had been quite successful for a unique venture of that nature. He hoped to get members views and arrange for a further meeting at which he hoped the Minister would be present. It was intended that the meeting would be held in the evening. It was agreed that consideration might be given at a later date to asking some senior Civil Servants to attend a subsequent seminar.

79/80 APPOINTMENT OF MEMBERS TO BEAUMONT HOSPITAL BOARD LETTER 20/5/1980 FROM THE DEPARTMENT OF HEALTH

Mr. Nolan said that as the letter indicated the term of office of the Board's two nominees on the Beaumont Hospital Board Prof. J. S. Doyle and himself would expire on 7th August 1980 and it would be necessary to appoint members for a further period. On a proposal by Dr. Behan seconded by Cllr. Glenn it was agreed that the existing members would be nominated for a further term.

80/80 DEPUTATION TO THE MINISTER FOR HEALTH ON 14/5/1980 RE TALLAGHT HOSPITAL, NAAS HOSPITAL AND ST. COLUMCILLE'S HOSPITAL Report No. 26/1980

The following Report No. 26/1980 was submitted by the Chief Executive Officer.

PRESENT

The Minister, Dr. B. Hensey, Mr. S. Hensey Ald. A. FitzGerald, Dr. J. Behan, Dr. A. Meade, Councillor S. Carroll, Cllr. J. Sweeney, Cllr. J. Connolly, Cllr. B. Durkan, Cllr. B. Stagg. Mr. J. J. Nolan, Mr. F. J. Donohue, Mr. R. N. Lamb.

Ald. FitzGerald thanked the Minister for receiving the deputation, outlined what the deputation wished to discuss and invited Dr. Behan to present aspects of the matter.

Dr. Behan said that the Eastern Health Board area contained the largest section of the population and in the general volume of service it delivered was essentially different from other Boards. Health Board members felt that the Board has not enough control or even influence in development of services, for example, hospital services, within its area. Its influence was weakened by the activities and status of Comhairle na 125

nOspideal, Local Appointments Commission, Voluntary Hospitals, etc. They noted that 50% of the budget available for the Board's area went to Voluntary Hospitals who attended to 15% of illness, whereas the other 50% was stretched to attempt to provide for all other health services. The private sector, i.e. the institution not controlled by health boards, were coming to be seen as fashionable and elitist, with self perpetuating autocracies taking decisions, that affected the direction of public funds, in private and without any apparent obligation to develop as part of a balanced health plan. The public sector, on the other hand, could be seen as a second class community allocated relatively poor resources. The Health Board sought a balanced health service, dedicated to social justice and based on partnership of all its elements. This would require that Health Boards should have fair representation on Boards of Voluntary Hospitals, say as to 50%. The arrangement on St. James's Hospital Board could be taken as a model.

Dr. Meade said that the Health Board sought more control in the health services in general. He said that St. Columcille's has been run down and was at the stage where its image would be tarnished and it will be by-passed by doctors and patients. Yet it carried an increasing casualty obstetrical load. The Health Board had met an Comhairle but without favourable outcome. It was, in the Board's view essential to restore St. Columcille's to its proper function in the Community and to that end to staff it adequately.

Cllr. Sweeney said that Arklow, for example, was 37 miles from St. Columcille's and people should not be required to undertake even longer journeys to get hospital treatment. Wicklow was denuded of hospital services and depended heavily on St. Columcille's. The Voluntary Hospital system might be suspected seeking to perpetuate their favoured status.

Cllr. Ourkan said that the Eastern Health Board would need much more money than was being provided to give needed health services. He raised the matter of a pension for Dr. Gibson formerly Surgeon at Naas Hospital. He referred to the increased work rate of the Acting County Surgeon and stressed the need for permanent appointments to carry the work load and a firm commitment for the future.

Cllr. Stagg said members felt they were but rubber stamps as far as controlling or influencing health services went.

Cllr. Connolly dealth with the housing population and transport factors that made the building of Tallaght Hospital an urgent necessity. 126 5/6/1980

Or. Behan stressed that the Eastern Health Board felt it was entitled to and demanded stronger representation on the Tallaght Hospital Board. He also felt that its Chairman should be appointed by the Tallaght Board.

The Minister stated that he felt that Health Boards might be more effective in other areas than the Eastern. He had some ideas himself about how health administration might be improved. He was personally against too high a degree of centralisation.

The Minister said that the, only thing holding up the Tallaght Board was the Eastern Health Board appointments thereto.

The Tallaght Hospital Boards establishment order has been made and so no change was possible at present but he would consider if representation could be increased on the permanent Board. St. James's not comparable.

Or. Behan said the Tallaght development seemed about to repeat the errors affecting St. James's — the collussus that maintained and deepened the split between hospital and community medicine.

The Minister questioned if two extra members could make much difference. He pointed out that other interested parties had agreed the present composition and that the Hospital would give service to people from outside Eastern Health Board area.

Ald. FitzGerald enquired if a time scale could be indicated for action in regard to review of administration structures. Dr. Hensey pointed out that it could be a matter of interest to the new Chief Executive Officer.

With regard to St. Columcille's, the Minister said that the whole area and its needs must be looked at. He was anxious to see something done quickly and had in mind a quick expert review to decide relativity needs, etc.

With regard to Naas he felt that the matter of specialities for Tallaght should be clarified and the role of Naas in that system discussed.

Cllr. Durkan said that there must be whole time commitment to Naas by holders of senior posts; back up posts to the surgeon and physician, etc. might be based elsewhere. Could the Department discuss soon the appointment of a permanent surgeon and permanent physician.

Or. Behan asked if there could be a further meeting with the Minister to discuss his ideas about the reforms he had mentioned. The Minister said there would. 127

Ald. FitzGerald said that the Tallaght representation matter had not been settled at this meeting nor was the outlook encouraging. He noted that the Minister may consider changed representation on the permanent Board. Dr. Behan remarked that the inability to make a change without all the consultation proposed illustrated the unresponsiveness of the system.

N.B. Since the deputation, the Department have arranged a meeting with representatives of the Board on 5/6/80 to discuss the future of Naas Hospital.

On a proposal by Dr. Behan seconded by Cllr. Hynes the report was noted. It was also noted that discussions were continuing regarding the Tallaght Hospital and the composition of the Board and it was agreed that discussion on this matter including item No. 14 on the Agenda be deferred pending the outcome of discussions.

81/80 ST. COLUMCI LLE'S HOSPITAL LETTER 20/5/1980 FROM THE DEPARTMENT OF HEALTH

Mr. Nolan told the members that the letter requested the Board to select four of their members to join the group to consider the position of St. Columcilie's Hospital in relation to the other hospitals in the area. Dr. Behan said that this is a fundamental issue in the Board's policy, the members should appoint a strong team with a distinct bias towards the area served by the hospital. Mr. Lamb said that the history of Department of Health dealings with the Board over the last seven years about St. Columcilie's suggested a protracted delaying action mounted to ensure that St. Columcilie's would decline in status to a level from which it would be difficult ever to restore it to the status of an acute General/Maternity Hospital. He suggested that the Board consider setting a time limit to the proposed groups deliberations. He said also that the Board should make some provision to relate the activity of its own Working Party on St. Columcilie's and Naas Hospitals to that of the proposed group.

The following were proposed and agreed. Cllr. Sweeney on a proposal by Cllr. Timmins and seconded by Cllr. Hynes.

Mr. P. J. Swords on a proposal by Cllr. Sweeney seconded by Cllr. Hynes.

Prof. J. McCormick on a proposal by Ald. FitzGerald seconded by Cllr. Hynes. 128 5/6/1980

Dr. A. Meade on a proposal by Cllr. Glenn seconded by Dr. Behan.

It was agreed that Mr. Lamb would be available on standby to replace any member of the group unable to attend at any meeting.

82/80 MENTAL HANDICAP CENTRE AT LOUGHLINSTOWN - LETTER 20/5/1980 FROM DEPARTMENT OF HEALTH

Mr. Nolan told members that the letter from the Secretary of the Department of Health was in reply to a personal letter sent by him advising that the Board was anxious to proceed with the project at Loughlinstown. Mr. Nolan said the letter now gives an assurance that the Department is actively considering the revised brief for the project. Mr. Nolan said he would report to the Board when he had further information.

83/80 TALLAGHT HOSPITAL BOARD LETTER 20/5/1980 FROM THE DEPARTMENT OF HEALTH

As agreed discussion on this item was deferred.

84/80 APPOINTMENT OF CHIEF EXECUTIVE OFFICER

Relating to the correspondence circulated with the papers for the meeting the Chairman expressed his views as follows to the members for their information.

"Following the unanimous resolution at the April Meeting regarding inclusion of a Board member on the L.A.C. interview committee for the post of Chief Executive Officer, I wrote accordingly on 21st item to the Minister and to the Local Appointments Commission and as well requested re-advertisement of the post as the salary (£16,850 p.a.) in the original advertisement was £1,305 p.a. less than the rate applicable to the job at 1st March, 1980. (£18,155) Copies of my letters were circulated with the Minutes, as well as a copy of L.A.C.'s reply of May 8th 1980, the contents of which I do not regard as satisfactory. It is hardly adequate for the Commission to state in effect that they did not consider it necessary, in respect of the most important health service appointment in the country, to inform potential candidates of the correct salary for the post. Surely it stands to reason that the field of candidates would be widened if the salary advertised is£18,155p.a. instead of the figure of £16,850 p.a. which appeared in the official advertisement. 129

Latest date for receiving completed application forms was 14th February, 1980. There was no upper age limit prescribed for the posts in respect of persons who were permanent officers of Health Boards and Local Authorities. Interviews were held on four separate days over a period of 3% weeks between 18th March, 1980 and 10th April, 1980.

The Members of the Interview Board were: Mr. T. P. Hardiman (Chairman) Mr. W. McEvilly Mr. D. Condon & Mr. B. Martin

Mr. Hardiman and Mr. Martin are graduate engineers. Mr. McEvilly is in a legal practice since he retired from his former post of Chief Executive Officer of the Southern Health Board. Mr. Condon is Assistant Secretary (Personnel) Department of Health. There was no medical doctor on the interview board nor member or officer of a Health Board.

The absence of a doctor and of a Health Board representative is hard to understand and reduces the significance of the interview for the post of Chief Executive Officer of the premier Health Board.

Interview boards of the Local Appointments Commission function on a marking system, usually divided into three sections:— A. Qualifications, B. Experience, C. General Suitability.

If there is no age limit prescribed, the interview board must not take into account the candidates age in assessing general suitability. The fact that a candidate may be within a few years of reaching the compulsory retiring age of 65 years in no way means that such person is unfit or incapable of doing the job efficiently. The reitral age for doctors in the General Medical Services is 70 years as it is for legal posts and university posts.

One of the interviewers for the above posts commenced a new professional career after he had retired from a Health Board.

I feel that in view of the unsatisfactory nature of the reply from the L.A.C., the Board should authorise me to inform them of our general dissatisfaction with the contents of their letter and request them to give a more comprehensive reply to the points raised.

In this regard I wish to refer to the recommendation from the Local Appointments Commissioners that Mr. Patrick B. Segrave of Kelts, Co. Meath be appointed to the office of Chief Executive Officer, Eastern Health Board. Mr. Segrave 130 5/6/1980 is at present Chief Executive Officer, North Eastern Health Board. It will be necessary for the Board to pass a formal resolution appointing Mr. Segrave to the office of C.E.O. after it has been ensured that he is willing to accept office. In view of our current correspondence with the L.A.C. it might be as well to have the formal resolution on the Agenda for the July Meeting, confirming in the meantime that Mr. Segrave is willing to accept office."

The Chairman said that the main concern of the members now was that the Local Appointments Commission be alerted to the Board's views regarding the composition of interview committees for senior appointments to the Board's staff. Dr. Behan agreed with the'Chairman and said that the Local Appointments Commission response to the Board's previous enquiry was unsatisfactory. It was untenable that the Health Board would not have a say in the appointment of its most senior officer. He also felt that the interview committee lacked balance in not having a medical representative. Cllr. Stagg said that while he did not consider it necessary that a Doctor be on the interview committee the Board should have had representation on the Committee selecting the new Chief Executive Officer. All members expressed their resentment that Mr. Nolan had not been recommended for appointment, apparently on some ground other than qualifications, experience or general suitability and again recorded their warm appreciation of the excellent manner in which he had administered the affairs of the Board over many years.

Mr. Nolan told the members that on the basis of the Chairman's submission a resolution should be put to the July meeting proposing the appointment of Mr. Segrave as the new Chief Executive Officer. On a proposal by Cllr. Hynes seconded by Dr. Behan it was agreed that the Chairman would write again to the Local Appointments Commission conveying the Board's dissatisfaction at the reply and asking for a more positive undertaking to have suitable Board representation on the interview committee for any future major appointment to the Board's staff.

85/80 DUN LAOGHAIRE AMBULANCE SERVICE PROPOSED ALTERATION OF EXISTING ARRANGEMENTS Report No. 27/1980

The following report No. 27/1980 was submitted by the Chief Executive Officer. 131

"I refer to meeting in your office on Friday 11th April, 1980 at which I was accompanied by Mr. Lamb, Programme Manager and you by the Chief Fire Officer, Mr. Murphy and Messrs. O'Hogan and O'Connor. The purpose of the meeting was to discuss cessation of ambulance services by Dun Laoghaire Fire Brigade and your claim for arrears of payment.

At the outset you informed us that you had decided to continue the ambulance service as part of Dun Laoghaire Fire Brigade and that you would be preparing to fill the three vacancies on the Fire Brigade staff forthwith. You expressed the view that it would be more desirable if the Board worked towards cessation of the ambulance service of the Dun Laoghaire and Dublin Fire Brigade at the same time.

As discussed at our meetings the evolution in this country, except for Dublin, and also in the United Kingdom is for the operation of full ambulance services independent of the fire services. Ambulance work is becoming more and more specialized so as to improve the quality of patient care at the place and time of collection and en route to hospital. This necessitates full time training and refresher courses in the treatment of a very wide range of injuries and illnesses involving the operation of sophisticated equipment which all ambulances should now carry. It is the intention of this Board, which has the statutory function in this regard, to extend our existing services and ultimately provide the full range of ambulance services directly in this region. To achieve this the maintenance of indefinite links with the local fire brigades would be inappropriate.

It would indeed be desirable if the changes to be made in this regard could be made at the same time as respects Dun Laoghaire and Dublin. But in the first place considerations of cost and organisation would preclude such a large operation at once. Secondly, for reasons, upon which we base no criticism of your Corporation or its officers, the Dun Laoghaire ambulance service is less satisfactory and more costly per call than that provided by Dublin. It is unsatisfactory that one ambulance only is available, that it is frequently out of commission, that the service does not extend to maternity nor infectious disease cases and that it is not always crewed with men fully trained to modern ambulance standards. The cost to the Board in covering incidents when the Dun Laoghaire vehicle is for any reason unable to turn out is considerable.

These considerations make it reasonable to begin with Dun Laoghaire, the process of disenagement from the fire services. The arrangements under which we have worked to date includes a provision that it could be terminated by either party giving the other party twelve months notice in writing and this Board hereby gives your authority formal notice of 132 5/6/1980

its intention to terminate the arrangement not later than 31st December, 1981. However, once it is understood and accepted that the Board is proceeding to develop its own direct services as outlined above it would not wish to proceed in such a way as to cause you great inconvenience or expense and perhaps the actual time schedule of termination could be further discussed.

In reply to Cllr. Doyle Mr. Sadlier said that the reason why the Dun Laoghaire service was more costly than the Dublin service was that the Dublin service was covering the whole range of ambulance work and was able to provide cover at less cost while in Dun Laoghaire with manpower shortages there were occasions when the ambulance was left unmanned at short notice. This meant that the area would then have to be covered by the Dublin Service. Cllr. Doyle pointed out that the Dun Laoghaire service covers South Dublin as well and this partly is the cause of their manpower problems. On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the report was noted and agreed.

86/80 REPORT OF WORKING PARTY MEETINGS HELD AS NAAS HOSPITAL ON 22/5/1980 AND AT ST. COLUMCILLE'S HOSPITAL ON 29/5/1980 Report No. 32/1980

The following Report No. 32/1980 was submitted by the Chief Executive Officer.

"The Working Party has to date held four meetings and has adopted a working scheme by which to ascertain and compile the data needed to complete its study.

It has met the medical staffs of Naas and St. Columcille's Hospitals and received their views of the present role and difficulties of their hospitals and how they saw the future of the hospitals.

The Working Party proposes to meet at any early date representatives of general practitioners in the areas served by the hospitals."

On a proposal by Cllr. Stagg seconded by Cllr. Sweeney the report was noted. Mr. Lamb advised the members of a meeting with the Department of Health regarding staffing of the Naas hospital at which it was agreed that die requirements of the Comhairle of 100,000 population were now met in the area being served by the hospital. The deputation to the Department therefore asked that the hospital be continued and be staffed as agreed by An Comhaiiie and properly equipped. The members of the delegation demanded that the Consultants posts now filled on a temporary basis be filled 133 on a permanent basis and this was agreed. It was also agreed that the hospital would be looked on as an acute general hospital but its ultimate future would be related to the future of the St. James's and Tallaght hospitals. The Department suggested that the appointments be made jointly with the Meath, Mercers and Adelaide Hospitals but the deputation rejected this proposal. The deputation urged that in any development of the hospital complex at St. James's or Tallaght, the hospital at Naas be considered as an on-going acute hospital. Dr. Behan said he considered that this meeting showed the first move in many years by the Department on this matter and this was hopeful. Cllr. Stagg said that the policy of the Board had been accepted by the Department of Health in the interim only and that it would be reviewed when the Tallaght Hospital comes on stream. However, it is expected that the appointments requested would be put in train straightway.

87/80 CAPITAL PROJECTS - FINANCING FROM SALES OF LAND Report No. 29/1980

The following report No. 29/1980 was submitted by the Chief Executive Officer.

"In a letter dated April 28th 1980, the Department of Health approved of the purchase of Garaldstown House for use as a child care facility, on the understanding that the cost could be financed from the resources already available to the Board. It was also stated in the letter that the question of making a capital allocation available towards the cost of the premises would be considered in deciding on the Boards capital allocation for 1981, but that no commitment could be entered into at this stage. As the Programme Manager had, after discussions with officers of the Department, already entered into a contract to purchase the house, it was decided to finance the purchase in the sum of £162,400 from the fund of £334,804 available from sales of land. The Department will be requested by the Finance Officer, in due course to refund the amount in the 1981 capital allocation.

In this regard generally I would like the Board to set up a Capital Developments Committee of not more than 3 or 4 members who with the senior officers concerned would press for the implementation of the Capital Programme received by the Board at the Meeting in Naas on 8/5/1980. (Report No. 18/1980) and re- submitted as agreed in Item 21 on the Agenda for this Meeting. At the moment I am setting up a Capital Projects Unit within the Management Team who in conjunction with the Programme Managers will help in the formulation, monitoring and control of larger capital schemes. The Capital Developments Committee as well as advancing 134 5/6/1980

the capital programme and advising on priorities would also assist in determining, in the light of future needs, what areas of land owned by the Board are surplus to our requirements and should be sold. From our experience of the trespass and vandalism on the lands at St. Clare's it has become quite clear that any unoccupied land unless constantly protected at very high cost, is sure to attract vandals and unofficial tenants with consequent harassment of our patients and staffs and depreciation of our assets. The sale of such lands however, provides funds for capital developments at a time when capital allocations from the Department are minimal."

Mr. Nolan said he was putting this report before the Board to give a 'composite picture of the present position. He would like the members to agree to set up a Capital Programme Committee which would help to set the Board's priorities and would exercise control over the disposal of land. Dr. Behan congratulated the Chief Executive Officer on the idea and recommended adoption by the members. It was worth exploring in full the disposal of land and he would like a report showing the extent of land available for sale. In reply to Cllr. Freehill Mr. Nolan said that when disposing of land the Board normally offered the land in the following order, first to a local authority, second to a public authority and third to any institution of community value and only if the Land was not required by any of those would the Board place it on the open- market for sate by auction. On a proposal by Cllr. Hynes seconded by Cllr. Glenn the report was adopted and it was agreed to defer the selection of the members for a Capital Programme Committee to the next meeting. It was also agreed that a schedule of lands belonging to the Board should be submitted to the next meeting.

88/80 CAPITAL PROGRAMME - PROJECTS COMMENCED AND PROPOSED Report No. 18/1980

Mr. Nolan asked each member to examine the report in detail as submitted to the last meeting. He intended bringing the report before each meeting each month and he would propose that the Capital Development Committee referred to earlier should take the members' views as to their priority ratings and establish a priority for capital projects and keep the members informed thereafter on progress. No departure from the agreed capital programme priority rating would thereafter be allowed unless it had been previously accepted by the Capital Development Committee.

In reply to Cllr. Timmin s enquiry about the Health Centre and Offices at Wicklow Mr. Sadlier said that the Contractor did not get a bond and the matter had been referred to the Department of Health. He has yet had no decision from the Department on the matter. Cllr. Hynes expressed his concern 135

that this work would not be undertaken if there was any delay over appointing a Contractor for the work.

89/80 ORTHOPAEDIC SURGERY IN HOSPITALS IN THE EASTERN HEALTH BOARD AREA Report No. 30/1980

The following report No. 30/1980 was submitted by the Chief Executive Officer.

"At the monthly meeting held on 8th May 1980 a motion was passed calling for a report on delays and numbers awaiting treatment for orthopaedic surgery in the various hospitals in the Eastern Health Board area. The following is the current position in the hospitals providing this treatment for eligible patients in the Board's area.

Orthopaedic Surgery for the treatment of arthritic hip conditions is carried out at the following hospitals:

Operations are carried out at Cappagh Hospital for patients referred from the Mater, St. Laurences and St. Vincent's Hospitals. The overall average waiting period is Vh years. In effect, however, the waiting period can vary from 6 months to 4 years depending on the particular specialist selected by the patient.

Dr. Steevens' Hospital — in practice, cases are assessed by a surgeon every three months over a number of years until a decision is made that the operation is medically desirable. Regard is had to the patients' age, condition, etc. Operation is not normally carried out on young persons unless the arthritic condition warrants it. The waiting period for urgent cases is 6 weeks.

Jervis Street Hospital — The average waiting period in Jervis Street is VA years and there are 37 patients at present on the waiting list for operations.

Adelaide Hospital — The average waiting period is 2 years but in urgent cases the waiting period is 2 months."

The Chairman said he was concerned at the number of cases of delays in the provision of orthopaedic surgery for hip replacement. It was agreed that further information would be sought and a report in more detail be submitted to the next meeting. 136 5/6/1980

90/80 CENTRAL MENTAL HOSPITAL

On a proposal by Dr. Behan seconded by Cllr. Glenn this item including proposed Youth Development Centre was deferred to the next meeting.

91/80 PROCEEDINGS OF MEETINGS OF LOCAL (HEALTH COMMITTEES)

The minutes of the following meetings of local (Health) committees having been circulated were dealt with as follows:

(a) Dublin City Local (Health) Committee meeting held on 21/4/1980.

On a proposal by Cllr. Freehill seconded by Cllr. Waugh the minutes were noted.

Cllr. Freehill said it appeared that the Social Work Service was so under-staffed that the workers are only able to undertake children work and were not able to carry out proper case work. She asked if a report could be submitted to the Board on staffing levels and on the work being carried out by the Social Workers in the various areas. It was agreed that this would be provided in respect of each programme by the appropriate Programme Manager to the next meeting.

(b) Dublin County Local (Health) Committee meeting held on 5/5/1980.

On a proposal by Cllr. Connolly seconded by Cllr. Hynes the minutes were noted.

Cllr. Connolly enquired about the Board's function in the matter of rat infestation. He said he believed there was a delay in providing the services. Mr. Donohue said that rodent control was carried out by the Board and the department responded to calls from the public. If the Councillor had any particular cases he would look into them. Cllr. Mrs. Glenn asked about the* proposal to have a Rat Week referred to in the minutes and Mr. Donohue said that Dr. O'Donnell was looking into this matter. It was agreed that a report be submitted to a later meeting of the Board.

On a proposal by Cllr. Waugh seconded by Cllr. Hynes the minutes were noted.

(d) Kildare Local (Health) Committee meeting held on 24/4/1980. 137

On a proposal by Cllr. Timrrins seconded by Cllr. Freehill the minutes were noted.

92/80 NOTICES OF MOTION

(a) As Cllrs. Carroll and Hand were not present the motion tabled in their name was not taken.

(b) The following motion was proposed by Cllr. Connolly:

'That a grant be now made to the Walkinstown Association for Handicapped to assist them in the administration of their Club for the Handicapped."

Cllr. Connolly said that the Association was looking after about 60 cases, was doing excellent work and deserved support. Mr. Keyes said that officers of his Programme had met the Association and would be meeting his officers again shortly to discuss how the Board could assist.

Ald. Fitzgerald asked that the Board respond as best it can in this case. He asked Mr. Keyes to report development to the members.

The motion was seconded by Cllr. Waugh and agreed.

"That a Day Centre for the Elderly be provided in the Walkinstown Sports and Athletic Federation Community Hall, Moran Road, Walkinstown, at the expense of the Eastern Health Board and the necessary finance, staff and equipment be provided for it."

Cllr. Connolly said there was an excellent hall at Moeran Road which was only used at nights and could be used as a Day Centre for elderly if the Board gave encouragement and help. Mr. Donohue said he would have his staff inspect the Hall and see if a service could be provided.

The motion was seconded by Cllr. Sweeney and agreed.

(d) The following motion was proposed by Cllr. Freehill:

"The Mobility Allowance recently announced by the Minister for Health does not apply to disabled people who live in Institutions. This is an unfair discrimination against such people who must live in Institutions and for the most part do not have access to transport for Interviews, and visits to their families.

Therefore this Board requests the Minister for Health to extend the Mobility Allowance to people who qualify on grounds of disability and who live in Institutions." 138 5/6/1980

Cllr. Freehill said that the provision of a Mobility Allowance is not of any use to many handicapped because of the stringency of the means test and the definition of mobility and because it cannot be paid to persons in institutions. The latter category need the allowance most because they are away from the families and have no way of getting about otherwise. The means test should take account of how expensive it is to travel in a wheel chair.

The number of cases approved since the commencement of the scheme was 99 while 104 were refused. This showed that not many were eligible for the scheme and as many were being turned down as were getting the allowance. She asked that the Minister be requested to relax the means text, improve the mobility qualification and permit the allowance to be payable to handicapped in institutions.

Seconding the motion Cllr. Hynes said it was sad to see people so handicapped that they were in institutions unable to get out occasionally because the allowance was not payable to them. He asked that the Minister be pressed to change the regulations as requested.

The motion was agreed.

(e) and (f) Dr. Behan asked that the motions tabled in his name be deferred to the next meeting.

The meeting ended at 8.50 p.m.

CORRECT: J J. Nolan, Chief Executive Officer.

139 3/7/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of 10th Annua! Meeting of Eastern Health Board held in the Boardroom St. Brendan's Hospital on Thursday 3rd July, 1980 at 6 p.m.

PRESENT

Ald. B. Ahern T.D., Ms. Noreen Kearney Dr. J. Behan Dr. D. G. Kelly Cllr. I_ Belton T.D.. Cllr. T. Leonard T.D., Dr. P. McCarthy Cllr. D. Browne Prof. J. McCormick Cllr. M. Carroll Sr. Columba Cllr. J. Connolly P.C., Dr. A. Meade Cllr. E. Doyle Cllr. M. Freehill Prof. J. S. Doyle Dr. B. Powell Cllr. B. Durkan Dr. B. Sheehan Ald. A. FitzGerald Cllr. E. Stagg Cllr. Mrs. A. Glenn Cllr. J. Sweeney Cllr. A. Groome Cllr. G. Timmins T.D., Cllr. T. Hand P.C., Dr. J. Walker Cllr. P. Hickey P.C., Cllr. Mrs. M. Waugh. Cllr. F. Hynes

APOLOGIES Mr. H. Corrigan Mr. K. Harrington

IN THE CHAIR Ald. Alexis FitzGerald

OFFICERS IN A TTENDANCE

Mr. J. J. Nolan Prof. I. Browne Mr. R. N. Lamb Mr. C. Mansfield Mr. T. Keyes Mr. A. O'Brien Mr. J. Doyle Mr. M. Cummins Mr. J. Reynolds Miss E. Larkin Mr. J. Sadlier Miss R. Carolan Dr. B. O'Donnell Miss M. Mulryan Mr. P. I. Lyons Miss J. McGowan Mr. P. J. Swords Mr. F. McCullough Miss A. Flanagan

93/80 ELECTION OF CHAIRMAN

Cllr. D. Browne was proposed by Dr. J. Walker and seconded by Cllr. P. Hickey. As there were no other nominations Cllr. Browne was declared elected and took the Chair. 140

Cllr. Browne thanked the members for their trust and confidence in electing him to the office and said he was aware of the onerous nature of the Chairmanship. He intended to do all required to carry out the functions and wishes of the Board in so far as its statutory obligations required. He complimented Ald. FitzGerald for the way in which he had conducted the office of Chairman in the two years he held that office.

Mr. Nolan welcomed Cllr. Browne to the Chair on behalf of himself and the staff of the Board.

94/80 ELECTION OF VICE-Chairman

Cllr. Hickey was proposed by Cllr. Sweeney and seconded by Cllr. Groome. Cllr. Mrs. Glenn was proposed by Cllr. Freehill and seconded by Cllr. Hand. Cllr. Glenn was elected Vice-Chairman the following being the voting —

For Cllr. Glenn 22 - Dr. Behan Ms. Kearney Cllr. Belton Dr. McCarthy Cllr. Browne Prof. McCormick Cllr. Carroll Sr. Columba Cllr. Connolly Cllr. Freehill Cllr. Doyle Dr. Powell Cllr. Durkan Dr. Sheehan Ald. FitzGerald Cllr. Stagg Cllr. Glenn Cllr. Timmins Cllr. Hand Dr. Walker Cllr. Hynes Cllr. Mrs. M. Waugh for Cllr. Hickey 5 - Ald. Ahem Cllr. Sweeney Cllr. Leonard Cllr. Hickey Cllr. Groome

Cllr. Mrs. Glenn thanked the members for electing her to the office. Ald. FitzGerald congratuled Cllr. Browne and Cllr. Mrs. Glenn on their appointments and said the Board was fortunate to have two such experienced members in the two offices. He thanked Cllr. Browne for all his support as Vice-Chairman in the past year and also paid a tribute to Mr. Nolan and all the Board's staff for their help and support given him during his two years in office.

Cllr. Hand also added his congratulations to Cllr. Browne and Cllr. Mrs. Glenn. 141

95/80 VISITING COMMITTEES

On a proposal by Dr. Behan seconded by Cllr. Hickey it was agreed that the Visiting Committees would be reappointed as they stand with the provision that members who wished to change to any other Committee could arrange through the Secretary.

The meeting ended at 6.30 p.m.

CORRECT: J. J. Nolan Chief Executive Officer Signed CHAIRMAN r^-lv_A^- 142 3/7/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Boardroom, St. Brendan's Hospital on Thursday 3rd July, 1980 at 6.30 p.m.

PRESENT Ald. B. Ahern T.D., Ms. Noreen Kearney Dr. J. Behan Dr. D.G. Kelly Cllr. L Belton T.D.. Cllr. T. Leonard T.D., Cllr. D. Browne Dr. P. McCarthy Cllr. M. Carroll Prof. J. McCormick Cllr. J. Connolly P.C. Sr. Columba Cllr. E. Doyle Dr. A. Meade Prof. J. S. Doyle Cllr. M. Freehill Cllr. B. Durkan Dr. B. Powell Ald. A. FitzGerald Dr. B. Sheehan Cllr. Mrs. A. Glenn Cllr. E. Stagg Cllr. a. Groome Cllr. J. Sweeney Cllr. T. Hand P.C. Cllr. G. Timmins T.D., Cllr. P. Hickey P.C, Dr. J. Walker Cllr. F. Hynes Cllr. Mrs. M. Waugh APOLOGIES

Mr. H. Corrigan Mr. K. Harrington IN THE CHAIR Cllr . D. Browne, Chairman OFFICERS IN ATTENDANCE

Mr. J. J. Nolan Prof. I. Browne Mr. R. N. Lamb Mr. C. Mansfield Mr. T. Keyes Mr. A. O’Brien Mr. J. Doyle Mr. M. Cummins Mr. J. Reynolds Miss E. Larkin Mr. J. Sadlier Miss R. Carolan Dr. B. O'Donnell Miss M. Mulryan Mr. P. I. Lyons Miss J. McGowan Mr. P. J. Swords Mr. F. McCullough Miss A. Flanagan 96/80 CONDOLENCES

The Chairman advised the members of the recent death of Mr. Eddie McCauley of Athy, Co. Kildare, who had been very much involved in voluntary work in connection with St. Vincent's Hospital Athy. The members stood in silence as a mark of respect. 143

97/80 CHAIRMAN'S BUSINESS

(a) The Chairman, on behalf of the members, congratulated Cllr. Mrs. Waugh on her election as Cathaoirleach of the Dun Laoghaire Borough Corporation.

(b) The Chairman also welcomed as a visitor to the meeting Mr. Crispin Chingalawa, Principal Officer, Department of Health, Lusaka, Zambia, who is on a study tour with the Institute of Public Administration.

