Brendan Howlin (Wexford, Labour)

I am very glad of the opportunity to support this critical motion and I congratulate Deputy McManus on its comprehensiveness and clarity. This is not one of the run-of-the-mill debates we have during Private Members' business about a particular identified need or an undelivered facility required in one part of the country or another; rather, it presents one of the rare opportunities the House gets to decide the shape of our future health service.

Health care has been at the top of the agenda for the past ten or 15 years. Taoisigh have campaigned in elections and discovered it is very much at the top of the agenda of the vast majority. Sooner or later, all of us will test the effectiveness of the health service. Our nearest and dearest, or ourselves, will be dependent on it one day or another and therefore it is critically important that we get it right.

I was dismayed when I read the Government's amendment to the Labour Party's motion. It calls on the House to support the Government's policy of encouraging the public and private sectors to work together, and to support the co-location initiative to develop private hospitals on the campuses of public hospitals. I regard that as health apartheid. There is no mandate for it from the people and I genuinely believe it will be resisted by the vast bulk of citizens.

The amendment calls on the House to note that the HSE is engaged in a public procurement process to develop private hospitals at ten public hospital sites. Members of all parties — but perhaps not from the Progressive Democrats as I do not recall whether they were present — met the senior executive of the HSE to ask who is calling for this public procurement process. We did not get an answer immediately but eventually that it was on the direction of the Minister and her Department. This approach represents an historic new direction in health care. Although it may be true that private health care has always been a feature of health care provision in Ireland, as the Minister invites us to acknowledge in the amendment to the motion, it is true of a different Ireland in which we built up a health service on an ad hoc basis. It featured at a time when religious orders provided services the State could not afford to provide, some of which were later subsumed into the system. We got along because we had to get along, with an element of private service and an element of public service. However, we now live in a new and different Ireland.

I intend to focus on the acute services but, as Deputy McManus stated, there obtains across the whole health service a philosophical attitude to the effect that health care is regarded as a commodity to be delivered by the market and not as an aspect of a public service to be delivered on the basis of need. That is the inescapable truth.

What the Government has embarked upon is radical, new and highly ideological. It is traditionally claimed that those on the left want to upset things with radical ideology, yet the most ideologically driven party in this House — the one with the least support — is the Progressive Democrats. It is driving an ideological agenda to deliver privatised medicine. Health care is to be privately delivered and owned, a commodity to be bartered in the marketplace, paid for by those who can afford it and queued for by those who cannot.

The exemplar of decent health care standards, to which most developed European countries have looked since the 1940s, is the United Kingdom's National Health Service. It has been considered a unified, integrated, world-class health system. Apparently the concept of a unified, integrated, world-class health system, free at the point of delivery, is no longer Ireland's objective. Ireland could never afford this goal in the past but it can afford it now. We are no longer debating the difference between Boston and Berlin, at least in health care, because we are already serving up the clam chowder in our private hospitals. This profound mistake will ingrain inequality, in the form of a two-tier hospital service, in this country for years to come. There is little public knowledge or awareness of the major shift that has led to the bedding down of a two-tier health care system. I honestly believe this approach is contrary to the overwhelming bulk of public opinion, including the public opinion that supports the major party in government.

If this policy is not abandoned, we will have parallel hospitals on adjoining campuses — one hospital for people who are insured, or who can pay, and another hospital for the rest of the people. I do not doubt that private hospitals will tender for some categories of public patient work, but they will not tender for difficult or long-term work that involves caring, for example. It will be paid for by some future version of the treatment purchase scheme. Public patients — the lesser mortals — will have to endure a sufficient waiting period before they can earn admission. The simple and inescapable truth is that as long as there are two parallel systems of health care delivery, the public system will always be seen as less important than the private system. If that were not the case, there would be no incentive for people to pay for health insurance. If the public system offered an identical standard and speed of care, who would pay to go private? The Tánaiste, Deputy McDowell, has said that "a dynamic liberal economy like ours demands flexibility and inequality in some respects to function". He added that such inequality "provides incentives". We will provide such incentives if we continue to base our health service on in-built inequality.

Similar problems are encountered when one examines how our society cares for the elderly. Families are being told to find private nursing homes for their elderly loved ones who are sick, so that acute hospital beds can be freed up. Every weekend, I deal with people who are distraught because they have been told to find private beds somewhere for their family members, who are too ill to go home. I do not know whether the Minister, Deputy Harney, has had the same experience at her clinics. I live in a large constituency. Patients who are based in Wexford town are sometimes referred to beds in New Ross, Gorey or somewhere in south-west Wexford. Such people deserve better at that stage of their lives. We should provide better services for them because we can afford to do so. Where are our First World public long-stay hospitals for the elderly? Why is it not our objective to provide such services at a time when, for the first time in our history, we can afford to offer a decent regime of publicly funded and staffed geriatric facilities, thereby allowing elderly people to live close to their home bases? Given that experience elsewhere has taught us that the standards in the private sector are less than optimum, why are we demanding that the market should provide such services for profit?

I have exhausted my time. I had hoped to refer briefly to Wexford General Hospital, but I will do so on another occasion. I would like to make a philosophical point in conclusion. The Minister for Health and Children knows I have great personal regard for her ability and her acumen as a politician. I genuinely believe that what is happening in health care under her stewardship is a profound shift. It will cause major hardship and will bed down inequality in the delivery of health care for generations to come. I hope the public is alert to what is happening.

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