Liz McManus (Wicklow, Labour)

I thank my Labour colleagues for agreeing to table this motion. It is important that we discuss in our national Parliament what we want as a people from our health service. Ask anyone in the street what they want when they become sick and the answer is unequivocal. It would be the same as what any of us in this Chamber would want for ourselves and for those we love, namely, to be able to get medical care when we need it and not because we can afford it, to be able to access a hospital bed without delay and with dignity, to receive top-class attention in a hospital that is clean, efficient and health promoting, to come home when we are able or able enough to do so with supports close at hand, and when our time comes to be able to die in conditions which respect our vulnerability at the end of our lives. That is what people want from our health service. The public desire is clear. It is diametrically opposed to the desire of private developers and business interests to make the biggest profits possible from health care. There is no shame in that because that is what they do. However, there is no glory in it either, although there are some on the Government side who glorify the market to a ludicrous degree. The leopard does not change its spots because of any glossy or soft-focus marketing of private health care and the pure and simple objective remains to make money.

On occasion, the making of money can coincide with the public interest but it does not always do so and when it comes to health care, the two interests rarely coincide. The Labour Party recognises that a role exists for the private sector but the over reliance on that sector espoused by this Government is not good for patients. The experience in general has been that the impact of large scale privatisation of health is socially regressive and very costly, yet we have a Government so wedded to the market that it makes the choice to follow the private route even when the best advice is to do otherwise. This is clearly a choice made by Fianna Fáil and the Progressive Democrats. By funding for-profit hospitals out of the public purse, they choose a quick fix solution despite poor returns for the taxpayer and a deepening divide between the public and private systems of health care. Having done so, they hope to divert attention from their inability to introduce progressive changes and real improvements in health.

The Minister for Health and Children is at least consistent. After all, she carries a lot of ideological baggage. Her leader has argued the case that inequality is good for society, her party stands by the principle that greed is good and her policy of featherbedding private health care businesses reflects her world view. The Labour Party fundamentally disagrees with the Progressive Democrats agenda. We are opposed to the privatisation of our health services and we will, if returned to Government, bring this wasteful and ill-thought scheme to an end. We will strengthen and expand the public and not-for-profit hospital sector and bridge the gap between public and private patients.

The Minister has prepared no proper analysis for her scheme and she will not do so because no analysis will support her case. In fact, the only argument in favour of such a plan would arise if the Government was unable to find the capital to invest in health care but we all know that is not an issue at present. If the Minister wants to convince us, she should publish the results of cost benefit analyses being carried out on her scheme. The Department of Finance seems to have no difficulty with stalling other health projects through sanctions, yet it blithely allowed this scheme to proceed despite an estimated first year cost of €2 billion. Today, I sought information from the HSE but, once again, it was impossible to extract any details which would help me prepare this speech.

The Minister's proposal was made for ideological rather than logical reasons because she has an almost foolish attachment to Boston over Berlin. Logic would warn us to keep as far as we can from US health care system, yet she is trying to bring us closer to it. Health care in the US is extremely expensive and deeply unfair. Approximately 40 million Americans who lack health cover are locked out of an unequal health system in an unequal society. In Ireland we spend €1,950 per person per annum on health, a sum which the Minister seems to consider excessive. Does she even know that health care largely provided by for profit interests in the US costs €5,535 per person? Due to the unequal nature of US society, health outcomes are relatively poor in terms of life expectancy and infant mortality.

The Tánaiste should be told that, far from inequality being good for us, a fair society is a healthier society. The US demonstrates the link between inequality and low health outcomes which a massive investment in health has failed to address. Almost 16% of GDP in the US is spent on health care because of the private nature of the health service and almost 50% of the world's expenditure on health occurs in the US. Despite that, the Government persists with private solutions in order to disguise its failure to deliver a decent health service, let alone a world-class one. The Minister will no doubt argue, as she has done before, that handing over scarce public lands to private interests along with enormous tax breaks is not privatisation. It looks, sounds and acts like privatisation but the Minister does not see it in that way. She maintains that all she is doing is freeing up private beds in public hospitals to provide more capacity. However, her claim is simply not true. She is creating additional private beds to those in our public hospitals. Private patients will still be entitled to access beds in public hospitals and they will continue to do so. After all, 68% of all patients come through accident and emergency departments, a figure which includes public and private patients. It is untrue to claim that private patients will no longer present at public hospitals.

Speaking at a private health care conference, the Minister stated: "It is not privatisation to cease the practice whereby 20% of new public beds built with public capital are reserved for private use." However, she never told us how she intends to stop patients from exercising their rights. There is no evidence to indicate that the addition of private beds will liberate beds for public patients on a like by like basis. We simply do not know whether that is the case and the Government has not bothered to find out. We do know, however, that the taxpayer will pay for a net increase in private beds. The likelihood is that we will end up with an overly doctored class of private patients who enjoy additional privileges and pay higher insurance premia, while public patients will continue to wait in line. There is an Irish phrase which, roughly translated, means "to grease the bum of the overfed pig". That, it seems, is the goal of this Government.