98/80 CONFIRMATION OF MINUTES

On a proposal by Cllr. Hickey seconded by Cllr. Freehill the Minutes were signed.

(a) Matters arising:

In reply to Cllr. Freehill, Mr. Doyle said that the Programme Manager would write to the Dept. of Heaith regarding her motion on mobility allowances. Cllr. Freehill pointed out that at the rate at which allowances were being granted the Board would not spend its allocation of £24,000 for these allowances in the current year. She said that both the means test and the test for mobility were too stringent and referred also again to the fact that allowances were not payable to those who are resident in institutions.

She suggested that as 1981 is the Year of the Disabled the Board should establish a sub Committee of members and officers in the interests of the disabled to plan next year's activities. The Chairman suggested she put down a motion in this matter.

Dr. Walker said that the figures quoted of those who were granted and refused mobiiity allowances were not representative as initially many people applied who were not at all eligible for the allowance.

Prof J. S. Doyle thanked the members for re-appointing him to the Planning Board of Beaumont Hospital and said that he would supply information to any member who required it about proceedings at the Board.

Prof. Doyle, referring to the reply to Mr. Harrington's question said he understood that as decided at the Board meeting on 11/7/1974, payments to the Foundation for Human Development would only be made after an annual report from the Foundation to be considered by the Scientific Committee. It was agreed to have a reply on the matter at the next meeting. 144 3/7/1980

In reply to Cllr. Durkan Mr. Lamb said that there had been no further consultation with the Matron of Naas Hospital regarding domestic staff. Cllr. Durkan asked that a report be submitted to the next meeting on this matter.

In reply to Cllr. Durkan, Mr. Doyie said that the Board was inspecting sites and alternative accommodation at Castledermot and a proposal was with the Department of Health.

Dr. Behan asked that it be recorded that in the report of the deputation to the Minister for Health on 14th May 1980 the Minutes as quoted at Paragraph 5 on Page 126 did not reflect the discussion as it took place. He asked the Chief Executive Officer to consider having a note-taker attend at such meetings. He also said that in the debate on the appointment of a Chief Executive Officer at the previous meeting the Minute did not note his proposal that the candidate recommended by the Local Appointments Commission should seek secondment to the post of Chief Executive Officer from his existing post, for one year, before deciding whether to take the post of Chief Executive Officer in a permanent capacity. He also said that the Minutes did not record his congratulations to Cllr. Freehill for her concern in bringing before the Board her motion about mobility allowances. He requested that these items be now recorded in the Minutes.

99/80 PROCEEDINGS OF VISITING COMMITTEES

The reports of the following visiting committee meetings, having been circulated, were dealt with as follows:

(a) No. 1 Visiting Committee meeting held at Vergemount Hospital on 24/6/1980.

On a proposal by Cllr. Sweeney, seconded by Prof. Doyle the report was noted.

Ciir. Sweeney drew attention to the way in which units had been renovated for long-stay accommodation and asked that other units be similarly dealt with. On a proposal by Cllr. Sweeney seconded by Dr. Walker the following resolution was agreed: —

"That this Board provide the necessary finance now to adapt Unit 1 to provide a link between units 2 and 3 in order to provide badly needed long-stay accommodation at Vergemount." 145

At Cllr. Connolly's request, it was agreed that efforts be made to make mortuaries less morbid in aspect. He was supported by Cllr. Mrs. Glenn who referred particularly to St. Clare's Home where there is no mortuary, resulting in relatives having to bring remains to a funeral parlour usually with added expense.

(b) No. 3 Visiting Committee meeting held at St. Ita's Hospital on 10/6/1980

On a proposal by Dr. Powell seconded by Cllr. Groome the report was noted. In reply to Cllr. Stagg. Mr. Keyes said that he had asked his Chief Nursing Officers to prepare job descriptions for all staff in all hospitals in his Programme. Mr. Sadlier told Cllr. Stagg that the minor repairs referred to had been carried out. He also told Cllr. Stagg that he was planning \c> provide heavy rubber doors in the kitchen area to keep birds from the food preparation and serving areas. Cllr. Stagg also said it should not be inferred from the report that he had apologised for his action in writing direct to the Minister for Health.

Cllr. Durkan said that while he understood the conditions pertaining at the hospital he thought standards of cleanliness were not always high enough and if the Board had the ress ponsibility of setting standards of hygiene it should live up to them at its own institutions. Cllr. Hynes while agreeing said that on the other hand the Board must be complimented on the condition in the upgraded wards. He was supported in this by Cllr. Groome who said he was gratified at the improvements that had been taking place over the six years he had been visiting St. Ita's. Cllr. Glenn said she thought this aspect of the service would benefit from an integration of Tiale and female nursing personnel on the wards and she was supported in this by Cllr. Freehill.

On a proposal by Cllr. Carroll seconded by Dr. Powell the report was noted.

(d) Community Care Visiting Committee meeting held at Area 8 on 22/4/1980

On a proposal by Cllr. Hynes seconded by Cllr. Doyle the report was noted.

Cllr. Hynes expressed dissatisfaction about the content of the report. He said that office accommodation had been discussed and this was not recorded and he asked the Chief Executive Officer to ensure that full reporting of the pro- 146 3/7/1980

ceedings be made; also that senior officers be available to answer questions. Cllr. Doyle supported Cllr. Hynes and asked why there was not a senior dental officer present at the meeting. He also asked would a physiotherapist be appointed to the area and referred to the concern at the delay over referrals of applicants for sight testing to hospital outpatient departments. He pointed out that the reference to social workers on the top of page 2 — the word "highest" should read "lowest". He was supported by Cllr. Stagg who also referred to the shortage of social workers for the amount of case-work in the area and said that the non-attendance of a dental representative was not acceptable to the Committee.

In reply Mr. Doyle said that on this occasion the senior dental officer had not been notified of the meeting. In any event the dental service was still centrally organised under the Chief Dental Officer and the staff association representing the dental officers had not accepted that the service was under the control of the Director at local level. The Board was planning to provide physiotherapy services in the local areas but couldn't create posts in the present year. While the shortage of social workers was also appreciated the same situation applied but extra staff would be employed when this became possible.

Dr. Sheehan said he believed that competent optician services should be able to cope with eye-tests for eligible persons and this would shorten the list of those who needed to attend an ophthalmic surgeon at an out-patient clinic. He also encouraged the provision of a community physiotherapy service to avoid hospitalisation for simple procedures at a higher cost

Mr. Nolan said that the Board was endeavouring to provide a community physiotherapy service through the out-patient departments in hospitals in the first instance conforming to the standards required by the Irish Board of the Chartered Society of Physiotherapy. Regarding eye testing. Prof. McCormick pointed out that it was technically difficult to carry out refractions on small children but he thought that the Board should be concerned at the size of the waiting list. Regarding community physiotherapy he suggested that married women might be available to provide some of the services.

100/80 TALLAGHT HOSPITAL BOARD

Mr. Nolan said that it was now necessary to proceed with the nominations for the Tallaght Hospital Planning Board as requested in the Department's letter of the 20/5/80. Dr. Behan said that he accepted with reluctance that the Board must now proceed in this way but he considered that the Minister should be asked to state his reasons for refusing to 147

accede to the Board's request for greater representation. He suggested that the Board, instead of appointing a panel of four, should appoint their two representatives and submit these names to the Minister. He also suggested that the Board provide a third name to the Minister and ask him to have that representative appointed as one of the Minister's five nominees, thus effectively giving the Health Board three representatives on the Tallaght Board. He also suggested that the Board should now open negotiations with the Minister seeking adequate and effective representation on the Management Board of the Hospital when it is ultimately set up.

Dr. Walker advised that the Board make nominations as any further delay would hold up the establishment of the Hospital Commissioning Board. Ald. FitzGerald and Cllr. Hand supported Dr. Behan on the proposed selection of two nominees with an extra name for the Minister to consider as one of his nominees and the following were selected:

Dr. Behan on a proposal by Dr. Powell seconded by Cllr. Hynes Dr. Walker on a proposal by Dr. Behan seconded by Cllr. Hand and Cllr. Connolly on a proposal by Cllr. Hand seconded by Dr. Behan as the third name.

101/80 SUSPENSION OF STANDING ORDERS

At this stage the members agreed to suspend Standing Orders to take the following motion proposed by Cllr. Carroll and seconded by Cllr. Hand:

Speaking to the motion Cllr. Hand referred to the document circulated at the previous meeting which explained the situation and asked for the Board's support. The motion was adopted unanimously.

102/80CENTRAL MENTAL HOSPITAL DUNDRUM

The following Report which was circulated at the June meeting was considered:— 148 3/7/1980

"Minutes of meeting held with representatives of Department of Justice on Monday 28th January, 1980.

PRESENT: From Eastern Health Board Mr. T. Keyes, Programme Manager Mr. F. J. McCullough, General Administrator Dr. I. Browne, Chief Psychiatrist Mr. E. A. Dunphy. Senior Executive Officer Dr. C. Smith A/Clinical Director. From Department of Health Dr. J. Robins, Assistant Secretary Mr. I. Flanagan, Principal Officer From Department of Justice Mr. B. Olden, Assistant Secretary Mr. F. Dunne, Principal Officer.

Mr. Olden, opening the meeting, outlined three main problem areas as follows:—

1. The presence in the prison system of socio-pathic prisoners. This was a problem for the prison system but, in so far as socio-paths could become mentally ill, it was also a problem for the Eastern Health Board in its capacity as ad-ministrator of the Central Mental Hospital. It was his Department's intention to provide a high security unit at Portlaoise prison for socio-paths but this could take a number of years to accomplish.

2. What he referred to as the "yo-yo" syndrome, i.e. the constant passing of prisoners back and forth as between the prisons and the Central Mental Hospital.

3. The presence of subversives in the prison system. These represented a constant threat to prison staff and in so far as any of their number became psychiatrically ill and required psychiatric treatment there was no alternative at present but to transfer them to the Central Mental Hospital. He understood that it was the presence of this type of prisoner in the Central Mental Hospital which was creating a major problem for the Eastern Health Board. Mr. Keyes agreed that item No. 3 represented a very big problem for the Board. While the number of subversive prisoners in the hospital at any time never exceeded a few, their presence in the hospital created an atmosphere of fear and insecurity amongst hospital staff. To the extent that some of these patients had managed to escape from the hospital with the aid of fire-arms supplied from contacts outside, the staffs fears were very real. Representations had also been received from local public represen- 149

tatives acting as spokesmen for the local community with regard to the accommodation of subversive patients in Dundrum. The staff had communicated their fears in relation to this matter to the Board and as a result of discussions with staff he was satisfied that if there was an attempt to admit a patient of this type to Dundrum in the future the Board could expect industrial action on the part of attendent staff. Dr. Smith pointed out that the majority of psychiatric crises arising in the prisons resulted from depression and this problem could be dealt with given two or three weeks in the Central Mental Hospital. While they would be reluctant to accept "political" prisoners in the future they would have no option but to accept them if the Minister so ordered. In this event they would require the provision of heavy security in the hospital for the duration of stay of the patient or patients concerned. This would be undesirable from the hospital's point of view and would also have an adverse effect on the treatment of the remaining 95% of patients in the hospital. However, he was firmly of the opinion that staff would not co-operate in caring for these patients unless there was visible security in the hospital and on the grounds. Dr. Robins made the point that the presence of security would detract from the hospital atmosphere and would create a prison atmosphere.

To this extent his Department would not be happy about the arrangement as mentioned by Dr. Smith. Dr. Smith in reply stated that he was not advocating the arrangement but was simply being realistic in saying that if political prisoners were to be catered for in Dundrum special security measures would have to be taken. In his opinion it woud be preferable to make special provision for mentally ill prisoners of this type within the prison system. In this event the Forensic Psychiatric Service would co-operate fully in providing a service within the prisons. Mr. Keyes made the point that the Board had officially sought a meeting with the Ministers for Health and Justice to discuss this problem. He did not regard himself as being free to make any final decision or accept any suggested solution without first reporting back to the Board. Mr. Olden made the point that the prison service would always require a mental hospital back-up to service the needs of mentally ill prisoners. His Department was in principle against the idea of establishing psychiatric units within the prison system. The existence of these units in prisons would leave the Minister open to all kinds of accusations including the coercion or conditioning of prisoners for questionable reasons. Dr. Browne stated his opinion that the admission of this type of prisoner to the hospital and consequential security measures would destroy the character of the hospital. He suggested that perhaps part of Mountjoy prison might be designated as part of the Central Mental Hospital. Mr. Keyes stated that in the event of the Minister 150 3/7/1980

for Justice making an order for the admission of a prisoner of this type to the Central Mental Hospital the Board would of course comply with the order. In his opinion there were two possible solutions to the problem — 1. Change in the law to provide for psychiatric units in the prisons or 2. Have the Central Mental Hospital administered by some body other than the Eastern Health Board. Mr. Olden stated that his Department was sympathetic to the Health Board's views on this matter. They could take it that prisoners of the type mentioned would be transferred to Dundrum only if there was no other solution. He referred to the report of the Hsncfcy Committee which had recently been issued and which interalia, included a recommendation that the Courts be permitted to refer psychiatrically ill offenders to designated health facilities. In response to a suggestion that the Governor's House in the grounds of the Central Mental Hospital might be considered as a special unit for subversive prisoners, he suggested that a Chief Superintendent of the Garda Siochana visit the Central Mental Hospital and examine the Governor's House with a view to establishing its suitability or otherwise for the accommodation of such prisoners. This was agreed.

It was agreed that a further meeting would take place when the report of the Chief Superintendent became available.

The meeting then concluded.

Signed. E. A. Dunphy."

Mr. Keyes said that the meeting of the 28th January 1980 with the Department of Justice had been inconclusive. There had also been some difficulty recently when on the advice of the consultants some patients were admitted to Dundrum who would not normally be admitted there and the nursing care for these patients was proving costly. He said he had asked for an inspection of the security arrangements by a Chief Superintendent and was awaiting his report. Radio-Telephone equipment had been delivered and will be installed shortly and the lighting and security of walls is also being improved. Mr. Keyes also said that because of the inconclusive nature of the last meeting and as the Department of Justice apparently does not want to set up mental treatment units in prisons he would suggest that the Board repeat its request to the Minister for a further discussion on these matters.

Mr. Keyes referred also to the Henchy Report circulated to members at the meeting and to his brief summary of the Report also circulated at the June meeting. He said that the Report in the main deals with rationalisation of Court pro- 151 ceedings. It also contains provision that the Courts can require certain patients to receive psychiatric treatment and this could have an impact on the available spaces in Dundrum. The Report also recommended Special Units for psychopaths presumably within the prison system and it also proposed flexibility between Dundrum and other psychiatric hospitals. It was agreed that Mr. Keyes should arrange for Board discussions with the Minister as already requested.

103/80 CAPITAL PROGRAMME - PROJECTS COMMENCED AND PROPOSED 1980 Report No. 18/1980 refers

On a proposal by Cllr. Carroll seconded by Cllr. Hynesthe Report was noted and referred for further consideration to the Capital Developments Committee in particular relation to priority proposals.

104/80APPOINTMENT OF CAPITAL PROGRAMME COMMITTEE

Mr. Nolan referred to the agreement at the June monthly meeting to appoint a Capital Programme Committee and suggested the selection of four or five members to form this Committee. The following members were selected:—

Dr. Behan Proposed by and seconded by Cllr. Carroll Dr. Powell Cllr. Hynes Proposed by and seconded by Cllr. Mrs. Waugh Deputy Timmins Cllr. Stagg Proposed by and seconded by Dr. Behan Cllr. Freehill Cllr. Carroll Proposed by and seconded by Prof. J. Doyle Mr. Kelly

It was agreed that the Committee would include ex officio the Chairman, Vice-Chairman and the C.E.O. of the Board and that other officers would attend as required.

105/80 FUTURE OF ST. BRENDAN'S HOSPITAL

The following Report No. 35/1980 from the Chief Executive Officer was submitted:—

"The Board at its meeting on the 8th May noted Report No. 21/1980 which outlined in general terms the findings of the Consultants in relation to St. Brendan's Hospital.

It was reported that it was intended to incorporate in the general report of the Psychiatric Services Sub-committee proposals to deal with the problems re this hospital and that this report would be submitted to the Board at its July meeting. 152 3/7/1980

However, this general report has been delayed and because of the urgency of the position in St. Brendan's it is desirable to deal with the matter at the July meeting.

The proposals adopted by the Psychiatric Services Sub- committee were as follows:—

1. Retain about 300 beds in Units 3A, 3B, 10,10A, 23, 23A, OPQR, as well as Assessment, Pharmacy, Nurse Training, Nurses' Home, Laboratory, Pathology, 2 Churches, Therapy Workshops and the Annexe Building.

2. Replace the remaining buildings in two phases as follows:—

Phase I should provide for 250 beds to enable the main block and units L M N to be demolished. It should also provide for medical records, workshop space and recreation area at present housed in the main block. The beds should be provided in units of 50 in different catchment areas. It should provide in the first instance for elderly patients in St. Brendan's but. thereafter, should be available as part of the long-stay needs of the catchment area. The implementation of this phase is extremely urgent.

Phase II should provide for the replacement of a further 500 beds approx. and these should again be located in the catchment areas. The extent to which this phase wiii need to be implemented will depend on:

(a) resources developed in the community for psychiatric services; (b) resources developed for geriatric care; (c) resources developed for the care of mentally handicapped patients.

In addition to the foregoing, substantial work will have to be undertaken on accommodation remaining in the hospital both on a long-term and short-term basis.

A recent survey of the hospital has disclosed that approx. 400 patients in the hospital are aged 65 years and over and the Chief Psychiatrist has stated that at least 270 of those are suitable for long-stay elderly accommodation.

I would estimate the minimum cost of implementing these proposals at £10 million.

I recommend the Board's approval in principle to the foregoing proposals within the context of the approved Capital Programme as already submitted to the Board and having regard to any priorities in that regard as may be decided by the Capital Programme Committee." 153

On a proposal by Dr. Behan seconded by Cllr. Carroll the report was adopted.

106/80 ASSOCIATION OF HEALTH BOARDS

The following Report No. 33/1980 from the Chief Executive Officer was submitted:—

"At the February monthly meeting of the Board a letter from the Chairman, South Eastern Health Board, proposing the formation of an Association of Health Boards was considered and the Chairman and Vice-Chairman of this Board were nominated to a Committee of Board members formed to explore this proposal further. This Committee has met on three occasions since and has prepared the attached draft Constitution for the Association. The Committee also proposes that the first Annual General Meeting, at which the Association would be formally set up, will be held in the week commencing 22nd September, 1980.

The organising committee has requested that this Board's members' views and agreement be obtained to the draft Constitution and that the eight members to represent this Health Board at the Annual General Meeting be now selected."

On a proposal by Cllr. Browne seconded by Cllr. Mrs. Glenn the report was adopted and the following were selected to represent the Eastern Health Board at the first Annual General Meeting of the Association —

Cllr. Carroll Ald. FitzGerald Cllr. Browne Cllr. Mrs. Glenn Dr. Walker Dr. Behan Dr. Meade Sr. Columba

107/80 CHOICE OF DOCTOR SCHEME APPLICATION FROM DR. R. O'DOLAN TO EMPLOY A PARTNER

The following report No. 34/1980 from the Chief Executive Officer was submitted:—

"Doctor Robert O'Dolan, 250 Swords Road, Santry, Dublin 9, is participating in the Board's General Practitioner Service. He has a list of 587 eligible persons and his practice premises are at (1) 250 Swords Road, Santry and (2) 144 Philipsburg Avenue, Dublin 3.

In his letter of the 13th February, 1980 he expressed his wish to employ a Partner. 154 3/7/1980

In accordance with paragraphs 21/22 of the circular letter 8/75 dated the 9th April, 1975 issued by the Department of Health, the Irish Medical Association and the Medical Union were asked for their observations on Doctor O'Dolan's request. In letters dated 1st and 7th May, 1980, the Irish Medical Association and the Medical Union respectively stated that they had no objection to Doctor O'Dolan's proposals.

I recommend, subject to the approval of the Board, that Doctor O'Dolan's request be approved and that a Partner for Doctor O'Dolan be selected in accordance with the procedure laid down in paragraphs 21/22 of the Department's circular letter 8/75 dated 9th April, 1975. The relevant extract from this letter is as follows:—

"21. The creation of a position as partner or as an additional member of a group practice, or as an assistant with a view to partnership for the purpose of the general medical service, will be subject to the approval of the Health Board. In considering any such proposal the Board shall have regard to the total practice of the applicant. Before giving approval the Board must be satisfied :- (a) that the creation of the position is preferable to the creation of an additional position which could be filled by open competition in the normal way; and

(b) that the creation of the position will not result in the admission of a particular person into the general medical service while other equally well or better qualified persons are not given a reasonable chance to compete. Where the Chief Executive Officer proposes to seek the approval of the Board to the Creation of a position as a partner, or as an additional member of a group practice, or as an assistant with a view to partnership he shall, before doing so, consult the medical organisations.

22. Where a Health Board agrees to the creation of a partnership or an addition to a group practice or to the recruitment of an assistant with a view to partnership the position will be advertised in the normal way but the doctor or doctors involved or a nominee of the doctor or doctors involved in the proposed taking in of a partner, or additional member or assistant will be entitled to sit on the selection board. The selection board shall pay due regard to any objection of this representative to the giving of the post to a particular individual or individuals. If the Board considers it desirable it may not recommend any candidate for appointment."

On a proposal by Dr. Sheehan seconded by Prof. Doyle the report was adopted. 155

108/80 APPOINTMENT OF CHIEF EXECUTIVE OFFICER

The following Report No. 36/1980 from the Chief Executive Officer was submitted:

"At February 1971 meeting of the Eastern Health Board the following draft Resolution was submitted as meeting the requirements of the Board in relation to delegation of functions and duties to management. The Resolution was unanimously adopted.

In connection with the proposed appointment of a new Chief Executive Officer the Board may wish to confirm or alter the terms of the delegation in question:

'DRAFT RESOLUTION

WHEREAS (a) it is necessary to make provision for the regulation of the exercise of the powers and functions and performance of the duties of the Eastern Health Board under the provisions of the Health Act 1970 (in this resolution for short called 'the Act').

(b) The Board has considered Chapter 2 of the McKinsey Report — 'Delegate to manage Services' — and accepts the Recommendations therein for vesting real and overall control in the board while giving clear-cut executive responsibility to the Chief Executive Officer NOW IT IS HEREBY RESOLVED AS FOLLOWS:

I.The following functions are reserved to the Board:

1.1 setting local objectives for improved health services and reviewing the plans by which these objectives will be reached,

1.2 determining the allocation of the revenue budget in accordance with its priorities and plans for improving services,

1.3 selecting capital projects,

1.4 monitoring the implementation of plans, the investigation of level of services and expenditure against budget,

1.5 the appointment of committees pursuant to section 8 of the Act, 156 3/7/1980

1.6 the approval to the granting of expenses to members of the Board and Committees pursuant to section 9 of the Act and approval of procedures for the submission of claims,

1.7 the determination of allowances to be paid to the Chairman and Vice-Chairman of the Board pursuant to section 10 of the Act,

1.8 the determination from time to time of the numbers and categories of officers and servants of the Board that may be appointed, pursuant to section 14 (1) of the Act,

1.9 the approval of the removal of a permanent officer of the Board from office other than for misconduct or unfitness pursuant to section 23 (4) of the Act,

1.10 the approval of any arrangment with a local authority pursuant to section 25 of the Act,

1.11 the approval of any arrangement with any person or body or other health board pursuant to section 26 of the Act,

1.12 the approval of estimates of receipts and expenditure to be submitted to the Minister for Health, pursuant to section 30 of the Act,

1.13 the approval of any arrangements for borrowing and the giving of security therefor, pursuant to section 33 of the Act,

1.14 the approval of any offer of a gift of money, land or other property, pursuant to section 33 (5) of the Act,

1.15 the making, amending and revoking of standing orders pursuant to clause 31 of the second schedule to the Act,

1.16 the approval of any proposals for the disposal of land belonging to the Board,

1.17 the appointment or election of persons to be members of any other body.

2. The Chief Executive Officer shall 2.1 advise the Board generally in regard to matters reserved to the Board under clause 1 of this resolution. 157

2.2 arrange for the execution of the decisions of the Board taken in respect of the matters referred to in clause 1 hereof,

2.3 subject to clause 1 hereof, exercise and perform every power, function or duty of the Board subject to section 17 (1) of the Act,

2.4 perform the functions specifically referred to in section 17 (4) of the Act.

3. In the performance of his duties the Chief Executive Officer may delegate executive responsibilities to other officers of the Board for the purpose of facilitating the implementation of decision of the Board or of the Chief Executive Officer.'"

The Chief Executive Officer advised the members that Mr. Segrave had indicated his acceptance of office and he would be available to take up duty on the 3rd November 1980. Mr. Nolan recommended that the members should confirm the terms of the delegation of functions to the Chief Executive Officer as at present operating and said it would be necessary for the Board to make a formal resolution appointing Mr. Segrave. The following resolution was proposed by Cllr. Browne, seconded by Cllr. Mrs. Glenn and agreed —

'That Mr. P.B. Segrave, Navan Road. Kells, Co. Meath be appointed to the post of Chief Executive Officer, Eastern Health Board in accordance with the recommendation of the Local Appointments Commission, on the terms and conditions attaching to the post and with effect from November 3rd 1980, as notified in his letter of acceptance dated June 30th 1980."

it was also agreed to confirm the terms of the delegation of functions to the new Chief Executive Officer as recommended.

109/80 DISPOSAL OF LAND SURPLUS TO REQUIREMENTS

The following Report No. 37/1980 from the Chief Executive Officer was submitted:—

"SPECIAL HOSPITAL CARE PROGRAMME

St. Loman's Hospital — Total Area 74 Acres approx. Area under Buildings and Grounds 34 Acres approx. Sports Field and Recreation 10 Acres approx. Area let for Graz ing 30 Acres approx. TOTAL 74 Acres approx. 755 3/7/1980

The area of land let for grazing surrounds the Hospital on 3 sides and appears to be eminently suitable for use in con junction with any proposal to extend the existing Hospital. St. Loman's Hospital services a rapidly expanding catchment area and, with the exception of the 30 acres mentioned above, the Board does not have any sites in this area for any developments which may become necessary in the future. Future developments need not necessarily be restricted to those services coming within the ambit of the Special Hospital Care Programme. The Hospital is surrounded by roads on 3 sides and is quite conceivable that additional entrances could be provided for Health Centre, Welfare Home, Hostel, Community Workshops or similar facility. The Programme Manager has recommended that the lands in question be retained by the Board.

Newcastle Hospital Of a total acreage of approximately 37, 27 acres are under buildings and grounds. This area also includes an area* of 2% acres which the Board has agreed to make available to the Co. Wicklow Association for the Mentally Handicapped for the purposes of providing a special School. The remaining 10 acres is divided into 3 separate lots and is generally inaccessible from the public road.

In the absence of road developments it would be of interest only to Land Owners whose land adjoins the Hospital lands. Here again this land may very well be required for developments in the years to come and the Programme Manager recommends that this be retained.

St. Ita's Hospital Of the total area of 281 acres 121 are let in con-acre. The Programme Manager has expressed the view that all the land at St. Ita's should be retained to facilitate the development of various services on the site.

GENERAL HOSPITALS AND HOMES

St. Cokimcille's Hospital All available land here has been scheduled for development including the unit for the mentally handicapped.

Bru Chaohnhin All land on this restricted site is required. Small portions of this property were disposed of some years ago for road widening and an extension to an adjoining factory premises.

Clonsfceagh Hospital This is the only site available in the Donnybrook/Milltown area. All available land is required for development for Care of the Aged, Special Hospital Care/Community Care. 159

St. Clare's Home Of the original holding of 97 acres approx. purchased by the former Dublin Board of Assistance in the 1940's — 62 acres have been disposed of to the Dublin Corporation, Church and School authorities and the Institute for Industrial Research and Standards, leaving approximately 35 acres still in the possession of the Board. It is considered that approximately 10 acres in the immediate vicinity and including the St. Clare's Home site would be sufficient for the Board's needs in the area, leaving approximately 25 acres available for disposal preferably for community needs.

St. Brigid's Home Approximately 16 acres available which is hilly and partly wooded.

Cherry Orchard Hospital Approximately 136 acres were acquired by the former Dublin Fever Hospital Board of which two lots totalling 58 acres have been disposed of to Dublin Corporation for housing and other development. Approximately-50 of the 78 acres remaining are under Hospital buildings, amenities, etc. and it is considered that approximately 25 acres could be disposed of preferably to Doblin Corporation.

District Hospital, Bartinglass No land available.

County Hospital, Naas No land available.

St. Vincent's Hospital, Athy No land available.

District Hospital, Wicklow No land available.

St. Colman's Hospital, Rathdrum Of the original holding of 18/19 acres approximately, 5.7 have been disposed of to Wicklow County Council. The Board has initiated discussions with the Council with regard to a further disposal of 5 acres leaving approximately 8 acres available which is adequate for the Board's needs.

St. Patrick's Home, Navan Road The total area of land at St. Patrick's Home including that occupied by buildings was 54 acres. Two disposals have already taken place to the County Council, 5% Acres approximately for housing in the 1960's and 17% acres approximately during the current year for amenity development. 160 3/7/1980

This leaves approximately 31 acres of which 3% acres are leased at Pelietstown House. Approximately 20 acres of the remaining 27% acres could be considered for disposal, preferably to the Dublin County Council.

The total of the surplus land available in the Programme is approximately 91 acres. Approximately 34 acres of land have been made available during recent years to Dublin Corporation, and Dublin County Council on the basis of a set-off for sites for Health Centres, etc.

It appears that there is a total area of 131 acres (30 + 10 + 121 + 91) at above hospitals surplus to our present requirements. While detailed consideration would have to be given to our possible future needs in any proposal to dispose of all or part of the properties concerned they should nevertheless be listed for review in the context of prevailing priorities and finances available to purchase sites and to proceed with plans for various projects."

Cllr. Hynes hoped that this report would receive further consideration so that the Board could be sure that it would retain all the land necessary for future development.

Mr. Nolan said the report was for information only and that no land would be considered for disposal until the Capital Development Committee had considered fully the implications. It was the policy of the Board to use land that was surplus to requirements either to finance developments or to exchange with the local authorities for sites required where the Board had no land. Preference was given, subject to sanction of the Board and of the Minister, to the local authorities and to statutory bodies. Cllr. Durkan asked particularly that when disposal of land at Cherry Orchard was being considered that adequate care and consideration be given to the security of the remaining hospital grounds and the proposal was seconded by Cllr. Stagg and agreed.

110/80 OFFICE ACCOMMODATION

The following Report No. 38/1980 from the Chief Executive Officer was submitted:

'The pressing need for suitable and adequate office accommodation has been the subject of a number of reports including that dated 28th June, 1978 (No. 14/1978) following consideration of which the Board approved in principle of the construction of a Headquarters on a site at St. Brendan's Hospital. A draft Brief for a building of approximately 7,000 sq. meters to house 300 staff and costing £2,500,000 was 161

prepared by a Project Team and submitted to the Department of Health on 23rd July, 1979. The matter has since been raised with the Department on a number of occasions and the need for urgent action emphasised but no reply has been received to our proposal, in the absence of approval from the Department it has not been possible to proceed with the work of planning the project. However, application was made to Dublin Corporation on 23rd May, 1980 for outline permission under the Planning Acts and the outcome of that application is awaited.

As a temporary relief for three of the sections most pressed for space arrangements have been made to provide accommodation for approximately 25 persons in a prefabricated building beside the old Canteen at 1 James's Street. This is a most unsatisfactory solution even for the small number involved and, of course, it does not alleviate the position of all the other staffs in the existing unsuitable and inadequate accommodation.

Apart from the generally unsatisfactory nature of the present offices the decision to provide alternative accommodation was occasioned by the repeated requests from the St. James's Hospital Board for an assurance that the entire area between James's Street and the boundary of the property leased to them would be made available at an early date for the development of the Hospital. In this connection we were informed early this year by St. James's that they would require a large area of our existing accommodation to be cleared in two years to make way for the Clinical Sciences Complex.

We have informed the Hospital Board that no question of vacation and handover of existing buildings or transfer of the plot in question could be entertained unless and until satisfactory arrangements had been completed for relocation of the staffs (115) and services now located there and that the Board could not hope to have its proposed new Headquarters constructed within the period of two years indicated nor has it any Capital or Revenue funds available to provide alternative accommodation.

As an alternative to providing the offices by direct building or purchase sustained efforts were also made to obtain rented accommodation and several premises were inspected but were not found satisfactory. It may be that in the short-term we will be forced to rent accommodation if it becomes necessary for us to vacate the front area of the site."

Mr. Nolan said this report was being submitted for the members information. He would like to draw attention to the fact that the Board's Headquarters' staff may have to rent accommodation at expensive rates if it becomes necessary to 162 3/7/1980

vacate the St. James's Site before new premises are built. The report was noted.

111/80 1980 BUDGET ALLOCATION - LIMITATIONS ON EXPENDITURE

The following Report No. 39/1980 from the Chief Executive Officer was submitted:

The revenue expenditure on health services to 31st May 1980 has been examined.

After making adjustments for salaries increases and pension revisions for which an extra allocation will be made available, the pay expenditure is at this stage generally in line with the budget allocation.

