Pat Rabbitte (Dublin South West, Labour)

It is intended as such.

The Minister of State does not believe a word of what he just said. He must recognise that Deputy McManus has identified an attempt to engineer a major shift in our health care system towards a for profit model. That is the net issue. The Minister for Health and Children, frustrated at her failures, is attempting to shift the balance of the existing system towards a for-profit model and the Minister of State is well aware that this will be expensive, inefficient and unfair, and will not be in the interests of either taxpayers or patients. That is the scale of the issue with which we are faced. The Minister of State is aware of the public-private mix in our system and knows the history behind the existence of such a mix. He is also aware that the motion is not complaining about the traditional public-private mix, rather it is complaining about the fundamental attempted shift in the provision of health care.

What is happening will undoubtedly exacerbate the problems relating to the two-tier health service that is in place. There is little point in the Minister of State pretending to misunderstand the motion. There is also little point in him pretending that he has not heard, on the doorsteps in his constituency, people's tales of woe, not only regarding their overall concern regarding the crisis in accident and emergency services, trolley queues etc., but also in respect of the fundamental unfairness of offers being made to constituents, taxpayers or citizens with access to the private system to have their treatment fast-tracked while those in the public system must wait indefinitely. In supporting the Minister for Health and Children, the Minister of State will exacerbate that two-tier system and I suspect that he knows that is the case.

The Minister received a fair wind from this side of the House. The scale of distress about the quality of our health service administration meant that people hoped she would be successful in addressing some of the bottlenecks, dealing with the crisis in accident and emergency departments and, in particular, dealing with the problem of queues of people on trolleys. She has failed and she is now striking out in an ideological way to sell off scarce public land for the construction of private hospitals. Entrepreneurs — some of them in the medical profession — will get a massive tax break for building private facilities on scarce public land, the effect of which will be to exacerbate the two-tier health service that currently exists.

Her frustration is understandable. She featured in my local newspaper this week, boasting about the success in tackling the accident and emergency issue in Tallaght Hospital. What actually happened was that the local management of the hospital made provision for 40 extra beds to treat accident and emergency cases in the teeth of opposition from the Department and the Minister. The Minister is now claiming this as one of the jewels in her sparse crown of achievement. I suspect that the Minister of State knows that this quick fix solution will not work. It is the wrong solution. It is not feasible to implement and it will exacerbate the two-tier health service. It will be costly for the taxpayer and will contribute to the running down of the public health service. In any event, it will not work because under the legislation that exists in this country, every citizen is entitled to a hospital bed. Private patients will continue to come through the accident and emergency system into public beds. The consultants will not evacuate them as their contract entitles them to practice in public hospitals.

The Minister of State said that 45% of elective operations in Tallaght Hospital were private. That is higher than I thought, but is not surprising when one thinks about it as the consultants are incentivised to do precisely that. The Government is now set to incentivise them even more. Does the Minister of State think that consultants will evacuate public beds in order to transfer the patients across the corridor to the new shiny hospital? It will not happen. What will happen will be that staff will migrate to the private service and the public health service will be required to pick up the slack. The private sector will cherry pick the straightforward procedures and the complex medical procedures and older people with multiple problems will be left to the public health service. We have scarce public land and we need that land for the construction of step-down care and community care, which is part of the solution to the accident and emergency problem. We badly need the provision of more beds in acute hospitals. The money should be going on these projects and not on incentivising the private sector with massive tax breaks.

I cannot but be impressed with the consultants that I meet around the country. However, the common contract negotiations are dragging on interminably and unconscionably long. The existing contract looks like they wrote it themselves and maybe they did. It must be addressed. There is no sign that this Minister has the skill or the patience to do it. Her predecessor did not even try. The general question of fees in the medical profession is another problem. This morning, the Taoiseach admitted that the promise of providing 200,000 medical cards had been broken. The Government created the doctor-only medical card, but only 12,000 have been taken up. It has not been made known to people that they exist. Meanwhile, people go along to their GP and pay ever-increasing prices. The cost of seeing a GP has risen by 97% since 1997. Some GPs have mainly a medical card client base, but others have the opposite. Some GPs treat people for nothing while others do the opposite. We all know of parents who are afraid to visit the GP because they cannot afford another fee. Until some order is imposed, there is no reason not to resort to a maximum prices order, like for many other professional fees.

Instead of addressing any of these issues that go to the heart of why we have ongoing problems in the health service, the Government is determined to exacerbate the two-tier health service, to dispose of valuable, scarce public land to the private sector, and to engage in the sophistry that we will continue to own the hospitals. We will do nothing of the kind. If the private owners decide to go to the Middle East and advertise for patients at an economic rent, there is nothing the Government can do about it. If they decide to turn the hospital into a supermarket, there is nothing the Government can do about it. Once a scarce public asset is disposed, then that is it. Further division will be created, staff will be induced to enter the private sector and the public sector will be left with the difficult areas. That is why this debate is critical. The people have not yet woken up to the fact that the Minister for Health and Children is trying to engineer a fundamental shift in our health care system to for-profit health care provision. That is not in the interests of our people.

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