It is worth reminding ourselves that we are citizens of a republic. During this year, the 90th anniversary of the 1916 Rising, we have spent much time debating many aspects of our history. We need to begin a debate on the meaning of being a citizen in this republic and the rights that citizenship confers on us as individuals, such as rights to education, health care and a roof over our heads. Must we accept these rights do not matter because it is all about "bling bling" or that gold credit cards are the passport to good health care? The Labour Party will not be drawn down that path. If returned to Government, we will end this crazy misuse of public resources and bridge rather than broaden the divide between public and private patients.

Overdependency on the private sector will lead to the cherry-picking of patients. For-profit hospitals choose profitable procedures and services rather than those which meet greatest need. This trend will be facilitated further if private hospitals are placed next to public ones. Private hospitals rarely have accident and emergency departments and usually lack services and equipment for severely ill or injured patients. Their proximity to public hospitals will enable the private operator to rely on tax supported services for costly aspects of patient care. As a recent report produced by the Irish Congress of Trade Unions pointed out:

The public hospital is the safety net that protects a community with a private hospital. If a private hospital performs badly or closes, the community will look to the State to come to their aid. The experience of Leas Cross private nursing home confirms that where there are private facilities the investors are not the only ones bearing a risk.

It is small wonder that stockbrokerage firms have advised investors that private hospital developments are good investment prospects in Ireland. When the scheme was announced it was met with whoops of jubilation by investors. "It is the answer to our prayers; we could not have written it better ourselves" is how one private health care promoter responded. Why would they not celebrate? For every €100 million invested the Irish people will contribute €40 million, a gift from a Government that cannot deliver to low income families the 200,000 medical cards it promised. However, it has no difficulty subsidising fat cats.

In reality the cost to the taxpayer is quite enormous. These are not the words of a red-clawed socialist, although they could be, they are the words of the man whom the Minister has appointed to the most senior post in the Health Service Executive. Time and again Professor Drumm has expressed his opposition to the Government scheme as clearly as the man can do in the circumstances. In October 2005 he warned:

The pendulum will leave the public health service and that for me would be disastrous. I really believe health care should be provided in as many facets as possible through the publicly funded system.

He sketched out the dangers on the Government proposals in stating:

We need to be extremely careful that we do not drive to the front gates of our hospitals and find the road left to the nice flowered structure with a fountain in front where those that can afford it go to that structure and someone goes sheepishly in the other direction towards the HSE hospital.

In reality that is exactly what will result if this scheme proceeds. That is the point of a private hospital; the more marked the divide the more attractive the private option and the worse will be the effect on the public hospital system. The attractions are not all based on hard medical evidence. There is mounting proof that the outcomes for treatments in for-profit hospitals compare unfavourably with those of not-for-profit ones. However, patients will still be beguiled by the flowers and the fountain.

Currently we need to employ more hospital consultants in certain specialties in our public hospitals. Since 2003, for example, only one additional accident and emergency unit consultant has been appointed. Private hospitals will become attractive options for those specialists who are frustrated with the problems and restrictions in the public system. Not only financial return but also better conditions will siphon away doctors who currently work within the public sector. Meanwhile public hospitals will lose vital funding they receive for looking after insured patients as they do at present, which is likely to lead to a downward spiral.

It is not just in the hospital system that the Minister is imposing her will to privatise. One of the hallmarks of the Government record is that since 1997 there has been a shrinking of public provision in care for the elderly and in community services. Since 1997 the number of community nursing beds has been reduced by hundreds of beds. As the Government struggles to make up the shortfall we are witnessing an increased reliance on private nursing homes to fill the gap. There are many excellent private nursing homes which fill an important need but surely even the Government has to learn from experience. There is an urgent need to ensure high standards and quality control of private nursing homes.

After all these years, we still do not have a satisfactory regulatory system of private and public nursing homes. We on this side of the House have grown weary raising this issue with the Government, yet there is still no sign of a full, effective statutory authority that will protect elderly and frail people in residential care. The current inspection system does not inspire confidence. The HSE asks us to trust it and places its minimalist reports up on the Internet. Most people would have more confidence in the opinion of Martin Hynes's conclusion of the current system of inspection as being "fragmented, disjointed, with no evidence of joined-up thinking". Mr. Hynes is the person who first blew the whistle on Leas Cross, yet his critique continues to be ignored. Eighteen months ago the Taoiseach promised an inspectorate independent of the HSE, and we are still waiting.