The non-play expenditure to 31 st May 1980 is £16,765,000 against a proportion of the budget allocation of £16,075,000, an excess of £690,000.

The major elements of this excess of £690,000 are due to General Medical Services schemes over which the Board has no control, viz.,

£ Limited Eligibility Medicines 337,000 Long term illness medicines 53,000 Appliances 40,000 £430,000

The remaining excess of £260,000 represents 1.8% of the appropriate proportion of the budget allocation.

It appears from present trends that the General Medical Services schemes will exceed the budget allocation by £1,250.000, viz.

Limited Eligibility Medicines £1,000,000 Long term illness medicines £ 150,000 Appliances £100,000 £1,250,000

The Board's expenditure on commodities and services, if maintained at its present level, will, despite the impact of economies, exceed the budget allocation.

This is due to the unexpectedly high rate of inflation in 1980. The allocation provided for a rate of 15%, whereas the consumer price index at mid-May 1980 shows an increase in twelve months of 20.2%. In the remaining months of the 163

year it seems on current trends that the inflation rate will increase still further. The cost to the Board of this rising trend is now forecast to be not less than £900,000 at this stage.

It is clear therefore that unless the original allocation is increased to cover (a) increases in General Medical Services schemes and (b) inflationery increases, certain of the Board's services will have to be curtailed. The position will be kept under constant review and a further report will be made to the August meeting."

The Finance Officer said he had to draw attention to the fact that the allocation for 1980 will not contain the Board's expenditure particularly under limited eligibility, long-term illness, and appliances headings. It is likely that expenditure on these areas will exceed the allocation by over £1 m. and the Department of Health had been advised of the situation. He also said that while the allocation allowed for an inflation rate of 15% inflation has now gone over 20% and while it is difficult to estimate on a five months spending it appears that the Board will exceed its allocation because of inflation by £900,000. It would be necessary, in order to remain within the allocation, to cut back on services. While no cuts had been made yet some purchases, such as hospital equipment, had been deferred.

Miss Kearney said she hoped that if cuts had to be made they would not be made in the areas of Home Helps and Meals on Wheels, which while small in the amount, were very important services.

Cllr. Stagg said he was aware from personal contact that economies were being made by the Board by increasing stringency in the means test and in the grant of medical cards. He asked that no further cut backs be made in these areas.

Supporting Cllr. Stagg Cllr. Freehill said that her experience also showed that it is now more difficult to avail of services particularly issue of rredical cards and admission to hospital. In support Ald. FitzGerald deprecated any cut backs that might be required and said that the Department of Health must be brought to the realisation of what is needed by way of services now and in the future.

Dr. Powell said that regard should be had to the way in which some patients abuse services and Miss Kearney said that while the system was less than perfect not all the blame attached to the public as indiscriminate prescribing was often forced upon patients particularly in hospitals, — what was needed was advice to people on how they should keep in good health. 164 3/7/1980

Mr. Nolan said that he had only recently issued an instruction that in considering applications for medical cards some account be taken of inflation since the beginning of the year. It was agreed that the report would be noted and that the members would await the next report on the matter to the August meeting.

112/80 REPORT OF COMMITTEE ON THE CARE OF THE AGED

The following Report No. 40/1980 was submitted:—

'The Committee met to consider the resolution adopted at the Special Meeting of the Board held on 1st May 1980 to consider Report No. 14/1980 viz.

'That the report on the Care of the Aged be adopted and that the Care of the Aged Committee formulate the recommendations contained in their report into a priority ordered set of general proposals and a specific five years development programme ordered for each of the three areas, Dublin North, Dublin South East and Dublin South West indicating the costings."

The Committee resolved:

"That this Committee recommends that Report No. 14/1980 be referred to the Minister for Hearth with request for early discussion on the programming and financing as a matter of urgency of a comprehensive scheme to care for the aged, with immediate action along the following lines."

(a) Development, starting at once, of the proposals of the Community Care Programme for the care of the elderly as set out p.p. 20 - 23 of Report No. 14/1980 which would include immediate provision of 120 purpose-designed welfare places in appropriate sized units and,

(b) establishment of geriatric/assessment units at St. Columcille's and Naas Hospitals."

Cllr. Mrs. Glenn, as Chairman of the Committee, introduced, the Report and proposed that the Board endorse the resolution passed by the Committee.

Seconding the proposal Dr. Walker complimented Cllr. Mrs. Glenn on the way in which she chaired the Committee. He said he was pleased that all concerned considered the priority was the acceptance of the proposals made for the care of the elderly in the community and he considered that the priorities of the Committee had been placed in absolutely 165

correct order. The report was adopted unanimously, and referred to Mr. Lamb for necessary submissions.

113/80LETTER 23/6/80 FROM CHIEF EXECUTIVE F.D.V.H.

The following letter of 23/6/80 from the Chief Executive Officer of Federated Dublin Voluntary Hospitals was considered:—

"Dear Mr. Nolan, At the last Central Council meeting when the question of Revenue Allocations for 1980 was being discussed, you suggested that the Central Council might ask the Eastern Health Board to support the pressure being brought on the Minister regarding the inadequacy of these allocations and in particular the allocation to St. James's Hospital for the current financial year. I now write to you to formally request the Eastern Health Board's support.

Yours sincerely,

D J Dempsey, Chief Executive"

Cllr. Stagg said that the situation in St. James's Hospital regarding finance was so serious that the Board of the Hospital might have to consider closing the Hospital down. He suggested that the Health Board make urgent represen-tatioions to the Minister to make funds available to enable the Hospital to continue for the year. He said St. James's Hospital as a "public hospital" is starved of funds in relation to other voluntary hospitals. Dr. Behan supported Cllr. Stagg's proposal that the Health Board write to the Minister. He said that St. James's Hospital was 50% a public institution catering for the local community and 50% private and could be a model of the way in which the private and public sectors could co-operate. He said that as Chairman of St. James's Hospital Board he had already written to the Minister on this matter. Ald. FitzGerald said that where the Health Board had representation on a hospital board and in particular 50% of representation as in the case of St. James's Hospital the Health Board should be formally advised of such situations and problems that arise. Dr. Behan agreed and said that the Health Board should have at least one annual report from the hospital. It was decided to write to the Minister as a result of the discussion on the letter advising him of all the points raised and requesting additional finance. 166 3/7/1980

114/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

The minutes of the following meetings of local (health) committees having been circulated were dealt with as follows:

(a) Dublin County Local (Health) Committee - 10/6/80

On a proposal by Cllr. Freehill seconded by Ald. Fitz-Gerald the minutes were noted.

(b) Kildare County Local (Health) Committee - 22/5/1980

On a proposal by Cllr. Durkan seconded by Cllr. Stagg the minutes were noted.

Cllr. Stagg asked that a progress report on the development of the County Hospital Naas arising from the recent meeting with the Minister for Health be submitted by Mr. Lamb to the next Board meeting.

Cllr. Durkan drew attention to the table of statistics relating to the population of Kildare by age groups and the estimate that by 1981 there would be 10,000 persons of 65 years of age and over in Kildare and West Wicklow. He pointed out that there were no Welfare Homes or no spare geriatric beds in the area to cater for this population.

115/80 NOTICES OF MOTION

The notice of motion in the names of CI Irs. Carroll and Hand had already been taken and Dr. Behan asked that the notices of motion in his name be deferred to the August meeting.

116/80 CORRESPONDENCE

In addition to the correspondence circulated with the notice, the following letter dated 1st July, 1980 from Mr. Logan, Secretary/Manager, James Connolly Memorial Hospital, Blanchardstown, was read by the Secretary:-

"Dear Mr. Nolan,

Re: Psychiatric Services

As you are aware discussions are currently taking place with the Department of Health on the Development of Services at this hospital. At our last meeting held on 13th June, 1980 provision of an Acute Psychiatric Unit was considered. A provisional 167

figure of 50 beds has been agreed. It is envisaged that this Unit would form an integral part of the new hospital. I wish to advise you that the Departments Psychiatric Services Division will consult with the appropriate officers of your Board on the question of beds. My Board wishes to be advised of progress in these discussions and to be consulted prior to a final agreement being reached.

Yours sincerely,

William Logan

Secretary/Manager"

Mr. Keyes said that it was the policy of the Health Board to help develop the psychiatric unit at Blanchardstown Hospital including the involvement of some of the Board's Consultants at the hospital. He said he would be putting a proposal in that regard to the Chief Executive Officer shortly.

117/80 OTHER BUSINESS

The following motion was proposed by Cllr. Freehill and seconded by Cllr. Hynes:

'That a Committee be established to examine and present a short-term and long-term programme for the 1981 International Year of Disabled Persons."

Speaking to the motion Cllr. Freehill said that as 1981 was scheduled to be the Year of the Disabled money would be made available by the Department of Health for Handicapped Services and it was important that the Board make plans and provisions now for what services the Board wishes to see provided and extended. She considers that the Committee might well have members both from the Board and outside the Board. Dr. Walker said he considered such Committee should only be formed of Board members and officials. The motion was agreed and it was also agreed that membership of the Committee would be selected at the August meeting.

Dr. Walker on his own behalf and on behalf of his profession thanked Ald. FitzGerald for the work he had done during his two years as Chairman of the Board.

Dr. Walker also said that there was a sense of history in the progress of the Health Board which had now been in existence for ten years and he would like to see a record of the former Chairmen displayed in the Boardroom possibly by having their photographs taken and placed on the walls. He thought that also there might be once a year a group photograph of members. Ald. FitzGerald supporting this said he also considered that there should be an Annual Dinner for 168 3/7/1980

the Board. It was agreed that these suggestions would be examined.

At the conclusion of the meeting Cllr. Browne again thanked the members for their confidence in him in electing him as Chairman. He said he looked forward to members' help and co- operation through the coming year.

The meeting ended at 8.30 p.m.

CORRECT: J.J.Nolan Chief Executive Officer.

Signed. CHAIRMAN 169 7/8/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Boardroom, St. Brendan's Hospital on Thursday 7th August 1980 at 6 p.m.

PRESENT Dr. J. D. Behan Ms. N. Kearney Cllr. L Belton T.D.. Dr. D. G. Kelly Cllr. D. Browne Dr. P. McCarthy Cllr. M. Carroll Dr. A. Meade Cllr. J. Connolly P.C., Cllr. M. Freehill Prof. J. S. Doyle Dr. B. Powell Cllr. B. J. Durkan Dr. B. Sheehan Cllr. Mrs. A. Glenn Cllr. E. Stagg Cllr. A. Groome Cllr. J. Sweeney Mr. K. Harrington Cllr. G. Timmins, T.D., Cllr. F. Hynes Dr. J. Walker Cllr. Mrs. M. Waugh APOLOGIES Mr. H. Corrigan and Prof. J. McCormick

IN THE CHAIR Cllr. D. Browne, Chairman OFFICERS IN A TTENDANCE Mr. J. J. Nolan Prof. I. Browne Mr. F. Donohue Mr. J. Doyle Mr. J. Clarke Mr. A. O'Brien Mr. R. N. Lamb Dr. C. Warde Mr. M. Hayden Mr. E. Dunphy Mr. F. McCullough Mr. T. Barry Mr. P. J. Swords Mr. C. McQuaile Mr. J. Brennan Miss E. Larkin Miss F. Heaney Miss P. Genochy

118/80 CONFIRMATION OF MINUTES

(a) Minutes of Proceedings of Annual Meeting held on 3/7/1980 (b) Minutes of Proceedings of Monthly Meeting held on 3/7/1980

On a proposal by Cllr. Carroll seconded by Cllr. Stagg the Minutes of the two meetings were signed. 170

Matters Arising:

Cllr. Stagg was advised that the letter regarding the inadequacy of the allocation for St. James's Hospital had been sent to the Department of Health. He asked that the matter be followed up urgently.

119/80 PROCEEDINGS OF VISITING COMMITTEES

The Reports of the following Visiting Committee Meetings having been circulated were dealt with as follows:

(a) No. 2 Visiting Committee Meeting held at St. Patrick's Home on 3/7/1980

On a proposal by Dr. Powell, seconded by Cllr. Hynes the report was noted.

Miss Kearney said she noted that a number of children were over a year in the Home and that they were reported to be unsuitable for placement. She claimed that professional opinion indicates that any child is suitable for placement if the proper foster parents can be found. She also commented on the lack of activities for the children and on the apparently high nursing staffing in the Home although there were normally no ill patients there. She referred to the alternative of accommodating mothers and children in small group homes such as that developed by the French Sisters of Charity at Donnybrook and suggested that the Board should consider this type of development.

Dr. Powell agreed and stated that children must be stimulated at an early age to reach their full potential. He also referred to the continuing problem of trespass and asked that the Dublin Corporation be requested to build the wall on the boundary of the land which the Board had transferred to them. He also recommended that the Board press forward its proposals for a unit for young chronic sick at the Home.

Referring to the last point, Mr. Nolan said that although, as notified to the Board, the Department had turned down the Board's proposals, they were being put again to the Department for approval. He was conscious of the recent gradual decline in use of the Home for its original purpose and the eventual decision of the Board to agree to the closing of the Delivery Unit had left staff and space to spare for the proposed Unit for the Young Chronic Sick. It was also proposed to have some accommodation for elderly females in the Home as a complement to the adjacent new Welfare Home and the facilities at James Connolly Memorial Hospital. Referring to Miss Kearney's comments on the fostering, Mr. Doyle 171 7/8/1980

said that the Board is constantly seeking suitable parents but some children are difficult to place. With regard to activities he said there is a post of Montessori Teacher at the Home which, while vacant at present, will be filled shortly. The group home as mentioned by Miss Kearney, had already been considered with the Order and the St. Louise Adoption Society but it would prove very costly on the Board to replace the Home with such units when -it is considered that the Home caters for 400 mothers per annum.

(b) No. 4 Visiting Committee meeting held at St. Mary's Hospital, Phoenix Park on 27/6/1980

On a proposal by Cllr. Sweeney, seconded by Cllr. Hynes the report was noted.

Cllr. Groome wished it to be noted that he had attended this meeting but was not recorded as having done so.

On a proposal by Mr. Harrington, seconded by Cllr. Hynes, the report was noted.

Cllr. Hynes said he wanted to bring again to the attention of the Board the matter of repairs to the roof and electrical wiring, that on this visit he found conditions the same as they were at the last visit when he also brought this matter to the notice of the Board. He also referred to the inadequacy of the service road around the Hospital, which was too narrow to take large vehicles, with the sharp right hand corners forcing them on to the grass area.

Mr. Nolan asked the Programme Manager to deal with these matters.

(d) Community Care Visiting Committee meeting held at Naas Hospital on 17/6/1980.

On a proposal by Cllr. Stagg, seconded by Cllr. Freehill the report was noted.

Cllr. Stagg asked the Board to note the staff shortages in most administrative sections in the KikJare area. He wished to praise the officers concerned for their speedy restoration of the office premises following the recent fire and the staff of the local offices for the way they carried on under difficult circumstances. He said he was glad to hear that relatives working as Home Helps would be treated in the same way as non-relatives and he asked if this was so throughout the Board area. 172

In reply to his enquiry about guidelines for eligibility for Home Helps Mr. Donohue said that each case was treated on its merits and the needs and resources available but relatives were not debarred from payment as Home Helps.

Cllr. Groome drew attention to the inadequacy of the ophthalmic service in the Kildare area and referred to the case of a child who although promised an appointment in three weeks time, had not been seen after three months. On a suggestion from Mr. Kelly, it was agreed that the Board would examine the possibility of a liaison between one of the Dublin City Hospitals for the provision of an Ophthalmic Service.

Cllr. Ourkan referred to the long waiting list for orthodontic treatment and to the back-log of cases for psychological assessment. Regarding Orthodontics, Mr. Donohue said that the Board has repeatedly advertised through the Local Appointments Commission for a Consultant Orthodontist without success but when this post is filled and the necessary support staff is provided the situation will improve. Mr. Harrington said that the demand for orthodontics will grow in the future and the Board must be prepared for this demand. He said, however, that orthodontic treatment is of its nature a long term treatment and could only be done at certain stages in the child's life.

Regarding the Psychological Assessments, Mr. Donohue said that discussions were at present going on with staff at St. Brendan's Hospital to increase the service but financial considerations might not allow the service to be increased as yet

120/80 NOMINATION OF MEMBER TO BOARD OF ST. JAMES'S HOSPITAL

The following Report No. 41/1980 was submitted by the Chief Executive Officer:

"The appointment of Professor B. O'Donnell as one of the ten representatives of the Eastern Health Board on the St. James's Hospital Board will terminate on 16th October 1980.

It is now necessary for the Health Board to nominate a person to the Minister for Health for appointment to represent the Health Board on the Hospital Board from 17th October 1980 for such period, not exceeding 3 years, as may be determined by the Minister." 173 7/8/1980

On a proposal by Dr. Behan seconded by Cllr. Carroll it was unanimously agreed to re-nominate Professor Brendan O'Oonnell as a Board representative on St. James's Hospital Board.

121/80 APPOINTMENT OF HANDICAPPED SERVICES COMMITTEE

Following discussion it was agreed that a report could be prepared before the next meeting of the Board identifying the areas to be examined by the Committee and that the Committee would then be selected with these needs in mind.

122/80 APPOINTMENT OF DEPUTATION TO MINISTER FOR HEALTH ON SERVICES FOR THE ELDERLY

On a proposal by Cllr. Mrs. Glenn seconded by Cllr. Connolly it was agreed that seven members be nominated to the deputation. The following members were selected:

Cllr. Mrs. Glenn Cllr. Stagg Dr. Meade, Cllr. Hynes, Dr. Behan, Dr. Walker, Cllr. Carroll

It was agreed that the Chief Executive Officer would select the necessary officers to accompany the deputation.

123/80 BUDGET ALLOCATION

The Chief Executive Officer told members that the Budget figures at the end of June showed that the Board's expenditure both on pay and non-pay was running at an average of 104% of allocation. While inflation was accountable for the non-pay excess, the Pay expenditure was causing concern and he was having an examination done of overtime being worked and of substitutes being employed for absence on leave etc. As the Board's special economies were only introduced from March onwards following notification of the allocation, he considered that the figures relating to the period to July would be more indicative of the situation and he would provide a detailed report to the September meeting, based on that information.

124/80 USE OF IRISH LANGUAGE IN THE CONDUCT OF BOARD BUSINESS

The following letter dated 7th July 1980 from the Department of Health was submitted: 174

"A Phriomh-Oifigigh, A Chara

Taim ag scriobh chugat chun cabhair a lorg uait i bhfor-bairt na h- oibre ata idir lamhaibh ag Bord na Gaeilge i la'thair na h-uaire.

As you will be aware from previous discussions Bord na Gaeilge has been established by the Government to promote the use of Irish throughout the community. The Chairman of the Board is Liam 0 Murchu and it has recently appointed a Chief Executive Officer, Sean O Cleirigh and other staff who are located in 7 Merrion Square, Dublin.

The Minister is anxious that health boards should co-operate to the maximum extent possible in promoting the use of Irish both within the Board and in contact with members of the public availing themselves of the boards' services. In the Appendix to this letter certain procedures are suggested which might be set in train in order to achieve the Government's objective.

The Minister is writing personally to Chairmen of Health Boards to seek their support in promoting the use of Irish. I am enclosing a copy of his letter for your information.

Members of health boards who are also members of Local Authorities will be aware that a special Steering Committee, comprising members and officers of those authorities and of the Department of the Environment, has been established to promote the use of Irish in the Local Authorities. They will also have received copies of a document issued by the Steering Committee. I enclose for your information two copies of that document, further copies of which may be obtained on request from Bord na Gaeilge. The Board is anxious to obtain ir.fcmation about specific activities being undertaken in the Public Service and would welcome suggestions ahout ways in which there objectives might be pursued.

I should be glad to hear from you in due course about the action which you have taken in regard to this matter. If there is any further information you require I shall of course be glad to make it available. The advice and assistance of Bord na Gaeilge would also be available in relation to any practical problems which may arise.

Mise le meas

B. Hensey 175 7/8/1980

Mr. Nolan said that it was Government policy to foster and assist the use of Irish in the conduct of business. While it would be a primary process for management to encourage the use of Irish he would like the views of the Board on possible applications. Dr. Behan agreed that the Board should encourage the greater use of Irish and suggested that the Board and Hospitals with which it was associated should introduce Irish on their headed paper. Cllr. Stagg said that it would be possible also for officers to use the Irish form of their title in correspondence. Prof. Doyle noted that Bord na Gaeilge was prepared to offer advice and suggested that this be taken. It was agreed that the Chief Executive Officer should proceed as discussed and consider the general position in conjunction with Bord na Gaeilge.

125/80 OFFICES-OUTLINE PLANNING PERMISSION FROM DUBLIN CORPORATION FOR DEVELOPMENT AT ST. BRENDAN'S HOSPITAL

Mr. Nolan informed the members that outline Planning permission to the Board's proposals for an office block at St. Brendan's site had now been received subject to more detailed planning being submitted for full permission. As he had told members at the last meeting there was no immediate prospect of capital funds for this project from the Department as yet and it might be necessary to seek rented accommodation, as the office staff might have to be moved off the St. James's site before the new office block is ready. It was agreed that pending further representations to the Minister for funds to provide a new office block, enquiries should continue to be made for suitable rented accommodation.

126/80 CAPITAL DEVELOPMENT COMMITTEE

Mr. Nolan referred to the appointment of this committee at the July meeting and said that a number of matters were being placed before the meeting now for disposal by resolutions or by referral to the Capital Development Committee for consideration. He suggested that items 10 and 12 on the Agenda be taken together and this was agreed. Item 10 relates to the disposal of land and the following four letters were submitted:

(a) Letter 17/6/80 from St. Michael's House group, requesting a site at St. Clare's for development — units for mentally handicapped:

"Re: Mental Handicap Centre, Ballymun, Dublin 9. 176

Dear Mr. Nolan,

Please find enclosed herewith St. Michael's House Brief for the above development, which has today been submitted to the Department of Health for consideration and progress to the next stage of planning.

I hereby formally request you to consider making available the lands necessary for this development at St. Clare's, Ballymun. The area required is all that land east of the current boundary fence running from the entrance at St. Canice's Road towards the Griffith Avenue Extension. I have outlined this boundary in red. I would be grateful for a decision at your earliest convenience.

Yours sincerely,

P. H. Moloney, EXECUTIVE DIRECTOR"

(b) Letter 16/7/80 from E.H.B. Staff's Sports Club Ltd. requesting site at St. Brendan's for development of recreation complex:

"Company Registration No. 76131 Dublin

"Dear Mr. Nolan,

Further to our meeting with you on 17th April last I wish to advise you that we have now assumed a corporate identity and have been formed into a company limited by guarantee.

On behalf of the company I wish to make a formal application to you for the lease of 3.50 acres at St. Brendan's Hospital.

Detailed requirements are as follows: 177 7/8/1980

Item Dimensions + Details Area (Sq. Ft.). Main Will include Functions Room, Bar. Building Games Room. I Toilets and Storage 10.000 Phase 1 2 x 32' x 21' plus changing area Squash 6 x 78' x 36' plus 10 ft. Runback and 3ft. Courts between courts Tennis 3.000 Courts 2 x 14m x 26m plus 2m around each Basketball court 25.000 120' x 100' plus 6.000 sq. ft. for Gym- 12.000 nasium changing wet area/storage. Swimmma 82:4' x 42' plus 12 ft. on all sides plus 18.000 Pool associated facilities 5.000 sq. ft. 12.000 Circulation Say 30 + ft. wide around the above 8V x 12' per car: 200 spaces not Car Park required if office car park available for 40.000 use. 31.000

Total 151,000 sq. Divided by 43,560 ft. 3.46 or excluding car acres 2.75 park acres

Note: No provision is made for a small garden or lawn areas.

Yours sincerely,

Brendan Carr, Hon. Secretary."

(c) Letter 3rd December 1979 from Programme Manager, Special Hospital Care, for development of school unit by C.B.S. North Brunswick Street.

"You may recall that at the Management Team I mentioned that the Christian Brothers were seeking a site at St. Brendan's Hospital to build a school to replace their existing Secondary School at North Brunswick Street. I have met Brother Quinian and Brother Creedon and they are looking for about six acres of land. Their problem is that the facilities at North Brunswick Street are totally inadequate and they have absolutely no room for expansion. They may have to leave the area unless they can obtain a site to build a new Secondary School and personally I feel that their leaving the area would be a most retrograde step for the area where there are large numbers of children. The amount of land available in St. Brendan's for any development is limited and portions are already committed for the Sports Complex and the proposed Office Block. However,

J 178

it may be possible to facilitate the Christian Brothers as well and could I suggest at this stage that an Architect would be appointed to examine the land available and to submit recommendations that might facilitate the three proposals that are now in front of us. Perhaps you might like to have this discussed at the Management Team meeting."

(d) Letter 17th July 1980 from Prof. Howie, requesting site at St. James's Hospital for development of Clinical Sciences Complex and Dental Hospital/School by St. James's Hospital Board.

"Dear Mr. Nolan,

I am glad to say that I have now had a letter from Mr. John Wilson, T.D., the Minister for Education in which he confirms that his Department "through the HEA and TCD, will be responsible for funding the Clinical Science Complex (at St. James's), including the dental hospital". He goes on to say that the Department of Education's Building Unit will advise on "the Brief, a budget cost limit, the terms and conditions for appointment of the Design Team and apportionment of cost for central services with the hospital".

These decisions are of very great assistance and they will allow us to make orderly progress with regard to the planning of the overall development at St. James's.

When we met last week I said that I had been in touch with Dr. Hensey saying that I would want to discuss with him the problems which would arise in relation to the availability of the St. James's Street site given that I could get the sort of declaration which has just been made by the Minister for Education. I have now written to Dr. Hensey to arrange an appointment hope that you will be able to obtain from the Eastern Health Board a decision to transfer the St. James's Street site to the hospital and subsequently the College, if this were done I think we would now be in a position to make substantial progress.

With best wishes,

Yours sincerely,

D. I. D. Howie

Items 12 relates to proposals regarding the Garden Hill Site at St. James's Hospital as set out in the letter dated 8th July, 1980 from the Department of Health, as submitted to the meeting. 179 7/8/1980

"A Chara

I am directed by the Minister for Health to refer to previous correspondence and discussions regarding the relocation of buildings from the Garden Hill site at St. James's Hospital.

On 2 May, 1980, the St. James's Hospital Board wrote to the Department setting out a proposed format of agreement on the matter. A copy of the Board's letter is attached for your information. The Department has informed the hospital board that there is no objection, in principle, to the proposals in respect of the Biological and Medical Research Institute, the Irish Foundation for Human Development and the Psychiatric Professorial Unit as set out in the letter from the St. James's Hospital Board, subject to:

(a) the understanding that the transfer of the Psychiatric Professorial Unit, mentioned in paragraph (1) under the heading "Eastern Health Board" on page 2 of the letter, does not imply agreement on the permanent location of the Professorial Unit, as such will be a matter for further consideration.

(b) the formal agreement of all the parties involved to the proposals and,

(c) the understanding that the proposals will not involve the Department in any expenditure prior to mid-1981 at the earliest and that the bulk of expenditure would fall to be met at a later date.

The Department would wish to be informed when all the parties involved have agreed to the proposals and wouid also require the final drafts of the Legal Instruments to be submitted for the Minister's approval prior to completion.

Mise le meas

S. Hensey"

Mr. Nolan said that he would like if the members would dispose of items 10 (d) and 12 at this meeting. Items 10(a), (b) and (c) might be referred to the Capital Development Committee.

Item 10 (a): The request for a site at St. Clare's for development of units for mentally handicapped for St. Michael's House related, he said, to the Board's policy to consider sympathicaily such applications from groups whose activities supplemented Board services. The Board was also 180

sympathetic to the request for a site at St. Brendan's Hospital for the development of a recreation complex for the Staff Sports Club Ltd. The request from the Christian Brothers for a site for a school on the St. Brendan's lands could only be considered, however, after the Board's own proposals for an office block and the sports complex on the site. He said he would propose that a meeting of the Capital Development Committee would be called within a matter of ten days and that the Committee would be able to examine these matters more fully with the advice of all the officers concerned.

In reply to an enquiry from Cllr. Carroll, Mr. Nolan said that the Board had already agreed in principle to provide a site for the staff Sports Complex at St. Brendan's. Cllr. Carroll said he considered that the site should be disposed of to the Staff Sports Club without any further delay as they were the first to make application and had brought their arrangements to an advanced stage. He was supported by the Chairman and Cllr. Glenn and after some further discussion the following resolution was proposed by Cllr. Stagg and seconded by Cllr. Connolly:

"It was hereby resolved that the Eastern Health Board agrees to transfer to the Eastern Health Staff Sports Club Ltd., 3.50 acres at St. Brendan's Hospital for the purpose of providing a sports and recreational facility as indicated in the letter of application dated 16th July, 1980."

The resolution was put to the members and carried by nine votes to eight, the following being the voting —

FOR: Cllrs. Stagg, Carroll, Connolly, Mrs. Waugh, Browne, Mrs. Glenn, Dr. McCarthy, Dr. Kelly and Ms. Kearney. (9).

AGAINST: Cllrs. Sweeney, Hynes, Groome. Durkan and Drs. Doyle, Walker, Sheehan and Behan. (8).

On a proposal by Cllr. Mrs. Glenn seconded by Dr. Walker it was agreed to refer the request for a site at St. Clare's for the St. Michael's House Group and the request for a site at St. Brendan's for a school for the Christian Brothers at North Brunswick Street to the Capital Development Committee.

With regard to items 10 (d) and 12,Mr. Nolan said that he is examining at present the draft agreements submitted by the Law Agent and would discuss them with officers of related units before submission to the Minister. Dr. Behan said that the letter of 8th July 1980 from the Dept. of Health was a very acceptable response to the Board's proposals except in regard to the reference to the location of the Chief Psychiatrist's Unit in paragraph (a). He pointed out that the 181 7/8/1980

Board has already decided the location of this Unit and its views should be reiterated to the Department. Dr. Behan also referred to letters of 17th and 30th July 1980 from Professor Howie regarding the proposals to proceed with a Clinical Sciences Complex at the site at St. James's on the funding of the Department of Education. He considered that the control of medical education should not be with the Department of Education but with an education section of the Department of Health which could integrate all under-graduate, graduate and post-graduate medical training with the services that are being provided on the ground. On the suggestion of the Chairman he agreed to put forward a motion in these terms to a later meeting. The following motion was then proposed by Cllr. Carroll, seconded by Dr. Behan and passed unanimously:

"It is hereby resolved that the Eastern Health Board, anxious to expedite development of the new St. James's Hospital

1. Agrees to transfer to the St. James's Hospital Board the Balance of the site fronting on to James's Street provided the Hospital Board can arrange to make available with the agreement of the Department of Health adequate suitable alternative accommodation for the offices, stores, dental clinics, pharmacy etc. at present occupied and used by the Eastern Health Board on that site;

2. Agrees to the proposals embodied in the Department's letter of July 8th regarding the Garden Hill site/building and authorises preparation of the necessary legal documents incorporating said proposals for submission to the Department;

3. Agrees to press the Minister for early approval to provision on the site, as already requested and agreed, of a headquarters unit and an adequate Research and Development Service for the Chief Psychiatrist.

In that regard generally, the Board wish to be informed, as soon as possible, of the specific proposals of the Irish Foundation for Human Development for accommodation on the site, to meet their existing and anticipated require ments."

127/80 ACCOMMODATION FOR YOUNG CHRONIC SICK/DISABLED PROPOSED UNIT AT ST. PATRICK'S HOME

The following letter dated 30th May 1980 to the Department of Health was submitted: 182

"I wish to refer to the Board's letter of 15th June 1979, and previous correspondence regarding confinements at St. Patrick's Home, Navan Road. Confinements ceased earlier this month and the alternative arrangements whereby the facilities at St. James's and other Maternity Hospitals are availed of, are working satisfactorily.

The Maternity Unit, which has ward accommodation for 18 persons, is being examined with a view to making it available as a self contained unit for "Young Chronic Sick". The Unit, which was constructed in 1933, is in very good structural order and has been well maintained and should accommodate about 18 "Young Chronic Sick" at ground floor level providing easy access to the grounds of the Home. Catering, lighting, heating etc. are already available but certain alterations will be needed such as the provision of ramps, certain alterations to toilets, bathrooms to permit access by wheelchairs etc. The Board proposes that the alterations be financed by using monies which we will receive during the current year from the disposal of lands. The Religious Community has indicated willingness to make available a Sister who has been receiving training in the care of "Young Chronic Sick", the redeployment of staff within the Home would provide the basis of our staff needs for the changed use of the Unit.

The Department will already be aware of the lack of specific in- patient accommodation for "Young Chronic Sick" and the proposal to avail of the Unit at St. Patrick's has been under consideration for some time. The Board would like to take advantage of the opportunity now afforded by the transfer of all deliveries from St. Patrick's and also to avail of the co- operation which the religious community has indicated in making available one of its Sisters.

The Board is aiso examining the possiblity of discontinuing the Isolation Unit as such at the Home. It is considering at this stage that this Unit could be made available as an extension to the new welfare home close by. We would thus provide additional residential accommodation for welfare cases, as well as day space.

The Department will be advised of developments in this matter."

