Olivia Mitchell (Dublin South, Fine Gael)

There is no doubt that the Minister of State can talk the good talk with regard to health issues. If talking were all that was required, we would probably have the best service in the world, with more consultants, more beds, more doctors in training, and public-only contracts for doctors and consultants. Owing to that good talk, we all bought into this agenda, which we have now supported for ten years. The problem is that we never got anything promised regarding the health service, and that is why this motion has been tabled.

On the other hand, we are getting things not promised to us, which have emerged like rabbits pulled from a hat, for instance, the use of land adjacent to public hospitals for private hospitals. Where did that originate? Why, if the Minister for Health and Children is as serious as she says about doing away with public private contracts and moving to public-only ones, do we need private hospitals beside the public ones? A consultant's working life is roughly 15 to 20 years. By the time the hospitals have been built, all those consultants will have retired, and we will have only public consultants in them.

Surely the best use of that land would be for community beds, which do not exist in Dublin. That way, people in acute hospitals, when they are ready to leave, could receive relevant therapies, medical care, rehabilitation and opportunities to convalesce before returning home. That facility simply does not exist in Dublin, and it would certainly relieve pressure on the expensive acute beds from which the Minister is so anxious to move people, not to mention delivering better care to patients.

If private beds are taken out of public hospitals, as the Minister is promising, all she will achieve is a two-tier system. Perhaps this is what the Minister wants but it is not in anybody's interest to do this, be they private or public patients. Insurance costs for private patients will go through the roof, whether VHI, Vivas or anybody else provides it. Money will be taken from public hospitals and such action will ultimately result in lower standards in public hospitals. There will be one service for private patients and a lesser service for public patients. This is the only result from that type of two-tier system. I believe in and support private hospitals, but only when services are being provided to both public patients paid for by the State and private patients through health insurance. If we create a two-tier system we will live to regret it, and I ask the Minister to go back to the drawing board on that matter.

In the short time available, I want to raise another matter against the backdrop of the Minister's promise to provide additional beds within the system. There is a gross and widely-accepted shortage of beds throughout the system. I refer to the plan to close the paediatric beds in Tallaght Hospital and concentrate a tertiary service in the Mater Hospital. I support the development of a tertiary paediatric hospital but I do not support the removal of beds from Tallaght, where expertise and experience has been built up over many years. There is also a very large catchment area of children.

Last year, some 65,000 children passed through accident and emergency departments in Tallaght and Crumlin, which is also to close. The vast majority of these were not acute cases from around the country requiring tertiary services for very complex illnesses. They were children local to the Minister's constituency, from my constituency and the burgeoning adjoining constituencies in Kildare, Wicklow and in south and west Dublin. These children had normal childhood illnesses or injuries from accidents.

If the Mater plan goes ahead these children will have nowhere to go, despite the Minister's claims they will go to a quality hospital. There are issues surrounding access and it is hard to see anywhere more difficult to physically access than the Mater site. My problem is with the medical access. Where will these children end up? The Mater Hospital is smaller than the hospitals being closed, so there will be fewer beds. However, it will have to deal with the really complex medical cases from around the country.

Inevitably, a tertiary hospital must deal with the more acute and complex cases first, which is correct. This leaves local children competing at the bottom of the queue for beds and facilities. I ask the Minister to rethink the matter as it is folly against the background of a burgeoning population. In other cases we have seen hospitals closing because we do not have the population to sustain them or the critical mass, but it is certainly there in Dublin.

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