Dáil Éireann - Volume 637 - 27 June, 2007

Private Members’ Business. - Co-location of Hospitals: Motion (Resumed).

The following motion was moved by Deputy Brian Hayes on Tuesday, 26 June 2007:

That Dáil Éireann:


the electoral success of candidates opposed to the Government’s plans to build private hospitals on public lands;

that over 1,000,000 voters supported such candidates;

that the former Government which alone supported this plan lost its majority in the House and a total of nine seats;

concludes that no electoral mandate for this flawed policy exists; and

calls on the Government to abandon this flawed policy immediately.

Debate resumed on amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“— supports the commitment in the programme for Government to proceed with the hospital co-location initiative, which is designed to improve access for public patients to acute hospital care in a timely and cost effective way by freeing up 1,000 publicly funded beds;

supports the further commitments in the programme for Government to ensure greater equality of access and care between public and private patients and, in particular, to provide an additional 500 beds dedicated to the needs of public patients; and

supports the Government’s policy of encouraging the public and private sectors to work together in the provision of health care for the benefit of the entire population and encourages further innovation and initiative in this regard.”

—(Minister for Health and Children).

[729]   An Leas-Cheann Comhairle: I understand that Deputy McManus is in possession and that Deputy Higgins is sharing time with her. Is that agreed? Agreed.

  Deputy Michael D. Higgins: I wish to take this early opportunity of congratulating you, a Leas-Cheann Comhairle, and wishing you well in your new post.

Regarding this amendment, probably no other action of the Government reveals the appalling shift that has taken place in Government policy. There is no more glaring example of the price that will be paid for the infection of Fianna Fáil by a PD proposal to build private, for-profit hospitals on the grounds of public hospitals. The Taoiseach, who has now taken on this proposal as if it were his own, stands exposed in another respect. I have witnessed his so-called campaign for citizenship around the country, which in reality is an appeal for volunteering. There is nothing wrong with volunteering, which is a good thing, but it is not a campaign for citizenship. Missing from the Taoiseach’s campaign is any hint of those egalitarian values that might be at the basis of genuine republicanism. This shows in a whole series of ways. It shows also how the public capital programme can be held back to make room for the most vicious kind of private accumulation. That is clear to anyone who has visited the University Hospital in Galway, known as the regional hospital, where there is an effective plan. If that plan was implemented, it would immediately yield up 150 beds. That plan relies on public capital investment, which will be withheld to facilitate the racket of private, for-profit hospital proposals.

Consultants are happy to work with their great professional gifts and training. The Minister for Health and Children’s invitation for them to become involved in a new contract was minimally about their work and conditions. The majority of the contract’s pages were about the opportunities in the new private racket to build on public hospital grounds. The Government is withholding public capital moneys from good projects in public hospitals to facilitate a private racket, in exactly the same way as with the 14.5 acre site in the centre of Galway city. Not one penny of public money will participate in a €1 billion development because it will sell off the greater proportion of the site for 800 apartments. The Government is withholding public investment to allow the private racket in.

All around the country, water systems require management and testing facilities. Instead of local authority projects being accepted, however, they are held back to facilitate build, design and operate projects from the private sector. It is profoundly ideological but deadly also. Those with whom the Taoiseach and the Minister for Health and Children have chosen to do business are people whose intellectual, corporate and moral history in the United States is something of which [730] anybody would be ashamed. It is interesting that the HSE, in forcing itself to provide a half honest answer, said that those bidding for contracts are not currently involved in any investigation. It would have been interesting if they had looked at the intellectual, corporate and moral history of those with whom they are dealing. The evidence from such corporations includes having been sued by patients and insurers, investigated by the FBI, and having done incredible deals to literally stay out of jail as a result of their practices. In 2001 the health care corporation formerly known as Columbia HCA, the largest for-profit hospital chain in the United States, agreed to plead guilty to criminal conduct relating to five areas of medicare and medicaid fraud and paid over $840 million in criminal fines and civil penalties to the federal government and the affected states.

Can the Minister for Health and Children, Deputy Harney, and the Health Service Executive say that those with whom they are dealing have a clean history regarding fraud? I do not believe they can and this is why we are not receiving answers to fundamental questions.

Any definition of a caring health system in a republic would involve a unified hospital system providing universal access based on medical need, not income. This is the kind of system we can now afford to have, given Government revenues, but instead we are inviting the commodification of health. We are inviting an ethos and ideological drive that sees not a health care system but a sickness industry. Similar companies have attended bank-sponsored promotional meetings in Dublin and have suggested in Britain that, ideally, the state, in addition to providing incentives allowing them to exist, should guarantee a certain number of patients. As was said at the conference in Dublin, the great thing is that if the system does not ultimately make money the State can buy back the contract after a period of years. The companies may get paid whether or not patients turn up.

This is a disgraceful abuse of public space in Ireland that abandons public land owned by the Irish people and delays the public capital programme that could deliver a first-class health care system. This policy discards all values of citizenship and equality and splits the health service. One principled consultant, Dr. John Barton, has resigned because of his objection to this racket that compromises the professional integrity of consultants. Consultants are being invited to agree to the new contract and in return participate in the racket taking place on hospital grounds.

In the United States 16% of income is spent on health care, 43 million people are without health cover and, on average, insurance premiums cost three times more than in Ireland. A limited service is provided that is bloated by fraudulent and excessive costs that raise premiums and this is what is being created on Irish hospital grounds.

[731] Studies have been done of private, for-profit hospitals and we should unemotionally examine what should be the test of a health system. Are these hospitals better for patients? Are they safer? Do they provide excellence? In every journal in the United States that has examined private, for-profit hospitals and public hospitals under these criteria, public hospitals have emerged as better.

How is this model of health care to be imposed? It is to be imposed through a refusal to spend money in the capital programme and in plans in the Department of Health. The greatest blackmail of all is to suggest no extra beds can be provided except through the co-location of hospitals. This pathetic blackmail has been forced on Tallaght Hospital but luckily there are other locations in the country where medicine means more than this, where professionals will choose to work in a way in which their vocation suggests is for the benefit of all citizens. Everyone who has examined the Irish health service, including Marie O’Connor, Risteard Mulcahy and Maeve Ann Wren, has suggested it needs reform but not a private, unaccountable racket on public hospital grounds. They object to the tap of badly needed capital funds being turned off, though those funds are available to give us the health service we need.

When all the Taoiseach’s posturing and commemorations are over he should note that it is a shabby version of a state and certainly nothing that could be called a republic that decides to go down this road. In public transport, health and the maintenance of public water supplies it is always the same, the Taoiseach bends his knee to the ideological poison that is the influence of the Progressive Democrats in Cabinet and which was rejected comprehensively by the people. There is no public mandate for the Minister’s policy, which is bad for medicine, the Republic and the State and will take generations to undo. For these reasons, it should be opposed by Fianna Fáil backbench Deputies who know very well that what I say is true.

  Deputy M. J. Nolan: I wish to share time with Deputies O’Connor, Ó Fearghaíl, Fleming, McDaid and Moloney.

I congratulate Deputy Howlin on his election to the office of Leas-Cheann Comhairle. From working with him on committees, I know he will do a fine job. I also congratulate the Minister for Health and Children, Deputy Harney, on her re-appointment.