Mr. Nolan said it was already explained to the Board there was accommodation and staff available at the Home to provide this facility but, as indicated in their letter of 29/7/80 circulated to members, the Department had turned down the Board's proposals. He said he had already written back to the Department reiterating the Board's wish to proceed with 183 7/8/1980

this facility at St. Patrick's site. In reply to Or. Kelly he said that the proposed Unit at St. Patrick's Home would link with the three north-side hospitals and that he was seeking another site on the south-side to link with the hospitals there at a later date.

128/80 HYGIENE STANDARDS AND POLLUTION - ARRANGEMENTS FOR MEETING OF JOINT COMMITTEE

Mr. Nolan referred to previous discussions on this matter and said that Dublin Corporation and Eastern Health Board had each appointed their members to the Committee and he recommended that the Board now fix a date for the first meeting. The Chairman suggested 6 p.m. on 8th September in the Boardroom St. Brendan's Hospital and this was agreed.

129/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

The reports of the following meetings of Local (Health) Committees having been circulated were dealt with as follows:—

(a) WICKLOW LOCAL (HEALTH) COMMITTEE meeting held on 16/5/1980

On a proposal by Cllr. Timmins seconded by Cllr. Sweeney the minutes were noted. Dr. Meade asked if the Board's Working Party on Hospital Services in South County Dublin and Wick low would continue now that the Department had established a Working Committee on the same lines. Mr. Lamb replied that Professor McCormick is anxious that the Board's Committee continue in existence.

(b) DUBLIN CITY LOCAL (HEALTH) COMMITTEE meeting held on 12/6/1980

On a proposal by Cllr. Carroll seconded by Dr. Meade the minutes were noted.

On a proposal by Dr. McCarthy seconded by Cllr. Durkan the minutes were noted. Cllr. Durkan again drew the Board's attention to disquiet in the Kildare area over the lack of geriatric beds for patients from North Kildare. It had not 184

proved possible to have any admissions to Dublin hospitals and as a result elderly patients were blocking beds in the Naas Hospital. He suggested that a quota of beds in St. Mary's and St. James's be allotted to the North Kildare area and said he would be putting forward his proposals when the information he had sought for the next Local (Health) Committee meeting was provided. Dr. Meade said he was surprised to see that there was a reported shortage of nurses in the Board's service as he was aware that nurses were emigrating from the country. Mr. Swords said that the shortages were mostly in the area where nursing was heavy and unattractive such as nursing the elderly in St. Mary's and St. Brigid's. Dr. Meade said that if the Board's shortage of staff was because of onerous conditions in the nature of the duties there should be some financial consideration given for this type of nursing.

Cllr. Durkan asked about the position of the change of use of two Units in Cherry Orchard to long-stay accommodation. Mr. Lamb explained the current position arising from the need to transfer patients from unsafe units in St. Brendan's Hospital. Cllr. Groome said he understood that there was still a block in Cherry Orchard being used as a store and he considered that it would be better used housing patients. Mr. Nolan said that Comhairle na n- Ospideal had written to the Board regarding the handling of infectious diseases case generally and wish to meet officers of the Health Board on the matter. Harcourt Street Hospital had also expressed an interest in liaison with Cherry Orchard Hospital in relation to paediatric services and the Board would be informed of these developments in due course.

Cllr. Sweeney referred to the announcement of the operation of the new Winter Fuel Scheme for the coming year and said he considered that guidelines had been too stringent last ye?-. He suggested that the Minister should be asked to broaden guidelines to include eligible pensioners who had a small Income

(d) DUBLIN COUNTY LOCAL (HEALTH) COMMITTEE meeting held on 7/7/1980

On a proposal by Ms. Kearney seconded by Cllr. Carroll the minutes were noted. Ms. Kearney asked if the guidelines for the granting of supplementary welfare allowances could be made known as otherwise applicants refused would not know whether to appeal or not. Mr. Donohue said these guidelines were provided by the Department of Social Welfare and he did not know if the status of these documents was such as to allow their publication. He said he would pursue the matter and report to the next meeting.

(e) DUN LAOGHAIRE LOCAL (HEALTH) COMMITTEE meeting held on 9/7/1980 185 7/8/1980

On a proposal by Cllr. Waugh seconded by Cllr. Carroll, the minutes were noted.

Cllr. Mrs. Waugh drew the members attention to the concern expressed by the Committee as minuted in paragraph 2 that there was little local imput to developments in the hospital area where these are funded direct by the Department of Health. Mr. Nolan said that this matter had been considered at previous Board meetings and there was an endeavour by the Board to seek membership on Boards of such hospitals for representatives of the Health Board.

Dr. Sheehan also mentioned the lack of involvement of the local Directors of Community Care in decisions relating to other services such as hospital and psychiatric services in their area. He said that the Board should examine the situation where the Director finds he is not in a position to involve himself in all the health services relating to people in his area. Dr. Walker said that such an involvement would mean a complete restructuring of the way in which the Board's management for community care services was organised at present. He was satisfied that each Director kept an eye on the activities of the other programmes in his area and any gaps arising were filled on this basis. Mr. Donohue said he appreciated that the Directors should be more closely associated with the hospitals and thought this could be done through their membership of the Boards or medical committees of the hospitals. Some hospitals have already invited the Directors to participate at different levels and these moves would be encouraged.

Professor Doyle said that the reply given to Cllr. Brady's question on page 2 of the minutes was erroneous as a great amount of attention is given to the care of the aged in the training of student doctors. The Chairman asked that this information be conveyed to the next meeting of the Dun Laoghaire Local (Health) Committee.

130/80 NOTICES OF MOTION

(a) The following motion was proposed by Cllr. Mrs. Waugh:

"To consider the possibility and feasibility of setting up in Belfield a sub-health centre for Community Care Area 5".

Speaking to the motion Cllr. Mrs. Waugh said this arose from the Community Care Visiting Committee at Baliinteer where the Director, Dr. Barry, pointed out that the student population of Belfield was equal to the population of the rest of the area. As most students had medical cards she suggested that a sub-health centre be set up at Belfield to avoid students having to go to Baliinteer to get services. 186

Mr. Donohue said that if students had medical cards they would be on the panel of a doctor near to their home or lodging. There may be a need to find a way of simplifying students applications for medical cards and he said he would examine the situation and report on this and on the current medical resources available at the Belfield complex to a later meeting.

(b) The following motion was proposed by Dr. McCarthy:

"That the location of the doctor in Dunlavin Health Centre be as outlined in Drawing No. DH/977/3 which was submitted to the Planning Department of Wicklow County Council on 11th October, 1977."

Speaking to the motion Dr. McCarthy said he brought it so that Board members would be able to decide that Board property be not developed in a way that would be detrimental to the future development of the health services. Mr. Donohue said that when planning permission was first sought for the Health Centre in 1975 the rooms were allocated as indicated by Dr. McCarthy but as the general practitioner at the time did not want accommodation it was subsequently decided to change the usage and the internal lay out was revised.

A discussion followed to which CIIr. Mrs. Glenn, Durkan, Sweeney, Timmins and Dr. Meade and Dr. Warde contributed. It was agreed by the members that they had not enough information available to them to decide on this matter and they requested that a report from the Director of Community Care, Technical Services Officer and Programme Manager be submitted to the next meeting when a decision would be made.

{c} With the permission of the members. Dr. Behan introduced the following motion, which had been deferred from the July meeting and had inadvertently been omitted from the notice for the August meeting:

"That the Health Board, with the objective of assuming its proper role in the planning, development and coordination of an integrated Health Service for the Community, should establish a Policy Committee to meet regularly in order to assist and advise the Board in formulating its overall policy objectives and plans for the development of the Health Services."

Speaking to the motion Dr. Behan said that he was proposing that a sub-committee be established to consider in greater depth and detail matters of policy relating to the Board's activities and to advise the Board in these matters. Mr. Nolan told members that this proposal was in line with 187 7/8/1980

the approach being pursued by Or. Behan arising from the view that the Health Board is not being consulted sufficiently or being given the opportunity to consider adequately matters which affect the Board's policy and activity. This committee will give members an opportunity to be more involved in policy making. The motion was seconded by Cllr. Mrs. Glenn and agreed. Selection of the committee was deferred to the next meeting.

131/80 CORRESPONDENCE

The Secretary read the following letter which had been received in the Board's offices on 7th August 1980 and had been circulated to the members at the meeting.

"A Chara

I am directed by the Minister for Health to refer to your letter of 14th July, 1980 regarding the appointment of members of the Tallaght Hospital Board.

I am to point out that article 5 (1) of the Tallaght Hospital Board (Establishment Order) 1980 provides, inter alia, for the appointment of two members from a panel of four persons nominated by the Eastern Health Board. As the health board has not nominated the specified panel of representatives the Minister is not in a position to proceed with the appointment of representatives of the health board to the Tallaght Hospital Board.

The Minister is qpncerned with the delay in finalising the membership of the Tallaght Hospital Board and I am to request that the health board submit a panel of representatives as specified in the Establishment Order.

In the meantime, the Minister proposes to proceed with the appointment of the other members of the hospital board, that is, the representatives of the other nominating bodies and the five other members as specified in the order.

Mise ie meas

S. Hensey."

It was agreed that as the notice was too short to consider this matter it would be deferred to the next meeting and the De partment should be informed accordingly.

The following correspondence which had been circulated with the notice and agenda for the meeting was noted:— 188

(a) Letter 20/6/1980 from Department of Health regarding the role of the Medical Co-Ordinator in the Major Accident Plan for Dublin and submission of the Board's views in that regard.

(b) Memo 2/7/1980 and attached correspondence from Mr. Keyes, Programme Manager, in relation to a request from Dun Laoghaire Local (Health) Committee on a report on Drug Abuse.

(c) Letter 11/7/1980 from the Minister of State. Department of the Public Service advising that Health Boards would be brought within the remit of the Ombudsman.

(d) Letter 15/7/1980 from the Secretary, Beaumont Hospital Board, with which were submitted copies of Accounts of that Board for 1977, 1978 and 1979 together with a copy of the discussion document on the development of specialist services in Dublin hospitals.

(e) Letter 16/7/1980 from the Department of Health regarding the Mobility Allowance.

(f) Letter 22/7/1980 from the Department of Health regarding the review of the organisation of Community Care Services by Imbucon Ltd.

(g) Statutory Instrument No. 213/1980 enabling members of the staff of the National Rehabilitation Board to be members of that Board.

(h) Address by Dr. Michael Woods, Minister for Health at the Inaugural Meeting of the National Committee for the International Year of Disabled Persons on 11/7/1980.

(i) Memo 15/7/1980 from Mr. Lamb advising of a Bequest of £1,000 to the Hospital.

The following correspondence had been dispatched to members under separate cover from the notice and agenda for the meeting.

(a) Memo 1/8/1980 from the Secretary advising members of communcations from the Department of Health providing

(1) an allocation to allow An Grianan, Ballymun and Geraldstown House, Santry to open, and

(2) commissioning of a number of health centres, hostels and other units. 189 7/8/1980

(b) Letter 19/7/1980 from the Department of Health already referred to at the meeting turning down the Board's proposals regarding use of a Unit in St. Patrick's Home for young chronic sick.

The following correspondence was circulated to members at the meeting.

(a) Memo dated 23/7/1980 and other correspondence from Mr. McCullough, Acting Programme Manager, Special Hospital Care Programme, advising of the appointment of Professor Levi, Director of the Clinical Stress Research Laboratory in the Karolinska Hospital, Stockholm, to carry out an evaluation of the Psychosomatic and Health Care Unit at the St. James's Hospital Complex.

Mr. McCullough said that it had been a condition in the Department of Health's Approval of May 1977 to the Establishment of the Unit that an independent evaluation of the scheme be made after three years. He had been advised that Professor Levi was an eminent person in this field of medicine and was available to conduct an evaluation and the Department had approved of this proposal. Professor Levi would be available to meet the Committee if required.

Dr. Behan enquired as to how this assessor was selected and said he considered that such an arrangement should have been handled by the Medical and Allied Research Committee and not the Department of Health.

Dr. Behan was supported by Professor Doyle and Dr. Meade and after further discussion it was agreed that a meeting of the Medical and Allied Research Committee would be convened to consider the matter.

Regarding An Gria:ijn, Ballymun, Cllr. Mrs. Glenn said that a lot of work had gone into the report on Children Living and Sleeping Rough and that the Dublin Corporation was living up to its commitments in regard to an assessment centre there but she understood now that the Board was not planning to use the Centre as originally agreed. She said she would like a report on the matter to the next meeting and it was agreed that a report would be provided.

The meeting ended at 9.20 p.m. 191 4/9/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegorman, Dublin on Thursday 4th September, 1980 at 6 p.m.

PRESENT

Ald. B. Ahern Cllr F. Hynes Dr. J. Behan Dr. D. G. Kelly Cllr. D. Browne Cllr. T. Leonard T.D., Cllr. M. Carroll Dr. P. McCarthy Cllr. J. Connolly, P.C. Mr. M. Matthews Prof. J. S. Doyle Dr. A. Meade Cllr. B. J. Durkan Cllr. M. Freehill Ald. A. FitzGerald Cllr. E. Stagg Cllr. J. Sweeney Cllr. Mrs. Glenn Cllr. G. Timmins T.D. Cllr. A. Groome Cllr. Mrs. M. Waugh Cllr. T. Hand, P.C. Mr. K. Harrington Cllr. P. Hickey P.C.

APOLOGIES FROM Ms. N. Kearney and Dr. B. Sheehan

IN THE CHAIR Cllr. D. Browne, Chairman

OFFICERS IN A TTENDANCE Mr. F. Donohue Mr. P. J. Swords Mr. T. Keyes Mr. A. O'Brien Prof. B. O'Donnell Mr. J. Brennan Mr. R. Lamb Mr. C. O Murchadha Mr. J. Reynolds Mr. M. O'Connor Mr. J. Clarke Mr. M. Cummins Mr. J. Sadlier Miss E. Larkin Prof. I. Browne Mr. C. Mansfield Mr. J. Doyle Miss F. Heaney Miss A. Flanagan

131/80 CONDOLENCE

The Chairman informed the members that since the last meeting Miss Mary Carroll, sister of Cllr. M. Carroll, had died and the members joined in expressing their sympathy with Cllr. Carroll and stood in silence as a mark of respect. 192

132/80 CONFIRMATION OF MINUTES

On a proposal by Cllr. Freehill seconded by Cllr. Hickey the minutes were agreed and signed.

Matters Arising:

Arising from the Minutes Dr. Behan referred to the minute on Page 180 regarding the disposal of land at St. Brendan's Hospital to the Staff Sports Club and said he wished to make it clear that there was no division of views among the members on the question of the disposal of the land to the Club. Views only differed on the matter of the timing of the transfer.

Or. Behan referred to the transfer of the area at Garden Hill to St. James's Hospital and asked that the transfer should be related to the Board's determination to press the Minister for early approval to provision on the Brookfield site of a headquarters unit and an adequate Research and Development service for the Chief Psychiatrist as recorded on Pages 180/ 181 of the Minutes.

133/80 CHAIRMAN'S BUSINESS

The Chairman advised members that he had received letters of resignation from two members of the Board — Mr. H. Corrigan, F.P.S.I. and Cllr. J. Connolly. Mr. Corrigan had submitted his resignation on the basis of ill health, while Cllr. Connolly's resignation arose from a system of rotation of membership by nominees of the Dublin County Council. The Chairman expressing his regret at the resignations, paid a tribute to these members for the excellent service they had provided to the Board.

Mr. Donohue associated himself with the Chairman's remarks on behalf of the staff of the Board. Cllr. Connolly thanked the Chairman and members for their expressions of goodwill and said that while he was regretfully resigning membership of the Health Board he would continue to retain his interest through his membership of the local health committee and through his interest in the handicapped.

The Chairman asked that a letter be sent to Mr. Corrigan conveying the Board's good wishes.

Cllr. Glenn said that the Dublin Corporation acknowledged service rendered with a presentation scroll and proposed that the Board consider doing the same. Cllr. Hynes seconded this proposal and it was agreed that the matter would be examined. 193 4/9/1980

The Chairman drew members attention to the week-end of events planned by the Staff Sports Club (as circulated to members) and invited members to participate. 134/80 PROCEEDINGS OF VISITING COMMITTEES The Report of the following Visiting Committee having been circulated was dealt with as follows:

No. 2 Visiting Committee meeting held at Bru Chaoimhin on 20th August. 1980.

On l proposal by Cllr. Hynes seconded by Cllr. Hickey the report was noted.

135/80 TEMPORARY BORROWING

The following Report No. 45/1980 was submitted by the Chief Executive Officer:

"At meeting held on 5th June 1980 the Board consented to the temporary borrowing by way of overdraft up to an overall limit of £1.5 million during the quarter ending on 30th September 1980.

It is considered that similar overdraft accommodation will be required during the December quarter 1980.

Accordingly, I request that the Board consent to borrowing by way of overdraft during the three months to 31st December 1980 up to a maximum of £1.5 million."

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the report was adopted.

136/80 BUDGET ALLOCATION 1980

The following Report No. 46/1980 from the Chief Executive Officer was submitted:

'The revenue expenditure on health services to 31st July 1980 has been examined.

The following table summarises the situation at that date. 194

Expendi Proportio Variatio i ture to n of n % 31st Budget Variation July (Revised 1980 to include approved Salaries & £000 £000 £000 +2% Superannuation Non- 25.738 25.200 +538 ♦ pay Expenditure — 3.803 3.778 + 25 1 General Hospital Care 5j609 5.437 +172 % Special Hospital Care 11.351 10.571 +780 + 3% Community Care 1.051 1.048 + 3 ♦ 7% Central Services 875 875 - 7 -1% Engineering Services 1.063 1.072 Ambulance/Transport

Total Non-pay 23.752 22.779 ♦973 ♦ 4% Expenditure Total 49.490 47.979 +1.51 + 3% Expenditure 1

Pay Expenditure

In the light of expenditure to 31st July 1980 it appears that expenditure on salaries and superannuation in 1980 will exceed the budget provision (plus approved increases) by about £900,000. Measures have been taken to minimise expenditure by cutting down the number of annual and sick leave substitutes, but it is unlikely that these measures will be sufficient to eliminate the expected excess.

It should be realised that in addition to the above-mentioned £900,000 the pay allocation will need to be increased by £4,750,000 to cover wages increases to nurses and various other grades and by a further amount to cover awards not yet paid and costed. Non-Pay Expenditure General Hospitals Expenditure in this programme is running 1% over budget. Were it not for the economies exercised in the use of medicines, provisions, fuel and materials, the expenditure would have been much higher. Prices have already risen substantially in 1980, food costs rising by 10%, fuel costs by 39% and postage by 25%. It is likely that prices will rise further in the remaining months of the year.

It is clear therefore that, unless services are drastically curtailed, expenditure in this programme will exceed the budget provision. From the evidence at present available this excess will be at least £50,000. Special Hospital Care Programme Expenditure in this Programme is at present running 3% over budget. The over-expenditure is partly due to additional 195 4/9/1980 purchase of equipment, clothing and bedding and increased cost of cleaning during the industrial dispute involving the nursing staff. When these costs (£68,000) are deducted from the excess expenditure, the increase over the budget is about 1%, which is in line with the General Hospitals expenditure.

The same considerations apply to this programme as to the General Hospitals Programme. The excess expenditure for the year is now estimated at £200,000.

Community Care Programme; The over expenditure of £780,000 in the Community Care Programme is caused largely by increased costs of the General Medical Services schemes viz.

Refund Medicines Schemes 523,000 Long Term Illness Scheme 108,000 Appliances 105,000 746.000

The remaining £34,000 represents less than 0.5% of the Community Care Budget.

From present trends it appears that expenditure on this Programme will exceed the allocation by approximately £1,400,000. Other Services It is expected that expenditure on central services, engineering services and ambulance and transport services will be contained within the allocation. Income

On the Income side an excess of approximately £700,000 over the original estimate is forecast, due mainly to increased superannuation and patients' maintenance contributions. These arise as a result of large retrospective pay increases and Social Welfare pension increases. Summary In the light of the Board's expenditure to 31st July 1980 it is clear that the net expenditure will exceed the approved allocation as adjusted to provide for approved increases (salaries and superannuation revisions, increased capitation rates and allowances, etc). The excess net expenditure is estimated as follows: 196

Pay expenditure 900,000 General Hospital Programme 50,000 Special Hospital Programme 200,000 Community Care Programme 1,400,000 2,550.000 Less Income Increase 700,000

Estimated increase in net expenditure £1,850,000

Mr. Donohue explained that the figures contained in the report represented expenditure to the 31st July 1980. The Department of Health were being kept informed of the situation and the Board was continuing to effect all possible economies without cutting back on any services.

He suggested that the report be noted and said he would report further to the next meeting on the basis of the expenditure to the end of August 1980 which would give a clearer indication of the Board's expenditure. On a proposal by Cllr. Hickey seconded by Cllr. Sweeney the Report was noted.

137/80 CAPITAL PROGRAMME - PROJECTS COMMENCED AND PROPOSED

The following report of the Capital Programme Committee following their meeting held on Friday 29th August 1980 was submitted:—

"MEETING OF CAPITAL PROGRAMME COMMITTEE HELD IN THE BOARDROOM. ST. BRENDAN'S HOSPITAL, ON FRIDAY 29TH AUGUST. 1980 AT 3.P.M.

Committee Cllr. M. Carroll Cllr. Mrs. A. Glenn Members Cllr. F. Hynes Mr. F. Donohue Present: Dr. J. Behan Mr. T. Keyes Mr. M. Cummins Officers Mr. J. Sadlier Mr. T. Leonard in Mr. J. Clarke Mr. J. Minogue Attendance: Mr. P. J. Swords Mr. K. Ward Mr. J. Doyle

Apologies Cllr. D. Browne Mr. J. J. Nolan

On a proposal by Cllr. Hynes it was agreed that Cllr. Carroll would act as Chairman. 197 4/9/1980

A vote of sympathy was passed with Cllr. Carroll on the recent death of his sister.

COMMITTEE'S RECOMMENDATIONS TO THE BOARD

1. Disposal of Land: (a) that reports No. 29/1980 and 37/1980 already sub mitted to the Board and dealing with the possible financing of Capital Projects from the sale of surplus land be noted and kept under review in light of prevailing priorities and available finances;

(b) that further reports be submitted on —

(i) the long term proposals for St. Clare's Home and land requirements there and

(ii) land to be retained at St. Patrick's Home — it was noted that Dublin County Council was interested in acquiring some of the site;

(d) that the Board agree in principle to the provision of a site at St. Clare's Home for the development of mental handicap services by St. Michael's House — the actual size of the site to be determined by reference to sketch plans etc. when available.

It was noted that the Board has sought representation on the governing body of St. Michael's House;

(e) that the Vocational Education Committee and the C.B.S. be informed that the Board cannot at this time accede to their request for sites at St. Brendan's Hospital for school developments;

(f) that a further report be submitted on long-term proposals for the use of lands at St. Brendan's Hospital.

2. Acquisition of Premises: That the following premises be acquired:—

(a) Ballyraine House, Arklow with about 8 acres for the sum of £102,000 for use as a Mental Handicap residential centre. The premises will accommodate approximately 15 persons and will be run by the Sunbeam House Training Centre.

(b) Grove House, Celbridge on a site of 2% acres to be used as a hostel (15 residents) and rehabilitation centre. Purchase price of £85,000 has been agreed. 198

3. Capital Programme: Report No. 18/1980 containing a schedule of all major capital works in the Board's programme had been noted by the Board in May 1980 and referred to the Capital Programme Committee. The Report was reviewed in light of an up-to-date commentary by the Technical Services Officer (copy attached) on progress on projects

(a) completed since May 1980; (b) under construction; (c) for which tenders have been sought; (d) at planning stage;

While satisfaction was expressed with progress achieved on the various stages of projects within the Board's area of authority it was noted —

(i) that a number of projects at tender and planning stages had been with the Department of Health, awaiting a decision to proceed, for up to 8 months

(ii) that a sum of only £260,000 had been allocated to the Board for new starts in 1980 and that this had been assigned by the Department of Health for —

Upgrading of facilities, St. Brendan's Hospital £150,000 Upgrading of facilities, St. Ita's Hospital £ 50,000 Grants to Voluntary Agencies £ 60,000

As a consequence no progress had been made on many other projects for which approval to proceed had been sought

(iii) that it was now necessary to seek the Department's approval to each seage of planning and await specific sanction before proceeding to a further stage.

The Committee requested that details be extracted of dates of submissions to the Department and approvals received concerning the various projects under review.

It was decided to recommend that the Board request the Minister for Health

(a) to reconsider his allocation of funds for Capital projects to enable the Board to proceed with the many urgent new projects and maintenance and upgrading schemes now halted at various stages and 199 4/9/1980

(b) to devise a coherent, balanced and equitable policy for the allocation of funds to the Board and to voluntary hospitals and other organisations providing health services.

Reference was made to the special needs of the Dublin area and Kildare and Wicklow arising from population growth and the emergence of new towns. 4. Office Accommodation: It was noted that outline planning permission had been received for a new Office Block on a site at St. Brendan's Hospital. However, a decision was still awaited from the Department on the draft Brief submitted on 23rd July, 1979.

The Committee was strongly of the view that a purpose-built premises as proposed was the only satisfactory and most economic solution to the problem. It was agreed that the matter should be taken up with the Minister with a view to obtaining an early approval to proceed with the project or failing this to negotiate for the leasing of suitable premises. The urgency of this matter was emphasised having regard to the acute problems of existing office accommodation and the repeated requests from the St. James's Board for the early vacation of the site at James's Street.

EASTERN HEALTH BOARD

CAPITAL PROGRAMME COMMITTEE

Progress Report - 28 August, 1980

Projects completed — since May, 1980 Programme Project Current Position

General Hospital Lifts — Bru Chaoimhin in operation

22 Bed unit - occupied Rathdrum

Special Hospital Improvements Units A and B — Si. Brendan's complete

Community Care Health Centre ready for — Finglas takeover by Board

28 August 1980 200

EASTERN HEALTH BOARD

Major Projects under construction Programme Project Current Position General Hospital Fire alarms — work commenced Legion of Mary May 1980. Progress satisfactory.

Electrical services — work commenced Wicklow Hospital July, 1980.

Special Hospital 1980 allocation- a number of up- £150.000 grading works in St. Brendan's progress.

1980 allocation Tenders for re- £50.000 St. Ita's placement steam boiler received.

Acquisition of Reconstruction of Psychiatric hostel Woodville House almost complete.

Reconstruction of Phase 1 of Male Male Chronic Block Chronic completed. and hostels for Hostels to be Mentally Handi- completed Sept. capped — St. Ita's 1980. Community Care Comm. Care H.Q. Expected com- Coolock pletion Sept. 1980.

Health Centre - Re-started June Shillelagh 1980. Expected date of completion -Nov. 1980.

EASTERN HEALTH BOARD

Projects for which tenders have been

sought Programme Project Current position General Hospital

Special Hospital Youth Development Report on tenders Centre C.M.H. submitted to Dept. Dundrum. of Health in June 1980 201 4/9/1980

EASTERN HEALTH BOARD Programme Project Current position Boiler house Awaiting approval to centralisation acceptance of ten- — St. Brendan's ders from Dept. of Health. Submitted Feb.1980. Upgrading of Tender formalities Laundry - St. Ita's being finalised

Community Care Health Centre — Tenders for the com- Blanchardsttiwn pletion of work submitted to Dept. of Health for approval Feb.1980

Health Centre and Recommendation re Comm. Care. H.Q. acceptance of lowest Wicklow tender re-submitted to Dept. of Health August, 1980.

Health Centre — Sanction to accep- Kilbarrack tance of tenders sought from Dept. of Health Aug.'80.

Health Centre - Tenders obtained. Knockananna Discussions continuing re site.

EASTERN HEALTH BOARD

Projects at Planning Stage Programme Project Current Position GeneralHospital Fire Precautions — Inspection carried St. Brigid's out by Chief Fire Officer Dublin Cor- poration. Board awaiting his approval to the scheme submitted.

Fire Precautions — Approval to scheme St. Mary's (Stage 1) proposed, received from Chief Fire Officer. Meeting arranged with Consultant. 202

EASTERN HEALTH BOARD

Projects at Planning Stage

Programme Project Current Position Isolation Unit — Working drawings Cherry Orchard and cost plan submitted to Dept. of Health June '80.

Upgrading of Scheme with Dept. Mechanical of Health for ap- services St. proval. Continuing Columcille's correspondence and discussions.

Stage 3 Sketch and development St. development plans Vincent's Athy with Dept. of Health for approval June, 1980. Special Hospital Fire Precautions Schematic layout — St. Lomans of rewiring and fire alarm proposals with Dept. of Health for approval to prepare tender documents July. 1980. Extension to Sketch plans sub- Vergemount mitted to Dept. of Psychiatric Health for clinic approval June'80.

Day Hospital — Sketch and Cost Finglas Plans suDmitted to Dept. of Health for approval Dec. 1979.

Day Hospital — Site in Cherry Or- St. Lomans chard Hospital being investigated

Extension to Al- Sketch plans etc. coholic Unit — being finalised. St. Dymphna's

Upgrading Units V Design Team pre- and W St. Ita's paring sketch plans for submission to Dept. of Health. Admission Unit (20 Planning Bed) Newcastle permission Hospital received on appeal. Project to be considered with Archi- tect in light of decision. 203 4/9/1980

EASTERN HEALTH BOARD

Projects at Planning Stage Programme Project Current Position

Child Psychiatric Brief being Unit Cherry Orchard finalised by Project Team 200 Bed Mental Revised brief sub- Handicap Unit — mitted to Dept. of St. Columcille's Health Feb. 1980

Maintenance work- Discussions con- shop St. Brendan's tinuing with Group of Unions re acceptance of new workshop.

Fire Precautions Tender documents and upgrading Mt. being finalised Pleasant Hostel

Day Hospital — Schedule of accom- Clontarf modation being reviewed.

Community Care Health Centre and Sketch plans sub- Comm. Care H.Q. mitted to Dept. of Naas Health for approval June'80.

Enlarged Comm. Schedule of accom- Care H.Q. Dun modation finalised Laoire following investi- gations by Architect sent to Dept. of Health July. 1980

Health Centre - Sketch and cost Athy plans submitted to Dept. of Health on Jan. 1980. Approval re site awaited following most recent submission July 1980.

Health Centre - Discussions con- Swords tinuing re acquisition of a site.

Harolds Cross Oral hearing held on Welfare Home Planning appeal June *80. Decision awaited. 204

EASTERN HEALTH BOARD

Projects at Planning Stage

Programme Project Current Position

Health Centre & Full tender docu Day Nursery - ments including Ballybrack Bill of Quantities to be completed by Design Team in 4 weeks.

Health Centre & Tender documents Day Nursery - submitted to Dept. Rowlagh of Health June 1980

Health Centre - Tender documents Blessington submitted to Dept. of Health June.1980

Health Centre - Architect preparing Leixlip contract documents

Health Centre - Planning in extension to Bride Progress" St.

Cllr. Groome said he was pleased to note that five of the temporary buildings at St. Ita's were in the course of being vacated and complimented all persons concerned.

Cllr. Stagg joined with Cllr. Groome in welcoming this decision and Mr. Matthews thanked the members for their appreciation of the efforts of the nursing staff in achieving the closure of these buildings. Mr. Keyes reported to mem bers that the female chronic block and the first phase of the male block harJ been completed and the 2nd phase of the latter was commencing. Work on the staff accommoda tion had also been completed, together with the new 'phone system and re-wiring. He paid a tribute to the Board and the Visiting Committee for the work the members had put into achieving these objectives. He said he could not speak too highly of the staff particularly the nursing staff for their efforts.

Dr. Behan said the meeting of the Capital Programme Committee had been very successful. However, he said that by comparison with the four projects completed, the long list of projects shown at the planning stage reflected the limitations imposed on the Board's development programme by the Department of Health through their financial control. 205 4/9/1980

He proposed that the Board write to the Minister asking for a discussion to seek the necessary capital for a proper development of the Board's services over all its programmes. He also proposed that the Board be given the dates for each stage of the planning of each individual project which would illustrate the length of time it takes to implement a project and where the delays arise. These proposals were seconded by Cllr. Carroll and agreed.

Cllr. Carroll thanked the officers for their help with this Committee. In relation to the disposal of land he said he considered the Board should work on a ten year rather than a five year programme. Cllr. Hynes and Cllr. Mrs. Glenn agreed with this view, Cllr. Hynes suggesting that statistics on how the Board's services had developed, over the past number of years should be considered together with future planning while Mrs. Glenn said that in planning for the utilisation of its land the Board must consider health requirements in conjunction with all other community needs.

On a proposal by Cllr. Carroll seconded by Cllr. Glenn, the Report was adopted. It was agreed that the Capital Prog ramme should be included on the Agenda for the monthly meetings of the Board until further notice.

