A key initial priority of the Irish Free State was to provide for the abolition or transformation of the workhouses. This was undertaken initially in temporary legislation 1923 and made permanent in 1925.
New Boards of Health and Public Assistance were established. They took over responsibility for county and district hospitals as well as county homes.
The Public Hospitals Act in 1933 established the Hospitals Commission and the Public Trust Board to administer the Sweepstakes and advice on distribution.
Several new county and district hospitals were built after independence, principally by hospital trust money raised under hospital sweepstakes.
Poor relief was reformed and remained public assistance under 1939 legislation. County hospitals came to be used both by paying patients as well as those receiving public assistance.
Lunatic asylums were renamed mental hospital. Lunatics became patients. Mentally handicapped persons in workhouses were transferred to county homes. Other mental hospitals remained. The Mental Treatment Act modernised methods for committal of patients to mental hospitals. It provided for procedures for temporary and long-term admission.
In 1925, the responsibility for dispensary medical services was passed to the Board of Health and Public Assistance. A midwife was employed in each dispensary district as well as the dispensary doctor. Practitioners were selected under the Local Appointments Commission arrangements.
The preventive/public health side was enhanced by the appointment of county medical officers of health and the tuberculosis school medical service.
Maternity and child welfare services developed to some extent in the early years of the State.
Legislation in 1942 introduced insurance for employees disabled through ill health.
Funds were made available for hospital and specialist treatment including dental and optical treatment of members. The additional benefits operated under auspices of the local authority.
Upon independence, The Local Government Board functions were taken over by the Department of Local Government and Public Health. Its head was the minister as opposed to own elected officers of the Local Government Board.
The Boards of Guardians were abolished in 1923 and replaced by County Boards of Assistance. Rural District Councils were themselves abolished in 1925 and absorbed into the County Councils. Their sanitary functions were taken over by the Boards of Assistance. They thereby became responsible as Boards of Health and Public Assistance.
These Boards were appointed by county councils. The membership was made up of the members of the parent county councils. They were also responsible for poor law services as well as being responsible for preventative health, sanitary services, and public health. County Councils made responsible for the mental health service. In some areas, councils form a joint mental health hospital board.
The county medical officers of health were responsible for the operation of the tuberculosis and school medical service. They were also responsible for infectious diseases, maternity and welfare services. Other preventative services came under the asylums of Boards of Health and Public Assistance in rural areas and Urban District Councils in urban districts. The dispensary medical service, general hospital service and care of the mentally ill were not administered by the county medical officer.
In the 1940s county management was introduced throughout the State. The principal management role for local authorities was taken over by professional county managers in place of the elected members. The Board of Health and Public Assistance were abolished, and their functions were taken over by the County Councils managers.
The financing of public health remained based on the local rate supplemented by grants from the central government. The central government grant met, in particular, costs such as tuberculosis, maternity, and child welfare schemes. The Hospital Trusts Fund became an important source of money.
The National University of Ireland was created with three constituent colleges in 1908. It established medical schools assimilating a number of existing separate schools.
A separate Irish medical register was established under the Medical Practitioners Act 1927. The Dental Board was established under the Dental Act 1928. It regulated entry into the profession and the professions respectively of doctors and dentists.
Training and qualification of midwives came under the hospices of the General Nursing Council of Ireland.
In common with other local authority positions, appointments to the local authority medical services were transferred to the Local Appointments Commission in 1926.