Having spoken on a number of health motions during the 29th Dáil, I welcome the opportunity to speak to this motion. The Minister and her Ministers of State in the previous Dáil are to be commended for the efforts they made in a difficult portfolio. Throughout her term of office in the previous Government, the Minister secured increased funding for the health budget. I hope [732] that Government’s policy of trying to ensure taxpayers got value for money will continue to be the cornerstone of the Minister’s stewardship of the Department of Health and Children.

In recent years, I have seen the value for money we get in keeping patients in publicly funded hospitals. If we could shift expenditure towards providing care in the home where patients would prefer to be, we would get much better value for money. The Departments of Health and Children and Social and Family Affairs, local authorities and the Health Service Executive have done a great deal of work in this area and provide many supports, including home helps and disabled person’s grants. The Alzheimer Society of Ireland has a programme in place offering assistance to families who look after a relative at home. We should provide more supports to the general practitioner service to ensure families are able to care for patients at home.

I support the co-location principle. One of last night’s speakers stated that under co-location private patients will turn right and public patients will turn left when they enter a hospital campus. This is already the case as many regional and general hospitals have separate wards for public and private patients. The proposals, therefore, will not make a great difference in that respect.

I am pleased the Green Party now supports the Government’s efforts to bring about co-location, which is already a feature in a number of public hospital campuses, including the Mater Hospital and St. Vincent’s Hospital in Dublin. Apart from providing up to 1,000 additional beds for public patients over the next five years, the initiative will encourage the participation of the private sector in generating additional capacity for patients, maximise the potential use of public hospital sites, which would be a welcome development, promote efficiency among public and private acute service providers and foster greater competition in the supply of hospital services.

The Health Service Executive will have a hands-on input in the roll-out of the co-location programme, which will be reviewed in several years. I support the co-location policy and wish the Minister every success with it.

  Deputy Seamus Kirk: I call Deputy Charlie O’Connor. A time sharing arrangement with other Deputies will apply.

  Deputy Charlie O’Connor: I am sorry the Leas-Cheann Comhairle, Deputy Brendan Howlin, has left the Chair because I wanted, like other colleagues, to be associated with the congratulations to him. He and I are colleagues in the Association of European Parliamentarians for Africa. I have known Deputy Howlin as a great man since 1994 — Deputy Brian Hayes will be too young to remember this — when, as Minister for Health he appointed me as a local member of the Tallaght [733] Hospital board. I have been in his debt since then.

It is good to see more famous colleagues from Dublin South-West present to hear my few words. I appreciate that support.

  Deputy Mary Harney: The Deputy was on the board of Tallaght Hospital.

  Deputy Charlie O’Connor: I will mention the hospital shortly. If the Minister prefers, I can talk about my wishes for my local hospital, but she knows all those so I do not need to do so.

With regard to the motion, it is good that we have the opportunity to discuss these issues. We traditionally compliment parties in this regard although this motion is more politically motivated than most. It is not for me to tell Fine Gael how to look after its Private Members’ business but it does not seem able to count and it certainly does not seem to understand the result of the last election. When I spoke in April last, Deputy Enda Kenny took the view that after the election he would be on this side of the House and I would be home in Tallaght tending my garden, but he is still on the other side of the House and I am back here. The people have made their decision.

In this debate we hear all kinds of views as to what the people decided. The people returned many colleagues and if one considers the result in Dublin South-West, one has to interpret what the people were thinking, and two Fianna Fáil Deputies from that constituency are still in the House.

In July 2005 the Minster announced an initiative to have co-located private hospitals built on the campuses of public hospitals. The aim of that initiative is to enable up to 1,000 beds in public hospitals which are currently used by private patients to be redesignated for use by public patients. Co-location is already a feature on a number of public hospital campuses, such as the Mater and St. Vincent’s.

There has been much talk of Tallaght in the past couple of days. I am always happy to mention Tallaght but I am on comfortable ground today as a number of colleagues have already done so. I do not usually pay much attention to what newspapers tell me, but The Irish Mail on Sunday recently stated “Hospital reform is a healthy move”. It stated that the decision on Saturday:

... by the board of Tallaght Hospital to embrace Health Minister Mary Harney’s co-location policy is both a welcome and a courageous one. There can be no doubt that Tallaght’s previously expressed reservations about the policy, founded as they were on the ethos of the old city-centre voluntary hospitals, were sincere and deeply held. But times change.

The article continued:

[734] ... over many years, the famous city-centre hospitals which merged to form Tallaght, the Adelaide and the Meath, had no difficulty in providing, on the same site, private treatment for their wealthier patients, and free treatment for others, including the poorest of the city poor.

I will continue through this Dáil term to regularly raise issues relating to the health services and Tallaght Hospital. The Minister will get different views from across the House but there is positive as well as negative reaction in Tallaght. It is very important that we understand that there is much to be done in Tallaght, and I support that.

I take the opportunity to remind the Minister that it is the aspiration of Tallaght Hospital to develop a landmark building on the current site. I understand the building will include vitally necessary administrative space and crucially required outpatient clinic services. With other issues, I hope we will continue to have the Minister’s support for Tallaght Hospital.

  Deputy Seán Ó Fearghaíl: Tá áthas orm cúpla nóiméad a fháil chun labhairt ar an ábhar tábhachtach seo. It is welcome to return to the House following the general election, during which, as we knocked on doors in our various constituencies, health featured as a particularly prominent issue with the electorate — it certainly did so in Kildare South, as I am sure it did in many other constituencies.

It is appropriate that one of the first issues we get to address on Private Members’ time is health related. However, I must join my colleague Deputy Charlie O’Connor in chiding the Fine Gael Party on bringing forward the motion in this format at this time. I suspect he is right in saying that what Fine Gael is about is an attempt to embarrass the Green Party, our new partners in Government. Rather than attempt to embarrass the Green Party, Fine Gael should, perhaps, look to it for guidance on how to be a constructive Opposition party. Over the course of the past five years in the House, I was conscious of the number of occasions on which the Green Party used its Private Members’ time to bring forward constructive legislative proposals. Perhaps if Fine Gael had adopted a more positive approach during the past five years and the general election, it would not find itself languishing on the Opposition benches. It is clear from the motion that Fine Gael has learned no lessons. After finding itself on the Opposition benches six elections in a row, the Fine Gael motto now appears to be “If it is broke, don’t fix it”.

Fine Gael used to have some interesting points to make on health. This was before it signed up to the bogus Labour Party accusation, as enunciated trenchantly and vehemently by Deputy Michael D. Higgins, that the Government is privatising the health service. On 4 May 2004 the Fine Gael health spokesman said: “It is only with the intro[735] duction of competition that we can capture for patients the benefits of the market”. He went on to say:

I do not expect that this will happen overnight or indeed that competition and private provision is the solution to all healthcare provision, but I believe it is in the direction in which we must go.

However, this evening Fine Gael asserts that moving 1,000 private beds from public hospitals is privatisation.

I support the amendment to the motion and Government policy as enunciated by the Minister for Health and Children, Deputy Mary Harney, who has been an outstanding Minister in this area. Its central objective remains the freeing of publicly funded beds for public patients. The co-location initiative will achieve 1,000 new public beds quickly and more cost effectively, ensuring better access to acute hospital services for public patients. I heard this demand from constituents throughout County Kildare over the past weeks and months. We want to achieve a situation where there is no two-tier entry into publicly funded hospitals, as has been the case for many years. We do not want to continue the current system forever, under which public hospitals and consultants are paid more for private patients than public patients for treatment in our tax-funded public hospitals. It is not privatisation to free beds for all patients, public and private. Nor is it privatisation to ask the private sector to finance and manage private beds and private hospital services.

