Liam Twomey (Wexford, Fine Gael)

The Minister of State should answer the questions I ask him if he is so intelligent and sure of his brief. The initiative on private hospitals will result in the transfer of €2 billion of capital and current assets from the public sector to the private sector. Where is the cost-benefit analysis carried out by the Department on this initiative and why has it not been made available to Members? The Department of Finance will not sanction a project in the Department of Health and Children which costs more than €30 million without first receiving a cost-benefit analysis. The extensions to Our Lady of Lourdes Hospital and Mullingar General Hospital did not proceed this year, despite budgetary allocations having been made for this purpose, because cost-benefit analyses were not submitted to the Department of Finance. The Minister tried to make hay about the private provision of dialysis services to the population of the south east. The plan to provide Beaumont Hospital with a dialysis unit will not proceed because the Health Service Executive did not submit a cost-benefit analysis to the Department of Finance.

The Minister of State informed me that the HSE is not a political organisation. Political interference in the HSE is widespread but there is no political responsibility. The Department is not being held to account for a decision to move €2 billion in taxpayers' money out of the public system. For example, no policy paper or cost-benefit analysis was produced on this initiative. I believe this crazy proposal was written on the back of beer mat when the Minister was out at night with her friends. If the Minister of State does not agree it is daft, he should prove the contrary. As Deputies ask week after week, let us see the proof.

Professor Drumm, as the Accounting Officer of the Health Service Executive, should be sacked this time next year if he does not produce a cost-benefit analysis on this proposal. Similarly, Mr. Michael Scanlan, the Secretary General and Accounting Officer of the Department of Health and Children, should be sacked if he does not provide a cost-benefit analysis of the proposal. The Minister is good at sacking Secretaries General but the general public should sack the Government. The Progressive Democrat Party talks a great deal about how it looks after taxpayers' money. It is the height of incompetence that the Minister has nothing to show how €2 billion will be spent.

It is possible that this initiative is no more than a pre-election charade by the Health Service Executive and Departments of Health and Children and Finance. Perhaps Professor Drumm knows in his heart that the proposal is rubbish and he is stringing out the issue until the general election in the knowledge that the Progressive Democrats will no longer be in power when a new Government is formed. Patients are being misled that a great initiative will proceed. How many loops must be jumped through in terms of qualifying even for pre-qualification? Certainly, there are enough loops to stretch out the proposal for five or six months. Patients and investors must ask themselves some hard questions because they may be being led down the garden path. Who is pulling the wool over their eyes?

Besides the taxation and financial implications of this daft approach, what are its implications for patients, those who will be most affected by this crazy, beer mat policy produced by a PD-led Government in which the Fianna Fáil Party has fallen asleep? As a result of it, consultants will spend their days in private hospitals looking after private patients. We already experience a problem of a small number of consultants who neglect their public patients and give their time to private patients. Given that private hospitals do not have the same number of doctors and nurses on duty as public hospitals, consultants will be compelled to stay in private hospitals during the day to look after their patients. As a result, less experienced doctors will be left to look after patients in public hospitals during the day.

What will happen at night? As the Minister of State will be aware, the standard of doctors on duty in private hospitals at night varies considerably. As private hospitals are not compelled to have doctors in training on duty, one cannot be sure of the quality of doctors working in them. While some of them are excellent, others are a little suspect. Fortunately, however, this is not a major problem because unlike public hospitals most private hospitals do not engage in intensive surgery. However, once an additional 1,000 private beds come on stream, more surgery will be performed in private hospitals without standards being in place.

The Government has not introduced standards for inspecting nursing homes and only minimum standards are in place for inspecting doctors. In addition, it failed to introduce a composite insurance scheme, despite a recommendation in the report of the inquiry into various matters in Our Lady of Lourdes Hospital that the Government get its finger out. This crazy policy puts patients at risk, even if the Government is not aware of it.

What will happen to the premiums of private patients? In the past decade, throughout which the current coalition has been in power, premiums have doubled for VHI and BUPA policy holders. Thanks to the Progressive Democrats, the Government proposes to introduce a free-for-all in which the insurance companies can make as much money as they like. I hate to think what will happen to VHI and BUPA premiums in the next five years if the Progressive Democrats return to power and continue to force through this crazy policy. It is possible, however, that this may be a ruse to fool people into believing that action is being taken. If that is the case, the Minister is playing politics with people.

On another matter about which the Minister is unable to answer questions, what is the current status of the consultants' contract? This time last year, the Minister stated she would introduce public-only contracts for consultants. What happened to that commitment? Did the Progressive Democrats fall asleep? The proposal has fallen by the wayside. The Minister's current policy is a waste of time and money because it could not work if public only contracts were in place.

