Mary Harney (Dublin Mid West, Progressive Democrats)

I move amendment No. 1:

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

"— welcomes the Government's commitment to promoting high quality health services and in particular to the setting up of the independent Health Information and Quality Authority which will drive the quality agenda in the health services;

notes the proposed statutory role of the Office of the Chief Inspector of Social Services in inspecting and maintaining registers of residential centres for people with disabilities, children in need of care and protection and older people, including private nursing homes;

recognises the fact that private healthcare is and has always been a feature of healthcare provision in Ireland;

commends the Government on the measures it is promoting to improve access for public patients to acute hospital care;

supports the Government's policy of encouraging 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;

supports the co-location initiative to develop private hospitals on the campuses of public hospitals in order that up to 1,000 beds currently reserved for private patients may be re-designated for use by public patients in a most cost effective way;

notes that the Health Service Executive is engaged in a public procurement process to develop private hospitals at 10 public hospital sites;

notes the increase of 1,200 in the number of inpatient beds and day treatment places since the publication of the Health Strategy in 2001 and the plans to open new acute hospital units;

notes that an independent review of the scheme of capital allowances for investment in private hospitals recommended its continuance as a means to address supply shortages and reduce costs;

welcomes the introduction by the HSE of a broad-based Winter Initiative which is designed to ensure that the services required to address the particular demands of the winter season are in place and operating optimally, including the co-ordination of services in relation to discharge initiatives, continuing care and home supports;

commends the Minister for Health and Children for the provision of over 900 long-stay beds in private nursing homes in the last two years and acknowledges that all private nursing home beds are subject to registration and inspection;

commends the Minister for Health and Children for providing funding to provide a further 1.75 million home help hours this year and a tripling of home care packages to 3,000 and notes that the HSE is improving and enhancing the service by using a range of additional providers including voluntary groups and the private sector;

acknowledges and supports the important role of public health nurses, who are a key element in the delivery of community based health services, and notes that the HSE sponsors 130 staff to train as public health nurses each year at a cost of over €5.2 million;

acknowledges that the HSE is currently engaged in contracting 800 additional nursing home beds as part of the Winter Initiative; and

acknowledges that the HSE is finalising proposals for the provision of 350 additional public beds in the Dublin region and an additional 200 such beds in Cork also."

Some might say the motion from the Opposition puts everything in black and white. Some could say it is devoid of colour and shades to reflect the diversity of health services and patient choice in Ireland today. That would be kind because the motion is not just black and white, it is all black. It betrays an attitude that private involvement in health is all bad. In a similar vein, 12 years ago, Deputy Liz McManus accused the then Minister for Health, Deputy Howlin, of having made slavish concessions to the private sector.

It is as if, in Labour Party eyes, only public sector doctors take the Hippocratic Oath. It is as if the vast majority of general practitioners were not self-employed in a direct relationship with two thirds of the population. It is as if Dean Swift had not set up a private hospital more than 200 years ago that is still in operation, and has been joined by many others over the years. It is as if thousands of beds in public hospitals had not been reserved for private patients under previous Ministers and Governments. It is as if the private nursing home subvention scheme had not been introduced by a Labour Party Minister for Health, Deputy Howlin, and perpetuated unchanged by a Fine Gael Minister. It is as if 52% of the population did not choose to pay for health insurance.

The fact is, we have a mixed public-private system of finance and of provision of health services. If any party does not want that, and wants to base policy on a public service monopoly, let them have the courage of their convictions and say so. Let them propose a ban on private interactions between patient and doctor. Let them ban the purchase of private nursing home places for older people. Let them close the National Treatment Purchase Fund, NTPF, and ban the State from purchasing badly needed treatments for 50,000 public patients who used to wait very long times. Let them refuse to allow a public patient use a private magnetic resonance imaging, MRI, scanner. Let them forbid the Health Service Executive to purchase kidney dialysis treatment for patients in the south east. Let them overturn European market freedoms and ban hospitals that seek to make a profit. Let them also forbid doctors in partnerships from making profits. Let them take themselves, but not us, back to North Korea.

The Government and I believe we can make better use of both public and private finance and health providers to provide a better health service to the whole population. The job of a Minister for Health and Children is to achieve the best possible health outcomes for the whole population, not just to fund and organise exclusively publicly provided health services, as seems to be the approach of the sponsors of this motion.