Private or independent hospitals here are not new. Indeed, it seems Fine Gael supports them as long as they are not on the same site as public hospitals. Private care has always been an integral part of our health care services and is not confined to one service or a group of people in one locality. The Mater Private, St. Vincent’s Private Hospital, the Blackrock Clinic, the Bon Secours group and, in my constituency, Clane General Hospital have been embedded and accepted in health care provision for many years. I reject the suggestion, so eloquently but so mistakenly put forward by Deputy Michael D. Higgins, that this represents some form of racket. I assure him that people who choose to avail of the services in those hospitals do not consider themselves as participating in a racket.

  Deputy Michael D. Higgins: It was called a fraud in the United States and proved to be so.

  Deputy Seán Ó Fearghaíl: The truth is we have a mixed system of financing — approximately 72% public and 28% private. This is not unusual. We are almost exactly at the OECD average of 73% public and 27% private finance. I commend the motion to the House.

[736]   Deputy James McDaid: I wish to share time with Deputy Michael Finneran.

  Acting Chairman: Is that agreed? Agreed.

  Deputy James McDaid: The main part of the motion seems to revolve around waiting lists. As long as medical research continues around the world, there will be waiting lists as international medical practitioners attempt and succeed in medical and surgical procedures only dreamt of previously. One of the greatest breakthroughs happened over 50 years ago in South Africa with the first heart transplant. If that procedure was carried out today in the same manner, it would be regarded as quite cumbersome. Even in this country we are performing liver transplants, heart transplants, lung transplants and heart and lung transplants, procedures we only dreamed of performing ten years ago. These procedures have become a way of life but, unfortunately, as I speak people are awaiting transplants.

That is why I look forward to the advent of stem cells because the future of medicine lies in the pursuit of research in this area. I hope we debate this subject in the House soon. Waiting lists will only become extinct the day that medical research stops. In too many cases, however, waiting lists are unacceptable. The high-tech issues I mentioned earlier are directly related. If we are to proceed in this area, space must be created. Given the huge steps taken over recent decades, the waiting lists are more a sign of our progress than of our deficiencies.

I fully accept that the co-location of hospitals is essential. The National Treatment Purchase Fund is the only available comparator and initially I wondered how it would work. The fund, however, has dealt with 171 of my patients. If one asked any of them did they mind whether they were treated in a private or public hospital they would say no. The pain they had suffered for years was gone and they now had a better quality of life. The ultimate aim of us all, especially those working in the health service, is surely to expedite the journey of the patient through the system so that he or she can have quality of life again.

The co-location policy must answer two questions: will it provide more beds more quickly than any other method and will it represent value for money? During its election campaign, the Fine Gael Party promised 2,500 beds for which the money was available through the national development plan.

  Deputy Brian Hayes: Actually the number was 2,300.

  Deputy James McDaid: However, it failed to clarify which part of the NDP it planned to curtail. In other words, a bed-only policy means that it planned to curtail the onward march of medicine in other fields.

[737] Is value for money as important in this area, where people are already diagnosed and awaiting operations so they can be pain free and resume a quality life with their families? I would support such a situation in the north west where we are still asking cancer patients to travel to Belfast, Dublin and Galway for radiation treatment at a time when they are most vulnerable. They spend weeks away from their families.

This was brought home to me last Friday night at the midsummer ball in Letterkenny where one of the auction prizes was two years’ commercial advertising on the back of the specially commissioned oncology bus which travels several times a week to Dublin hospitals. It was described as a golden opportunity to promote a business. The space was sold for €6,000. That is why I am prepared to support co-location. If we can find a reasonable solution to the question of beds, while continuing to debate value for money, by all means let us do so. Let us, however, put the patient first as that is the priority.

  Deputy John Moloney: I welcome the Government policy on co-location. The point has been made that it is a Progressive Democrats-driven policy but it is important to remember that Fianna Fáil, when fighting the election, made it clear it fully supported the policy. It was Government policy going out and it is Government policy coming back in.

Co-location cannot be termed a “racket”. The people who supported the Government parties recognised that the proposal would free up waiting lists and create 1,000 new beds in the system. That was the issue going before the people and that is what they supported. In answer to the allegation that it is a racket, purely for profit, it is worth noting that the National Development Finance Agency, the financial advisers to the Department, has recognised the value for money in the proposal for co-location.

It is also important to take other points into account. We need change within the health structure. The point has been made that, over the years, funding for health has quadrupled yet waiting lists have remained. I congratulate the Minister on her initiative in bringing the policy of co-location before this House. Co-location will mean that publicly-funded beds in public hospitals will always be available to all patients in order of medical need. The initiative will free up designated public beds on each site. Public beds will no longer be used for fee-paying private care.

It is important to note more beds will be freed up than the number of designated private beds. Most important is that, by the time this initiative has been implemented, we will have 1,000 new beds. That will demonstrate cause and effect in regard to this proposal and will clear the waiting lists once and for all.

I support the co-location policy because it is a way of increasing bed capacity in the major public hospitals, in a forward-thinking way, in a new [738] partnership with the private sector, whose involvement I welcome. I was alarmed when I heard the process characterised as one in which the rich go into a hospital and turn right or left and the poor turn the opposite way. That is an unfair comment which does not stand up to scrutiny, particularly when it is recognised that, in the policy document, one accident and emergency unit is provided for on site. There is no prospect of people being left to one side because they did not have the necessary financial arrangements. The policy document also makes it clear there is no validity in the claim that facilities will be built to too high a specification.

It is also important to recognise that the proposal will encourage investment. It will be open to scrutiny and will be guided by the Department of Finance. Any suggestion of plundering for profit alone will not stand the test of time.

I publicly support the co-location policy. It is one of many initiatives introduced by the Minister for Health and Children. I am glad to see her back in the job and believe that, by the end of this Government’s term in five years’ time, the issues currently surrounding health will have been totally resolved. I welcome this initiative, as well the many others the Minister has brought forward.

  Deputy Michael Finneran: I welcome the opportunity to make a brief contribution to this important debate on the Private Members’ motion before the House tonight on the subject of co-location. I firmly support the position adopted by the Minister for Health and Children and the Government in co-locating private beds on grounds attached to our public hospitals.

The Minister should be complimented on the initiative and I also compliment her on the initiative to create the National Treatment Purchase Fund. That has been a success second to none. Deputy McDaid stated that from his surgery alone, 171 patients have benefitted from this scheme.

  Deputy Dan Neville: Children are waiting for eye treatment for two years.

  Deputy Michael Finneran: From my constituency offices in Roscommon town and Ballaghaderreen, I have referred many people to the number provided by the Department. The only deficiency in the scheme relates to the inability of people to get appointments with consultants. I hope the Minister takes on that matter at some stage and sorts out the bottleneck that exists. I am not accusing consultants, but I feel there is a reluctance to go ahead with appointments. They know we can deal with the matter through the Department soon after that.

The opportunity to provide 1,000 extra beds and free those beds that are currently being taken out of the public system for private use is an innovative and welcome development. I compli[739] ment the Minister for it and I have no doubt it will be successful. Any further investment in the health services by the private sector is most welcome. Deputy McDaid made the point that we must keep investing because new technologies are coming into the health services all the time.