As a supporter of private medicine, I believe the Minister's policy on private medicine is daft and makes no sense. It is time she got her finger out and produced background information on this initiative with a view to persuading the Opposition it has substance.

With regard to community care beds, I acknowledge that while they cannot do everything, the majority of those involved in the private nursing home sector are doing a great job. The Minister received a set of standards for private nursing homes from a Government body in November 2005 but did not publish them. As a result, the private nursing home representative bodies had to publish their own standards in June this year. We are still waiting for the Minister to publish the standards she has chosen to sit on.

The Minister of State should not talk about protecting elderly patients. The Minister of State has done the least to protect elderly patients during the term of this Government. He has been a shocking disgrace. He promised much but delivered nothing.

Eligibility and provision on entitlement have moved nowhere since the publication of the health strategy in 2001. I understand why elderly patients prefer to remain at home. With this Government in office, I would not wish to send anybody into a nursing home. The Government has no respect for these patients and will not protect them. The Health and Social Care Professionals Bill has been postponed until 2007. The social services inspectorate will not be a statutory agency until the legislation is passed but that will not happen until the next Government takes office. It will not happen under this Government.

The legislation the Minister is trying to sneak in under the radar will take their homes from elderly people. However, Age Action Ireland has sent a letter to every Fianna Fáil Deputy to alert them to what the Minister is doing. I wonder what they will do when the legislation is voted on in two weeks. The Minister is taking away their homes and there is nothing else to it. The Leas Cross report, which the Minister refuses to publish, shows that the Government and the HSE are a disgrace. They have neglected patient care in an unbelievable manner. That is why they are hiding behind lawyers and claiming the report cannot be published because of the people who are named in it. The only people named in it as a disgrace, and I have read it, are the Government and the HSE.

There is also the report on P. J. Walsh, the elderly man who was allowed to bleed to death. I asked the Minister, Deputy Harney, priority questions about it but the answer was so comprehensive that I have had to submit six further parliamentary questions to get answers. If I get an answer from the Minister, Deputy Harney, to a question, I will be bowled over. I never get answers, only waffle. After the two speeches this evening, I am sure I will be able to put down another 20 parliamentary questions.

The Minister cannot claim that the home care packages look after patients. There are no occupational therapists, community physiotherapists or speech therapists for patients in the community who have suffered strokes. The home care package gives the idea that patients are being looked after. Elderly patients are being sent home from hospital with PEG tubes, where a tube is inserted into the person's stomach and they are fed with a bottle through that tube. One must be careful that one does not put in too much, that one does not put the substance in too fast or that one does not make the patient sick.

Elderly men and women in their 70s and 80s are being asked to look after spouses on PEG feeding. They are not qualified nurses and they were not qualified 20 years ago. However, the HSE says that if they get a nurse, it will give them the home care package. It is stretching the imagination to consider this a progressive policy. It is dangerous and patients' lives are being put at serious risk. The Minister is paying no attention to what is happening. She is simply full of waffle and daft proposals. The home care packages will work for a certain number of people but they are not the ultimate solution the Minister thinks. She is putting patients at serious risk.

With regard to the 800 additional nursing home beds the Minister is currently contracting as part of the winter initiative, I believe she is looking for the beds in Westmeath and, perhaps, in east Galway. There are no nursing home beds available anywhere else. Where the Minister is sourcing the 800 beds will be the subject of another parliamentary question. I heard on the grapevine that she is seeking these beds in Westmeath, which will be great for a family from Fingal, Ballymun or Darndale. The family will have to visit their elderly relative in a nursing home 30 miles beyond Athlone on the Galway road. I am sure plenty of people will be willing to take those beds.

The Minister has allowed this bad situation to build up and is now trying to deal with it through the winter initiative as a pre-election problem. The Minister has neglected to deal with the problem in the last couple of years and has made a right mess of the health service. In the amendment, the Minister commends the Government on the measures it is promoting to improve access for public patients to acute hospital care. Three to five years waiting for an orthopaedic appointment is not improving access to acute hospital services. It is a two to three year wait for ENT services.

Procedures to test for cancer and heart disease are not being carried out. They are regularly cancelled because the Minister has made a mess of the acute hospital service. She claims to be doing something about the trolley crisis but she is disregarding other patients. It is the most cynical attempt I have seen by a Government to try to win an election. It is cynical and sickening. We support the motion because we wish to speak the truth about what is happening.

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