Brian Cowen (Laois-Offaly, Fianna Fail)

We have set up the Health Information and Quality Authority, HIQA, to ensure developments, whether under a tax-based scheme or otherwise, meet regulatory standards. The authority fills a gap in the monitoring process which had led to certain well known cases in which the standard of care was not what we would have expected. The response of the Minister for Health and Children was to set up the HIQA on a statutory basis. The HSE has an inspection regime and monitors standards as a matter of great importance.

The hygiene audit system in hospitals is another example of where we need to get the basics right. Many of the new-build developments were approved under the health board system and by the HSE which certified them as adequate and continued to check that standards were maintained.

The review of tax reliefs was comprehensive and my responsibility was to ensure value for money. The public system has produced 7,500 beds in the nursing home care sector alone as a result of the tax breaks introduced by my predecessor. If we had depended exclusively on public sector procurement for those beds, we would not have met the demand as quickly as by engaging the private sector.

The health reform policy has been rhetorically referred to as a process of privatisation but it is nothing of the sort. It uses private sector disciplines and expertise to complement the provision of public health care. We have traditionally relied on a mixed system of private and public health care to make sure the best possible consultant staff are attracted to the public health system. The contractual review in which we are trying to engage and which is now starting to make some headway is fundamental to changing the skills mix within the health sector in order that we will have far more consultant staff and a consultant-provided service rather than a consultant-led service, as is the case at present where the number of junior hospital doctors far exceeds what would be appropriate in a consultant-provided service.

Public private partnerships and private sector involvement are fundamental to the speedy and effective delivery of improved services through the capital investment programmes envisaged under the national development plan. That investment will be accelerated and encompass exclusively public sector provision, as well as private sector involvement, not only in private hospitals but in universally available facilities, in a way which provides value for money for the taxpayer.

The subject of the review for which the Deputy calls is within the remit of the HSE which has already taken initiatives in that regard. It is a matter for the Department of Health and Children to decide how it plays its departmental role but it is not within my remit to become a proxy Minister for Health and Children. My job is to ensure schemes requiring tax expenditure are continually monitored, not just by means of a three-year review but as a matter of budgetary policy. I will monitor their implementation throughout the year, as well as in the Estimates campaigns, to ensure they secure their objectives.

Among the reviews I will undertake will be an exercise to judge whether we secure a return on the investment to justify a scheme's existence. The Indecon draft report which I will make available on the website in due course confirms that continued tax-based investment is justified. We must ensure there is private sector involvement in developing a spectrum of care facilities, not simply residential or home-based facilities, and much investment in community-based services. Other care models are provided for in the Bill to meet an identifiable need and are justified on the basis of Indecon's findings.

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