I was here for the contribution to the debate by Deputy Michael D. Higgins. He is quite lucky that he has two private hospitals in his city. They provide a wonderful service and he is lucky to have that service in Galway city.

  Deputy Michael D. Higgins: Deputy Finneran should tell that to Jimmy Sheehan. I was very well treated in the public system.

  Deputy Brian Hayes: He was not handed the land. He bought it himself.

  Deputy Michael Finneran: The service is available to my family if we need it and to the Deputy’s family if he needs it, as well as his constituents. If the Minister is looking for a location, we have about 25 acres attached to Roscommon County Hospital and I would support a decision to make that location available for any further expansion of the health services, whether private or public. It would be very welcome.

I compliment the Minister for her innovation in the health portfolio. She has had five good years in it and I look forward to five more progressive years. I have no doubt that the success behind her will be doubled by the time she finishes the job. She has set out a very clear agenda which is becoming very apparent. I am glad the consultants have had the common sense to go back into discussions with her and are now prepared to enter into new contracts. I was glad she took the initiative in announcing new posts. Sometimes people in government must take decisions and she is one who does this. I am glad to support her decisions on issues that should have been dealt with many years ago.

Vested interests in the health services have been a major problem and a block on services to the public over many years. I am glad the Minister is taking on the vested interests and looking to the customers who come from the public. The vested interests must take second place.

  Deputy Dan Neville: I welcome the opportunity to contribute to this debate and I congratulate Deputy Brian Hayes for his initiative in bringing the motion forward. People are very divided and concerned about this issue. There is grave concern that public property will be moved into private ownership at knock-down prices at the expense of the taxpayer. There has been little consultation about this. The Minister has not held any consultation. It seems more an ideological approach to moving the entire health system into the private sector rather than a consultation on what is best for the delivery of patient care.

[740] There now will be two types of patient on site. Those of us who are in politics a long time, and dealing with the public, see the divide in the service provided to people in hospitals. Those who can afford private insurance and those who can afford to pay get a different level of service from those who cannot. In dealing with the health service, that is the most glaring fact all of us face. This relates especially to waiting lists, but also to other areas. When somebody comes to you stating he or she has VHI or Quinn-Healthcare, one knows that he or she has a better opportunity of obtaining the service. I have seen cancer patients having to wait three or four months for a proper consultation, whereas somebody who can afford private insurance will get attention within weeks. This is unfair and discriminatory. The proposal to co-locate in public hospitals will exacerbate that position.

No doubt key personnel will move from the public service into the private service because the incentive will exist. We all are human. Consultants are human. They will see a better return in being in the private sector and will move that way, and the investors will attract the key personnel, who are most qualified and who attract the most patients, into the private sector and leave those who are less qualified or in whom the people in the public sector have less confidence. It will exacerbate the division between private and public delivery of patient care. There is no evidence that the new system will be more efficient.

Deputy McDaid spoke about the National Treatment Purchase Fund and in that regard, I want to raise an issue with the Minister. I understand that those who wish to remove marks from their bodies, including tattoos, can be facilitated under the National Treatment Purchase Fund because it is a surgical intervention.

  Deputy Mary Harney: Cosmetic surgery is not allowed.

  Deputy Dan Neville: It was stated recently.

  Deputy Mary Harney: I explained that. Breast reconstruction is allowed, as is anything to do with accidents where a person suffers deformity. Certainly, nothing cosmetic is allowed.

  Deputy Dan Neville: Varicose veins are covered.

  Deputy Mary Harney: Yes, varicose veins are covered. That is a medical procedure not a cosmetic one. Although it was suggested, cosmetic surgery and tattoo removal are not facilitated.

  Deputy Dan Neville: There was a discussion on that point. The Minister is saying that it is not the case and I welcome that.

  Deputy Mary Harney: I already clarified that.

[741]   Deputy Dan Neville: Varicose veins are allowed, and rightly so. I do not have a difficulty about that, but a child waiting two years for a psychiatric consultation will not be facilitated under the National Treatment Purchase Fund. We know that intervention at an early stage in psychiatric illness and emotional difficulties, especially among children, is vital to the opportunity for a full recovery, and that is not allowed. The Minister should examine psychiatric intervention under the National Treatment Purchase Fund because the longer someone is left without treatment, the more chronic the case becomes, the poorer the chance of recovery and the greater the later demands on the resources of the HSE.

  Deputy Olwyn Enright: I welcome my colleague, Deputy Brian Hayes, and thank him for tabling the motion. Deputy Harney will leave the House glowing from all the support from the Fianna Fáil backbenches. It was a lot less glowing three months ago but it is nice for her to hear it.

  Deputy Brian Hayes: Even on the doorsteps.

  Deputy Olwyn Enright: This important debate gives Members the opportunity to vote on the matter. We have had much grandstanding on the issue of co-location over the past few months——

  Deputy Mary Harney: We sure have.

  Deputy Olwyn Enright: ——not to mention the massive conversion from some parts of the new Government. This has been couched in terms of a review. In reality, the matter will be so far progressed at that stage that it will be irreversible because it would not be cost effective to reverse it. It is important that point is made.

  Deputy Mary Harney: We will be reviewing the success of it.

  Deputy Brian Hayes: We will all be long gone at that stage.

  Deputy Olwyn Enright: If the review shows it is not a success it will be too late to do anything about it.

The real issue is the use of public land; private hospitals on private land is another matter and one will be built in Tullamore in my constituency. The Government is effectively selling the family silver at a questionable price. Many of the hospitals to be used are located in key areas of towns and cities, where the value of the land is high. If we need to build public facilities in these areas, those of us who make representations on behalf of public hospitals are told decisions are delayed or the project will fail to be approved because of the lack of land in the area and the cost of buying land. It is similar to the position of schools, where the purchase of land is delayed because of cost. The same will happen in the pro[742] vision of medical facilities. Today’s decisions will cost us dearly tomorrow.

Co-location is hailed by the Government as the answer to all the problems in the health service. Rather than seeking a quick fix solution the Government would be better occupied solving all problems in the system. It sees co-location as the grand plan but the cost of the plan is less than clear. One of the Government Deputies incorrectly referred to the number of hospital beds to which Fine Gael was committed. The performance of the three Fianna Fáil Ministers at the press conference in respect of this issue was less than clear.

  Deputy Brian Hayes: The three stooges.

  Deputy Olwyn Enright: There is still not enough clarity. The public did not support giving public land to private developers. Deputy Finneran has almost sold the site beside the hospital in Roscommon. The area is not far from my constituency and I am aware of the difficulties. I remind him that people in that constituency spoke very clearly and elected two Fine Gael candidates out of three seats. He will hear that loud and clear when he returns to Roscommon-South Leitrim. We are giving public land to private developers to build hospitals that will have the aim of making money, not caring for patients. That there was no Green Paper to examine the issue and no cost benefit analysis calls the Government decision into question.

  Deputy Leo Varadkar: I congratulate Deputy Mary Harney on her appointment as Minister. Responsibility for health is a difficult job and it is testament to her courage as an individual and her dedication as a politician that she sought the job despite her party’s result in the election.

I join with party colleagues in expressing my concern about the co-location proposal and my opposition to it, not just on the basis that it has no mandate, which is the case, but more important on the basis that it is bad public policy. The policy is bad for three principal reasons.

