Ms Teresa Cody:

I will go back to some of the issues that were raised earlier. There was a reference to perverse incentives. Mr. Woods has already stated this but I will reinforce it by saying it is absolutely not the case that the generation of income should take precedence over ensuring access for public patients in the public health system. I will refer to the rationale for the Health (Amendment) Act 2013. In 2010, the Comptroller and Auditor General identified that for 50% of private patients, no private in-patient charge applied because they were accommodated in either a designated public bed or a non-designated bed. The inability under the law to collect a private in-patient charge in such instances represented a significant loss of income to the public hospital system and taxpayers and represented an indirect subsidy to private health insurance companies. The Health (Amendment) Act 2013 was implemented to address the issue identified by the Comptroller and Auditor General and provided for the charging of all private patients in public hospitals irrespective of the type of accommodation used. Patient choice still applies to whether one is treated on a public or private basis. That Act came into effect in 2014 and the Department carried out analysis earlier in the year on trends in public-private patient activity in the acute hospitals. The conclusion was that while overall hospital activity continues to increase on an annual basis, the proportion of patients treated privately remains very stable. We both referenced that in our opening statements. The new charging regime introduced in 2014 has not had an effect on the public-private mix.

There is definitely no cosiness in the court cases that are coming up with regard to that. The Government has made quite clear it is contesting those cases.

Deputy Louise O'Reilly asked about the broader issues on the Health (Amendment) Act. In his opening statement, although he did not get to read it all, Mr. Woods addressed some of the issues of the effects of the designation particularly in the context of those who are still on the 1997 contract. Issues around the monitoring of off-site private practice were mentioned. They are some of the issues with which we are engaging. That was raised initially earlier in the summer and we are responding to proposals made by the HSE in September, which predated the "Prime Time" programme. As the issues on monitoring the contracts have been well rehearsed by my colleagues from the HSE, I will leave it at that.