Health Board
Encyclopedia
The Health Board system of the Republic of Ireland
was created by the 1970 Health Act. This system was initially created with eight health boards, each of which were prescribed a functional area in which they operated. The system was reformed in 1999 from eight to eleven regional bodies.
On 1 January 2005, the health boards were replaced by the Health Service Executive
, although the system is still in a transition phase.
, which was later withdrawn under Church and doctor opposition.
Under the 1947 act, the health authority for a functional area was the city council
or county council
of that area. This reflected the fact that until 1947, the Minister for Local Government and Public Health was responsible for public health
, and in that year, the Minister for Health
was created as a separate Minister of the Government by the 1946 Ministers and Secretaries (Amendment) Act.
In 1970, the healthcare system of Ireland was still very much a private and voluntary system with the Catholic Church still retaining effective control of healthcare, in particular the ownership of hospitals and institutions. Doctors served very much in a sole trader capacity with the state taking few responsibilities beyond the organisation of the provision of healthcare to the disadvantaged.
and more often assisted by an ad-hoc management team consisting of professionals who were public servants
.
In the late 1990s, the counties of Dublin, Kildare and Wicklow represented almost half of the population of the state and had only one health board, the Eastern Health Board. The rest of the state was served by seven health boards, each with a designated functional area. The 1999 Health (Eastern Regional Health Authority) Act was introduced and dissolved the Eastern Health Board and created four bodies in its place, thus bringing to eleven the number of regional health authorities and boards.
The Eastern Regional Health Authority (ERHA) was given overall responsibility for the former health board functional area, however the actual provision of services was delegated to three area health boards. These area health boards were; the Northern Area Health Board (NAHB), East Coast Area Health Board (ECAHB) and the South-Western Area Health Board (SWAHB).
The functional areas of the area health boards did not correspond exactly to the city and county council boundaries and instead were defined in the First Schedule of the Act. The 1999 Eastern Regional Health Authority (Area Health Boards) Regulations determined the composition of the board of each area health board. The composition of the Eastern Regional Health Authority was determined by the act.
. Typically about half of the board members were appointed by the city or county councils of the functional area; and the Minister for Health appointed three members on each board. The cumulative effect was that over half of the board members were, in effect, appointed by local and national government; the nominated board members were often the aspiring members of political parties.
This method of nomination and selection was often considered to be the core problem of the healthcare system; poor accountability and service provision due to the politicised nature of the system which meant that decisions were made on political needs rather than professional teams deciding on medical need and weighing factors like value for money.
Additional members were appointed by election by registered chemist
s, doctor
s, dentist
s, and nurses who practiced in the functional area.
Republic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...
was created by the 1970 Health Act. This system was initially created with eight health boards, each of which were prescribed a functional area in which they operated. The system was reformed in 1999 from eight to eleven regional bodies.
On 1 January 2005, the health boards were replaced by the Health Service Executive
Health Service Executive
The Health Service Executive is responsible for the provision of healthcare providing health and personal social services for everyone living in Ireland, with public funds. The Executive was established by the Health Act, 2004 and came into official operation on January 1, 2005...
, although the system is still in a transition phase.
Background
Prior to the advent of the health board system, the 1947 Health Act was the principal legislation on the State's role in the provision of healthcare in Ireland; this was the act that served as the legislative basis for the Mother and Child SchemeMother and Child Scheme
The Mother and Child Scheme was a healthcare programme in the Republic of Ireland that would later become remembered as a major political crisis involving primarily the Irish Government and Roman Catholic Church in the early 1950s....
, which was later withdrawn under Church and doctor opposition.
Under the 1947 act, the health authority for a functional area was the city council
City council
A city council or town council is the legislative body that governs a city, town, municipality or local government area.-Australia & NZ:Because of the differences in legislation between the States, the exact definition of a City Council varies...
or county council
County council
A county council is the elected administrative body governing an area known as a county. This term has slightly different meanings in different countries.-United Kingdom:...
of that area. This reflected the fact that until 1947, the Minister for Local Government and Public Health was responsible for public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
, and in that year, the Minister for Health
Minister for Health and Children (Ireland)
The Minister for Health is the senior minister at the Department of Health in the Government of Ireland and is responsible for health care in the Republic of Ireland and related services.The current Minister for Health is James Reilly, TD...
was created as a separate Minister of the Government by the 1946 Ministers and Secretaries (Amendment) Act.
In 1970, the healthcare system of Ireland was still very much a private and voluntary system with the Catholic Church still retaining effective control of healthcare, in particular the ownership of hospitals and institutions. Doctors served very much in a sole trader capacity with the state taking few responsibilities beyond the organisation of the provision of healthcare to the disadvantaged.