First, it will lead to the perpetuation of the two-tier health service. Freeing up 1,000 public beds by providing 1,000 private beds misses the point. What we should be trying to do is move towards a system where there are no private or public beds and no private or public patients in the health service. The best way to achieve that is through a system of universal health insurance, as is done in many other countries, whereby all patients are effectively private patients and money follows the patient. By going down the route of this co-location plan, the Minister is making it harder for future Governments and generations to achieve that. She is making it especially difficult by introducing a new vested interest into the health care system in the form of up to ten private hospitals.

[743] The second reason I am opposed to this proposal is that it will result in the downgrading of our existing public hospitals. New beds, new facilities, new radiology services and new laboratories will inevitably go to the co-located hospitals rather than public hospitals. For example, the Connolly Hospital in Blanchardstown has been waiting for almost 15 years for the implementation of phase 2, namely, the provision of new radiology and new laboratory facilities. We know what will happen inevitably is that this investment will not be delivered; it will now turn up in the co-located hospital instead.

In yesterday’s debate the Minister stated Tallaght had not been bullied into making its decision in favour of co-location, but that is untrue. Most members of that board are opposed to co-location but it was clear to them that if they did not agree to co-location, they would not get the beds or investment they need. Essentially, hospital boards now have a gun to their heads and they are being told that if they do not back the Minister, Deputy Harney’s co-location plan, there will not be investment in their hospitals. That is not to mention the loss of revenue to them, which by the Minister’s own estimation is €80 million per year for six hospitals. I do not know how much it will be if there are nine or ten co-located hospitals.

The third reason is a personal one. I am not sure the Minister has considered the fact that by introducing co-location we will introduce a two-tier admissions policy in accident and emergency departments. I am most concerned about this issue. Essentially, an SHO or registrar admitting a patient in an accident and emergency department will for the first time have to make a distinction between a private patient and a public patient. It will be necessary for the doctor on duty to talk to both the private hospital and the public hospital to see if a bed is available in one or the other. If there is a space in the private hospital, the patient may get admitted; if there is no space, he or she will not get admitted in the public hospital either.

It may also be necessary to talk to two different consultants, one in the private hospital and one in the public hospital where there may be different thresholds for admission depending on whether the patient would bring in money. That is an ethical minefield for doctors. Currently, the accident and emergency department is the only place in a hospital where patients are treated equally. The Minister has proposed to get rid of this last area of equality in the health service by making a distinction between patients in accident and emergency departments at the point of admission.

To sum up, this policy has no mandate from the people, it will reinforce the two-tier health system, downgrade public hospitals, cost the taxpayer millions and lay a new moral and ethical [744] minefield for doctors admitting patients in accident and emergency departments. It is a bad policy for the taxpayer, public hospitals, patients and society. I appeal to Deputies to support the motion.

  Deputy James Bannon: I thank my family and the people of Longford-Westmeath who elected me to represent them. During my campaign I placed health at the top of my priorities for them when elected and pledged to bring about the long-promised completion of phase 2B of Longford-Westmeath General Hospital. One may ask what this has to do with the debate but it is my contention that it is at its heart. It relates not only to my priorities but to those which should be at the centre of the agenda of the Minister for Health and Children. Sorting out the existing difficulties and outstanding projects in the health service should be to the fore in her endeavours rather than further diluting our resources. Robbing Peter to pay Paul is not acceptable when the losers will be the public hospital sector.

In reply to a question I tabled yesterday on phase 2B of Longford Westmeath General Hospital, which was the latest effort in my decade-long campaign to get closure on this issue, once again the Minister took refuge in the fact that she is waiting for a detailed cost-benefit analysis of the outstanding funding for this project, conveniently overlooking the fact that this issue has been dragged out for in excess of a decade and that she is trying to drip-feed the final funding necessary for the completion of this lifesaving facility for the midlands.

Although many Members have asked the Minister to publish the cost-benefit analysis of all the aspects of the proposal under debate it is not available. The Tánaiste and Minister for Finance and the Minister for Health and Children show an alarming lack of knowledge of the financial implications of co-location and neither can give the full lifetime cost to the State of this proposal.

Longford-Westmeath is a long way from the £62 million promised ten years ago, given the present delay in the provision of the sum of €45 million required to complete the project. Lives will continue to be lost until this facility is fully up and running and I am determined to see this project completed sooner rather than later. I call on the Minister to honour the Government’s oft-repeated promise to the midlands in this regard. Given an underspend of €100 million by the Health Service Executive in 2006, I am at a loss to understand how on the one hand the Government can continue to ignore the needs of the sick, the elderly and the disabled while on the other, the Exchequer grabs back the money earmarked for their well-being.

However, the Minister’s disregard for the suffering of her fellow man was surely illustrated horribly by her latest pronouncement in which [745] she assured Members that it was pleasant for many patients on trolleys in accident and emergency departments. The Minister’s statement was outrageous and I wonder what the 200 or more patients who are forced daily to spend days on trolleys think about such an extraordinary utterance.

Moreover, the Minister has stated clearly that a difference exists between her and the head of the HSE in respect of co-location policy. The Minister’s attempt to disregard the comments of the HSE’s chief executive have only served to reveal a deeper disparity between his views, those of the Minister and Government policy.

During both today’s Question Time and this debate, the Minister has shown that there are key areas of confusion regarding the co-location policy. Professor Drumm has stated that co-located hospitals and the HSE will be competitors, whereas the Minister has stated that the public and private facilities will be integrated. Moreover, the Minister claims that the project is designed to provide an additional 1,000 acute beds, while the head of the HSE states there is no requirement for additional acute beds.

While the Minister may attempt to blur the lines of these divisions, the facts are clear for all to see. It appears that the HSE’s chief executive has as much enthusiasm for the advancement of this project as does the public, who voted in such numbers for candidates who opposed it. It is high time the Government recognised it as a misguided and ill-conceived plan before our health service is further damaged and vital public land is irretrievably lost. This will be the case if the Minister proceeds with this policy.

On behalf of the people of Longford-Westmeath and the entire region, I beg the Minister——

  Acting Chairman: While I am reluctant to interrupt the Deputy on his maiden speech, I would appreciate it were he to conclude.

  Deputy James Bannon: ——to consider what is her mandate on behalf of the public sector of the health service.

  Deputy Enda Kenny: Standing Orders should be amended. I say “well done” to Deputy James Bannon.

  Deputy Caoimhghín Ó Caoláin: The Sinn Féin Members fully support this motion opposing co-location and emphatically reject the Government amendment. It is a sad day for Irish democracy that a policy that is so wrong and so widely rejected should still be pursued in this manner. It is also sad and disgraceful that the Green Party and Independent Deputies who expressed strong opposition to co-location are now likely to vote for it along with Fianna Fáil and the Progressive Democrats.

[746] The Fianna Fáil-Progressive Democrats-Green Party Government is ploughing on regardless with its disastrous private for-profit hospital co-location scheme. This plan must be stopped before it is too late. It is the biggest single step towards the privatisation of our public health services. It has met with widespread opposition, both from within the health services and from the wider public.

8 o’clock

I welcome the efforts of patient and community groups which yesterday highlighted the fraud carried out by the parent US corporations of private health care companies benefiting from Government money in this State. These companies are lining up to profit from the co-location scheme. They have also been given lucrative HSE contracts for cancer screening and cancer care. Quest Diagnostics Incorporated in Ireland is under contract with the HSE to carry out smear tests in US laboratories. From 1996 to 2004, it is reported that Quest Diagnostics Incorporated and its predecessors in the US paid $175 million in settlements under the False Claims Act, involving, among others, charges for medically unnecessary tests and overcharging for prostate cancer blood tests. Laboratories in Irish hospitals are being closed to give business to privateers such as this.