When a crisis occurs, as it did in the Leas Cross nursing home exposure by the media, the public rightly expect a response from the Government. Promises were rightly made by the Taoiseach and the Minister for Health and Children but then, wrongly, they were broken. Last May the Health Service Executive received the Professor O'Neill report into Leas Cross. Last May, the Minister for Health and Children could and should have published it. She has failed to do so to this day and it is her greatest failing. On the one hand, she is so excessively reliant on the private sector, yet on the other she is lethargic in her approach to proper regulation and strong oversight on the facilities that she is enriching.

All this is having a demoralising effect on those working within the health service. There is seepage from the health service of public provision that is often almost invisible except to those who experience it directly. Public health doctors disappear into a layer of bureaucracy and are not replaced. The anecdotal evidence is legion. A dentist in my county of Wicklow left and was not replaced. It was only when parents discovered their children were not being treated that the loss was discovered because accountability has been stripped from the system with the establishment of the Health Service Executive. There are vacancies in a range of health professional posts that are not being filled.

I was contacted by a general practitioner recently who works in the north east. He is clearly a good family doctor and wanted someone to hear what was happening on the ground. His medical practice provides blood tests for patients who need them and the samples were, until recently, tested in the laboratory at Our Lady of Lourdes Hospital in Drogheda. Now the laboratory is unable to keep up with demand and has sought one extra staff member and some equipment from the HSE. However, instead of meeting that need the HSE decided to pay, at heaven knows what expense, for testing of blood samples to be transferred to a private clinic in Kildare and another one in Britain. According to the doctor it is not as good or as speedy a service as the public one. The HSE seems infected by the privatisation bug which is being spread by the Minister to a point where rather than developing further a tried and trusted service in Our Lady of Lourdes Hospital, the HSE made the choice to export blood samples to Britain. The family doctor is frustrated in what he sees as an enormously wasteful solution to a simple problem.

I have promised to table a parliamentary question on the cost of this change but, knowing the Minister and the HSE as I do, I reckon it will take until Christmas to get the reply and probably much longer, if ever, to get the information I want. The silliness of replies to parliamentary questions never fails to amaze. Recently I asked if the minutes of the HSE management meetings for July and September 2006 had been signed off yet. In a functional world the answer would be a simple yes or no, but in the dysfunctional world of the Minister of Health and Children the answer was:

Section 6 of the Health Act, 2004 states that the Health Service Executive is a corporate body. In view of this, the matter of minutes from Health Service Executive management meetings is a matter solely for them. Accordingly, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have this matter investigated and to have a reply issued directly to the Deputy.

This is heartbreaking stuff. It is as simple as lifting the phone, asking whether the minutes have been signed off and getting me the answer. The problem is that, as long as the minutes are not signed off, it is not possible to obtain answers to freedom of information requests regarding decisions that have been made. People probably do not appreciate this fact. We receive our replies and are supposed to be satisfied with the kind of gobbledegook contained therein.

Earlier this year, we witnessed another example of the Minister's determination to promote the private over the public. The Government instituted home care packages to help elderly patients to stay in their homes. This is a very worthy objective and we all support it but even in this area the Minister is intent on favouring the private over the public. She launched the American Comfort Keepers franchise in Ireland and spoke glowingly of the role of private companies in home care. Since the launch there have been complaints in some instances and there is no proper regulatory system to protect patients at home. A senior trade union official, who has been very concerned about the status and extremely shabby treatment of home helpers in the public sector, described this trend as part of a parallel private home help system that would fit into the Minister's wider privatisation plans.

By far the most significant of these plans is the scheme to develop private hospitals on public lands, essentially in the car parks of public hospitals. These will be partial hospitals creaming off profitable work and leaving costly long-term care to the taxpayer. The two-tier system will be further institutionalised and locked into the system. There will be no incentive to have continuity of care or develop an integrated service where the money follows the patient regardless of his or her income. It is pure Progressive Democrats ideology in action. It is noteworthy that Fianna Fáil Members are willing to fall in like sheep behind a policy that fails to deal with the important challenges that must be faced so as to meet the public desire for fairness and efficiency in the health service. I would have thought Fianna Fáil would have adopted a different approach but it has offered no criticism and has not expressed an alternative view.

We have great doctors, nurses and other staff in our system who are committed to patient care and looking after people on the basis of need. They deserve better. When I visit hospitals, I find it striking to listen to the needs of the staff, which can include increased space in the accident and emergency unit, more acute beds or more step-down beds. Not one person I have met in my travels around the country has sought the building of a private hospital beside a public one. Individuals raise their eyes to heaven when I mention it and ask what I think of it. They know it is not a good idea because they are working in the health service and trying to meet the needs of patients while dealing with the restrictions and pressures that exist. They deserve better and this is why the Labour Party has tabled this Private Members' motion, for which we seek full support to ensure that what is done in the health service truly meets the needs of patients and those who care for them.

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