Health policy encompasses all sources of finance, all types of health providers and all patients. Private health care is a long established feature of health care in Ireland, in almost every county. It involves general practitioners, dentists, pharmacists, chiropodists, private nursing homes and private hospitals, now used systematically by the National Treatment Purchase Fund. Our GP service, in particular, is a public-private mix that works very well for all patients who use the same facilities and are seen by the same doctors. It works far better for patients than the models in some other countries which have a more nationalised GP service. It takes almost a week in some parts of the UK to see a GP.

This Government is committed to using fully the scope for the private sector to provide additional capacity and services in the health system. There are a number of Government policies and initiatives that support the co-existence of public and private health care. They include the designation of private and semi-private beds in public hospitals, income tax relief on private health insurance premiums, income tax relief on medical and dental expenses, the work of the National Treatment Purchase Fund, the co-location initiative to free up to 1,000 beds for public patients and capital allowances for investment in the development of private hospitals and nursing homes.

The policy of this Government is to achieve the best for all patients using the mixed public-private system we have. Far from preserving the public-private mix on ice, that means change in the way it works. I am committed to ensuring private practice within public hospitals will not be at the expense of fair access for public patients.

There are 13,000 beds in the 53 public hospitals and 2,500 of those beds are designated for use by private patients. The figures I have given the House previously show that in most public hospitals, the designated ratio of private work, approximately 20%, is greatly exceeded, sometimes accounting for up to 40% of inpatient activity. For example, 46% of elective work in Tallaght Hospital last year was for private patients. This means some public hospitals are increasingly being run as private fee earning opportunities. Changing this is the very opposite of privatisation: it is reclaiming public beds and public facilities for public patients.

It is high time to start changing the system of reserved, subsidised private beds in publicly-funded hospitals. When the private sector is willing to finance the facilities, to manage the service and to fund the running costs 100%, why stop it? What compelling reason is there for the State to insist the public sector must pay all the capital cost of reserved private beds in public hospitals and more than half of the running cost? The State pays for the nurses, management, support staff and service staff dealing with private beds. The co-location initiative will free up to 1,000 of these beds for public patients.

The Health Service Executive is now undertaking the procurement process to select a consortium to build and operate a private hospital on each of ten public hospitals. The new private hospitals will be procured by utilising the new competitive dialogue tendering process. It involves a three stage process including a pre-qualification stage, a competitive dialogue phase within which solutions are identified and discussed and a final tendering stage.

The HSE has seen much of interest in the initiative. It has pre-qualified a number of bidders for each site and is now in the process of evaluating outline proposals and short-listing bidders for each site. The site will be made available to the successful bidder at the full market value. Each proposal will undergo a rigorous value for money assessment, the public interest will be fully protected and each proposal will fully adhere to public procurement law and best practice.

I expect innovative proposals from the private sector to maximise the use of public hospital sites and foster full co-operation between private and public hospitals. This procurement process will be completed in the early months of next year.

As we see contracts completed for St James's Hospital, Beaumont Hospital, Connolly Hospital and Tallaght Hospital in Dublin, and in Galway, Cork, Limerick, Waterford, Sligo and Letterkenny, I expect local populations will be very keen to see the new facilities and new public beds open. I also expect that what is opposed in theory today at national level, will be supported in practice next year at local level. Some of the loudest local calls for public patients to be treated at off-site private facilities at Limerick and Waterford, for example, have come from members of parties opposite who oppose this plan at national level.

There has been much misinformation about this cost effective plan. Far from creating a new two tier system, the new facilities will be required under the Finance Act to offer their services to the State for purchase at a discount. The NTPF has shown how the purchasing of treatments can work to benefit nearly 50,000 people and it has opened private hospitals for public patients, breaking down a two tier barrier in our system. In addition, while managed separately, the private hospitals will connect physically on site with the public hospitals and there will be opportunities for shared services.

There will be no sweetheart deals or bailouts. The lease of land will be on fully commercial terms and no public land will be given away. If anyone wants to claim that there is more value for patients to be gained from grass and empty lawns at public hospitals, they can attempt to do so. Under this plan, we will maximise the value of the land to the public sector.