At the heart of the Government’s policy is a glaring contradiction. On the one hand, it is removing services from local public hospitals on the spurious basis that they do not have the critical mass of patients to sustain them and, on the other, it is giving tax subsidies and access to land to private hospitals to provide services on a for-profit basis. The co-location plan is being carried through by means of coercion. The board of Tallaght Hospital was, despite the Minister of State’s denial here this afternoon, presented with an ultimatum to accept co-location or to go without the additional beds needed. This is an outrage.

Sinn Féin Deputies will today and everyday continue to oppose this plan and the privatisation of our health services. Accordingly, I welcome and look forward to supporting the Fine Gael Private Members’ motion as tabled.

  Deputy Pat The Cope Gallagher: I wish to respond to some of the issues raised by the Opposition in the course of the debate. Private patients are receiving priority access to public hospitals at the expense of public patients. Some 2,500 beds in public hospitals are ring-fenced for the exclusive use of private patients and that is not equitable or fair. As the Minister for Health and Children, Deputy Harney, stated last night, the State pays for nurses and other staff to look after the patients in those beds and provides the diagnostic equipment needed, but the beds are off limits to patients unless they are the private patients of consultants. The initiative will [747] provide that 1,000 of the 2,500 beds in question can be used by public patients.

In July 2005, the Minister issued a policy direction and the HSE identified the most appropriate sites to include in the initiative based on existing and planned capacity. It identified what a co-located hospital would need to deliver for each site to best serve the interests of the public hospital and prospective patients.

  Deputy Liz McManus: Will the Minister of State give way? I raised an issue regarding the 2005 directive and asked the Minister to outline the statutory basis for that letter.

  Deputy Pat The Cope Gallagher: I will deal with that issue.

  Deputy Liz McManus: I thank the Minister of State.

  Deputy Pat The Cope Gallagher: There was a great deal of interest in the initiative from public hospitals and the private sector. When the co-located hospital has been built and opened, every public bed in the public hospital will be accessed on the basis of medical need and no other. There will be no preferential treatment in the public hospital system for insured patients or self-payers.

As part of its contract with the HSE, the co-located hospital must provide 24-hour admission, train doctors and share its profits. Public hospitals will also benefit in the case of debt refinancing. Details in respect of each site will be made public, but it is not possible to release details of bids during a procurement process or to provide commercially sensitive information.

Last night, a figure of €700 million was quoted as the loss of income to hospitals, but the six hospitals in the first tranche of co-location collected €80 million from private health insurers in 2006, less than half the cost of running the beds. No land is being given away. The land on which the co-located hospitals will be built will be leased at above the market value.

  Deputy Bernard J. Durkan: For how long?

  Deputy Pat The Cope Gallagher: Public hospitals will enter into contractual arrangements with the new co-located hospitals to provide what the former need. The new private co-located hospitals will be required to provide services to the HSE at discounted prices under the rules of the capital allowance scheme. Last night, the Opposition put forward a figure of €70 million for seven years in reference to the cost of the capital allowance scheme. The precise capital allowance cost to the State of each project depends on the financial profile of each of the successful bids. However, this is necessarily less than half the con[748] struction cost, since relief would be claimed at the marginal income tax rate applicable at the time.

As the Minister pointed out last night, the capital allowance costs to the State will only come on stream after the new co-located hospital facilities have opened — from 2011 onwards — and the costs to the State will cease after the seventh year. For every €1 million in allowable investment, the gross tax cost to the State would typically be €455,000 at current tax and PRSI rates, spread over seven years, without taking account of tax buoyancy from the activity generated. The expected capital allowance costs have been included in the financial evaluations of tenders.

Last night, Deputy McManus questioned the statutory basis for the policy direction on the co-location initiative that issued to the HSE in July 2005. The Minister is satisfied that this policy direction conforms with section 10 of the Health Act 2004. Claims were made by Members last night and again today that the HSE bullied Tallaght Hospital. However, the board of the hospital was asked whether it wished to continue to participate in the co-location initiative.

  Deputy Liz McManus: I ask the Minister of State to give way and allow me to make a point.

  Deputy Pat The Cope Gallagher: I have five minutes to make my response.

  Deputy Liz McManus: He said he would answer my question on the statutory basis for the policy direction, but he has not done so.

  Deputy Pat The Cope Gallagher: I did; I said it conforms with section 10 of the Health Act 2004.

  Deputy Liz McManus: No, he said the Minister is satisfied that it conforms. There is absolutely no evidence that this is the case.

  Deputy Pat The Cope Gallagher: Deputy McManus should read section 10 of the Act.

  Deputy Liz McManus: I wish to put on record that the Minister of State has offered no evidence for the statutory basis of this policy direction.

  Deputy Pat The Cope Gallagher: The board of Tallaght Hospital agreed unanimously last week to proceed with co-location. No hospital has been forced to participate in this initiative.

Private health care has always been a feature of the State’s health care system, and public and private service provision have complemented each other. Access to public hospitals should be based on need only. The co-location initiative will provide an additional 1,000 beds for public patients. Private patients at these hospitals will be treated in the new co-located private hospitals. It is the quickest and least expensive means of providing 1,000 beds for public patients. There is [749] much interest in the initiative. The HSE has evaluated tenders for six sites and expects to appoint the successful bidders following approval from its board at the beginning of next month.

  Deputy Simon Coveney: I am pleased to have the opportunity to express concern at the Government’s plans to build private hospitals on public hospital lands. I thank Deputy Hayes, our new spokesperson on health, for bringing this motion forward so quickly. It is appropriate that we are debating two of the key issues concerning the electorate in the first week of the new Dáil. Earlier today we discussed stamp duty reform and we are now dealing with hospital health care provision. Ironically, it is the Opposition and not the Government that reflected the public mood in our calls for a comprehensive stamp duty reform package and an end to the controversial and unpopular plan to locate new private hospital beds on public hospital sites.

The Progressive Democrats Party approach to health care reform was rejected comprehensively by the electorate. Yet there is no reflection of that in the new Government’s policy. The Minister for Health and Children, Deputy Harney, has on many occasions justified her plans for co-location by claiming it is the quickest and most effective way to introduce more beds into the hospital system by freeing up beds in public hospitals currently occupied by private patients. This makes some sense mathematically. What about the other factors which need to be considered and what is the cost of such a plan? One would assume with plans this far advanced that detailed costings and a cost-benefit analysis would be available and publicised but not even the Minister for Finance knew during the election how much this plan would cost the taxpayer. We were first told it would be co-neutral and that the taxpayer would not have to pay anything. On “Questions and Answers”, the Minister quoted a figure of €70 million per year over seven years, or nearly €500 million. The following day, that figure was again revised in a press conference and we were told it would cost €40 million. This is the Government’s main plank for hospital health care provision, yet we do not even know how much it will cost in terms of site leasing cost and tax relief on investment.

Pragmatic problems also arise, particularly in the area of staffing. At present, seven private hospitals are being built or are in the pipeline. Adding a further eight co-located hospitals will bring the number to 15. With limited availability of consultants, experienced nursing specialists and, most important, the absence of a new consultant contract, we run the risk of supporting the building of private hospitals without adequate planning for how they will be staffed or consideration of the knock-on staffing consequences for public hospitals.

