Joe Costello (Dublin Central, Labour)

I welcome the Minister of State, Deputy Seán Power, to the House. I am glad to have an opportunity to speak on this legislation. The Health Bill 2006, which will establish the Health Information and Quality Authority and the office of the chief inspector of social services, will provide for a scheme of registration and inspection of residential services for older people, people with disabilities and children who need care and protection. It is hard to read this rather turgid 65-page Bill without thinking "so what". Why have all these provisions not already been made? Why are these offices not already in place? Why have we had to wait until the seventh year of the 21st century for someone to be appointed as the chief inspector of social services? We would have expected basic protections, such as the scheme of registration of residential services for older people, people with disabilities, people at risk and children in care, to have been put in place within the system long ago. The rights of these vulnerable people have never been properly protected by the State, despite the lip-service to "cherishing all of the children of the nation equally".

While the Bill before the House is welcome, it simply underlines the State's long-standing neglect of its duty to meet the basic entitlements of, and provide basic protections to, all its citizens. The legislation does not reach the heart of the matter — the malaise in our creaking and rudderless health service, which is drifting from crisis to crisis. We have to deal virtually every day with the nursing homes scandal and the ongoing accident and emergency crisis. The accident and emergency unit in Beaumont Hospital had to deal with record numbers this week. I am familiar with the waiting times in the Mater Hospital's accident and emergency department. No agreement can be reached on the location of the proposed national children's hospital. The entire system is rudderless and in a state of malaise. The lack of leadership at ground level is at the heart of this problem.

The insidious policy of creeping privatisation is espoused by the Progressive Democrats. The Minister for Health and Children, in particular, champions privatisation as a means of easing bottlenecks and streamlining the system. Fianna Fáil is tolerating this approach, obviously. The Labour Party has indicated that it will reverse this trend if it gets into office. The Minister, Deputy Harney, said during her first couple of weeks in office that she intended to conduct an audit of all the land owned by the Department of Health and Children. The Minister of State at the Department of Finance, Deputy Parlon, has been hawking land like a street trader buying and selling in the capital and putting prices up around the country in his decentralisation process. The Tánaiste and Minister for Justice, Equality and Law Reform, Deputy McDowell, has been likewise hawking as much public land as he can. He has even sold his own offices in St. Stephen's Green for €52 million or €53 million and has moved into private rented accommodation which will cost the State an arm and a leg for the foreseeable future.

The first action taken by the Minister for Health and Children was to seek an audit of all health authority lands. She wished to identify lands that were surplus to need, mar dhea. This was then transposed into a policy of co-location of hospitals where the private sector would be allowed buy the land and build private hospitals with tax exemptions and reliefs. The private sector would operate these hospitals which would enjoy full access to the facilities and equipment in the public hospitals on the co-located site.

As I understand, there will be a private 80 or 90-bed unit constructed on public lands at Beaumont Hospital and this private for-profit health enterprise will have access to all the facilities in the public hospital. This operation will be replicated all over the country through the Minister's policy of providing a two-tier health system on the spurious grounds of creating 1,000 extra private beds and taking the same number of private beds out of the public hospitals. There is no guarantee whatsoever that the private beds in public hospitals will go. I challenge the Minister to give the House such a guarantee in her response to this Second Stage debate. We could have the worst of both worlds, where private hospitals will continue because of the squatter principle held by the consultants. We are all familiar with the history of Beaumont Hospital which was kept closed for four years because the consultants insisted there was no way they would work in Beaumont Hospital unless they were given their private beds. They would not tolerate a system of being employed to work in the public sector. They insisted that Beaumont Hospital could not open unless they were given their private beds and so the hospital was closed for four years. I do not think the consultants who have the existing private beds will run away from that cash cow. I can see these new private hospitals co-located in public grounds will be operating to their own dispensation but with access to the public operating theatres and facilities in the adjacent hospital. The Minister must clarify to the House how she will ensure that the 1,000 private beds already in the public hospital system will be dispensed with and how such beds will revert to public use.

If more proof was needed of the creeping privatisation of the health system, I can easily point to significant indicators. One third of all cataract operations in the Royal Victoria Eye and Ear Hospital are now being conducted through the National Treatment Purchase Fund, even though there are 12 consultants working in that hospital who could easily perform this surgery. They are not performing surgery because of the insufficient number of beds for elective surgery in the hospital. A total of 4,000 children are waiting for eye consultations in the Rathdown clinic in my constituency. Two ophthalmologists would solve the problem but the HSE is prepared to leave the children waiting for more than two years without treatment rather than make these appointments. This issue has been brought to the attention of the HSE on a number of occasions by the medical staff in Temple Street Hospital. Children with eye problems on the waiting list are in limbo and will not be dealt with because two additional ophthalmologists will not be appointed to carry out the required work. It is the old system of keeping them waiting for the private sector to deal with the problem.

The new phenomenon is that casualty patients are now occupying elective beds and this is not a progressive phenomenon. An astonishing 20% of hospital work is now elective while 80% is casualty. There are not enough beds in the system but the Minister will not supply them to the public hospitals and this is the reason the Minister's ten point plan for accident and emergency departments has not worked. This is the reason there is no solution to the problem for the foreseeable future but we will eventually reap the whirlwind because there has to be a domino effect. The public system will deteriorate as it is increasingly starved of resources and morale will reach rock bottom. We will end up with a two-tier system. Even the Minister has acknowledged that more people are opting for private treatment. The public sector has been deliberately run down with the result that waiting lists and accident and emergency departments are driving patients out, as are the fears about MRSA. Both the morale in the system and its nuts and bolts must be taken into account.

The accident and emergency departments of hospitals are in a deplorable condition. The HSE figures are inaccurate regarding the daily number of patients waiting in the accident and emergency units for treatment beds as the figures refer only to patients who have been seen by a doctor and are to be admitted. These figures do not reflect the numbers of people who are waiting many hours to be seen and who are discharged without admission.

Last Saturday week I visited the accident and emergency department in the Mater Hospital. It was crowded. I spoke to one elderly man from Glasnevin who had fallen down the stairs in his home the previous Saturday. He had damaged his back and fractured his arm. He sat uncomfortably in a chair in which he had been for a full week. He had a week's stubble on his face and his arm in a sling. He had not had a shower in that week. He did not know if or when he would get a bed or a trolley or whether he would eventually be sent home after a week in a chair. This is not right and it can never be right. It is an undermining of human dignity. It has nothing to do with medicine but everything to do with dignity and how we treat our people who are ill or elderly.

The Minister and her predecessors have signally failed to provide a service which respects human dignity and which is efficient. More beds, better management and state-of-the-art casualty departments are essential to smooth the interface between the patient and the hospital service. This is not the ultimate goal of a world class health service——

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