138/80 NOMINATION OF MEMBERS FOR TALLAGHT HOSPITAL BOARD TO REPRESENT EASTERN HEALTH BOARD

The letter of 6th August 1980 from ths Department of Health, circulated to members, had been quoted as correspondence in the Minutes of the August meeting of the Board, when it had been deferred for consideration to the present meeting. Following discussion Cllr. Connolly proposed that the Board nominate a panel of four members to the Minister for Health from which the Minister would select two representatives cf the Health Board on the Hospital Boord. The motion was seconded by Cllr. Hickey and put to the meeting and carried, the following being the voting —

FOR: Ald. Ahem Cllr. Mrs. Glenn Mr. M. Matthews (23) Dr. Behan Cllr. Groome Dr. Meade Cllr. Browne Mr. Harrington Cllr. Freehill Cllr. Connolly Cllr. Hickey Cllr. Stagg Prof. Doyle Dr. Kelly Cilr. Sweeney Cllr. Durkan Cllr. T. Leonard Cllr. Timmins Ald. FitzGerald Dr. McCarthy Cllr. Mrs. Waugh 206

AGAINST: (3) Cllr. Carroll, Cllr. T. Hand, Cllr. F. Hynes

Nominations were then requested. Dr.O'Donnell was proposed by Cllr. Mrs. Glenn and seconded by Dr. Meade but Dr. O'Oonnell withdrew his nomination.

Mr. J. J. Nolan was proposed by Prof. Ooyle and seconded by Cllr. Hynes.

Mr. D. Kelly was proposed by Cllr. Durkan and seconded by Ald. FitzGerald.

Dr. J. Walker was proposed by Mr. Harrington and seconded by Dr. Behan.

Cllr. Hickey was proposed by Cllr. Sweeney and seconded by Cllr. Groome.

Dr. McCarthy was proposed by Cllr. Glenn and Cllr. Connolly was proposed by Cllr. Browne but each withdrew their nomination.

The four names that remained before the meeting were agreed by the members as the panel to be forwarded to the Minister.

Dr. Behan proposed that the Board seek another meeting with the Minister for Health to ensure a full and proper role for the Health Board on the management board of Tallaght Hospital when this is set up, and asked that this meeting be sought straight away. Seconding this motion Cllr. Carroll asked that the question of the Board representation on Leopardstown Park Hospital Board be also considered. These proposals were agreed by the members, the nominations for the deputation to be made when a meeting has been arranged.

139/80 INTERNATIONAL YEAR OF DISABLED PERSONS SELECTION OF COMMITTEE

The following Report No. 44/1980 from the Chief Executive Officer was submitted:—

"INTERNATIONAL YEAR OF DISABLED PERSONS -1981

At the meeting of the Board held on 3rd July 1980 the following motion was adopted on a proposal by Cllr. Freehill seconded by Cllr. Hynes:— 207 4/9/1980

'That a Committee be established to examine and present a short-term and long-term programme for the 1981 International Year of Disabled Persons."

Following discussion at the August meeting it was agreed that a report be prepared identifying the areas to be examined by the Committee and that the Committee would be selected at the September meeting.

Suggested Areas for Examination by Committee

Prevention Prophylaxis — Prevention of disabilities of pre-natal or natal origin or in early childhood — Road Safety — Occupational Safety — Working conditions. Early Identification Birth Notification — Handicap Report — Home Visits — Counselling. Register of Mental Handicap — Register of Physical Handicap — Liaison with Maternity Hospitals. Counselling Mental and Physical Handicap — Role of Voluntary Bodies — Role of Public Health Nurse. Support House adaptation (Local Authority Grants) — Aids — Occupational Therapy — Physiotherapy Finance — Provision of adequate and realistic Allowances — Publicity. Education Primary Schools — Special Schools — Secondary or Technical — Third Level — Training Centres. Access to and special furniture in educational establishments. (All matters for Department of Education but Board would have a function in the provision of medical and nursing assistance.) — School Health Service; Evaluation of results in early identification of handicap. Rehabilitation Training Centres — Evaluation of Services — AnCo — Community Workshops — Special Allowances — Day Centres for activation of permanently handicapped. Transport Accessibility to Public Transport vehicles and systems — Voluntary Organisations — Co-ordination. 208

Placement and Employment National Rehabilitation Board services — 3% quota — State — Public Bodies — Voluntary Organisations — Private Em ployers — Working environment. Accommodation Hostels — Housing — Avoidance of segregated housing — Integration not Isolation. Publicity. Renewal of Immunisations Campaign — Education of Public — Involvement of Health Education Bureau. Information Household Surveys to determine extent of problem — Information services for disabled — National Social Services Council.

Personnel Training of professional and technical staffs — Recruitment — Involvement of Health Board in training Professional Staffs where necessary in co-operation with Professional Bodies. Recreation Sports — Cultural Activities — Holiday Camps and other holidays — Holiday relief for relatives of those living at home — Provision of skilled supervision. Accessibility Public Buildings and places of entertainment (Disabled — Deaf — Blind etc.) — Signposting — Public Address Systems. Integration Inclusion of representative on bodies, committees, delegations etc. on matters concerning disabled. Planning Adoption of long-term programme — Prevention and rehabilitation services to be part of national planning process — Development of abilities of disabled — Removal of any restrictions or discrimination limiting freedom of disabled to participate fully in society. Institutional Care Provision of sufficient beds (a) for Physically Handicapped (b) for Mentally Handicapped — Separate divisions for young chronic handicapped and elderly — Provision by institutions of facilities for education, recreation, cultural stimulation 209 4/9/1980

etc. of young persons and others — Allowances for handicapped in institutions - Travel facilities — Psychiatric handicapped: provision of half-way houses — Evaluation of services."

Mr. Donohue thanked Cllr. Freehill for her assistance in the preparation of the report. Cllr. Freehill said that the report submitted gave general headings which would be fleshed out by the Committee. The Committee must aim at educating the able- bodied to assist the disabled to live full meaningful lives. The Committee should set out the needs of the Board to put before the Minister for Health. Ald. Fitz-Gerald, welcoming the establishment of the Committee, said that it was incumbent on the Health Board as the premier body in the country to take a lead in this area and he suggested and hoped that the first meeting of the Committee would be arranged for an early date.

On a proposal by Cllr. Freehill seconded by Ald. Fitz-Gerald the following motion was adopted.

'That Committee of 7 be established and that members of the Board be invited to make submissions."

Mr. Donohue said that officers of the Board have already been meeting together and with organisations dealing with handicapped and putting together proposals. The following 7 members were selected to comprise the Committee.

Cllr. Freehill Ald. FitzGerald Cllr. Carroll Cllr. Hickey Cllr. Hynes Dr. McCarthy Cllr. Groome

It was agreed that the members would arrange the first meeting among themselves.

140/80 REGULATIONS MADE UNDER FAMILY PLANNING ACT 1980

Mr. Donohue told the members that the Regulations made under the Act had been introduced and that the commencement date was 1st November. However, no Circular had issued from the Department explaining such matters as who would be entitled, whether the service would be free and to whom and who would remunerate general practitioners providing the service, what the rate or fees would be etc. He said that talks were taking place between the Chief Executive Officers and the Department of Health and he would have no information on the answers to these questions until after the meeting arranged for next week with the Minister. On a proposal by Cllr. Browne seconded by Ald. FitzGerald it was agreed to defer further discussion on this matter to a special meeting to be convened. 210

141/80 POLICY COMMITTEE - SELECTION OF COMMITTEE

On a proposal by Cllr. Hickey seconded by Cllr. Groome it was agreed to defer this matter.

142/80 ALLOCATION OF ACCOMMODATION AT DUNLAVIN HEALTH CENTRE

Mr. Donohue told the members that having heard the representations made and the discussion on this matter at the last meeting he had visited Dunlavin Health Centre. He considered the prudent thing to do was to maintain the status quo and let the general practitioner retain the accommodation he at present occupied and reallocate the dentist accommodation with the provision that the dentist have the exclusive use of one room only. On a proposal by Cllr. Mrs. Glenn seconded by Dr. Meade it was agreed that the accommodation be allocated as outlined by the Deputy Chief Executive Officer.

143/80 AN GRIANAN, BALLYMUN REPORT No. 47/1980

The following Report No. 47/1980 from the Chief Executive Officer was submitted:—

"USE OF AN GRIANAN, BALLYMUN

Arising out of the recommendation of the Joint Committee on CHILDREN SLEEPING OR LIVING ROUGH and the regular discussions between the Board, Dublin Corporation, Department of Health, the Garcia Siochana and other bodies, it was decided that there was need for a Reception/Assessment Centre for children found begging or living/sleeping rough. An Grianan, Albert College, Ballymun became available to the Corporation and following consultation was considered suitable, with adaptation, to cater for up to 10 small children.

The following staff would be required to operate the Reception/Assessment Centre as envisaged, to receive children on a 24 hour, 7 day week basis: Supervisor (resident) Deputy Supervisor 8 Child Care Staff 1 Cook 2 Cleaners Secretarial Staff 211 4/9/1980

Staff costs would be in the region of £65,000 per year, other costs would be in the region of £20,000 per year, a total of £85,000 per year approx. However, no funds were made available to the Board this year for the operation of new services and capital moneys were very limited. Consequently, the Board could not proceed as intended and informed the Corporation accordingly in May of this year and asked if the premises would be made available to the Board, in any event for use as a residential home of the normal type.

The Corporation's Community & Environment Department subsequently reported to An Coisde Cuspoiri Coiteann of the Corporation at its meeting of 28th July in the following terms:

At its meeting on the 17th December, 1979 An Coisde decided that the above premises be made available to the Eastern Health Board for the establishment of a reception/ assessment centre for children sleeping rough. This decision of An Coisde was approved by the City Council at its meeting on the 7th January, 1980. Tenders were then sought for the necessary repairs and adaptations to the premises. Before the tender for this work was accepted it was deemed prudent to ask the Eastern Health Board to confirm that it would be in a position to make (i) the agreed contribution towards the cost of this work and (ii) to finance the running of the centre.

On the 19th May, 1980 the Eastern Health Board replied stating:—

"that the financial situation of the Board could not permit the making of any contribution towards the capital cost of the project, in the current year.

If the Corporation decide to proceed without any financial contribution from us and makes the premises available the Board will set about establishing the residential centre for children. In order to do this we will have to use our existing resources in staff and finance and the project can not therefore be staffed or financed on the scale envisaged up to now."

The Chairman of the Eastern Health Board Alderman A. FitzGerald when acquainted of this, arranged through the Secretary, Department of Health for an immediate meeting of officials of the Corporation, the Eastern Health Board, the Department of Health and the Alderman. At a second meeting on the 16th June, 1980 (same persons present) officials of the Health Board and the Department stated that they considered that the position in relation to the proposal had changed since it was originally discussed. They outlined the position of the Board and the Department as follows:— 212

It was agreed at our meeting on 5 June 1980 that a note would be prepared by the Department, in consultation with the Eastern Health Board, outlining how the position regarding reception and assessment had changed since the joint decision taken by the Eastern Health Board and the Dublin Corporation in relation to the establishment of a reception/assessment centre. It was also agreed that the note would outline how the health board would now propose to use the premises.

The main changes which have taken place since February, 1979 might be summarised as follows:—

(i) the combination of a number of initiatives in relation to services for travelling children has considerably eased the problem in relation to such children sleeping rough and wandering abroad at night. These measures include the provision of an additional day centre, a night shelter, a night hostel, the development of far more detailed information on the children and their families and the strengthening of liaison arrangements between various agencies.

(ii) the provision of additional residential places, particularly short to medium stay places, has clearly been identified as a major priority in itself and an essential to the effective working of any organised assessment procedure.

(iii) the health board has further clarified the policy in relation to the care of children and is trying to provide a mixture of facilities, including residential care, in each of the eight community care areas in Dublin. It is also trying to provide additional facilities for emergency cases or. the north side of thfe city, particularly in relation to young children.

The Department and the Eastern Health Board are most anxious to avail of the Corporation's offer to make the Ballymun premises available. It is located in a situation where it can be of great use in providing a suitable combination of care for children both travelling children and those from the settled community. The Department or the health board does not suggest that all the emergency needs of the Dublin area could be met by the premises at "An Grianan" even if it were operated on the basis originally planned and it is not now being suggested that the need for further accommodation of an emergency and short-term nature no longer exists. 273 4/9/1980

&. It is the view of the Department and the health board that the most appropriate use of the premises at Ballymun, within the overall child care services of the health board, is as a short to medium stay facility for children up to about 12 years of age. Operated on this basis, it would be possible to take in some emergency cases on much the same basis as Madonna House and other centres do at present.

5. Under this arrangement children woud spend up to 6 months at "An Grianan" and would then be either returned to their own homes, placed in foster care or put in another home which will provide long-term care for them. During their stay there, the normal process of assessment which is part and parcel of all care would be carried out.

6. When the premises is available later this year, the Board would be in a position to appoint the staff necessary to provide the service outlined. If the premises are made available by the Corporation, sufficient revenue funds will be made available to the Board to enable them to provide a service. The health board will regard the making of a contribution towards the capital cost of the renovations as a priority in the allocation of its capital fund in 1981."

Having regard to the now proposed use of An Grianan by the health board this report is submitted to give An Coisde an opportunity of reconsidering its recommendations."

The Department of Health have now indicated that if the premises can be made available it can be treated as a new unit for which they approve a budget of £15.000 in 1980 (equivalent to £45,000 in a full year). This limited allocation would not permit the operation of the centre on the 24 hour, 7 day basis envisaged for a Reception Centre but would enable the operation of a residential care home there. As such, the home could of course receive children only during the hours when the limited staff would be available for this purpose. No capital funds have been made available to the Board.

Dublin Corporation have been again informed of the position. They have been asked again to make the premises available for the limited service outlined above. We are anxious to hear that the Corporation will agree to this course as soon as possible, so that the necessary steps can be taken to recruit staff."

A discussion followed regarding the type of child that would be accepted in the Centre and the expected length of 214

stay and other matters regarding the future use of the Centre. The members asked that more information be made available regarding these matters and on a proposal by Cllr. Mrs. Glenn seconded by Dr. Meade it was agreed that the persons concerned in the provision of this facility meet to seek collective agreement on the use of the Centre at An Grianan and that the Corporation officials concerned be asked to sit in on these talks.

144/80 APPLICATION FROM DR. MAURA O'DWYER 'MARJAN' STRADBROOK ROAD. EMPLOY A PARTNER - REPORT NO. 42/*980

The following Report No. 42/1980 from the Chief Executive Officer was submitted:—

"Dr. William N. Dillon, Belgrave Park, Chapelizod, Co. Dublin is participating in the Board's General Practitioner Service. He has a list of 1,320 eligible persons and his practice premises are at (1) Belgrove Park, Chapelizod and (2) Bally-fermot Health Centre, Dublin 10.

In his letter of the 6th June, 1980 he expressed his wish to employ a Partner.

In accordance with paragraph 21/22 of the circular letter 8/75 dated the 9th April, 1975 issued by the Department of Health, the Irish Medical Association and the Medical Union were asked for their observations on Doctor Dillon's request. The Irish Medical Association and the Medical Union have stated that they had no objection to Doctor Dillon's proposal.

I recommend, subject to the approval of the Board, that Doctor Dillon's request be approved and that a Partner for him be selected in accordance with the procedure laid down in paragraphs 21/22 of the Department's circular letter 8/75 dated 9th April, 1975.

The relevant extract from this letter is as follows:

"21. The creation of a position as partner, or as an additional member of a group practice, or as an assistant with a view to partnership for the purpose of the general medical service, will be subject to the approval of the Health Board. In considering any such proposal the Board shall have regard to the total practice of the applicant. Before giving approval the Board must be satisfied:

(a) that the creation of the position is preferable to the creation of an additional position which could be filled by open competition in the normal way; and 215 4/9/1980

(b) that the creation of the position will not result in the admission of a particular person into the general medical service while other equally well or better qualified persons are not given a reasonable chance to compete. Where the Chief Executive Officer proposes to seek the approval of the Board to the creation of a position as partner, or as an additional member of a group practice, or as an assistant with a view to partnership he shall, before doing so, consult the medical organisations.

22. Where a Health Board agrees to the creation of a partnership or an addition to a group practice or to the recruitment of an Assistant with a view to Partnership the position will be advertised in the normal way but the doctor or doctors involved or a nominee of the doctor or doctors involved in the proposed taking in of a partner, or additional member or assistant will be entitled to sit on the selection board. The selection board shall pay due regard to any objection of this representative to the giving of the post to a particular individual or individuals. If the Board considers it desirable it may not recommend any candidate for appointment."

On a proposal by Cllr. Hickey, seconded by Dr. Kelly the report was adopted.

145/80 APPLICATION FROM DR. MAURA O'DWYER 'MARJAN'STRADBROOK ROAD. BLACKROCK, TO TAKE ON AN ASSISTANT WITH A VIEW TO PARTNERSHIP REPORT NO. 43/1980

The following Report No. 43/1980 from the Chief Executive was submitted:

"Dr. Maura 0'Dwyer, Marjan, Stradbrook Road, Blackrock, Co. Dublin, is participating in the Board's General Practitioner Service and her centre of practice is at Stradbrook Road, Blackrock. In her letter of the 29th February, 1980, she expressed a wish to take on an Assistant with a view to Partnership. She has a large list of eligible persons.

In accordance with paragraph 21/22 of the circular letter 8/75 dated 9th April, 1975 issued by the Department of Health, the Irish Medical Association and the Medical Union were asked for their observations on Doctor O'Dwyer's request. In letters dated 14th May 1980 and 17th June, 1980, the Irish Medical Association and the Medical Union stated respectively that they had no objection to Doctor O'Dwyer's proposal. 216

I recommend that, subject to the approval of the Board, applications be invited in the usual manner and that an Assistant with a view to Partnership for Doctor O'Dwyer be selected in accordance with the procedure laid down in paragraphs 21/22 of the Department's circular letter 8/75 dated 9th April, 1975. The relevant extract from this letter is as follows:—

(a) that the creation of the position is preferable to the creation of an additional position which could be filled by open competition in the normal way; and

(b) that the creation of the position will not result in the admission of a particular person into the general medical service while other equally well or better qualified persons are not given r. reasonable chance to compete. Where the Chief Executive Officer proposes to seek the approval of the Board to the creation of a position as partner, or as an additional member of a group practice, or as an assistant with a view to partnership fie shall, before doing so, consult the medical organisations.

22. Where a Health Board agreed to the creation of a partnership or addition to a group practice or to the recruitment of an Assistant with a view to partnership the position will be advertised in the normal way but the doctor or doctors involved or a nominee of the doctor or doctors involved in the proposed taking in of a partner, or additional member or assistant will be entitled to sit on the selection board. The selection board shall pay due regard to any objection of this representative to the giving of the post to a particular individual or individuals. If the board considers it desirable it may not recommend any candidate for appointment."

On a proposal by Cllr. Hickey, seconded by Dr. Kelly the report was adopted.

146/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEE

Wicklow Local (Health) Committee meeting held on 18/7/1980 217 4/9/1980

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the minutes were noted.

Cllr. Sweeney drew the member’s attention to a proposal agreed at the Local (Health) Committee meeting regarding the Working Party established on the future of the hospital services in South County Dublin and Wicklow. Cllr. Sweeney proposed the same motion to the Board meeting, and the motion was seconded by Cllr. Timmins and agreed as follows:

"(a) the inquiry committee be enlarged by the addition of a number of members of the Wicklow Local Advisory Health Committee.

(b) the inquiry committee receive a deputation from Wicklow Local Advisory Health Committee."

147/80 NOTICES OF MOTION

As Dr. Behan was not present at this stage the motions tabled in his name were not moved.

The following motion was proposed by Cllr. Sweeney:—

'That this Board examine the ambulance service and transport of patients in the Board area in regard to the prolonged waiting time frequently encountered."

Speaking to the motion Cllr. Sweeney said that there was dissatisfaction in the Wicklow area about the length of time people were away from their homes when brought to outpatient clinics and hospitals. He suggested that a small committee should meet with the Ambulance Officer and Transport Officer to examine the problem.

The Chairman proposed that the three Wicklow members together with the necessary staff form such a committee and this was seconded by Cllr. Hynes and agreed.

148/80 CORRESPONDENCE

(a) The Secretary advised members that the Annual Cuspoir Walk was on September 1980.

(b) The Secretary read letter dated 22nd August 1980 from the Dept. of Health advising that the allowance for Chairman and for Vice-Chairman had been increased to £1,210 in the aggregate with effect from 1st January 1980. 218

149/80 OTHER BUSINESS

Mr. Keyes told members that the Minister had made a grant available to the Hanley Centre and had asked the Centre to accept one of the Board's nominees on the Board of Management of the Centre. On a proposal by Mr. Harrington seconded by Cllr. Sweeney it was agreed that Dr. B. Sheehan would be the Board's nominee.

Mr. Donohue told members that the National Social Service Council was holding a Conference on the Care of the Aged in Dublin on 13th and 14th September, 1980. He suggested that the Board should be represented at the Conference. On a proposal by Mr. Harrington seconded by Cllr. Hynes it was agreed that Cllr. Mrs. Glenn be nominated to attend the Conference.

Cllr. Mrs. Glenn referred to reports of the grant of £5,000 to the Rape Crisis Centre and said there were objections to this grant as it was felt that there was not enough information about the membership of this organisation and the purpose for which the money was being provided. Mr. Donohue said that similar representations had already been made to the Board and were being examined. This first grant was exploratory and its use would be monitored and he would keep the Board informed.

The meeting ended at 8.15 p.m.

CORRECT. F. J. Donohue Deputy Chief Executive Officer. 218 2/10/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegorman, Dublin on Thursday 2nd October, 1980 at 6 p.m.

PRESENT

Ald. B. Ahem, T.D.. Cllr. F. Hynes, Dr. J. O.Behan Ms. N. Kearney Cllr. L. Belton T.D., Dr. D. G. Kelly Cllr. O. Browne Dr. P. McCarthy Cllr. M. Carroll Sr. Columba McNamara Cllr. E. Doyle Mr. M. Matthews Prof. J. S. Doyle Dr. A. Meade Cllr. B. J. Durkan Dr. B. Powell Ald. A. FitzGerald Cllr. H. Reilly Cllr. Mrs. A. Glenn Cllr. J. Sweeney Cllr. A. Groome Cllr. G. Timmins T.D. Mr. K. Harrington Dr. J.Walker Cllr. P. Hickey P.C.

APOLOGIES RECEIVED FROM Dr. B. Sheehan, Cllr. E. Stagg and Cllr. Mrs. Waugh

IN THE CHAIR Cllr. Dan Browne, Chairman

OFFICERS IN A TTENDANCE Mr. J. J. Nolan Miss A. Flanagan Mr. F. Donohue Prof. I. Browne Mr. T. Keyes Mr. A. O'Brien Mr. J. Sadlier Mr. C. Mansfield Mr. P. I. Lyons Mr. C. Murphy Mr J. Clarke Mr. M. Cummins Mr. M. M. Hayden Mr. J. Leech Mr. F. McCullough Miss E. Larkin Mr. P. J. Swords Miss B. Kelly

HO/30 CHAIRMAN'S BUSINESS

The Chairman advised members that since the last meeting Cllr J. J. Sheehan, father of Dr. Bartley Sheehan, had died. The members stood in silence as a mark of respect to the deceased.

The Chairman advised the members that Mr. Reynolds, Finance Officer, was ill and members asked that their good wishes for his speedy recovery be conveyed to him. 219

The Chairman welcomed Cllr. H. Reilly who had been appointed to the Board by the Dublin County Council in succession to Cllr. J. Connolly.

151/80 CONFIRMATION OF MINUTES

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the Minutes of Meeting held on 4th September 1980 were agreed and signed.

Matters Arising:

Mr. Harrington drew attention to the heading on item 144/80 referring to the employment of a partner in the general practitioner service. The heading should read "Dr. Dillon, Belgrove Park, Chapelizod, Co. Dublin" as referred to in the body of the report.

Mr. Kelly asked that the nomination for the Tallaght Hospital Board listed at item 138/80 be altered to read "Cllr. Durkan was proposed by Mr. Kelly and seconded by Ald. FitzGerald". The alterations were accepted.

152/80PROCEEDINGS OF VISITING COMMITTEES

The Report of the following Visiting Committees having been circulated were dealt with as follows:

(a) No. 1 Visiting Committee meeting held at Newcastle Hospital on 21/8/80

On a proposal by Cllr. Sweeney seconded by Cllr. Timmins the report was noted.

In reply to Cllr. Sweeney Mr. Keyes agreed that there was overcrowding at the hospital'and said that the 20 bed unit was now being proceeded with. Cllr. Sweeney said that there must be an effort made to improve maintenance at the hospital as its condition was deteriorating. He also said that while an appointment of Consulting Psychiatrist was being refused by Comhairle na n-Ospideal on population grounds An Comhairle should take into account the spread of the area and the travel necessary to cover it which would justify an additional appointment. Mr. Keyes said that An Comhairle worked on guidelines that were countrywide and were not prepared to sanction an extra appointment at present. He proposed to review the situation in a year's time.

Cllr. Hynes also referred to the maintenance problem and said that the Board's requirements should be put before the Minister. Mr. Sadfier said that the day to day maintenance and routine work required to keep the Board's premises in 220 2/10/1980

good order would need an expenditure of 4% million to 5 million pounds per annum and unless such money became available the dilapidated state of the buildings would continue and worsen.

(b) No. 1 Visiting Committee meeting held at St. Coium- cille's Hospital on 17/9/1980.

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the report was noted.

In reply to Cllr. Sweeney Mr. Nolan said that all hospitals had at present reasonably adequate oil supplies and the situation was being kept under daily review.

On a proposal by Cllr. Hynes seconded by Mr. Harrington the report was noted.

The Chairman asked Mr. Keyes to comment on (1) the type of patients being admitted to Dundrum and the earlier request by the Board for a deputation to meet the Ministers for Health and Justice on this matter and (2) the position in relation to the drug unit following the introduction of the Misuse of Drugs Bill and the need for a "designated centre".

Mr. Keyes said that the meeting asked for had not yet been arranged and he was following this up. At the suggestion of Ald. FitzGerald it was agreed that the Chairman would approach the Ministers directly in this matter.

In regard to "designated centre" Mr. Keyes said that this was the Dundrum Hospital and he considered that the drug unit should be re-opened and he would put proposals to the Board later. Regarding the Youth Development Centre Mr. Keyes said that the Tenders were with the Minister for a considerable time but that the project was not considered among the highest priorities of the Board at present.

Mr. Matthews asked that congratulations be conveyed to the staff involved in the provision of the new dining hail at thehospitei.

(d) No. 3 Visiting Committee meeting held at St. Vincent's. Amy, on 27/8/80

On a proposal by Cllr. Groome seconded by Dr. McCarthy the report was noted.

(e) No. 4 Visiting Committee meeting held at Mount Pleasant Hostel on 27/8/80 221

On a proposal by Ald. FitzGerald and seconded by Mr. Harrington the report was noted.

(f) Community Care Visiting Committee meeting held in Area 2 on 15/7/1980

On a proposal by Cllr. Hynes and seconded by Cllr. Mrs. Glenn the report was noted.

Mr. Donohue advised members that at a Community Care Visiting Committee meeting held in Wicklow on 23/9/80 the current position regarding the operation of the Family Planning Act had been discussed. The following report of that discussion was read and noted.

"HEALTH (FAMILY PLANNING) ACT 1979

DISCUSSION AT COMMUNITY CARE VISITING COMMITTEE MEETING IN WICKLOW ON 23rd SEPTEMBER, 1980.

Mr. Donohue referred to the discussion at the Board's September meeting when it had been decided to defer this matter to a special meeting to be convened. While the Department of Health had indicated that further information would issue on the operation of the new Act this was still awaited. He had placed the item on the Agenda for this meeting of a Committee of the whole Board in anticipation of the information becoming available. However, it had not yet come to hand.

The members had already received copies of the Regulations and statements issued by the Minister on the new service which was due to commence on 1st November, 1980. These had indicated that the Family Planning service would include information, instruction, advice or consultation on family planning, contraception or contraceptives; that it would be provided by the Health Board or by another body or person and that, in general, it was envisaged that the family doctor would provide such services. Other bodies offering a service involving the use of contraceptives would require the consent of the Minister for Health. The Health Board would have no function in the supply of contraceptives.

Members expressed the view that no useful discussion could take place in the absence of further information from the Department of Health. There was general agreement that the Health Board should not take steps to set up clinics until the picture became clearer on matters such as costings, financing, staffing requirements, entitlements and charges, if any, as well as the role of general practitioners and the extent to which they and voluntary bodies, including those yet 222 2/10/1980 to be approved by the Minister, would provide a service appropriate and adequate to meet needs in the area."

153/80 DEVELOPMENT OF NAAS HOSPITAL

The following Report No. 48/1980 from the Chief Executive Officer was submitted:

"When Naas Hospital was transferred to the Board in April 1971, it was found that there were serious inadequacies in many areas and in particular the access to the wards on the 1st and 2nd floor levels. Despite the fact that the Hospital was providing accommodation for 95 patients, the kitchen facilities were primitive and a tribute must be paid to the staff who worked for so many years in such over-crowded and inadequate accommodation. There was one time expired X-Ray machine and an absence of automatic processing and other ancillary equipment. As the X-Ray plant had reached the end of its useful life it was subject to frequent breakdowns resulting in inconvenience to patients and additional expense in providing alternate arrangements. The residential accommodation available for medical, nursing and other staffs was of minimal proportions and poor quality.

One of the first projects dealt with was the provision of lifts, finance was obtained from the Department of Health for this work after considerable and patient negotiations particularly since the future role of the hospital had not been determined at that stage. The Board also secured approval from the Department to the purchase of six houses on the housing scheme adjacent to the Hospital for staff accommodation. Over a period of almost three years and while maintaining the services at the Hospital, the X-Ray Department has been enlarged and is now equipped with two new x-ray machines and ancillary equipment of the most advanced type capable of dealing with practically all radiological procedures. The kitchen and staff dining areas are now housed in a new building, which has been designed and sited with a view to future extensions to the Hospital. An extended Coronary Care/Intensive Care Unit has been developed in the existing ward areas and is now fully operational. Piped oxygen has been supplied to the wards.

Levels of staff in a number of areas have been gradually improved on the basis of continuous representation to the Department of Health.

During the early part of September, there were a number of telephone discussions between the Board, Assistant Secretary, Department of Health and the Chief Officer, Comhairle na nOspideal. Trie Department indicated that the Minister was prepared to designate Naas as a General Hospital and the 223

Board was asked to consider with Comhairle na nOspideal and the Meath/Adelaide Hospitals linked appointments at consultant level. The Boards of the Meath/Adelaide Hospitals have accepted the principle of linked appointments for Naas. The proposal to designate Naas as a General Hospital with linked appointments has been endorsed in principle by the Kildare Local Health Committee and the Hospital Visiting Committee. In this regard a copy of the Report of a meeting of No. 3 Visiting Committee at Naas on 24th September, 1980 is attached. This Report sets out in detail the advantages which will arise at Naas on the designation of the Hospital and the making of appointments at consultant level to meet the growing demands on the hospital from an expanding community.

While a preliminary examination of the potential development of the hospital has been made by the Architect and has indicated a possible bed complement of 200, it is proposed to examine the matter in more detail and to have available to the Board a Report at the January 1981 meeting. This Report will set out in more detail the ultimate development of the hospital to provide for the immediate needs, which include new theatre facilities, accommodation for staff changing and for the hospital administration as well as accommodation for accident and emergency, physiotherapy and extended out-patient facilities. Additional beds are required — for surgery, assessment, re-habiiitation and long- stay.

The proposed staffing structure at consultant level will provide for two posts each of Surgeon, Physician, Anaesthetist and Radiologist with additional consultant staff on sessional basis for specialties as the need arises. One of the physicians would have a special responsibility for care of the aged in Kildare and West Wicklow.

I recommend that the Board endorse the proposal to designate Naas as a General Hospital and that they also accept the principle of linked appointments. It is also recommended that the Board approve of the creation of the additional posts involved viz: Surgeon, Physician (Geriatric Medicine), Anaesthetist and two posts of Radiologist.

The acceptance of these recommendations will enable the Board to proceed as quickly as possible with the appointment of an adequate complement of consultant and junior medical staff and to prepare a programme to cover the immediate and the longer term needs of the Hospital to meet the present level of demand and the increasing demand which is anticipated with the expanding level of population."

Cllr. Groome proposed that the report be adopted and said he welcomed this report and asked that his appreciation of the work put in by Mr. Nolan and Mr. Swords and the staff 224 2/10/1980

over the years be recorded. Seconding the motion Cllr. Durkan supported Cllr. Groome's remarks and also congratulated the officers concerned. He said he was pleased that a declaration of intent had now been made for the development of Naas as a full acute hospital. Cllr. Hickey and Cllr. Carroll endorsed the views expressed by the other members and said it was due primarily to the efforts of all concerned that this matter had been brought to its present stage.

154/80 BUDGET ALLOCATION 1980

Report No. 49/1980 from the Chief Executive Officer was submitted, derails from which as adjusted in summary form are set out hereunder, showing the anticipated outcome of the year's work in terms of income and expenditure for each programme viz..

Expenditure Proportio Variation Per- to 31st n of centage August 1980 Budget Variation (Revised to include approved increases) £000 £000 £000

General Hospital 12,333 11,900 +433 +3% Care Special Hospital Care 15.921 15.779 +142 +1%

Community Care 20.295 19.212 +1083 +5%

Central Services 4.265 4.074 +191 +4%

Engineering Services 2.300 2.223 +77 +3%

1.861 1.831 +30 +2% Ambulance/Transpor 56,975 55.019 +1956 +4%

In the light of expenditure to 31st August 1980 it appears that expenditure on salaries and superannuation in 1980 will exceed the budget provision. Measures have been taken to minimise expenditure by cutting down the number of annual and sick leave substitutes, but these measures may not be sufficient to eliminate the expected excess.