[750] However, my strongest objection to the Government’s insistence on pursuing the co-location policy is a more principled one. Issues such as costing and staffing implications can be addressed with a pragmatic response but the question which must be asked is whether we should be selling valuable landbanks on public hospital campuses for the construction of private hospital beds when we urgently need additional beds in our public hospital system. Should we not instead prioritise the financing of public hospital beds and the expansion of public health care provision?

  Deputy Brian Hayes: Hear, hear.

  Deputy Simon Coveney: How can we maximise the potential of public landbanks on public hospital sites? Fine Gael has no problem with the principle of private hospitals being built on private sites and it is ridiculous for Government spokespersons to suggest otherwise. We have not been inconsistent at any stage in what we have said on this issue. However, we are strongly opposed to the sale of precious landbanks which could be used for the expansion of public hospital provision and which will have significant implications in the medium and long term for public health care and hospital expansion programmes.

As Deputy Enright noted earlier, in the same way that we encounter problems in finding sites for new schools, we could end up leasing precious landbanks for long periods of time only to pay out huge amounts of money to provide public hospital beds. That seems like mad logic. By facilitating the construction of additional private for-profit hospitals as a policy alternative to building public hospital beds, we are increasing the public’s reliance on private health care provision. That will only serve to deepen the divide between those who can afford private health insurance and those who cannot and threatens to widen the already existing gulf between the quality of care a public can expect compared to the care received by private patients. Surely modern Ireland should aspire to something different. I urge the Minister to reconsider how the State can make best use of the available valuable landbanks on public hospital sites to advance health care provision and prioritise public patients.

  Deputy Bernard J. Durkan: I fully support the motion tabled by my colleague, Deputy Brian Hayes. My first reaction to the co-location concept was amazement because there is no way it can benefit public patients who cannot gain access to hospital beds at present and remain on trolleys and waiting lists.

The proposal before us, as my colleague Deputy Coveney has pointed out, will not in any way alleviate the problems that exist. In fact, it will contribute to them. I cannot understand how private patients who are allegedly occupying [751] public beds in public hospitals at present will suddenly disappear from the face of the earth, to be replaced by public patients. I do not think that will happen.

A new formula has been found. A number of years ago when Deputy Micheál Martin was Minister for Health and Children, he decided to solve the health problem. He had discovered that the problem was the health boards, so he abolished them. That was the panacea that was going to solve all the health problems for the foreseeable future. What happened? Absolutely nothing happened, except that the problems that existed before got immeasurably worse. This has gone on and on. The current Minister for Health and Children and former Tánaiste has obviously been in the Department, shifting around and sifting in the sands, looking for some other magic formula to solve the health problems.

It will not work. In four or five years’ time somebody will tumble to the notion that it was a bad, expensive experiment. In the mid-1980s a proposal was put forward to realise as much from State assets as possible. The Government decided to sell sites owned by CIE, Iarnród Éireann and other lands owned by the State. That is what happened and a number of years later people asked why it was done. Why we are doing this now? There is no evidence to support the concept that this proposal will address the issue that must be addressed, namely the deficit in the public health service.

I cannot see any evidence of the much vaunted benefit to the public health sector and no Government speaker has illustrated from where it will derive. If one discusses the issue with health service workers, they will tell one that the service is full of chiefs, with not enough Indians. There are many turf wars going on and health workers will tell one that readily.

Let us examine some of the structures that will emerge. Let us suppose the proposal goes wrong, which I believe it will. How will we unravel the leases on the white elephants sitting on public hospital grounds for our lifetime and long after that? How will the beds be shared out and in what proportion? The Minister said these matters will be resolved but many other simpler issues within the health service have not yet been resolved and will not be in our lifetime unless some other formula is found.

The delivery of health services begins with local health centres. We have a reasonably good network of health centres throughout the country which could be upgraded, thus relieving a considerable amount of the burden on accident and emergency departments, providing a very valuable service, complimentary to hospital services.

I worry about the logic behind this proposal. In recent years, in the Department of Health and Children, somebody who Members of this House [752] cannot identify, has been making decisions. Somebody made a decision to close St. Luke’s Hospital and to relocate the children’s hospital to a place, it was said, which would be convenient because it was on bus, train and Luas routes. One must ask who goes to hospital on a bus or a train. Has anyone heard of a child or adult doing that? What motivated the people who came up with those answers? Do they think we are all fools? With regard to the proposed relocation of the children’s hospital, surely someone argued that the Mater Hospital site is very confined and inaccessible from all quarters and that it would be better to build a new hospital on a site that is accessible, readily available and large enough to accommodate the requirements of that sector for the foreseeable future. That did not happen, however, and it is unlikely to occur. I want to issue a friendly warning to Members on the Government side of the House. I do not know whether that was a policy of the Progressive Democrats, Fianna Fáil, the Green Party or the Independents, but there must be some policy there that somebody will own up to.

  An Ceann Comhairle: The Deputy has one minute remaining.

  Deputy Bernard J. Durkan: In one minute it is not possible to describe the full degree of my revulsion at the proposal, but I will do my best. In the aftermath of the general election, the Government is ignoring the will of the people. I do not know what people said to the Government candidates, but in the course of the election, not a single person said to us that a great job was being done on the health service, that they agreed with co-location, the closure of St. Luke’s Hospital or the relocation of the National Children’s Hospital. No one in the country made such a statement, as far as I am aware. We have done our best to make the case and bring the issue to public attention. God help the Government Deputies if they ignore it.

  Deputy Brian Hayes: I thank all my colleagues who contributed to this important debate both yesterday and today. We have heard excellent contributions, including some particularly good maiden speeches from colleagues on all sides. It should be noted that during the debate we did not hear one contribution from the Green Party. This is the same party whose Member, Deputy Gormley, described the co-location proposal as a Frankenstein in a press statement issued six months ago. He did not have the courage of his convictions to explain why he has done such a drastic U-turn on the issue. The Green Party has serious questions to answer in respect of its duplicity, given the firm commitments it gave the public during the recent election campaign.

The Minister, Deputy Harney, had to leave the House as she was so overcome by the love-bomb[753] ing from Fianna Fáil backbenchers. It was not always this way, of course. About a month ago they were individually filleting her in each of the 43 constituencies because she was being blamed for public anger on the doorsteps. I recall the remarks of Deputy O’Flynn at the time, who was specific as to where the blame lay.

  Deputy Bernard J. Durkan: That is right.

  Deputy Brian Hayes: A few weeks later, however, all that has been forgotten. Speaking from both sides of one’s mouth at the same time is a path well trodden by Fianna Fáil backbenchers over the years.

One of the most fundamental questions in this debate was posed by Deputy McManus, although it was not answered by the Minister of State. Since May, she has been attempting to elicit a response, by way of correspondence, concerning the statutory basis for this proposal. The Minister said the Government’s initial decision conforms to section 10 of the Health Act 2004. It has taken them eight weeks to come up with that pathetic explanation, which goes to the heart of this problem. I believe the Government is making it up as it goes along. It has not thought through any of the consequences that will follow once our land is handed over, even by way of lease, to private for-profit hospitals. A Government decision was taken 18 months or two years ago, which has no statutory basis. We could face litigation from any of the unsuccessful bidders for each of these hospitals. In addition, we could face litigation on EU competition grounds from any of the existing private hospitals which bought their own land ten or 15 years ago because of this preferential deal that is now being given to new private hospitals on public lands. If the Government is going into this Frankenstein scenario, as Deputy Gormley called it six months ago, it should do so with its eyes open. The Government could quite quickly find itself in courts up and down the country and I have not heard a legitimate statutory or legal reference point, bar the kind of limp excuse I heard from the Minister tonight.