The operators of the new facilities will have to bear all the financial risk and they will be compelled to manage their services efficiently. There will be no guaranteed State contracts, and any service arrangements with the State will be competitively priced. This is a financially sound proposition. Only the most twisted logic, and there has been some, could suggest it is more cost effective for the State to continue to meet 100% of the capital cost of private beds and half the running cost.

Arrangements will be put in place whereby consultants will be able to work at these facilities. As stated in the policy direction, this will be subject to better work practices being put in place in each public hospital. Many consultants at individual hospitals are keen to do this already and have expressed their support for this arrangement to me. This initiative does not introduce for-profit hospitals into Ireland; for-profit hospitals exist here already and are used by private and public patients. We have a mixture of not-for-profit and for-profit independent hospitals in Ireland and this mix will continue. The largest private operator in the country, Bon Secours Ireland, is a not-for-profit organisation.

The co-location initiative does not require an operator to be a for-profit hospital. I expect there will be strong interest from not-for-profit hospitals in winning some of these contracts. They, too, must raise finance to expand their activities and that finance, unless it is a charitable donation, has to be repaid. The finance invested has tax advantages for investors, but those tax advantages are not in any way dependent on whether the hospital is operated on a for-profit or not-for-profit basis.

The motion from the Labour Party proposes the abolition of this capital allowance for investment in hospitals. It describes the position, pejoratively of course, that there is no provision whatsoever in our tax code for "super-private" clinics. However, the motion does nothing to explain why it is more socially just to give capital allowances for film productions than for hospitals. The motion calls for the Government to publish a programme for investment in additional acute hospital beds. We have done so; it is called our capital investment framework for health and it is a €3 billion programme. We will have invested more than €2 billion in acute hospitals under the current national development plan. There are 1,500 more publicly-funded acute hospital beds now than in 1997, a rate of annual increase that is about six times that of previous governments. Current plans include provision for another 450 beds in addition to those released by the co-location initiative. We are also committed to developing an entirely new tertiary children's hospital.

It is no wonder that the motion looks to the Government to provide new beds since the combined Labour and Fine Gael parties failed, as recently as two weeks ago, to make a commitment to any number of new hospital beds in their A&E document. The motion also seems to forget that it was the Labour party that set up the social services inspectorate without any statutory powers and no scope to inspect public nursing home places.

The motion's call for the Government to move immediately to provide 1,500 community care beds for patients currently in hospital is also miscast and out of date. I do not know what sort of government would move immediately to acquire new community beds but rule out private nursing home providers on ideological grounds. This year so far, the HSE, with my support, has sourced more than 500 beds and will acquire 200 more by the end of the year. In all, 1,350 beds are being arranged. There is no ideological bar here — beds are being acquired in both public and private facilities. Far from running down home help services, this year we are expanding all services for older people, particularly home helps and home care packages. The full year cost next year of this expansion will be €150 million. This year, 1.75 million more home help hours are being provided, with 3,000 home care packages. Whatever works best and fastest for patients is being done, using all providers, public and private.

The Government is investing one quarter of all current expenditure in health. We are investing more than €500 million annually in health capital. With this, we are funding approximately 75% of all health spending in the economy. This is the OECD average. The American model is different with 60% coming from the private sector and 40% from public sources. These patterns of high public investment will continue in a coherent framework where both public and private providers will be challenged to deliver top quality health care of all types to all patients.

It makes sense to use the public and private systems together. While the private sector does not provide all the answers to our health care problems, it has a complementary role to play. Many private providers in Ireland, like the Bon Secours hospitals or St. Vincent's Hospital, are not-for-profit organisations. They provide the bulk of the private beds that currently exist in our private hospital facilities. Anyone who would suggest converting into public beds 1,000 of the 2,500 private beds that currently exist in public hospitals is privatising the health system. Why are all the nursing, management, clerical, catering and support staff paid for by the taxpayer? Why is 100% of the capital cost of providing those beds funded by the taxpayer? Only one group of employees, consultants, get paid for seeing those patients. Surely this does not make sense. Seeking to minimise this in public hospitals and convert those beds for public patients, and have private beds and nursing staff funded and managed privately makes eminent sense to increase capacity in the health care system. The co-location model is important. It will keep doctors on site instead of having to travel around a couple of different hospitals. This makes eminent sense for the public and private systems.

I commend the amended motion to the House. I forgot to say at the outset that I am sharing time with the Minister of State, Deputy Tim O'Malley, if it is in order.

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