It should be realised that the pay allocation will need to be increased by over £4 million to cover wages increases to nurses and various other grades and by a further amount to cover awards not yet paid and costed. 225

Were it not for the economies exercised in the use of medicines, provisions, fuel and materials, the expenditure would have been much higher. Prices have already risen substantially in 1960, food costs rising by 11%, fuel costs by 39% and postage by 25%. It is likely that prices will rise further in the remaining months of the year.

In the case of the Special Hospital Programme some over- expenditure is partly due to additional purchase of equipment, clothing and bedding and increase I cost of cleaning during the industrial dispute involving the nursing staff.

Over expenditure in the Community Care Programme is mainly caused by increased costs of the General Medical Services schemes.

Expenditure on central services, engineering services, and ambulance and transport services will be above budget, because of increase in a variety of items, including postage, phones and travel costs.

On the income side an excess of approximately £1 million over the original estimate is hoped for, due mainly to increased superannuation and patients' maintenance contributions. These arise as a result of large retrospective pay increases and Social Welfare pension increases. 8 MONTHS TO 31 st AUGUST 1980 4 MONTHS TO 31st DECEMBER 1980

PROGRAMME Expenditure Proportion of Variation Expenditure Proportion of Variation £000 Budget £000 £000 £000 Budget £000 £000 General Hospital 12,333 11,900 433 7,000 6,229 771 Specialist Hospitals 15,921 15,779 142 8,610 8,291 319 Community Care Central 20,295 19,212 1,083 10,903 10,466 437 Services Engineering 4,265 4,074 191 2,610 2,445 165 Services 2,300 2,223 77 1,187 1,101 86 54 Ambulance/Transport 1,861 1,831 30 919 865

Total Expenditure 56,975 55,019 1,956 31,229 29,397 1,832

Income 3,162 2,483 679 1,962 1,591 371

Net Expenditure 53,813 52,536 1,277 29,267 27,806 1,461

Totals for 12 Months to 83,080 80,342 2,738 31/12/1980

227

Mr. Nolan said that this report was updating the one submitted to the September meeting. He proposed writing to the Minister for Health indicating the excess of expenditure over allocation that would arise.

Cllr. Durkan said that there was a clanger of breakdown in services from reduction in staff. He proposed a deputation to the Minister to seek an extra allocation to keep services going. Alderman FitzGerald said it must be remembered that there was no minor capital allocation and a very small capital allocation this year. He was also concerned that delays in provision of services would arise through shortage of staff.

In reply Mr. Oonohue said that there were no serious cut backs in the services provided, but the Board was unable to expand its services and shortage of staff was certainly causing some delays in dealing with applications for services. On a proposal by Cllr. Durkan seconded by Cllr. Mrs. Glenn the report was adopted and it was agreed that a deputation would be sent to the Minister for Health seeking a sufficient allocation to enable the Board to continue to provide the full range of services for the rest of the year.

The following members were selected to accompany the Chairman on a deputation:

Ald. A. FitzGerald, Cllr. J. Sweeney and Cllr. Mrs. Glenn.

155/80 CAPITAL PROG RAMME - PROJECTS COMMENCED AND PROPOSED

Mr. Nolan said that in line with the Board's policy not to change the programme for capital expenditure except by agreement of the Board he was advising members that the management team had agreed that the first priority in the Community Care Programme now should be the completion of the Health Centre at Blanchardstown. On a proposal by Cllr. Carroll seconded by Cllr. Mrs. Glenn this proposal was agreed unanimously.

Mr. Nolan said that in the Special Hospital Care programme the work on the boiler house and ancillary services in St. Brendan's Hospital must also be taken as first priorities in that area and on a proposal by Cllr. Carroll seconded by Ald. FitzGerald this was agreed.

In reply to Cllr. Sweeney Mr. J. Sadlier said that the Contractor for the Wicklow Health Centre had obtained a Bond but the Department had not yet agreed to the commencement of the work. The Chairman said that the Board must proceed with the project. 228 2/10/1980

156/80 SUSPENSION OF STANDING ORDERS

With the Chairman's permission Dr. Walker introduced a proposal for a symbol to identify the Health Board. It was agreed that a small Committee of Dr. Walker, Mr. Harrington, Dr. Meade, Cllr. Mrs. Glenn and the Chairman would examine the proposal and make a recommendation to the Board.

157/80 SELECTION OF POLICY COMMITTEE

The following Committee was selected —

Cllr. D. Browne, Cllr. A. Groome, Dr. J. Behan, Cllr. B. Durkan, Cllr. J. Sweeney, Mr. M. Matthews, Cllr. P. Hickey, Dr. B. Sheehan.

It was agreed that Dr. Behan would convene the first meeting of the Committee.

158/80 POST OF CHIEF EXECUTIVE OFFICER NOTICE OF RESIGNATION

The Chairman advised members that he had received a letter from Mr. Nolan indicating his resignation from office with effect from 3rd November 1980. Cllr. Browne paid a warm tribute to the dedication and application to work and the complete and total knowledge of the working of the Board in all its departments displayed by Mr. Nolan and to the respect he commanded from the staff and members. He said he hoped that the Board would be able to retain Mr. Nolan's services in some capacity.

Ald. Fitzgerald joined in the tribute to Mr. Nolan and proposed that a Committee be formed to arrange a function to mark his retirement and that this might best be considered as the first Annual Dinner of the Board with Mr. Nolan as the honoured guest.

This proposal was seconded by Cllr. Hynes and agreed. The following members also paid tribute to Mr. Nolan particularly in reference to__his involvement in the areas and interests that they represented on the Board — Cllr. Mrs. Glenn, Cllr. Doyle, Dr. Behan, Cllr. Durkan, Cllr. Carroll, Cllr. Sweeney and Prof. J. Doyle.

Mr. Donohue also paid tribute to Mr. Nolan on behalf of the Staff of the Board and asked to be associated with the remarks of the members. 229

The following were selected to form the Committee to organise theprjposed function — Cllr. Ourkan, Ald. Fitz-Gerald, Ms. Kearney, Dr. Behan, Cllr. Hynes, together with Programme Managers, Alderman FitzGerald to convene the first meeting.

159/80 MEDICAL AND ALLIED RESEARCH COMMITTEE - MINUTES OF MEETINGS ON 22/4/1980 and 9/9/1980

The following minutes of meetings of the Medical and Allied Research Committee held on 22/4/80 and 9/9/80 were submitted —

MINUTES OF MEETING OF MEDICAL AND ALLIED RESEARCH COMMITTEE HELD IN ST. BRENDAN'S HOSPITAL ON 22nd APRIL, 1980 at 3.00 p.m.

PRESENT: Professor J. McCormick Mr. J. J. Nolan Professor J. S. Doyle Mr. T. Keyes Professor B. O'Donnell Dr. J. Cullen Dr. J. Behan Mr. T. Harty Sr. Columba McNamara Mr. M. Cummins

IN THE CHAIR: Professor J. McCormick

Rutland Centre Ltd. Dr. Cullen referred to his evaluation of the Centre which was prepared at the request of Mr. Keyes and stated that the Centre appeared to be carrying out the function for which it was set up. Since the centre was opened over 200 patients had been catered for and there are generally 20 — 30 patients in residence.

Over 60% of the patients are being treated for alcohol addiction and a number of young male patients are receiving treatment. He considered this to be a welcome alternative to caring for these in mental hospitals. A sizable minority (35%) of patients are under treatment for drug abuse which is almost exclusively confined to prescription drugs.

Dr. Cullen stated that the distribution of paying and non- paying patients is considered a reasonable mirror of the community while the tables on treatment outcome (pages 4 and 5) seem to indicate a reasonable success rate for the programme. In reply to a question from Professor McCormick, Mr. Keyes stated that approximately 22% of patients are admitted to public wards for diagnostic alcoholism. 230 2/10/1980

In reply to a question from Sr. Columba, Mr. Keyes stated that the Eastern Health Board paid £95,000 to the centre in 1979 and £150,000 has been requested for 1980.

The payment made is by Section 65 Grant and covers salaries. No additional payments are made in respect of public patients treated at the centre.

Dr. Behan disagreed with Dr. Cullen's recommendation that the Board continue to support the centre. He stated that the following are his reasons for disagreeing with Dr. Cullen's recommendation:

I. The Centre's objectives are not scientifically stated.

2. The criteria by which evaluations will be made are not set out.

3. Evaluations are made on a single criteria, there is no indication of relapse rate or of follow up, or that patients are attending other doctors or hospitals.

He is not convinced on the basis of information provided that the Centre is providing what can be scientifically determined as a useful service.

Dr. Cullen accepted Dr. Behan's remarks as valid, but pointed out that the information which could be obtained would depend on the level of investment the Board was prepared to make in follow uo procedures. He had no mandate to carry out an investigation of the centre, and the information available to him was merely turnover data.

Following discussion it was agreed:

1. That Dr. Behan would prepare a draft questionnaire setting out a list of headings under which the committee requires information. This will be circulated to the members of the Scientific Committee for any additions they may wish to make and when finalised the Programme Manager will send it to the Management of the Rutland Centre.

A copy of the questionnaire will be sent to Dr. Cullen.

2. On receipt of the replies to the questionnaire the com mittee with Dr. Cullen and some officers should visit the centre.

Health Care and Psychosomatic Unit Dr. Cullen referred to his report and stated that:

1. the unit should be a research unit with a clinical as well as a scientific dimension 231

2. the unit has not set out to do clinical studies on any particular group

3. the unit is interested in the methods by which psychosocial factors are converted into psysiological changes.

Dr. Cullen and Mr. Harty withdrew from the meeting and the committee considered his report.

It was agreed following discussion-

1. To circulate to each member of the committee copies of the additional data supplied by Dr. Cullen.

2. To arrange for an independent assessor, with Dr. Culien's agreement, to assess the unit. The assessor would ideally be someone prestigious in this field and would probably be an academic Psychiatrist with an interest in biofeedback.

Mr. Keyes undertook to arrange for the engagement of an assessor on receipt of three suggested names from Dr. Behan.

The meeting concluded at 4.30 p.m."

" MINUTES OF MEETING OF MEDICAL AND ALLIED RESEARCH COMMITTEE HELD ON 9th SEPTEMBER 1980

PRESENT: Prof. J. S. Doyle Dr. J. Behan Mr. T. Keyes Mr. T. Harty Mr. M. Cummins

IN THE CHAIR:- Prof. J. S. Doyle

APOLOGY:- Prof. J. McCormick.

(1) Minutes of Meeting of 22nd April 1980 having been circulated were agreed.

(2) Matters arising from the minutes

Rutland Centre Ltd. Prof. Doyle stated that the project appeared to be highly motivated and statistical evidence indicated a higher than average throughput. There was a need for definitive assessment of results, and the method of treatment and approach merited investigation in greater detail. 232 2/10/1980

Dr. Behan asked if the Centre had been given an original remit and mandate. Mr. Keyes stated that the Centre applied a certain system of treatment and the Board had been asked to assess results.

Dr. Behan informed the Committee that his questionnaire on the Rutland Centre (vide page 2 minutes of 22/4/1980) was not completed and undertook to submit it to the Programme Manager before the end of the week in order that it can be circulated to the other members of the Committee for their observations before being sent to the Rutland Centre. It is intended that the replies to the questions should be evaluated by Dr. Cullen by 16th October in order that his report may be available to the members at the November Eastern Health Board meeting.

Mr. Keyes informed the Committee that the present lease on the premises expires on November 3rd 1980 and he is in the process of examining the prospect of a long term lease to the Eastern Health Board. The Health Board could create a secondary lease to the Rutland Centre and so maintain overall control of the use of the premises and site. Consequently he requires a decision as to whether the Centre should be continued as a long term service commitment by the Board.

Prof. Doyle commented that a general practitioner in the area has spoken highly of the unit and the centre poses no problems with the local community.

It was agreed that the project would be reviewed at the meeting of the Committee on 21st October 1980.

(3) Review of Psychosomatic Unit With reference to the recommendation contained in page 2 of the minutes of meeting of 22nd April 1980 that "an independent assessor, who would ideally be someone prestigious in this field and would probably be an academic psychiatrist with an interest in bio feedback" should be engaged with Dr. Cullen's agreement to assess the operation of the unit Mr. Harty informed the Committee that Professor Lennart Levi of the Karolinska Institute Stockholm, who is the Director of the World Health Organisation Stress Laboratory in Stockholm and a consultant to the International Labour Office Geneva, and the author of several publications in this field had been invited to carry out the evaluation, and had done so and his report was expected within the week. The Department of Health in a letter dated July 1980 approved the appointment of Professor Levi to carry out this assessment as the assessment was also in accordance with terms of the Department's letter of 23rd May 1977 to the Chief Executive Officer which set out as follows:— 233

"As this is a research cum service project it will be necessary after three years when trends have been established, to have an independent evaluation of the scheme."

Or. Behan stated that the Committee should not accept as the only criteria the visit of one referee. Prof. Doyle recommended and it was agreed that the members of the Committee should receive a copy of Prof. Levi's report and that they should visit the Psychosomatic Unit with Dr. Culien's consent on 23rd September at 2.30. This date to be confirmed with Dr. Cullen. The Committee will then reconsider the situation in the light of the visit and the report.

The next meeting of the Committee will take place on 21st October 1980 at 3 p.m. in the Boardroom, St. Brendan's Hospital.

The meeting concluded at 4 p.m."

In relation to the minutes Prof. Doyle drew the members attention to the fact that the present lease of the premises occupied by the Rutland Centre expires on November 3rd 1980 and that the prospect for a long term lease to the Eastern Health Board is being examined. The on-going assessment of the Rutland Centre is still under close scrutiny and the Psychosomatic Unit is still proceeding.

Dr. Behan said he had written to Mr. Keyes Programme Manager regarding the evaluation of the Rutland Centre and had submitted a questionnaire to enable the committee through the answers to the questions to have more information on the activities of the Centre, the type of cases being dealt with, and whether such cases are being treated effectively and what sort of input the Centre is making to the Alcoholism problem. The Centre was set up by the Minister at the request of the Board on the condition that its activities be evaluated at this time and it was proper for the Board to examine the activities of the Centre to see how treatments offered there compared with the treatment of alcoholism elsewhere.

Dr. Powell agreed with Dr. Behan and said he would also like to see a breakdown of how the money granted to the Centre was being spent.

Prof. Doyle thanked Dr. Behan for the compilation of the questionnaire which would be a great help to the Committee in their preparation of a full report to the Board.

Mr. Keyes said that the Medical and Allied Research Committee must decide soon on the future of the project. He believed that good results from the Centre would be of value to all. Regarding the lease he said he hoped to arrange a care- 234

taker lease for six months to allow time to make a final decision on the Centre. He would recommend the purchase of the building as the Health Board could use it otherwise if the Centre did not continue.

The Minutes were adopted on a proposal by Cllr. Sweeney seconded by Cllr. Durkan.

160/80 GARDEN HILL SITE - LETTER 8/9/1980 FROM DEPT. OF HEALTH

The following letter dated 8/9/1980 from the Department of Health was submitted:—

"A Chara

I am directed by the Minister for Health to refer to the agreement, dated 15 September, 1980, between the Eastern Health Board and the St James's Hospital Board regarding the relocation of buildings from the Garden Hill Site and associated matters.

The Minister has no objection to the proposals as contained in the agreement.

I am also to draw your attention to this Department's letter of 22 Bealtaine 1980 on this matter, particularly the conditions in relation to the Psychiatric Professorial Unit and the expenditure involved in the proposals.

Mise le meas"

The Chief Executive Officer circulated the following memorandum for the information of members:

"GARDEN HILL

The Agreement with the St. James's Hospital Board regarding the relocation of buildings from the Garden Hill site and associated matters, was sealed on 15th September, 1980 under signature by the Chairman, Councillor D. Browne and Chief Executive Officer, J. J. Nolan and referred to the De- partment. In their reply dated 18th September, 1980 the Department stated that the Minister had no objection to the proposals as contained in the Agreement. Previously the draft of the Agreement had been referred to heads of units involved for consideration. The final Agreement included an additional specific provision that the Hospital Board, B.M.R.I., and Foundation would respectively furnish to the Health Board all sums payable by the Health Board relative to the relocation of the B.M.R.I. and the Foundation for Human Development as appropriate. Mr. D'Alton, Project Manager 235

of St. James's Hospital has at my request clarified in a letter dated 29th September, 1980, the cost significance of the provision relative to the B.M.R.I. He has also stated in a letter dated September 30th that as soon as the Agreements with the B.M.R.I. and the Foundation for Human Development (which are now ready for sealing by the Board) are completed, the building contract for Phase 1A of the new St. James's Hospital can be signed tomorrow Friday October 3rd 1980."

Mr. Nolan asked the Board to endorse his proposals so that the building contract for the next phase of the St. James's Hospital development could be signed.

Dr. Behan proposed that the Board endorse the Chief Executive Officer's action and asked that the Board renew its commitment to its policy to develop the Unit for the Board's Chief Psychiatrist on the site agreed. Mr. Nolan assured Dr. Behan that the Department will be advised of the Board's requirement that the Chief Psychiatrist's Unit and the Research and Development Unit should be provided on the site agreed.

Cllr. Carroll seconded Dr. Behan's proposal and it was agreed unanimously.

161/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

(a) Dublin County Local (Health) Committee meeting held on 1/9/80.

On a proposal by Cllr. Carroll seconded by Cllr. Reilly the minutes were noted.

(b) Dun Laoghaire Local (Health) Committee meeting held on 10/9/80

On a proposal by Cllr. Carroll seconded by Cllr. Mrs. Glenn the minutes were noted.

Cllr. Sweeney advised members that at the last meeting of the Working Party on the future of hospitals in the South County Dublin and Wicklow area he asked that submissions be received from the various local health committees representing these areas.

On a proposal by Cllr. Mrs. Glenn seconded by Cllr. Carroll the minutes were noted. 236 2/10/1980

Cllr. Mrs. Glenn brought forward the following matters arising from the meeting of the Committee:

(i) Cllr. Keating's motion regarding the admission of itinerants to hospitals;

(ii) Cllr. Sherwin's motion that all medical goods be dated at time of issue and

(iii) the Committee's action in sending a telegram to the Taoiseach regarding petrol supplies for doctors and paramedical staff.

Regarding (ii) Or. Powell agreed that many doctors were over prescribing and said that it was necessary to work out where saving can be made in this area. Prof. Browne said that the major abuse is with tranquillisers, but further research and training would be needed to develop alternative type of treatment for stress other than drugs.

Dr. Behan agreed that doctors cannot take time to deal adequately with patients as he felt that the general medical services were still deficient in structure and remuneration to permit this.

Or. Meade said that these matters had already been examined but he felt that the real deterrent to over prescribing would be a charge for prescriptions in certain cases. At present the expiry date was shown on most drugs and an effort was being made to have the date of issue and the doctor's name also noted on prescriptions issued but this procedure was not always acceptable.

Or. Powell said the demand for drugs was often for self induced illness. Also the need to have prescriptions renewed monthly means monthly visits to the doctor. He said that while certain categories should be eligible for the services free other categories should have to pay a charge for some services or for certain types of non essential drugs.

Mr. Nolan suggested that the officers of the Board would collect information and statistics in this regard to put before the Board members for their information.

Dr. Walker suggested that when findings of any special investigation are available they be given to the medical schools for the instruction of medical students and young doctors.

Cllr. Durkan referred to the Health Education Bureau's campaign last year on misuse of drugs and suggested that this be developed further to increase public awareness to the inherent danger of misuse of drugs. The proposals were agreed unanimously. 237

162/80 NOTICES OF MOTION

The following motions were subjitted:

(a) Proposed by Cllr. Sweeney and seconded by Cllr. Hynes:

'That this Board proceed to erect a Welfare Home on the Site the Board has in Arklow. This project to be included in the 1981 Capital Programme."

Speaking to the motion Cllr. Sweeney said that there were no hospital facilities in the Arklow area and he proposed that the Welfare Home should contain some primary care beds for observation of patients or while they were waiting transfer to another hospital.

Mr. Nolan said that this proposal should be processed through the Capital Programme Committee and it was agreed to refer the motion to the Committee.

It was agreed that the following two motions in the name of Dr. Behan be taken together:

(b) "That this Health Board calls on the Minister for Health

(i) to provide a satisfactory explanation for the Department of Health's policy of having an imbalanced distribution of resources in the Health Services whereby the Hospital Services operated by the Private Sector in direct association with the Department of Health (and outside the control and scrutiny of the Health Board) have developed exponentially over the past decade in stark contrast to the discrimination, neglect and repression of the Psychiatric, Geriatric, Mental Handicap and other Community Care services for the Public Sector run directly by the Health Board, and therefore

(ii) this Health Board calls on the Minister for Health to state whether he is satisfied with the internal administrative structures and public accountability of a of a Department of Health whose policy making systems clearly favour the Private Sector of the Health Services whilst actively discriminating against the Public Sector."

(i) deplores the imbalanced distribution of resources by the Department of Health in favour of the Private Sector to the neglect of the Public Sector of the Health Service with the creation of a two-tier Health Service, and therefore 238 2/10/1980

(ii) this Health Board calls on the Minister for Health to make a commitment to the utilization of available resources for the balanced development of the Health Services based on the constitutional principles of social justice and equity with a viable social partnership evolving between the Public and Private Medical Sectors rather than, as currently, the suppression and neglect of the Public Sector Health Service to meet the needs of the Private Sector Health Service thereby reducing the role of the Health Board to that of providing a second class service for second class citizens."

Speaking to the motion Dr. Behan said that the first motion indicated the imbalanced distribution of resources irf the health services. In relation to expenditure over the past 20 years he illustrated that while in 1962 the public and private sectors of the services were equally funded, from 1973 onwards there was a marked discrepancy in spending to the stage where expenditure on the running of voluntary general hospitals in relation to the public sector was in the ratio of 4 to 1, representing a developing budget for the private sector and only the addition of increases arising out of inflation in the public sector.

The development of the private sector was not subject to scrutiny of public bodies or health boards and his motions would require the Minister for Health to say if he is satisfied with the public accountability of the Department of Health whose policy he felt clearly favoured the private sector while discriminating against the public sector.

Since the Health Boards were set up the health authorities had lost a lot of their autonomy as there was now much more central control of finances and policy.

In regard to his second motion he proposed that the Minister for Health be asked to make a commitment for the utilization of the available resources to provide a balanced development of the services. He felt that the Minister had no facility to keep him aware of the real needs and requirements of the services nor had he any statutory responsibility to provide services nor had the people any right to treatment. He considered that the Minister should be asked to have a "right to treatment" act enacted to enable the people to receive the necessary treatment as a right.

Dr. Behan asked that the Association of Health Boards be informed of his motions and be asked for their support.

The motions were seconded by Cllr. Carroll, who congratulated Dr. Behan and agreed that as matters stood any cut backs in the services would only affect a certain cate- 239

gory. Supporting the motion Cllr. Ourkan said that services provided by the Board should be financed on a par with the voluntary and private hospitals. The Board could not accept the continuation of a second-rate service. But the Board must be able to $/.^w that given the proper finance it could provide the necessary standard of services. In reply to Or. Meade, Or. Behan said that the figures quoted by him related to expenditure on services and not on capital works. He agreed that the lack of money to the public sector had denied that area the opportunity to provide an adequate service but if given the same opportunity as the private sector a competent and adequate service could be provided.

Mr. Nolan said that historically the public authorities were given the job of caring for the long-stay and sick poor while the large voluntary hospitals had in general provided a service for acute cases — this had given rise to a two-tiered service. While standards had improved in public hospitals, the private sector continued to attract the major consultants. The relevant authorities did not take the opportunity in the 1947 and 1953 Health Acts to bring the voluntary hospitals directly under the control of the public authorities although these Acts placed a legal responsibility for the provision of hospital services on the public authorities. This meant that in this area these services were now provided on an agency basis by the voluntary hospitals. This left the Board with the care of long-stay and sick poor as well as psychiatric patients without resources to develop the services properly. Representations were now being made to the Minister for Health by the Board to provide the necessary resources to bring the public institutions to the level of private institutions.

The motions were agreed. It was decided to refer the matter to the Policy Committee for consideration and report.

163/80 CORRESPONDENCE

(a) The Secretary advised the members that the Minister had reappointed Mr. J. J. Nolan and Prof. J. S. Doyle to the Board of Beaumont Hospital

(b) Mr. Harrington asked that dental officers be also con-sidered for 'flu vaccination along with the medical care personnel referred to at para. 2 (c) in the letter from the Department of Health circulated to the members.

The meeting ended at 8.15 p.m. 240 2/10/1980

CORRECT: J.J.Nolan Chief Executive Officer.

CHAIRMAN

241 6/11/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of the Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegorman, Dublin on Thursday 6th November, 1980 at 6 p.m.

PRESENT

Dr. J.D. Behan Ms. N. Kearney Cllr. L. Belton T.D., Dr. P. McCarthy Cllr. D. Browne Sr. Columba McNamara Cllr. M. Carroll Mr. Michael Matthews Cllr. E. Doyle Dr. A. Meade Cllr. B J. Durkan Cllr. Mary Freehill Cllr. A. Groome Cllr. H. Reilly Cllr. T. Hand P.C., Dr. B. Sheehan Mr. K. Harrington Cllr. J. Sweeney Cllr. P. Hickey P.C., Dr. J. Walker Cllr. F. Hynes Cllr. Mrs. Waugh

APOLOGIES FOR ABSENCE Prof. J.S. Doyle, Cllr. Mrs. A. Glenn, Cllr. E. Stagg

OFFICERS IN A TTENDANCE

Mr. B. Segrave Mr. M. Hayden Mr. J J. Nolan Mr. J. Doyle Mr. F. Donohue Miss A. Flanagan Mr. T. Keyes Mr. C. Mansfield Mr. R.N. Lamb Mr. A. O'Brien Mr. J. Sadlier Mr. T. McManus Mr. P.I. Lyons Mr. C. Murphy Mr. J. Clarke Mr. M. Cummins Prof. B. O'Donnell Mr. J. Leech Mr. F J. McCullough Miss E. Larkin Mr. P J. Swords Miss R. Carolan Prof. I. Browne

164/80 CONDOLENCES

The Chairman informed members of the recent death of Mr. Felix Callow, a former officer of the Board. The members stood in silence as a mark of respect to the deceased. 242

165/80 CHAIRMAN'S BUSINESS

The Chairman welcomed Mr. B. Segrave, Chief Executive Officer, on behalf of the members. He said he looked forward to continued co-operation between the executive and the Board in the development of the services for the area.

Mr. Segrave thanked the Chairman and members for their welcome and said he appreciated the assurance of cooperation and support from the Board in the difficult and challenging job ahead of him and he said he would give the same co-operation and support to the Board. He also thanked the staff for the welcome extended to him on taking up duty and paid tribute to his predecessors Mr. O'Keeffe and Mr. Nolan.

166/80 CONFIRMATION OF MINUTES

Dr. Behan asked that paragraph three of page 235 be amended to include the congratulations expressed at the October meeting to Mr. Nolan on bringing the proposals for St. James's Hospital to their present stage. Or. Behan advised the members that the contract for the first phase of the development of the hospital had been signed last week.

Or. Walker, referring to Minute 156/80, said he understood that the emblem submitted by him had bee., accepted by the Board. After some discussion it was agreed to alter the Minute accordingly.

On a proposal by Cllr. Sweeney seconded bv Or. Behan the Minutes of the Meeting held on 2nd October 1980 were agreed and signed.

167/80 PROCEEDINGS OF VISITING COMMITTEES

The reports of the following Visiting Committees having been circulated were dealt with as follows:-

(a) No. 1 Visiting Committee meeting held at St. Colum-cille's Hospital on 17/9/1980

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the report was noted.

In reply to Cllr. Sweeney's enquiry, Mr. Sadlier said that he was forwarding a report on the Ambulance Service to the next meeting of the Visiting Committee.

Mr. Swords told Dr. McCarthy that the working party on hospitals in the south Dublin/Wicklow area was continuing to meet, that the existing arrangements on consultant posts 243 6/11/1980

were continuing for the time being and that the working party had agreed to meet the relevant local health committees and other interested parties and that he would report to the Board further on the outcome.

Dr. Sheehan expressed the view that general practitioners should be asked to meet the working party and Dr. Meade assured the Chairman that as a member of the working party himself he was satisfied that the G.Ps.' views had been invited.

(b) No. 1 Visiting Committee meeting held at St. Col- man's Hospital on 23/10/80

On a proposal by Cllr. Sweeney and seconded by Cllr. Hynes the report was noted.

Cllr. Sweeney asked in particular that the Board would consider the purchase of the mini-bus with ramp to facilitate wheelchairs as mentioned in the report. It was agreed to make arrangements for the purchase of the mini-bus as requested.

On a proposal by Cllr. Durkan seconded by Dr. McCarthy the report was noted.

In reply to Cllr. Durkan's enquiry about the present position regarding the development of the hospital, Mr. Swords referred to the letter from the Department of Health last month in which the Department accepted the designation of Naas Hospita! as a general hospital with linked appointments with the Adelaide and Meath Hospitals for which arrangements will soon be made. Regarding Cllr. Durkan's enquiry about the purchase of houses for staff accommodation. Mr. Swords said he would report shortly on this matter. This could then^be referred to the capital programme committee. Regarding the stated difficulty of employing and keeping Cooks and Assistant Cooks in the Hospital, having regard to the wage differential between Dublin and Wicklow and Kildare areas, Mr. Lyons told Cllr. Durkan that the matter of rationalisation of pay rates was being negotiated nationally by the Local Government Staff Negotiations Board in cooperation with the Unions representing workers throughout the local authorities and health boards. Following discussion in which concern was expressed at the problems of recruitment the Chairman asked that a report on the matter be submitted to the next meeting and this was agreed.

(d) No. 3 Visiting Committee meeting held at St. Brigid's Home, on 22/10/80 244

On a proposal by Cllr. Hynes seconded by Dr. McCarthy the report was noted.

Cllr. Hynes asked that Mr. Crumlish and the staff concerned be congratulated on the appearance of the buildings following the recent painting and window replacement work which had completely transformed the appearance of the buildings since his last visit.

Cllr. Durkan said he wished to be associated with these congratulations to the maintenance staff. He said he welcomed the reference to proposals for geriatric beds for the Kildare, west Wicklow and south Dublin areas and asked that the unit at Cherry Orchard be made available as soon as possible as long-stay accommodation.

(e) No. 4 Visiting Committee meeting held at the Legion of Mary Hostel on 15/10/80

On a proposal by Cllr. Freehill seconded by Mr. Harrington the report was noted.

Cllr. Freehill asked if the families resident at the Hostel could be re- housed by the Dublin Corporation and expressed concern at the number and length of their stay.

Following a discussion it was agreed, on the suggestion of the Chairman, that a report would be prepared and circulated to trie Board members on the occupancy of the Hostel including the length of stay of the persons catered for.

Miss Kearney referred to the difficulty of getting families housed in an emergency because the hostel was full and said that it was impossible to have travelling people accommodated. She said she considered in any event the accommodation was not suitable for long-stay. The Chairman asked her to put down a motion in the matter to a later meeting.

(f) Community Care Visiting Committee meeting held in the Wicklow area on 23/9/1980

On a proposal by Cllr. Hynes seconded by Cllr. Sweeney the report was noted.

Dr. McCarthy expressed his objection to the wording of the report where it stated "the standard of the small rented premises was reasonable." He described the unsatisfactory nature of some of the accommodation. Mr. Donohue referred to the financial constraints on expenditure on premises and said that while much progress has been made some premises were still unsuitable but were kept in the best condition possible in the circumstances. 245 6/11/1980

Following a discussion it was agreed to delete the sentence referred to from the report.

In reply to Cllr. Sweeney, Mr. Swords said that the Board had written to the Department of Health regarding the present position in relation to the Health Centre at Wicklow but had received no reply.

The Chairman asked that the Board continue its efforts to have this project commenced.

In relation to an enquiry from Miss Kearney on the social worker services in Wicklow, Mr. Donohue undertook to examine the complement for the area in the light of present needs.

168/80 QUESTION

On a proposal by Cllr. Sweeney seconded by Cllr. Groome it was agreed that the Chief Executive Officer answer the question lodged.

QUESTION: Cllr. Mary Freehill In relation to Report No. 47/1980 "Use of An Grianan, Ballymun" circulated at the September meeting of the Board, will the Chief Executive Officer state in what way has the situation changed that it is now less necessary to provide a residential reception centre for both settled and itinerant children who are sleeping rough.

REPLY: An Grianan, Ballymun was originally intended for the reception of children up to twelve years of age found sleeping or living rough. In general, though not entirely, these were children of itinerant families. With the provision of facilities, under the aegis of the Dublin Committee for Travelling People, at Strand Street and Townsend Street where there are day centres-cum-special schools, together with a residential centre at Ontario Terrace for emergency stay and the provision of a night shelter at Exchange Street, the incidence of such children sleeping out has been largely diminished.

The situation regarding children sleeping rough is kept under constant review through regular contact with the Dublin Committee, The Gardai, the local authorities and others directly concerned.

169/80 REVIEW REPORT

Mr. Nolan introduced his report which had been circulated to members at the meeting. 246

He said that while the Report was lengthy it was intended as a personal summary on his retirement, of the more significant elements affecting and involved in the constitution and administration of the Health Board. There were a number of matters in the report which he hoped would be of help and guidance to both members and staff in the further development of policies and services by the Board. The Chairman thanked Mr. Nolan for the report and on his proposal it was agreed to refer it to the Policy Committee for consideration and report.