The Health Boards
In 1970, the Health Boards Regulations were made under the Health Act, 1970 and defined among other things the functional area, membership and composition of each health board. Each health board was headed by a chief executive officerChief executive officer
A chief executive officer , managing director , Executive Director for non-profit organizations, or chief executive is the highest-ranking corporate officer or administrator in charge of total management of an organization...
and more often assisted by an ad-hoc management team consisting of professionals who were public servants
Public service of the Republic of Ireland
The public service of Ireland consists of agencies which, while not formally part of a Department of State, provide services on behalf of the government...
.
| Health Board | Members | Functional Area |
| Eastern Health Board (EHB) | 35 | City of Dublin, County Dublin County Dublin County Dublin is a county in Ireland. It is part of the Dublin Region and is also located in the province of Leinster. It is named after the city of Dublin which is the capital of Ireland. County Dublin was one of the first of the parts of Ireland to be shired by King John of England following the... , County Kildare County Kildare County Kildare is a county in Ireland. It is part of the Mid-East Region and is also located in the province of Leinster. It is named after the town of Kildare. Kildare County Council is the local authority for the county... , County Wicklow County Wicklow County Wicklow is a county in Ireland. It is part of the Mid-East Region and is also located in the province of Leinster. It is named after the town of Wicklow, which derives from the Old Norse name Víkingalág or Wykynlo. Wicklow County Council is the local authority for the county... |
| Midland Health Board (MHB) | 30 | County Laois County Laois County Laois is a county in Ireland. It is part of the Midlands Region and is also located in the province of Leinster. It was formerly known as Queen's County until the establishment of the Irish Free State in 1922. The county's name was formerly spelt as Laoighis and Leix. Laois County Council... , County Offaly County Offaly County Offaly is a county in Ireland. It is part of the Midlands Region and is also located in the province of Leinster. It is named after the ancient Kingdom of Uí Failghe and was formerly known as King's County until the establishment of the Irish Free State in 1922. Offaly County Council is... , County Longford County Longford County Longford is a county in Ireland. It is part of the Midlands Region and is also located in the province of Leinster. It is named after the town of Longford.Longford County Council is the local authority for the county... , County Westmeath County Westmeath -Economy:Westmeath has a strong agricultural economy. Initially, development occurred around the major market centres of Mullingar, Moate, and Kinnegad. Athlone developed due to its military significance, and its strategic location on the main Dublin–Galway route across the River Shannon. Mullingar... |
| Mid-Western Health Board (MWHB) | 28 | County Clare County Clare -History:There was a Neolithic civilisation in the Clare area — the name of the peoples is unknown, but the Prehistoric peoples left evidence behind in the form of ancient dolmen; single-chamber megalithic tombs, usually consisting of three or more upright stones... , City of Limerick, County Limerick County Limerick It is thought that humans had established themselves in the Lough Gur area of the county as early as 3000 BC, while megalithic remains found at Duntryleague date back further to 3500 BC... , Tipperary North Riding |
| North-Eastern Health Board (NEHB) | 30 | County Louth County Louth County Louth is a county of Ireland. It is part of the Border Region and is also located in the province of Leinster. It is named after the town of Louth. Louth County Council is the local authority for the county... , County Meath County Meath County Meath is a county in Ireland. It is part of the Mid-East Region and is also located in the province of Leinster. It is named after the ancient Kingdom of Mide . Meath County Council is the local authority for the county... , County Cavan County Cavan County Cavan is a county in Ireland. It is part of the Border Region and is also located in the province of Ulster. It is named after the town of Cavan. Cavan County Council is the local authority for the county... , County Monaghan County Monaghan County Monaghan is a county in Ireland. It is part of the Border Region and is also located in the province of Ulster. It is named after the town of Monaghan. Monaghan County Council is the local authority for the county... |
| North-Western Health Board (NWHB) | 27 | County Donegal County Donegal County Donegal is a county in Ireland. It is part of the Border Region and is also located in the province of Ulster. It is named after the town of Donegal. Donegal County Council is the local authority for the county... , County Sligo, County Leitrim County Leitrim County Leitrim is a county in Ireland. It is located in the West Region and is also part of the province of Connacht. It is named after the village of Leitrim. Leitrim County Council is the local authority for the county... |
