THE delegates to the annual conference of the Association of Health Boards in Ireland represent those who have responsibility for spending £1.34 billion of taxpayers money.
This is the amount of this year's total health budget of £2.4 billion allocated to the health boards, the main deliverers of health and social services to the public.
The range of services provided by the health boards is vast: it includes hospitals, both general and psychiatric, general medicine, especially to holders of medical cards, and a wide range of community health care ranging from child protection to drug treatment centres, women's health, home helps and other support for the elderly.
In order to deliver this service, each health board has three subdivisions, or "programmes community care, general hospital services and special hospital services, although the North Western Health Board does not have the latter, as it no longer runs any psychiatric hospital. Each has a programme manager, working immediately under the chief executive officer, who runs the health board as a whole.
CEOs, therefore, have huge power and responsibility in the delivery of health services. They are effectively the employers of the majority of health workers, from consultants to public health nurses, in most of the health board areas. (Dublin is the exception because of the large number of voluntary and religious run hospitals). They meet on a monthly basis to discuss matters of common interest.
However, the health boards are meant to be democratic institutions, run by boards elected by a combination of the general public (indirectly) and by the medical and paramedical professions (directly).
Thus each local authority elects from among its own members representatives to sit on the health boards, and the different categories of medical professionals - general practitioners, consultants, nurses, social workers - elect their representatives. Three members of each board are appointed by the Minister for Health.
Seats on health boards are prized by county councillors for various reasons. From the public service point of view, it is clear that health is important to most members of the public, and having a hand in the delivery of health services is therefore attractive to public representatives on this basis alone. If accountability is to mean anything, it should be that the public can exercise control through its representatives.
But there are also perks. Between the board as a whole and the committees there are at least two meetings a month, usually in different parts of the health board area, which involves a lot of travelling at very attractive mileage rates. One public representative member of a board acknowledged to this reporter at the weekend that there was "good money to be earned" from membership; this was one reason why nominations were sought.
Membership of health boards is also a means for public representatives with national ambitions to keep in touch. Conferences like that at the weekend provide a venue for aspiring senators to maintain contact with their electorate.
Health is an increasingly complex - and controversial - area. For example, in the Eastern Health Board the questions of drug treatment and of women's health are only two which are being discussed at the moment.
The boards are also responsible for deciding on the overall levels of service and expenditure. It is a lot to expect of public representatives, who are not involved in health on a full time basis, to be in command of all the financial, technical and ethical issues associated with the provision of a modern health service. Yet, if accountability is to mean anything, they must be.
The Association of Health Boards is made up of eight members elected from each board. It meets on a monthly basis and presents the views of the members to the Minister. It has an a.g.m. each September and an annual conference, which discusses topical health issues, at the end of April or beginning of May. For example, this year the conference discussed child protection, cancer and possible dangers from mobile telephone and electricity masts.