On a proposal by Cllr. Browne, seconded by Dr. Behan, it was agreed unanimously that Mr. Nolan's appointment to the various Hospital Boards of which he has been a member in his capacity as an officer be continued viz., St. James's, Meath, James Connolly Memorial, Beaumont and Tallaght.

170/80 BUDGET ALLOCATION 1980 - (a) Letter HSG609 of 16/10/80 from Dept. of Health (b) Report No. 51/1980

The following letter of 16/10/80 from the Department of Health was submitted:—

"A Chara

I am directed by the Minister for Health to let you know that the Government has decided that extra funds are to be made available so as to ensure that essential health services are maintained and any hold-up in the carrying out of capital projects now in progress is avoided. In addition, it will be necessary to provide funds to meet costs arising under the terms of the draft proposals for a Second National Understanding for Economic and Social Development as may be agreed and further special pay claims that may be sanctioned before 31 December, 1980. The necessary financial motions will be presented to the Dail for approval during the session which commenced on 15 October.

In arriving at the decision relating to the maintenance of essential services account has been taken of the co-operation of health agencies in achieving economies in the running of services. It will, of course, be necessary to ensure that every effort will continue to be made by health agencies to effect economies where this can be done and that expenditure is not incurred on developments, increases in staffing, etc. for which approval has not been given.

The further special allocation being made available to your Board for the maintenance of essential services in 1980 is £2.7 million. This sum excludes the following expenditures for which separate provision requires to be made, viz: 247 6/11/1980

(a) increases in cash allowances approved in the 1980 Budget;

(b) such expenditure as may arise on the basis of the proposals for a second National Understanding for Economic and Social Development and the costs being met by the board in meeting special pay claims sanctioned in 1980;

(c) additional payments in respect of services provided for eligible patients in voluntary and joint board hospitals and in homes for the mentally handicapped and for general medical services financed by the General Medical Services (Payments) Board;

(d) expenditure on commissioning new units of accommodation in 1980;

(e) expenditure at the approved levels in the special schemes for the provision of dental and ophthalmic services for persons with full eligibility;

(f) expenditure resulting from revision of capitation and subvention rates.

Is mise.

The following Report No. 51/1980 from the Chief Executive Officer was submitted:— 248

Budget Allocation — Review of Expenditure to 30th September 1980

Expenditure Proportion Variation Percentage to 30th Sept of Budget Variation 1980 (Revised to include approved increases)

General Hospital Care £000 £000 £000 + + 6% + 3% Special Hospital Care 14.090 13.290 800 + + 6% + 3% Community Care Central 18,234 17.736 498 + + 1% + 2% Services Engineering 22.931 21.559 1372 + Services 4^65 4.713 152 + Ambulance/Transport 2.536 2,499 37 + 2,089 2.041 48 Total Expenditure

64.745 61,838 + 2907 + + 5% + 3%

3,560 2.794 766 61.185 59,044 + 2141 + 4%

Since the last Meeting the Board has been informed by the Department of Health that an additional allocation of £2,700,000 has been made. This is not included in the amounts shown above under the heading "Proportion of Budget". It is hoped that by careful management of the Board's resources the out-turn for the year will not exceed the total of the Department's allocations. The principal adverse factor in this regard is the probable continued upward trend in prices."

On a proposal by Cllr. Hynes, seconded by Cllr. Sweeney the letter and report were noted.

171/80 CAPITAL PROGRAMME - (a) Report from Mr. Keyes dated 24/10/1980 re Workshop for Mentally Handicapped, Bray (b) Report from Mr. Sadlier dated 29/10/1980 re Lassa Fever Unit at Cherry Orchard.

(a) The following report dated 24/10/1980 from Mr. Keyes was submitted:—

"Re/ Workshop for Mentally Handicapped Persons at Bray

The above project was included as one of the projects to be considered for E.E.C. Grants. The original intention was to 249 6/11/1380

provide a purpose built workshop at Bray but the cost of £400,000 made this prohibitive. I now enclose report from Mr. Liam Sweeney on a proposal to purchase an existing premises at a cost of £117,000 with an additional £17,000 for repairs making a total cost of £134,000. The premises has been examined by the Technical Services Officer and is regarded as suitable. This project is being carried out in association with Sunbeam House Limited and they, in fact have obtained terms for a loan from the Industrial Credit Company for the full amount of £134,000 at an average interest of 14.82%. The Department of Health have approved in principle of the project and have indicated that provided that funds are made available next year, the running costs, including the loan charges will be met out of funds for new units.

I recommend approval to this project."

Mr. Nolan said the Board would have to decide on the recommendations submitted by the Programme Manager. Approval to this project need not affect the Board's capital programme. On a proposal by Cllr. Carroll, seconded by Cllr. Sweeney it was agreed to proceed as outlined in the report.

Dr. Behan drew attention to the high rate of interest quoted and the loan fee being charged on the financing of the project and suggested that the Health Boards should be organised nationally to arrange for funding at more advantageous rates. He proposed that the Association of Health Boards be asked to examine alternative ways of funding health boards and this was agreed.

The following Report dated 29/10/80 from Mr. Sfdlier was submitted:—

(b) Re:- Lassa Fever Unit — Cherry Orchard Hospital.

About 3 years ago two Isolators were purchased following Departmental sanction for the treatment of special diseases such as Lassa Fever and the like. When delivered it was established that the existing rooms in the Smallpox Unit were too small for the operation of the Isolators and so some adaptations or extensions were obviously necessary. Visits were arranged to two Hospitals in England to see isolators set up ready for use and the equipment necessary to deal with the care of patients in same. Following an investigation of the existing Small pox Unit it was established that it would be uneconomic to adapt same and a suitable extension was planned while the existing accommodation could be availed of to provide Recovery Rooms and facilities for suspects. 250

Working drawings were submitted in June last to the Department of Health together with a Cost Plan in the sum of £261,050.00 seeking sanction to the proposed extension. This figure includes for the sterilizers, special treatment tanks for the drainage, air conditioning installation etc.

The Department have not yet officially responded to our submission but at what was arranged as an informal meeting between the Principal Engineering Advisor, Mr. T. Gallagher and the writer to consider the temporary installation of the Isolators in the existing Unit No. 1 Dr. J. Walsh, Medical Adviser and Mr. P. Bermingham, Architectural Adviser also attended. At very short notice Dr. E. O'Connor also attended as did Mr. J. V. Crumlish.

Dr. Walsh expressed concern at the delay in making these Isolators operational which he felt could be a serious embarrassment if a case of Lassa Fever were to arrive and in view of the financial stringencies urged that immediate steps be taken to instal the Isolators temporarily in Unit 1. I was asked to submit a rough sketch plan of Unit 1 with the proposed location for the Isolators and the vital ancillary equipment, such as the Sterilizers, indicated thereon together with the estimated cost of the minimum adaptations necessary.

The costings to state the amount recoverable when the work at the Smallpox Unit is approved, in order to expedite the work it was agreed that we should seek tenders for the Sterilisers and Treatment tanks Immediately and I have asked the Consulting Engineers to prepare the necessary documentation without delay.

I estimate that the cost of the temporary works in Unit 1 will amount to more than £100,000 of which £75,000 to £80,000 will be recoverable when the permanent work is put in hand. While this is not an ideal solution iff the short term it does afford an opportunity of making the Isolators operational with the minimum delay — the delivery time of the specialized equipment. If we were to get approval now to the extension proposed it would at least be next June/July before it would be completed.

I would be obliged for a decision in this regard, whether I am to proceed as requested by the Department of Health or inform them that no solution other than the permanent one is acceptable to us. While it is possible to state our needs in regard to Unit 1 for normal hospital use the Department officials, and particularly Dr. Walsh, are very aware that there have been no patients in same for a very long time."

Mr. Sadlier explained the position as outlined in his report. Mr. Nolan said he considered it more logical to proceed with an extension to the existing purpose-built isolation unit 251 6/11/1980

rather than make temporary adaptation of a standard Ward i.e.. Unit 1, and that the Department should be pressed to proceed along these lines. This view was supported by Cllrs. Groome and Durkan who considered it would be false economy to proceed with temporary arrangements which would also mean reducing bed accommodation. Dr. O'Donnell agreed with Mr. Nolan that the Small-Pox Unit was the appropriate area to be adapted for the Isolators. It was agreed to press the Department to extend the existing isolation Unit and to ask them to provide a special separate allocation for the work as the Unit would be providing a national service.

172/80 GENERAL PRACTITIONER SERVICE -APPLICATION FROM DR. J. FLEETWOOD, 11 PROBY SQUARE, BLACKROCK, TO TAKE ON AN ASSISTANT WITH A VIEW TO PARTNERSHIP

The following report No. 50/1980 from the Chief Executive Officer was submitted:—

"Doctor John Fleetwood, 11 Proby Square, Blackrock, Co. Dublin, is participating in the Board's general practitioner service and his centre of practice is at 11 Proby Square, Blackrock. In his letter of die 22nd November, 1979 he has expressed a wish to take on an Assistant with a view to Partnership, as his workload is increasing due to the fact that his practice is situated in an expanding area.

In accordance with paragraphs 21/22 of the circular letter 8/75 dated 9th April, 1975 issued by the Department of Health, the Irish Medical Association and the Medical Union were asked for their observations on Doctor Fleetwood's request. In letters dated 9th and 10th September, 1980, the Irish Medical Association and the Medical Union stated that they had no objection to Doctor Fleetwood's proposal.

I recommend that, subject to the approval of the Board, applications be invited in the usual manner and that an Assistant with a view to Partnership for Doctor Fleetwood be selected in accordance with the procedure laid down in paragraphs 21/22 of the Department's circular letter 8/75 dated 9th April, 1975. The relevant extract from this letter is as follows:

'21. The creation of a position as partner, or as an additional member of a group practice, or as an assistant with a view to partnership for the purpose of the general medical service, will be subject to the approval of the Health Board. In considering any such proposal the Board shall have regard to the total practice of the applicant. Before giving approval the Board must be satisfied: 252

(a) that the creation of the position is preferable to the creation of an additional position which could be filled by open competition in the normal way; and

(b) that the creation of the position will not result in the admission of a particular person into the general medical service while other equally well or better qualified persons are not given a reasonable chance to compete. Where the Chief Executive Officer proposes to seek the approval of the Board to the creation of a position as partner, or as an additional member of a group practice, or as an assistant with a view to partnership he shall, before doing so, consult the medical organisations.

22. Where a Health Board agrees to the creation of a partnership or addition to a group practice or to the recruitment of an Assistant with a view to partnership the position will be advertised in the normal way but the doctor or doctors involved or a nominee of the doctor or doctors involved in the proposed taking in of a partner, or additional member or assistant will be entitled to sit on the selection board. The selection board shall pay due regard to any objection of this representative to the giving of the post to a part.cuiar individual or individuals. If the board considers it desirable it may not recommend any candidate for appointment.' "

In reply to an enquiry from Dr. Sheehan and Dr. McCarthy about the length of time taken to process the application, Mr. Donohue said that there was no time scale for such applications, that each is dealt with separately on its merits and that in this case there was a need tor consultation with the applicant and other interests which took a considerable time.

On a proposal by Cllr. Sweeney, seconded by Dr. Sheehan, the report was approved.

173/80 FAMILY PLANNING SERVICES - CIRCULAR NO. 14/80 FROM DEPARTMENT OF HEALTH.

The following Circular No. 14/80 dated 30/10/80 from the Department of Health was submitted:

"Family Planning Services

To each Chief Executive Officer 253 6/11/1980

A Chara,

1.1 am directed by the Minister for Health to refer to the Health (Family Planning) Act, 1979 which, in accordance with the Health (Family Planning) Act, 1979 Commencement Order 1980 (S.I. No. 247 of 1980) comes into operation on 1st November next. I am to enclose three copies of the white print of the Act. Further copies of the Act, the Commencement Order and of the Health (Family Planning) Regulations, 1980 (S.I. No. 248 of 1980) may be obtained from the Government Publications Sale Office, G.P.O. Arcade, Dublin.

Definitions 2. Section 1 contains the definitions for the purposes of the Act, It should in particular be noted that "family planning service" means a service for the provision of information, instruction, advice or consultation in relation to any one or more of the following:—

(a) Family planning (b) Contraception, (c) Contraceptives.

It will be clear from this definition that family planning services do not include the provision of contraceptives.

Duties of Minister 3. Section 2 of the Act requires the Minister to secure the orderly organisation of family planning services and to provide a comprehensive natural family planning service. In pursuance of the latter obligation he has arranged for meetings to be held with the major voluntary organisations which are concerned with the provision of such services at present. Health boards might consider the extent to which such bodies, operating within their area, might be assisted in the provision of these services either by supporting them financially or, for example, by making available to them health board premises for holding meetings in relation to the service they are providing. A further communication regarding the general services being provided by these bodies will be sent to you after the meetings with their representatives have taken place.

Provision of Family Planning Services 4. In accordance with the provisions of Section 3(2) of the Act a person or body is entitled to make available a family planning service for the provision of information, instruction, advice and consultation in relation to methods of family planning that do not involve the use of contra ceptives. 254

5. The role of health boards in providing family planning services is defined in the Regulations. The manner in which it is envisaged such services will be provided is set out in paragraphs 9,10,11 and 12 below.

6. Section 3(3) provides that bodies other than health boards may with the consent of the Minister and in accordance with Regulations make available a family planning service other than a natural family planning service. To date applications have been received from and ministerial consent has issued to the provision of such services by the following:

Irish Family Planning Association, Cathal Brugha Street and Synge Street, Dublin; Cork Family Planning Clinic, 4 Tuckay Street, Cork; Galway Family Planning Association Ltd. 16 Merchants Road, Galway; Family Planning Clinic, 10 Patrick Street. Dun Laoghaire. Some other applications are still under consideration.

Sale and Supply of Contraceptives 7. The sale and supply of contraceptives is dealt with in Section 4 of the Act which provides, in general, that contraceptives may be sold only by pharmaceutical chemists or dispensing chemists and druggists or their servants or agents acting as such. These sales must nor mally be made at the place where the pharmacist keeps open shop. He may, in connection with keeping open shop, sell contraceptives at a place where family planning services are provided under Section 3 of the Act i.e. by a health board or approved family planning clinic. Contra ceptives may be sold only to persons who are in pos session of a prescription or authorisation which has been issued by a registered medical practitioner. Article 5 of the Regulations indicates the form which such prescription or authorisation should take. Contraceptives may not be sold or supplied otherwise than in accordance with the provisions of the Act and the Regulations.

Importation of contraceptives 8. Section 5 of the Act empowers the importation of contra ceptives into the State. Unless they are imported, in limited quantities, in personal luggage they may be im ported only under licence. Licences may be granted only to persons who will sell them to pharmacists or to persons who are themselves pharmacists. To date licences to import contraceptives have been issued to

Irish Rubber Limited, Kilcullen. Co. Kildare; Fredrick Trading Company, 12 Longford Terrace, Monks-town, Co. Dublin. 255 6/11/1980

United Pharmacists Co-operative Society Ltd., 1 Belmont Avenue, Donnybrook, Dublin 4. Some other applications are still under consideration.

Services to be provided by Health Boards 9. It is generally accepted that advice on family planning comes within the scope of general medical practice and, in the normal course, would be provided by a general prac titioner. For the majority of the population therefore such family planning advice as they require may be obtained from their general practitioner in the ordinary course of private general medical practice. Persons eligible for general medical services who require family planning ser vices, as defined, will be entitled to obtain them from the general medical practitioner whom they have chosen under the General Medical Service. If such practitioner is not willing to provide these services they may then obtain such services from another registered medical practitioner who participates in the Service.

10. Discussions have been held with the medical organisations and it has been agreed in principle that the fee to be payable for an eligible patient who seeks family planning services under the General Medical Service will be the normal consultation fee. Where the medical practitioner who has the patient on his list does not wish to participate in providing family planning services and the patient obtains such service from another participating doctor, the latter may claim the special consultation fee, currently £4.53. In this case the claim for special consultation fees should be sent for payment to the G.M.S. (Payments) Board.

11. Where a consultation involves instruction in the fitting of a diaphragm the fee payable will be the fee to be paid for the special services which are currently the subject of negotiation in relation to the G.M.S. The amount of this fee will be notified to you as soon as possible. Where a G.M.S. patient's own doctor provides family planning services, but the patient chooses to seek advice elsewhere, the patient must bear the cost.

12. Health boards are required to make available a family planning service as defined in the Act. It should be made clear to all concerned that the boards have no authority to make contraceptives available to any person. A health board may make a family planning service available either wholly or partly by way of an arrangement under Section 26 of the Health Act. 1970 with a body or person to provide such a service (Article 3 of the Regulations). As information on family planning will ordinarily be sought in the first place from general practitioners the service to be provided directly by health boards should be seen 256

primarily as being complementary to that provided by general practitioners. It might appropriately provide more specialised information and advice in relation to particular matters of family planning which would not normally be available from the general practitioner. Under Section 3(4) of the Act where information, instruction, advice or consultation in relation to the use of contraceptives is available this must be provided under the general direction and supervision of a registered medical practitioner. Health Boards should, therefore, consider the arrangements which would be necessary to ensure that the services described in this paragraph ere available and consider the extent to which they be made available by using existing facilities such as hospitals and clinics at which specialist obstret-rical and gynaecological services are currently being provided.

Training Courses 13. A programme for a training course in family planning for general practitioners has been drawn up by the In stitute of Obstretricians and Gynaecologists of the Royal College of Physicians in Ireland and the Royal College of General Practitioners in Ireland. It is expected that the first course will be held in Dublin soon, followed by courses in various parts of the country. As soon as further information is available about this course it will be sent to health boards.

Nurses, including public health nurses employed by health boards, have attended at short courses relating to family planning. The extent and nature of such further training as may be required by these nurses will require further consultation with health boards.

Saver in Relation to Abortion 14. I am to draw attention to Section 10 of the Act which provides specifically that nothing in it shall be construed as authorising the procuring of abortion, the administering of drugs or the use of instruments to procure abortion or the supplying of drugs or instruments to procure abortion or the sale, importation into the State, manufacture, advertising or display of abortifacients.

Conscientious Objections 15. Section 11 of the Act provides that nothing in it shall be construed as obliging any person to take part in the pro vision of a family planning service, the giving of pre scriptions or authorisations for the purposes of the Act or the sale, importation into the State, manufacture, ad vertising or display of contraceptives. The attention of the appropriate members of the board's staff should be drawn to this. Mise le meas' 257 6/11/1980

The Chairman referred to an earlier decision to hold a Special Meeting on this subject but said that the Board has not yet got enough information to put to such a meeting. He suggested that the Special Meeting be deferred until such time as in consultation with the Chief Executive Officer and the Programme Manager he was satisfied that there was sufficient information available to justify the holding of the Special Meeting, and this was agreed.

174/80 OFFICE ACCOMMODATION - LETTER 24/10/80 TO DEPT. OF HEALTH

The following letter of 24/10/80 to the Department of Health re office accommodation was submitted and considered:—

"Dear Sir,

On 10th September last I wrote to you conveying a request that the Minister would receive a deputation from the Board regarding, inter alia, the urgent need to proceed with the planning of our new office block or, as an alternative, the leasing of suitable premises. A decision on that request is awaited.

You will recall that apart from the generally unsatisfactory nature of the present offices, the decision to seek the new accommodation was occasioned by the repeated requests from the St. James's Hospital Board for an assurance that the entire area between James's Street and the boundary of the property already leased to them, would be available at an early date for the development of the Hospital arid the Clinical Sciences Complex.

We have informed the Hospital Board that there was no possibility of vacation and handover of existing buildings or transfer of the plot in question unless and until satisfactory arrangements had been completed for relocation of the staffs and services located there, that the Health Board could not hope to have its proposed new Headquarters constructed in the time available and that it had no Capital or Revenue funds available to provide alternative accommodation.

We have now been informed by Professor Howie that he has recently discussed with Dr. Hensey his Board's concern in this regard and their proposal to take over within the next year that part of the property on which will be built the Clinical Sciences Complex.

The Board, while appreciating the present difficult financial position, would prefer that the Minister make capital fund', available to finance the construction on the St. Brendan's 258

site of an office block of about 70,000 sq. feet to cater tor the Board's office needs. There is also the possibility of outside funding and in that regard the Board would welcome the opportunity of pursuing with the Department the possibility of an arrangement with a Bank or other finance agency whereby the necessary monies might be otherwise provided. This could involve e.g. the building by the agency of a suitable premises on our site at St. Brendan's and leasing it to the Board, perhaps on a deferred repayment basis. I am to request the Minister's approval as a matter of urgency to seek such an arrangement or, as an alternative, to negotiate for rented accommodation of approximatly 70,000 sq. feet (with car parking) at a rent of around £8 per sq. ft. in a suitable location in the city. This would cater for the current needs of the various departments included in the draft Brief submitted to the Department on 23rd July, 1979.

Another aspect of the matter is that the Irish Local Government and Public Services Union require discussions with us regarding possible compensation for their members if existing facilities such as parking and catering are not available when we leave the site. If however the office block was located irv St. Brendan's, such facilities would probably be available.

Yours faithfully/:'

Mr. Nolan referred to the alternative proposals contained in the letter for the provision of office accommodation and reminded members that the site required for the Clinical Sciences Complex could not be made available until such office accommodation was provided.

The members asked that a reminder be sent to the Department impressing the urgency of the situation.

In reply to Dr. Behan, Mr. Nolan said that as he had already informed the Board the Personnel Building had connections with the 1916 Rising and seven trees were planted in the front of the grounds in 1966 in commemoration of the Rising: these considerations had been referred to already in correspondence with the St. James's Hospital authorities. Dr. Behan asked that a definitive agreement regarding the future of the Buildings and the trees be obtained from the Hospital and th is was agreed.

175/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEE

Dublin County Local (Health) Committee meeting held on 6/10/1980-

On a proposal by Cllr. Carroll seconded by Dr. Walker the Minutes were noted. 259 6/11/1980

Or. Behan referred to the proposal made at the Committee Meeting relating to facilities for fathers to be present at births. It was agreed that each Maternity Hospital be asked to provide information on the current situation in this matter at their hospital.

176/80 MEDICAL AND ALLIED RESEARCH COMMITTEE MEETING HELD 21/10/80

The following Minute of proceedings of the above committee meeting was submitted:—

"MINUTES OF MEETING OF MEDICAL AND ALLIED RESEARCH COMMITTEE HELD ON 21 OCTOBER 1980

Present: Dr. J. Behan Dr. J. Cullen Prof. J.McCormick Mr. T. Keyes Prof. J. S. Doyle Mr. T. Harty Prof. B. O'Donnell Mr. M. Cummins

In the Chair: Dr. J. Behan

(1) Minutes of the meeting held on 9th September 1980 having been circulated were agreed.

(2) Report on visit to Psychosomatic Unit, Garden Hill on 23rd September 1980 was circulated and agreed. It was noted that Mr. Keyes name had been inadvertantly omitted from those present.

Professor Levi's report was also circulated and unanimously accepted.

Referring to the report Prof. McCormick congratulated Dr. Cullen on his work and proposed that the Board should continue to finance the unit for at least two years at its present level of activity and resources, corrected for inflation.

The present constraints on the Board's finances do not allow for any increase in this level of support for the time being. Prof. O'Donnell seconded this proposal and Dr. Behan wholeheartedly endorsed the recommendation and requested that the minutes show that those who visited the unit were impressed. On behalf of the committee he thanked Dr. Cullen and his staff for their co-operation with the Committee in its detailed investigation of the Psychosomatic Unit.

Dr. Behan also indicated that the Committee had noted during its visit to the Unit that the original subvention had not kept pace with inflation and consequently the Unit had not been able to maintain its professional staff 260

level and further, that there should be an administrative post for the Unit of at least Senior Executive Officer level.

Mr. Keyes informed the Committee that Mr. Harty is a member of his staff on release to the Unit. It was unanimously agreed to recommend to the Board that a Section Officer be appointed to Mr. Keyes programme to fill the vacancy created by Mr. Harty's secondment.

Dr. Cullen said he wished to thank the Committee for its vote of confidence in the Units activities, and staff and referred to possible expansion of the unit, which he stated would be die basis of formal proposals. He is currently preparing proposals in which the Board may join with the Health Education Bureau in researching certain areas e.g. stress in pregnancy, counselling re smoking cessation in pregnancy, adolescents and their choice of mental and physical health care.

Mr. Keyes stated he would like detailed costs, designs and protocols of new proposals and expansions which Dr. Cullen has in mind to be prepared for examination by the Management Team prior to submission to the Board. Professor Doyle indicating his support for the unit referred to the importance of ensuring that resources are not dissipated in too many projects and also drew attention to the unsatisfactory state of &e grounds and sign posting for this Unit of Board which was rapidly gaining international support.

Mr. Keyes indicated he would take this matter up with Mr. D'Alton of St. James's Hospital on behalf of the Unit.

Dr. Cullen stated that most of the projects which the unit had undertaken have been completed or are nearing completion. An annual report will be published which will show how the skills of the personnel are being used and will set out the projects undertaken.

It was agreed that Prof. Levi's fee of £250 should be paid.

The following is a summary of the items agreed.

(a) Acceptance of Prof. Levi's report.

(b) New proposals in respect of the unit should be referred to Management Team for consideration before submission to Board and Department of Health.

(c) That there should be an administrative post for the Psychosomatic Unit of at least Senior Executive Officer level. 261 6/11/1980

(d) Administrative support should be provided for Mr. Keyes's Programme to fill the vacancy created by Mr. Harty's secondment.

(e) Support for the unit should be continued at present level of activity and resources, corrected for inflation and the matter should be reviewed in two years time.

Rutland Centre Professor McCormick referred to the report on the centre and Dr. Culien's comments on the report, which had been circulated and commented that the centre appeared to be selective in the type of patient accepted for treatment. The cost to the Health Board of maintaining the Centre is £70,000 per annum out of a total cost of £120,000.

Prof. O'Donnell considered that the Board is getting a reasonable return for its expenditure on the centre and Professor Doyle recommended that the centre should be given time to settle down as two years is a short period in which to arrive at a definitive final opinion.

Dr. Behan was not satisfied that all his questions have been answered but was prepared to recommend continuance of the Board's support in order that the centre might be given every reasonable opportunity to develop. There are some areas e.g. sobriety, social adaptation of patients on which more detailed information is required which he would like to resubmit for examination. Dr. Culien recommended that future reports from the centre should contain the type of facts required by the Board and less of its methodology.

Dr. Behan informed the Committee that Dr. Stevenson has indicated his willingness to co-operate in any comparative study of the Rutland Centre and St. Dympna's Unit.

Mr. Keyes referred to the proposal that the Board purchase the premises' and lease it back to the Rutland Centre. It was agreed that the Board should proceed on these lines. He also stated that some of the staff are now three years working in the Centre and want permanency of tenure of office. Prof. McCormick considered that these staff may de-jure have established certain rights in relation to continuance of their employment but this was a matter which should be dealt with by the Rutland Centre Board. Prof. Doyle referred to the Diploma conferred by the Rutland Centre and asked:

(a) Who sets the examination standards and (b) What educational bodies have approved of this diploma

It was agreed to reconsider the report on the Centre at the next meeting. 262

The following is a summary of the main decisions taken:

(a) The Committee recommends to the Eastern Health Board that the evaluation period for the centre should be extended for a further year and therefore support for the centre be continued for this period; the operation of the Centre be reviewed in one year on foot of the next annual report.

(b) It was agreed that the Eastern Health Board should purchase the premises and lease them to the Rutland Centre Limited.

(c) It was agreed that Mr.Keyes would write to the Minister informing him of the Board's views and recommendations to extend the period of evaluation and interim support, and also that it is primarily the Health Board's function to evaluate this service fully before it could make final recommendations.

(d) To recommend to the Eastern Health Board that the vacancy on the Board of the Rutland Centre Limited which arises from Cllr. J. Connolly ceasing to be a member of the Eastern Health Board be filled.

The meeting finished at 4.20 p.m."

Or. Behan recommended the adoption of the Minute of the meeting which was self explanatory. Mr. Keyes pointed out that amongst the recommendations was one for the creation of an administrative post and one relating to the renewal of the Lease for the Rutland Centre. He said he wished to congratulate Dr. Cullen on the excellence of the report which he had prepared for the Committee. On a proposal by Dr. Behan seconded by Cllr. Hynes the Minute including the recommendations therein was adopted. It was also agreed that Cllr. Reilly be appointed to the Committee to replace Cllr. Connolly.

177/80 COUNSEL'S ADVICE ON MOTIONS PROPOSED BY DR. BEHAN AND ADOPTED BY THE BOARD AT THE MAY 1980 MEETING

The following Case for Counsel to Advise and Counsel's Opinion were submitted:

"In the Matter of

1. The Health Acts 1947-1970.

2. The Mental Treatment Acts 1945-1961. 263 6/11/1980

CASE FOR COUNSEL TO ADVISE

Querist in this case is the Eastern Health Board (the Board).

The Board as established commenced to function with effect from 1st April 1971 pursuant to the provisions of:

1. The Health Act 1970.

2. The Health Act 1970 (Commencement) Order 1970 (SI. 47/1970).

3. The Health Boards Regulations 1970 (SI. No. 170/1970).

4. The Health Act 1970 (Commencement) Order 1971 (SI. No. 90/1971).

On establishment the Board took over the functions of the Dublin Health Authority (the functional area of which was the City and County of Dublin) and the health functions of the Kildare and Wicklow County Councils and the functions generally referred to in Sect. 6 of the 1970 Act. The Board's functional area now comprises the City and County of Dublin and the Counties of Kildare and Wicklow.

Pursuant to section 34 and the Third Schedule of the 1970 Act the premises of the Dublin Health Authority and the premises of the Councils used for health purposes were vested in the Board.

In the past, psychiatric illness was dealt with separately as such through other statutory bodies but there has been a progressive move in more recent years to have it treated as an illness like any other illness within the broad ambit of the health services. It is unnecessary for present purposes to give counsel a historical review of the past legislation. It is sufficient if counsel notes the Mental Treatment Act 1945 which is the real start of the current code of mental health legislation. Some of this Act is still in force. Because of the special controls necessarily applicable to psychiatric patients they are still dealt with in hospitals and institutions specially approved for the treatment of mental illness and, of course, special admission procedures have to be observed in relation to the involuntary admission of patients thereto.

As is usual in relation to statutory bodies, querist is subject to the overriding control of the Minister for Health in the manner provided for in the 1947 and 1970 Acts. The Board is beholden to the Minister for most of its funds. Funds are 264

sought annually on the basis of estimates submitted to the Minister. He decides what funds to allot in response to the estimates submitted. For example for the calender year 1980 the Board sought £88.6 million but was allocated £85.6 million. The Minister himself is not a free agent for he, of course, is dependent on the amount of funds allocated for his Department out of the monies voted annually by the Oireachtas. If the Board requires additional funds over and above those sought in the estimates to meet some exceptional expenditure it must seek them from the Minister.

The Board does not always get the funds it needs either on foot of the annual estimates or to meet exceptional extra-budget expenditure. While the Board may have plans for the modernising or replacement of existing premises, the building of additional ones, the improvement of the equipment in hospitals, etc. its abitityto implement such plans obviously must depend on the availability of funds to meet the cost. Thus the Minister for Health, as the 'holder of the purse string' effectively controls the extent to which any such plans can be carried out.Inevitably this must lead into differences of opinion between the Board and the Minister in relation to what should or should not be done in relation to the provision of adequate, not to say improved, health services. It is possibly true to say that when the Minister does not provide funds for particular proposals it may be as much due to the shortage of funds available to the Minister himself as to his disagreement with the proposals.

It is axiomatic that if the Board does not get all the funds required to finance measures which it deems necessary for the proper provision of health services in discharge of the Board's statutory obligations, the standard of the services provided must necessarily, in some respects, fall below that which the Board would like to observe. For example, some of the hospitals and institutions inherited by the Board comprise very old buildings. Yet the modernisation or replacement of them would be dependent on the Board getting funds for the purpose from the Minister. Again, because of the progressive statutory extension of health service facilities to the public, more and more people are availing of these services. If the accommodation available in hospitals and institutions of the Board is overtaxed the building of extra accommodation will be dependent on the Board getting funds for the purpose.

That the Board is concerned with possible inadequacies in the available health services emerges from the following motions which were submitted to and passed at its May 1980 Meeting: 265 6/11/1980

(1) 'That the Chief Executive Officer be requested to obtain Senior Counsel's opinion as to the liability in law of the Minister for Health, the Department of Health and this Health Board in respect of a situation where the Board has admitted a patient for a specific treatment when, in fact, due to the inadequate facilities available to the Board, such treatment is not, and cannot be made available.

(2) That the Chief Executive Officer be requested to obtain Senior Counsel's opinion as to whether or not the psych ia-trically ill person, the elderly infirm or ill 'geriatric' patient and the mentally handicapped person has a constitutional, statutory or other legal right to the provision by the State of adequate and effective facilities for the care and treatment of their debility or infirmity.

