Health Board

for Health Boards in countries other than Ireland.

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 which where prescribed a functional area in which they operated. The system was reformed in 1999 from eight to eleven regional bodies and this system often became disparagingly called the Eleven Kingdoms.

On January 1, 2005, the health boards were replaced by the Health Service Executive, 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in Ireland; this was the act that served as the legislative basis for the Mother and Child Scheme, which was later withdrawn under Church and doctor opposition.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 & 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.

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 officer and more often assisted by an ad-hoc management team consisting of professionals who were public servants.


 * †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 borough 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
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.

Criticisms
Chief among the criticisms of the health board system was that of political patronage. 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 chemists, doctors, dentists, and nurses who practiced in the functional area.

The Eleven Kingdoms
The term the Eleven Kingdoms was a term that gained some currency among journalists, politicians and the public in the early 2000s before the system was reformed. The Eleven Kingdoms refers to the eleven health authorities and boards which were then in existence.