My party has no problem with private money in medicine. I would have no great difficulty, in principle, with the Government allowing private builders to construct a hospital and lease it back to the State, provided the State runs the operation. We have no problem with public private partnerships, PPPs, in the construction of new schools, but this proposal is like handing the schools over to the private sector tomorrow. There is no argument for such a course of action and it has never happened before. Schools are built by the private sector but are still controlled by Marlborough Street and the same principle should apply when it comes to hospitals.

Last night the Minister said this unified model of public and private hospitals working side by [754] side will benefit everyone. Do people actually believe that? In the real world, will public patients receive exactly the same treatment as private patients? Such a suggestion is absolute rubbish, as every Member of this House knows. The two-tiered system of health care that exists at the moment is deliberately beneficial to private patients and this will continue.

The notion that intensive care beds will be divvied up between public patients and private patients is rubbish. If there is only one intensive care bed and both a public patient and private patient need it, who will get it? If an anaesthetist is working at 2.30 a.m. and calls come from both the private hospital and public hospital, where will he or she go? This is all on the basis of the service agreement the Minister spoke of, yet her chief executive officer in the HSE suggests the HSE will be in competition with such ventures with no unified system. This, Sir, is more of the same from the Government, thinking things up as it goes along, putting things in the public domain when caught on the hoof.

The Minister for Health and Children, Deputy Harney, revealed the new piece of the jigsaw to the House last night that the green light for this project has been by the National Development Finance Agency, NDFA. This is a new piece of information and I would like to hear from the Minister in the coming days how it came about. Was it as a result of this Private Members’ motion that the National Development Finance Agency suddenly produced its report, like a rabbit from a hat, stating that this is fine and should proceed? This report still has not been published and we have not received a copy. I request that the Minister immediately send a full copy of the report to the health spokespersons on the Opposition benches. I want that report in the public domain. The Government, surprisingly, could not produce a copy of this report for the past six months but, hey presto, the election is over and the report has emerged.

Are people fools? The 52% of the population with private medical insurance will pay greatly for this proposal and they have seen their premiums double in the past ten years. Premiums will double again because of this stroke that is being played.

The Minister argues that locating two hospitals on one site means consultants will go merrily back and forth between hospitals rather than whizz around town wasting time. There is nothing to prevent consultants from working in three or four hospitals.

The majority of people oppose this proposal because it is a tax wheeze that is deeply contrary to their wishes. The majority of Deputies elected to this 30th Dáil object to and have taken stances against this proposal. It is now time for Deputies to put their money where their mouths are, honour the mandate they received from their con[755] stituents and reject this proposal, which will have drastic consequences for public health care for a generation to come.

[756] Amendment put.

The Dáil divided: Tá, 76; Níl, 68.

    Ahern, Noel.

    Andrews, Barry.

    Andrews, Chris.

    Ardagh, Seán.

    Aylward, Bobby.

    Behan, Joe.

    Blaney, Niall.

    Brady, Cyprian.

    Brady, Johnny.

    Browne, John.

    Byrne, Thomas.

    Calleary, Dara.

    Carey, Pat.

    Collins, Niall.

    Conlon, Margaret.

    Connick, Seán.

    Coughlan, Mary.

    Cowen, Brian.

    Cregan, John.

    Cuffe, Ciarán.

    Cullen, Martin.

    Curran, John.

    Dempsey, Noel.

    Devins, Jimmy.

    Dooley, Timmy.

    Finneran, Michael.

    Fitzpatrick, Michael.

    Gallagher, Pat The Cope.

    Gogarty, Paul.

    Grealish, Noel.

    Harney, Mary.

    Haughey, Seán.

    Healy-Rae, Jackie.

    Hoctor, Máire.

    Kelleher, Billy.

    Kelly, Peter.

    Kenneally, Brendan.

    Kennedy, Michael.

    Killeen, Tony.

    Kirk, Seamus.

    Kitt, Michael P.

    Kitt, Tom.

    Lenihan, Brian.

    Lenihan, Conor.

    Lowry, Michael.

    Mansergh, Martin.

    Martin, Micheál.

    McDaid, James.

    McEllistrim, Thomas.

    McGrath, Finian.

    McGrath, Mattie.

    McGrath, Michael.

    McGuinness, John.

    Moloney, John.

    Moynihan, Michael.

    Mulcahy, Michael.

    Nolan, M. J.

    Ó Cuív, Éamon.

    Ó Fearghaíl, Seán.

    O’Brien, Darragh.

    O’Connor, Charlie.

    O’Dea, Willie.

    O’Flynn, Noel.

    O’Hanlon, Rory.

    O’Keeffe, Batt.

    O’Rourke, Mary.

    O’Sullivan, Christy.

    Power, Peter.

    Roche, Dick.

    Sargent, Trevor.

    Scanlon, Eamon.

    Smith, Brendan.

    Treacy, Noel.

    Wallace, Mary.

    White, Mary Alexandra.

    Woods, Michael.


    Allen, Bernard.

    Bannon, James.

    Barrett, Seán.

    Breen, Pat.

    Broughan, Thomas P.

    Bruton, Richard.

    Burke, Ulick.

    Burton, Joan.

    Byrne, Catherine.

    Carey, Joe.

    Clune, Deirdre.

    Connaughton, Paul.

    Coonan, Noel J.

    Costello, Joe.

    Coveney, Simon.

    Creed, Michael.

    Creighton, Lucinda.

    D’Arcy, Michael.

    Deenihan, Jimmy.

    Doyle, Andrew.

    Durkan, Bernard J.

    English, Damien.

    Enright, Olwyn.

    Feighan, Frank.

    Flanagan, Charles.

    Flanagan, Terence.

    Gregory, Tony.

    Hayes, Brian.

    Hayes, Tom.

    Higgins, Michael D.

    Hogan, Phil.

    Howlin, Brendan.

    Kehoe, Paul.

    Kenny, Enda.

    Lynch, Ciarán.

    Lynch, Kathleen.

    McCormack, Pádraic.

    McEntee, Shane.

    McGinley, Dinny.

    McHugh, Joe.

    McManus, Liz.

    Mitchell, Olivia.

    Neville, Dan.

    Noonan, Michael.

    Ó Caoláin, Caoimhghín.

    Ó Snodaigh, Aengus.

    O’Donnell, Kieran.

    O’Dowd, Fergus.

    O’Keeffe, Jim.

    O’Mahony, John.

    O’Shea, Brian.

    O’Sullivan, Jan.

    Penrose, Willie.

    Perry, John.

    [757] Rabbitte, Pat.

    Reilly, James.

    Shatter, Alan.

    Sheahan, Tom.

    Sheehan, P. J.

    Sherlock, Seán.

    Shortall, Róisín.

    Stagg, Emmet.

    Stanton, David.

    Timmins, Billy.

    Tuffy, Joanna.

    Upton, Mary.

    Varadkar, Leo.

    Wall, Jack.

Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Paul Kehoe and Emmet Stagg.

Amendment declared carried.

[758] Motion, as amended, put and declared carried.