| South-Eastern Health Board (SEHB) | 31 | County Carlow County Carlow County Carlow is a county in Ireland. It is part of the South-East Region and is also located in the province of Leinster. It is named after the town of Carlow, which lies on the River Barrow. Carlow County Council is the local authority for the county... , County Kilkenny County Kilkenny County Kilkenny is a county in Ireland. It is part of the South-East Region and is also located in the province of Leinster. It is named after the city of Kilkenny. The territory of the county was the core part of the ancient Irish Kingdom of Osraige which in turn was the core of the Diocese of... , County Wexford County Wexford County Wexford is a county in Ireland. It is part of the South-East Region and is also located in the province of Leinster. It is named after the town of Wexford. In pre-Norman times it was part of the Kingdom of Uí Cheinnselaig, whose capital was at Ferns. Wexford County Council is the local... , City of Waterford, County Waterford County Waterford *Abbeyside, Affane, Aglish, Annestown, An Rinn, Ardmore*Ballinacourty, Ballinameela, Ballinamult, Ballinroad, Ballybeg, Ballybricken, Ballyduff Lower, Ballyduff Upper, Ballydurn, Ballygunner, Ballylaneen, Ballymacarbry, Ballymacart, Ballynaneashagh, Ballysaggart, Ballytruckle, Bilberry, Bunmahon,... , Tipperary South Riding |
| Southern Health Board (SHB) | 33 | City of Cork Cork (city) Cork is the second largest city in the Republic of Ireland and the island of Ireland's third most populous city. It is the principal city and administrative centre of County Cork and the largest city in the province of Munster. Cork has a population of 119,418, while the addition of the suburban... , County Cork County Cork County Cork is a county in Ireland. It is located in the South-West Region and is also part of the province of Munster. It is named after the city of Cork . Cork County Council is the local authority for the county... , County Kerry County Kerry Kerry means the "people of Ciar" which was the name of the pre-Gaelic tribe who lived in part of the present county. The legendary founder of the tribe was Ciar, son of Fergus mac Róich. In Old Irish "Ciar" meant black or dark brown, and the word continues in use in modern Irish as an adjective... |
| Western Health Board (WHB)† | 29 | County Galway County Galway County Galway is a county in Ireland. It is located in the West Region and is also part of the province of Connacht. It is named after the city of Galway. Galway County Council is the local authority for the county. There are several strongly Irish-speaking areas in the west of the county... , County Mayo County Mayo County Mayo is a county in Ireland. It is located in the West Region and is also part of the province of Connacht. It is named after the village of Mayo, which is now generally known as Mayo Abbey. Mayo County Council is the local authority for the county. The population of the county is 130,552... , County Roscommon County Roscommon County Roscommon is a county in Ireland. It is located in the West Region and is also part of the province of Connacht. It is named after the town of Roscommon. Roscommon County Council is the local authority for the county... |
- †In 1990, the functional area was changed to explicitly include the city of Galway and as a result two board members were added to the board in accordance with the 1990 Health Boards (Amendment) Regulations. This change was due to the city obtaining county boroughCounty boroughCounty borough is a term introduced in 1889 in the United Kingdom of Great Britain and Ireland , to refer to a borough or a city independent of county council control. They were abolished by the Local Government Act 1972 in England and Wales, but continue in use for lieutenancy and shrievalty in...
status on January 1, 1986 and thus the need for representation on the health board which had continued to be de-facto responsible for health within the city in the interim period.
Reforms of 1999
The Eastern Regional Health Authority (ERHA) was given overall responsibility for the former health board functional area, however the actual provision of services was delegated to three area health boards. These area health boards were; the Northern Area Health Board (NAHB), East Coast Area Health Board (ECAHB) and the South-Western Area Health Board (SWAHB).
The functional areas of the area health boards did not correspond exactly to the city and county council boundaries and instead were defined in the First Schedule of the Act. The 1999 Eastern Regional Health Authority (Area Health Boards) Regulations determined the composition of the board of each area health board. The composition of the Eastern Regional Health Authority was determined by the act.
Criticisms
Chief among the criticisms of the health board system was that of political patronagePatronage
Patronage is the support, encouragement, privilege, or financial aid that an organization or individual bestows to another. In the history of art, arts patronage refers to the support that kings or popes have provided to musicians, painters, and sculptors...
. Typically about half of the board members were appointed by the city or county councils of the functional area; and the Minister for Health appointed three members on each board. The cumulative effect was that over half of the board members were, in effect, appointed by local and national government; the nominated board members were often the aspiring members of political parties.
This method of nomination and selection was often considered to be the core problem of the healthcare system; poor accountability and service provision due to the politicised nature of the system which meant that decisions were made on political needs rather than professional teams deciding on medical need and weighing factors like value for money.
Additional members were appointed by election by registered chemist
Chemist
A chemist is a scientist trained in the study of chemistry. Chemists study the composition of matter and its properties such as density and acidity. Chemists carefully describe the properties they study in terms of quantities, with detail on the level of molecules and their component atoms...
s, doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
s, and nurses who practiced in the functional area.