(3) That the Chief Executive Officer be requested to obtain Senior Counsel's opinion as to whether the distribution of available resources by the State in an imbalanced and inequitable manner in favour of any one sector of the Health Services or community to the detriment of equally if not more necessitous sectors of the Health Service, thereby neglecting and discriminating against vulnerable, weak and underprivileged sectors of the community, is repugnant to the Constitution or infringes any statutory or other legal duty including those, imposed on the State by the Treaty of Rome and the European Court of Human Rights.'

The questions posed in the motions raise interesting and rather complex legal questions involving, for example:

I. Who decides the standard of health services to be provided by the Board in the discharge of its statutory duties

2. The extent of the Board's liability to the public when, due to the inadequacy of funds available to the Board, the standard of services provided is lower than the Board might wish.

3. The accountability of the Board and/or the Minister and/ or the State when distinctions are drawn between different classes, as mentioned in the motions.

Relevant to the questions posed in the motion quoted this case is the Judgment of the President of the High Court delivered 13th April 1976 (Record No. 1975 No. MOSS) in a case of The State (at the Prosecution of Karl Crawley) v. The Governor of Mountjoy Prison and In the Matter of the Constitution. A copy of that Judgment is annexed. Karl Crawley took the matter further and appealed to the European Human Rights Commission. A copy of his appeal is annexed. 266

Agents have not a copy of the Judgment of the Court. They have been informed this appeal was declared inadmissible as no breach of the European Convention on Human Rights was established and the Judgment of Judge Fin lay was effectively upheld.

Also of some relevance is the decision of the Court of Human Rights in favour of Mrs. Johanna Avery who had complained that the Irish Government had denied her a constitutional right in failing to provide her with free legal aid, which she needed to pursue matrimonial proceedings against her husband. Agents have not a spare copy of the Court's decision in that case but undoubtedly Counsel can get access to one in the Library.

Counsel is asked to advise on the points mentioned in the above quoted motions.

If Counsel needs any further information it will be supplied on receipt of a note of his requirements.

Dated this 13th day of June 1980

Roger Greene & Sons,

11, Wellington Quay,

Dublin 2.

OPINION

QUERIST: EASTERN HEALTH BOARD

The facts upon which this opinion is based are those set out in the Case to Advise dated 13th June, 1980. Save for illustrative purposes I shall not recite the facts.

Before attempting to advise on the three resolutions referred to at P. 4, I first express my views on the queries set out at P. 5.

1. The standard of health services to be provided by the Board in the discharge of its statutory duties is to be decided by the Board, not by the Minister for Health or the Department of Health or by an individual doctor or doctors who seeks to have a patient admitted as a patient for specific treatment.

2. Such legal liability as the Board has arises from statute. The Board is a creature of statute and while it can of course be liable at Common Law, its liabilities for breach of statutory duty, depends on what duty is imposed by 267 6/11/1980

statute. Part IV Chapters II et seq. lay down the duties. The duties are not absolute in the sense that there is not absolute duty to provide each and every possible or conceivable form of medical treatment or maintenance irrespective of all circumstances, reasonable or otherwise. There may be good medical and humanitarian (altogether from political reasons) why a health board would wish to provide an exhaustive health service — but they are not so obliged by statute. The liability to the public arises from a breach of statutory duty not from the wishes or aspirations of the Board or its individual members.

3. The Board is the person in law accountable for the drawing of distinctions between different classes of sicknesses and persons who are sick.

To turn now to consider the motions.

1. Where the Board admits a patient for specific treatment, and due to inadequate facilities available to the Board, such treatment is not, and cannot be made available — the Board could find itself involved in litigation — even if not liable. The acceptance of admission of a patient ought only to be to provide a service that is available. A situation could arise where a doctor refers a patient for admission for specific treatment — it is the duty of the Board to admit the patient, eligibility etc. being in order. The referral and admission are two different functions, the Board ought not to undertake to do that which it cannot. Neither the Minister for Health or the Department of Health have a direct legal liability for the acts or defaults of the Board. It follows that as the Board's finances are 'covered' by the Minister and the Department, that indirectly the Minister and the Department may have to indemnify the Board. If specific treatment is not available patients ought not to be admitted on the basis that it is.

2. The psychiatrically ill person, the elderly infirm or ill 'geriatric' patient and mentally handicapped person has the same constitutional rights as other members of the Community — likewise their rights under statute are equal to those of the rest of the community. Their rights are no higher, but because these members of society are under a disability the Courts are extra solicitous for their welfare, and so also ought the Board. In this context I refer the Judgement of Finlay, P. in the State (Crawley) -v-Gov. Mountjoy Prison (13/4/1976 — unreported) wherein he stated —

"The right of bodily integrity as an unenumerated constitutional right is clearly established by the decision of the Supreme Court in Ryan -v- A.G. (1965) I.R." 268

Again later in the judgement —

"A failure on the part of the Executive to provide for the prosecutor treatment of a very special kind in an institution which does not exist in any part of the State does not, in my view, constitute a failure to protect the health of the prosecutor as well as possible in all the circumstances of the case — but even if one were to accept in full all the assumptions upon which Dr. McCaffrey's opinion is based — would constitute only a failure of an absolute duty to provide the best medical treatment irrespective of the circumstances. I am satisfied as a matter of law that no such absolute duty exists."

If in the above passage one substitutes 'the Board' for 'the Executive' and 'the patient' for 'the prosecutor' one arrives at a conclusion that not only makes good sense but good law. A test of reasonableness must be applied — Reasonableness must be related to existing and favourable circumstances. I do not accept the view that the statutory duty is absolute.

3. To assert or suggest that the distribution of available resources by the State in an imbalanced and inequitable manner in favour of any one sector of the Health Services or community to the detriment of equally if not more necessitous sectors of the Health Service, thereby neglecting and discriminating against vulnerable, weak and underprivileged sectors of the Community is to make a value judgement. The Board is not capable of levying monies to provide the services it is obliged to provide by statute. The Case to Advise explains the procedure clearly. The resources sought are not always met — the Board if sued wouio ultimately be reimbursed or indemnified by the State. The Courts could enquire into the performance of the Board's statutory duty: but the Courts cannot and do not usurp the functions of the State or statutory body. If there was a finding of fact in a particular case that some legal right had been infringed and if the Plaintiff proved that he/she suffered damage as a result, whether under the Constitution, Statute, Treaty or otherwise — the Board could be liable. But someone must decide on the distribution of available resources, and so long as there is an exercise of good faith on an informed basis within the legal framework laid down by the Oireachtas the Courts would not intervene by declaration or otherwise.

T. C. Smyth. S.C . 269 6/11/1980

As this matter had already been discussed and referred to the Policy Committee, Dr. Behan undertook to call the first meeting of this Committee, at an early date.

178/80 NOTICES OF MOTION

(a) On the request of Cllr. Sweeney it was agreed that the motion tabled at 13 (a) on the Agenda be deferred to the next meeting.

(b) The following motions were proposed by Cllr. Reilly:

(i) "That this Board see that an allergy clinic be set up in the greater Dublin area and that this motion be discussed."

At Cllr. Reilly's request it was agreed that the words "a fully comprehensive" would be inserted before the words "allergy clinic" in the motion.

Cllr. Reilly presented evidence from allergy sufferers and asked that a service for them be set up preferably in one of the Board's own hospitals and tied in with the pollen count service to which the Board already contributes. He was supported by Cllr. Belton who said he had received several representations from allergy sufferers who had been attending the allergy clinic which was formerly held in Mercers Hospital. Cllr. Freehill said she had also received many representations which clearly established a demand for a specialist clinic. The motion was also supported by Cllr. Mrs. Waugh and Cllr. Durkan who had also received representations in the matter.

Dr. Meade said that while he considered that the needs of allergy sufferers were not being met adequately, a consultancy service in this field would need to be approved by Comhairle na n-Ospideal. Consequently it was not fully within the Board's authority to institute such a service.

Dr. Behan said he considered the members had not enough information at this time on the whole question to make a decision and at the suggestion of the Chairman it was agreed that a report on the matter would be submitted to the next meeting.

(ii) "That this Board agreed to the following:

That, the Social and Community Welfare Service that operates in the Finglas area be extended to take in St. Margaret's, Toberburr, Rivermeade and, if possible, a particular day be taken to service this locality. The reason for this motion is the vast increase in the population of this area." 270

Cllr. Carroll seconded the motion. Cllr. Reilly explained that the area referred to was four miles from the nearest health centre which was at Finglas and people had to travel that distance to attend at Clinics. He asked that a service be provided locally at least on one day a week. He was supported by Mr. Matthews who referred to the very inadequate bus service in this area also. The motion was adopted unanimously.

179/30 CORRESPONDENCE

The following correspondence had been circulated to the members with the agenda and notice for the meeting.

(a) Motion passed by Naas Urban District Council on 16/9/1980.

(b) Letter of 29/9/1980 from Dept. of Health re Working Party on hospitals in south county Dublin and Wicklow.

(d) Letter of 9/10/1980 from Dept. of Health approving Prof. O'DonneH's membership of the St. James's Hospital Board.

(e) Letter of 13/10/1980 from Dept. of Health re care of aged report 14/1980.

(f) Letter of 17/10/1980 from Dept. of Health regarding Naas Hospital.

(g) Letter of 24/10/80 from Dublin Corporation re An Grianan.

180/80 OTHER BUSINESS

Mr. Nolan advised members that the new Health Centre in Ballinteer would be officially opened by the Chairman on Friday 5th December at 3 p.m.

The meeting ended at 8.05 p.m.

CORRECT.

P. B. Segrave Chief Executive Officer.

Signed CHAIRMAN 271 4/12/1980

EASTERN HEALTH BOARD

Minutes of Proceedings of Monthly Meeting of the Eastern Health Board held in the Boardroom, St. Brendan's Hospital, Grangegorman, Dublin on Thursday 4th December 1980 at 6 p.m.

PRESENT Ald. B. Ahern T.D.. Mr. K. Harrington Dr. J.D. Behan Cllr. P. Hickey P.C., Cllr. L. Belton T.D., Cllr. F. Hynes Cllr. D. Browne Cllr. T. Leonard T.D.. Cllr. M. Carroll Dr. P. McCarthy Cllr. E. Doyle Sr. Columba McNamara Prof. J.S. Doyle Mr. M. Matthews Cllr. B J. Durkan Cllr. M. Freehill Ald. A. FitzGerald Dr. B. Sheehan Cllr. Mrs. A. Glenn Cllr. John Sweeney Cllr. A. Groome Cllr. G. Timmins T.D., Cllr. T. Hand P.C., Dr. J. Walker

APOLOGIES Ms. N. Kearney, Prof. J. McCormick and Dr. A. Meade

IN THE CHAIR

Cllr. D. Browne, Chairman

OFFICERS IN A TTENDANCE Mr. P.B. Segrave Prof. I. Browne Mr. F. Donohue Miss A. Flanagan Mr. T. Keyes Mr. A. O'Brien Mr. J. Clarke Mr. C. Mansfield Mr. R. N. Lamb Mr. C. Murphy Mr. J F. Reynolds Mr. M. Cummins Mr. J. Sadlier Mr. J. Leech Mr. P J. Swords Miss E. Larkin Mr. F J. McCullough Miss F. Heeney Mr. J. Doyle Mr. P.I. Lyons Prof. B. O'Donnell

181/80 SUSPENSION OF STANDING ORDERS

At the commencement of the meeting Dr. Behan asked permission to move that Standing Orders be suspended to allow him to submit a motion relating to a report that the Department of Health in 1979 had returned £27 million unspent to the Exchequer. He said that this, taken in conjunction with the Department's refusal to adopt a plan for a community psychiatric service estimated to cost £25 million 272

over five years, meant that the needs ot the psychiatric service were being totally ignored. If this had happened in 1979 he felt it could well happen again in 1980 and his motion would be in terms that would seek to prevent this happening.

Mr. Clarke informed members that the Secretary of the Department of Health had advised the Board that a supplementary revenue estimate of £27 million had been introduced at the end of 1979 for the specific purpose of financing the payment of a pay award, including arrears, to nurses, which was expected to be made before the end of that financial year. In the event the pay award was not accepted by the nurses at that time and therefore the payment including the arrears was not made. In accordance with Government accounting practice this money was returned to the Exchequer in 1979 and was re-introduced in 1980 to pay the award when it was finally accepted.

The motion to suspend Standing Orders was proposed by Dr. Behan and seconded by Cllr. Carroll and put to a vote. The vote was thirteen (13) for and ten (10) against. As the motion was not carried by a three- quarters majority of those present it was declared lost.

182/80 CHAIRMAN'S BUSINESS

The Chairman said that it had come to his notice that a matter relating to Board business tiad appeared in the evening papers that day prior to the Board meeting being held. He said he considered that the publication in the Press of matters of sufficient importance to the Board to be subject of discussion by the Board before the Board members had an opportunity to see and discuss these matters was a discourtesy to the Board and was to be deplored. The Chairman also referred to a recent article in a magazine which had referred to recommendations which a committee of the Board were proposing and which had been published before the Board or indeed the Committee itself had seen or discussed the report. He referred also to an interview with an officer of the Board published in a national newspaper recently. He said he considered it improper that members or officers of the Board should impart information to the media on matters relating to Board business or policy before the Board members were given an opportunity to see and discuss such matters.

The Chairman advised the members of the recent death of a brother of Matron of St. Colman's, Rathdrum, Sr. Philomena, and members stood in silent prayer as a mark of respect to the deceased. 273 4/12/1980

The Chairman also advised members that Mr. JJ. Nolan, former Chief Executive Officer, had been ill but was now recovered. The members asked that their best wishes be conveyed to him.

The Chairman also advised members of the forthcoming retirement of Mr. R.N. Lamb, acting Programme Manager, and paid tribute to Mr. Lamb for his personal qualities and qualities as an officer displayed by him during his long career in the public service. He said that while he regretted to see a man of his calibre retiring, on his own behalf and on the behalf of the members he wished him all the best in his retirement.

The Chief Executive Officer joined with the Chairman in paying tribute to Mr. Lamb. He said that he had hoped that Mr. Lamb would have been with him for a longer period but that he fully understood, and appreciated, Mr. Lamb's decision to retire at this time. There was a great tradition of integrity, loyalty and dedication to duty in the Irish public service and Mr. Lamb in many years of outstanding service to the community had been guided by these basic and important values.

On behalf of all the staff of the Board he wished Mr. Lamb good health and happiness in the future.

Cllr. Freehill and Cllr. Hickey on behalf of the members added their best wishes to Mr. Lamb on his retirement.

183/80 CONFIRMATION OF MINUTES

The Minutes of Proceedings of Meeting held on 6th November, 1980, having been circulated, were confirmed on a proposal by Cllr. Carroll seconded by Cllr. Sweeney.

(a) MATTERS ARISING Cllr. Durkan asked for the report on the matter of the employment of a cook at Naas Hospital.

The Chief Executive Officer said that as he had the statutory responsibility for the control and remuneration of the Board's staff he had looked into the matter in detail. He had arranged to have the post re- advertised and there were now a number of applicants. Interviews would be held following the closing date for applications for the competition and he was hopeful that an appointment would be made following the interview.

The Chairman said that he had discussed the matter with the Chief Executive Officer and he hoped that there would be a positive result to report at the next meeting. 274

184/80 SERVICES FOR PERSONS WHO MAY SUFFER FROM ALLERGIES

Cllr. Reilly asked permission to have the report listed at number 4 on the agenda discussed at this stage as he would have to leave the meeting early, and this was agreed.

The following Report No. 54/1980 from the Chief Executive Officer was submitted:—

'The Board at a meeting held on 6th November, 1980 considered the following motion submitted by Cllr. H. Reilly:

"That this Board see that an allergy clinic be set up in the greater Dublin area and that this motion be discussed."

The Board requested that a report on the current position be submitted for the December meeting.

At present allergism in itself is not recognised as a medical sub- specialty. Where allergic conditions occur, and they do so commonly, they are treated within the following recognised specialties: Neurology Gastro Enterology Dermatology Nephrology Rheumatology Metabolic Diseases Paediatrics (including diabetes) Psychiatry Endocrinology Respiratory Medicine Physical Medicine Cardiology Geriatrics

For instance, a substantial proportion of people who attend dermatology clinics have got allergic conditions and indeed this also applies to many patients who attend respiratory, asthma or gastro-enterology clinics.

Persons who may suffer from allergies of different kinds are recommended to attend their own family doctors who may then decide, if they consider it necessary to do so, to refer them to a consultant in the appropriate sub-specialty.

Our Board is required to make available in-patient and outpatient services and these are provided in the recognised subspecialties outlined above, and mainly through long standing arrangements in various hospitals in the area.

It would be the function of Comhairle to grant or refuse an application for the establishment of an appropriately structured post within any recognised new sub-specialty.

The information and advice available at the present time do not indicate that the medical criteria for setting up a separate 275 4/12/1980

allergy sub-specialty are clearly met. There is no indication of widespread medical support for the view that existing needs are not being met within the family doctor and consultant services.

It is evident, however, that there is a substantial body of patient opinion firm in the view that there is a need for the establishment of special allergy clinics.

It may be that in the light of further consideration of the problem the Board may wish to refer the matter to its Medical and Allied Research Committee with a request that it consider and report on allergy as a health problem and advise the Board of the adequacy of existing services to deal with the problem as presented by the patient representations."

A full discussion followed on the services for allergies to which the following contributed — Cllr. Reilly, Cllr. Mrs. Glenn, Cllr. Hand, Ald. FitzGerald, Cllr. Freehili, Cllr. Belton, Cllr. Doyle, Cllr. Carroll, Prof. Doyle, Cllr. Durkan, Dr. Sheehan, Cllr. Groome, Dr. Behan and Dr. Walker. Prof. O'Donnell and the Chief Executive Officer also spoke.

On a proposal by Prof. Doyle it was agreed as recommended in the report to refer the matter to the Board's Medical and Allied Research Committee to have that committee assemble information on the current position and make recommendations on the adequacy of the present services or the need for other clinical, specialist or training facilities.

185/80 SPECIAL MEETING OF THE BOARD

Cllr. Freehili sought permission to bring forward the motion tabled at 10 (b) on the agenda paper and this was agreed.

Before the motion was proposed the Chairman agreed with the members that the Special Meeting requested on Family Planning services be fixed for the 15th January 1981 at 6 p.m. in the Boardroom St. Brendan's Hospital, and consequently Cllr. Freehili agreed to withdrawal of her two motions at 10 (b) and (c) on the agenda and asked to have the motion at 10 (c) tabled for the Special Meeting.

186/80 PROCEEDINGS OF VISITING COMMITTEES

The reports of the following Visiting Committee meetings having been circulated were dealt with as follows:

(a) No. 1 Visiting Committee meeting held at District Hospital Wicklowon 17th November, 1980 276

On a proposal by Cllr. Hynes seconded by Cllr. Sweeney the report was noted.

Cllr. Sweeney thanked the Chairman, the Chief Executive Officer and Mr. Swords for attending at the Visiting Committee meeting at which a presentation had been made by the Wicklow Hospital Patient Benefit Fund of £3,500 worth of equipment to the hospital.

(b) No. 2 Visiting Committee meeting held at Bru Chaoimhin, on 7th November, 1980

On a proposal by Cllr. Sweeney seconded by Cllr. Hynes the report was noted.

The Chairman said this report had been circulated in error and would be put to the next meeting of the No. 2 Visiting Committee for their consideration.

(d) No. 4 Visiting Committee meeting held at St. Clare's Home on 19/11/80

On a proposal by Mr. Harrington seconded by Dr. McCarthy the report was noted.

(e) Community Care Visiting Committee meeting held at Area 3 on 21st October 1980

On a proposal by Or. McCarthy seconded by Deputy Timmins the report was noted.

187/80 CAPITAL PROGRAMME - PROJECTS COMMENCED AND PROPOSED

Mr. Clarke said that this item appeared on the agenda at the request of the Board, to enable the members to comment on and raise any item for consideration or for referral to the Capital Programme Committee. At present the list of capital projects was under review by the Management Team. When the review was completed the Capital Programme Committee would be asked to meet and examine the list of projects.

In reply to Dr. Behan, the Chief Executive Officer said that the Department of Health gives the Board a revenue allocation on the basis of the Department's assessment of the cost of maintaining the Board's existing services at current level. If developmental funds (for new or extended services) became available from the Department of Health the Board would be notified accordingly. 277 4/12/1980

Alderman FitzGerald said he hoped the list of projects would be brought up to date for the January meeting and that the Department would then be advised as to the Board's full needs. He was supported by Dr. Behan who recommended that the Board seek a meeting with the Minister for Health after the next Board Meeting to review the Board's total capital programme.

The following motion proposed by Dr. Behan and seconded by Cllr. Carroll was adopted:

'That the Board, noting with concern the large backlog of Capital Projects in Report 18/1980 awaiting departmental sanction and being aware of the serious deficiencies in its institutions and facilities for the treatment of the mentally ill, the aged and the mentally handicapped, hereby calls on the Minister for Health to hold any unspent surplus from the 1980 allocation for Health in a special account for these services to the weaker and underprivileged sections of our community in the Eastern Health Board area."

188/80 TEMPORARY BORROWING

The following Report No. 52/1980 from the Chief Executive Officer was submitted:

"At meeting held on 4th September 1980 the Board consented to the temporary borrowing by way of overdraft up to an overdraft limit of £1.5 million during the quarter ending on 31st December 1980.

It is considered that similar overdraft accommodation will be required during the March quarter 1981.

Accordingly, I request that the Board consent to borrowing by way of overdraft during the three months to 31st March 1981 up to a maximum of £1.5 million."

On a proposal by Dr. McCarthy seconded by Deputy Timmins the report was adopted.

189/80 GENERAL MEDICAL SERVICES (PAYMENTS) BOARD REPORT FOR 1979

The following Report No. 55/1980 from the Chief Executive Officer was submitted:

'The report of the General Medical Services (Payments) Board for 1979 has been circulated to the Board. The report shows that a total of £46,770,461 was paid to Doctors and Pharmacists for the year ended 31st December, 1979 278

compared with a total of £39,479,575 paid the previous year, representing an increase of 18.5%.

GROSS EXPENDITURE (DOCTORS FEES AND MEDICINES) 1977 1978 1979 % Increase on 1978

£ £ £ E.H.B. 8.355,762 9.839.923 11,449.729 16.4 National 33,184.469 39,479.575 46,770.46 f 18.5

FEES PAID TO DOCTORS 1977 1978 1979 % Increase on 1978

£ £ £ E.H.B. 2.647,234 3.004,409 3,551,659 18.2 National 10,931,577 12,817,303 15.404,548 20.2

INGREDIENT COSTOF MEDICINES (INCLUDING V.A.T.) 1977 1978 1979 % Increase on 1978

£ £ £ E.H.B. 4,016,460 4,918,954 5,684.625 15.6 National 14,306.175 17,543,460 20,695,568 18.0

DISPENSING FEES PAID TO PHARMACISTS 1977 1978 1979 % Increase on 1978

£ £ £ E.H.B. 1,643.044 1.867,493 2,154,640 15.4 National 5.353,928 6.173,103 7,348,199 19.0 279 4/12/1980

STOCK ORDERS (INGREDIENT COST, DISPENSING FEE & V.A.T.) 1977 1978 1979 % increase on 1978

£ £ £ E.H.B. 49.024 49,067 58,805 19.8 National 2.528.250 2,886,488 3.262.054 13.0

*A sum of £60,092 for needles and syringes is included.

In addition to the above payments retrospective payments for 1978 were paid in 1979 to:-

Doctors amounting to £531,803 Pharmacists amounting to £170,205

and in V.A.T. on the Pharmacists arrears amounting to £2,241.

Adding these payments to the payments for 1979 Doctors & Pharmacists were paid a total of £47,474,710, which is an increase of 20.3% on what they were paid in the previous year.

Administration For the year 1979 the cost of administration in the Payments Board was £597,833 (1.26% of the total expenditure) of which approximately £155,436 (26%) was apportioned to the Eastern Health Board. The cost of administration of the service in the offices of the Eastern Health Board was £250,000. The total cost of administration for the services in the Board's area for 1979 was, therefore, £405,436.

Participating Doctors Table 1 page 10 shows that at the 31st December, 1979 there were 430 doctors (including 56 former District Medical Officers) participating in the Scheme in Dublin, Wicklow and Kildare representing 33% of the total number of doctors participating in the Scheme.

Participating Pharmacists Table 2 page 11 shows that at the 31st December, 1979 there were 381 Pharmacists in the Board's area — 34% of the total Pharmacists participating in the Scheme. 280

Persons covered by Medical Cards The number covered by medical cards in each of the Health Board areas is shown in Table 4 page 13. The figure for the Eastern Health Board as at the 31st December, 1979 was 274,371 (23.14% of the total population)* as against 260,851 (26.73% of the total population)as at 31st December, 1978. * Based on 1979 Census of Population.

Overall Payment per person (total cost of consultations together with total cost of prescriptions divided by total of persons on doctors panels)

1977 1978 1979 E.H.B. 32.16 37.67 43.39 National 25.59 32.40 38.62

Number of Consultations by Doctors paid by fee Table 8 page 17 lists the number of consultations by doctors paid by fee in each Health Board area. It will be noted that for the year ended 31st December, 1979 the number of consultations by doctors in the Board's area was 1,593,271 of which 1,224,274 were surgery consultations and 368,997 were domiciliary visits. The number of consultations in the Eastern Health Board area represents approximately 24% of the total (6,607,614) for the country.

In table 22 page 31 it will be seen that the average payments to doctors per consultation for the Eastern Health Board area for year ended 31st December, 1979 was £2.23 which was almost 5% below the national average of £2.33.

Visiting Rates In table 10 page 19 it will be noted that the average visiting rate of doctors (paid by fee) in the Board's area for year ended 31st December, 1979 was 6.15 as against 6.45 for the previous year. The national average visiting rate for 1979 was 5.59. The surgery and domiciliary visiting rate in the Eastern Health Board area was the highest in the country and was 10% above the national average.

Table 11 page 20 shows that the visiting rates of 323 doctors in the Board's area were in the range 1 — 7.9,41 in the range 8 - 9.9, 5 in the range 10 - 11.9 and that 3 doctors had a visiting rate of 12 and over.

Table 11 — 18 inclusive allow of a comparison of visiting rates of doctors in the range 4 — 8.99 in the eight Health Board areas as follows:—

4/12/1980 281

HEALTH BOARD Visiting rate of doctors

4.0 - 5.9 6.0-7.9 8.0-9.9

Eastern 155 144 41 Midland 59 16 2 Mid-Western 53 19 1 North Eastern 53 37 6 North Western 45 27 4 South Eastern 93 29 1 Southern 78 86 7 Western 82 38 4

618 396 66

Seventeen doctors had a visiting rate of 10 and over and of these doctors 8 were in the Eastern Health Board area.

Consultation Fees paid to doctors in the period from January, 1979 to December, 1979 inclusive.

Number of Doctors Income Range

From To £ £ 87 0 - 2,500 75 2,501 - 5,000 67 5,001 - 7,500 47 7,501 - 10,000 43 10,001 - 12,500 39 12,501 - 15.000 18 15,001 - 17,500 15 17,501 - 20,000 22 20,001 - 25,000 3 25,001 - 30,000 2 30,001 - 35,000 1 35,001 - 40.000 1 40,001 - 45.000 282

Income ranges of Pharmacists based on dispensing fees paid in the period from 1st January, 1979, to 31st December, 1979.

Number of Income Range

Pharmacists From To £ £ 96 0 - 2.000 114 2,001 - 4,000 66 4,001 - 6,000 46 6.001 - 8,000 27 8.001 - 10,000 17 10,001 - 12,000 12 12,001 - 14,000 9 14,001 - 16,000 5 16.001 - 20,000 6 20,001 - 25,000 2 25.001 - 30,000 1 30,001 - 35,000 1 Over £35,000

Most Commonly Prescribed Drugs Table 35 page 44 sets out the thirty most commonly prescribed drugs in the order of their prescribing frequency in 1979.

In Table 36 page 45 there is an analysis of prescribing frequency according to therapeutic classification.

Distribution of drugs and medicines according to therapeutic classification for the year ended 31st December, 1979 In Table 37 (pages 46 to 49 inclusive) the distribution is shown under the headings of therapeutic class, prescribing frequency, % of scheme total and ingredient cost.

Summary of Statistical Information Table 38 page 50 is a summary of statistical information on the Choice of Doctor Scheme in the eight Health Board areas for the five years ended 31st December, 1979."

The Chairman told Dr. Sheehan that the Health Board's representative on the Payments Board was Mr. Donohue, Programme Manager, Community Care. Dr. Sheehan said that, due to a printing error in one million prescription forms, general practitioners had to write the name and address of patients twice which was laborious and time consuming, having regard to the number of prescriptions to 283 4/12/1980

be written, and he recommended that the Health Board's representative ask the Payments Board to withdraw these forms and issue correctly printed forms.

190/80 APPOINTMENT OF ADDITIONAL COMMUNITY WELFARE OFFICERS

The following Report No. 53/1980 from the Chief Executive Officer was submitted:—

"During 1979 there were significant increases in the demands for Supplementary Welfare Services in certain districts in Dublin, in order to adequately meet these demands it was necessary to recruit four additional Community Welfare Officers, with the concurrence of the Department of Health. At the same time, it was decided to carry out an Organisation and Methods survey on the workloads in the districts in Dublin.

Reports have been completed on what were identified as the most hard pressed districts. These reports confirm the need for the four officers already recruited and recommend the recruitment of a further two. The Department of Health have sanctioned the creation of two further posts on a temporary basis.

I recommend that the Board approve of the creation of two additional temporary posts of Community Welfare Officer for an initial period of six months or until the Organisation and Methods survey is complete, if sooner."

On a proposal by Dr. McCarthy seconded by Cllr. Sweeney the report was adopted.

191/80 RECEPTION OF DEPUTATION ON CARE OF THE AGED BY MINISTER FOR HEALTH

Mr. Lamb explained that the Department of Health was not yet in a position to meet a deputation from the Board. The Chairman said that a number of the recommendations in the Report would not be expensive to implement but were urgently needed and that the Board should press for a meeting with the Minister and if necessary the deputation should not wait for the presentation of the report of the Psychiatric Services Committee which was originally intended to be dealt with by the same deputation. 284

192/80 PROCEEDINGS OF LOCAL (HEALTH) COMMITTEES

The reports of the following Local Health Committee meetings having been circulated were dealt with as follows:

(a) Wicklow Local (Health) Committee meeting held 26/9/1980

On a proposal by Deputy Timmins, seconded by Dr. McCarthy the minutes were noted.

In reply to Deputy Timmins' enquiry Mr. Sadlier said that the proposed Health Centre at Blessington had not yet been sanctioned by the Department but that capital would be made available by the Department for the work when sanction was given.

Regarding the Health Centre and Offices at Wicklow Mr. Sadlier told Deputy Timmins that he had written to the Department of Health requesting sanction. This had not as yet been received.

Cllr. Sweeney and Cllr. Hynes joined with Deputy Timmins in pressing for the urgent commencement of a number of projects. In reply to Dr. McCarthy Mr. Sadlier said that planning had been commenced on the proposed Health Centre at Donard in anticipation of monies becoming available for the project.

Referring to the Working Party on the hospital services in South County Dublin and Wicklow Dr. Sheehan said he understood that the advice and observations of the local general practitioners would be sought before the report was prepared. Mr. Swords said he would undertake to convey the request of the general practitioners to the Working Party, and also the wishes of the local health committees in the area to be given an opportunity to submit their views.

(b) Dun Laoghaire Local (Health) Committee meeting held on 12/11/1980

On a proposal by Cllr. Carroll, seconded by Cllr. Hynes the minutes were noted.

On a proposal by Cllr. Durkan seconded by Cllr. Hynes the minutes were noted.

In reply to Cllr. Durkan Mr. Donohue said that the proposed site for the Health Centre at Castledermot was the best available at present and the Board would proceed to build on that site unless a better one would become available before the money for the project was allocated. Department of Health approval to the present site has been obtained.

In reply to Cllr. Durkan, Mr. Keyes said that he had spoken to the residents in the area about the Board's proposal for Grove House and felt that it was now possible to go ahead with the project. He was arranging for the Technical Services Officer to examine the premises and subject to his report a recommendation to purchase the premises will be put to the Board.

193/80 NOTICES OF MOTION

The motions tabled at (a) (b) and (c) having been already disposed of the following motion was proposed by Dr. McCarthy:

'That the notional system of assessment of farmer's income be abolished, or else that the Index be reviewed realistically bi- annually."

Speaking to the motion Dr. McCarthy said he considered that the present system for assessing eligibility for farmers was unjust in present terms. An index of 117 per £1 valuation was used both for assessment of entitlement to health card and eligibility for medical card. This notional system was, he considered, unjust as the valuations on property were not standard and the notional figure of income resulting from this index was also subject to variations. He considered that farmers and self-employed should be considered for eligibility on the basis of their income and where a farmer is unable to pay a health contribution he should be considered eligible for a medical card. The motion was seconded by Deputy Timmins who said that farm incomes were dropping while at the same time the index was being revised upwards.

Mr. Donohue said that in relation to medical card applications the index was used as a guideline only. He undertook to examine the situation to see if the Board's operation of the assessment method of determining farmers' income is causing undue hardship.

Mr. Lamb pointed out that the index is fixed by the Government in relation to the health contributions scheme as this scheme applies to farmers. 286

CHAIRMAN The motion was agreed.

The meeting ended at 8.15 p.m.

CORRECT. P. B. Segrave Chief Executive Officer Signed