Brian Hayes (Dublin South West, Fine Gael)

I pay tribute to Fine Gael's former health spokesman, Dr. Liam Twomey, who unfortunately lost his seat in the recent election. More than anyone else, Dr. Twomey was responsible for the very clear positions our party took up in the course of the recent campaign. He was a forceful parliamentarian whose presence will be missed in the House. I recognise the contribution he made as our party's spokesman over the past two and a half years.

Tonight and tomorrow night Fine Gael is asking Dáil Éireann to stop the most controversial plan to affect Irish health care in a generation. Handing over public land to private, for-profit hospitals does not have the support of the people and will serve to further entrench the two-tier health system which currently prevails. After ten years in office, the only big idea advocated by Fianna Fáil and the Progressive Democrats — now supported by their allies in the Green Party — is to hive off public landbanks at knock-down rates to private developers at considerable cost to taxpayers in taxes foregone. It is not a plan for patients but one which introduces unnecessary competition onto the grounds of our public hospitals.

This is not an experiment which can be altered. When the plan is up and running there will be no going back. It came not from the wishes of the people but from the wishes of Government without any consultation. There was no Green Paper, detailed cost-benefit analysis, Dáil scrutiny or accountability. The decision was foisted on public hospitals and the HSE because the Government decided it would look at only one option to provide additional bed capacity in the system. The effect of the policy in the years ahead is plainly foreseeable. Public and private hospitals on the same sites will be pitted against each other in direct competition. While some facilities will be shared in the interests of patients, they are not the ones who will gain most from the experiment. Under the new system, two hospitals will co-exist on each site with two types of patient, one public, one private. Competition between patients for limited intensive care beds will apply. Key medical personnel will be lured from public hospitals to private hospitals. New co-located private hospitals will pick and choose the procedures they offer. The new model represents a nightmare scenario for our health care system and it should be resisted by all right-thinking Members.

Last Saturday, the board of Tallaght Hospital in my constituency of Dublin South-West decided, as was inevitable, to proceed with a co-location plan. The decision followed many months of bullying and threatening behaviour by the HSE which warned that Tallaght Hospital would have to pay for some of the costs associated with the project if a positive decision was not reached. Faced with the real needs of patients for increased provision of beds on any terms, the hospital bowed to the inevitable. Like those of other hospitals, the board of Tallaght Hospital had no choice.

Just as there was no mandate for the radical shift in policy after the 2002 general election, no mandate for the co-location policy was produced in the most recent general election. Fianna Fáil and the Progressive Democrats lost nine seats. The PDs lost 75% of its Dáil seats and the Minister's vote in her constituency of Dublin Mid-West fell by 7%.

On what basis does the Minister believe she has a mandate to continue with this policy? At least 84 members of this House had clear unequivocal positions against co-location during and prior to the recent election campaign. Fianna Fáil did its usual thing by stating one thing nationally and bad-mouthing the Minister for Health and Children, Deputy Mary Harney, locally over the policy. However, I did hear the Minister put on record, in a recent radio interview, that this policy was and is Fianna Fáil policy despite the distancing of some members.

We are less sure about the position of the Green Party, which wrestled with its conscience on co-location and decided a review would be the price-tag for its participation in a Government where it was surplus to requirements. Even this major concession of review won by the Greens does not kick in until 2011, long after the damage will have been done. It is difficult to review a decision to enter into a 60 or 70 year lease. We need to know in the context of this debate how many co-located hospitals are to be built. The PDs states it is 11 hospitals while the Green Party states it is seven or eight after which its much heralded review will apply. Will the Minister be clear in her reply as to what exactly is Government policy on the number of sites to be advanced for co-location?

Two weeks ago, in this House, the Minister for Health and Children suggested my party and its leader had indicated a willingness to support her co-location plans in discussions she had with Deputy Kenny prior to the formation of the Government. I want to put on the record of the House that there is no basis for this suggestion, if it was made. Fine Gael never expressed support for the proposal to sell public land for private hospitals as the Minister proposed. What we were prepared to do was examine how improved public services, including beds, could be provided using the private sector to build new facilities.

Tonight, I want the Minister to put on record her view on whether Professor Drumm fully supports the Government's plans on co-location. His comments at a recent health summit, as reported in The Irish Times, highlight a clear difference between the stated position of the Government and that of the HSE. He stated on that occasion, "The co-location project, in terms of running the health services in Ireland, is not a significant issue for me". The CEO of our health service stated it is not a significant issue for him. He further stated:

My job is to run the public health service...We were asked to facilitate Government in terms of handing over sites and making sure that we got proper economic payment for them, but once that's facilitated then it really has nothing to do with us going forward.

This seems an extraordinary statement given the importance of the policy and its implication for the health service. Professor Drumm is not an irrelevant backbencher. He is the person responsible for co-ordinating the reform programme and moving ahead on many key issues in our health service. Did the Minister ever ask Professor Drumm to submit his views in writing or for his formal position on the issue of co-location? If so, I want her to publish it without further delay. A cloud is hanging over whether Professor Drumm and his colleagues in the HSE support this radical policy announced by the Minister and her colleagues.

Many Deputies asked the Minister to publish a cost benefit analysis on all aspects of this proposal. If this work has been completed, why did she decide not to publish the analysis in full? During the recent election campaign we saw the sorry spectacle of three senior Ministers, including the Minister for Finance, show an alarming lack of knowledge regarding the financial cost of co-location. Eventually rescued by a party official, they looked like the three stooges, seemingly unaware of the real cost and the likely financial implications. Before any contract is signed I want the Minister to tell the House the full lifetime cost for each co-location proposal.

Will the Minister guarantee to the House that all details of co-location including public private contracts will be open to public scrutiny? There must be no secret deals on public land and no secret deals with taxpayers' money. I do not want to hear that certain deals cannot be published on the grounds of being "commercially sensitive". This is not a matter for the HSE but for the Dáil and, ultimately, for the Government. These are public lands which are being offered as part of a tax wheeze. The public has a right to know what is going on and the terms of each of the contracts. Will the Minister guarantee to the House that she will publish the names of the beneficial owners of any successful consortium? I want that commitment in the House this evening.

Patient safety groups have legitimately raised concerns over the ownership and control of the newly proposed co-location private hospitals. The question must be asked how well prepared we are to police against fraud and what new measures are to be introduced to counter the threat of fraud in this sector. While HIQA can investigate complaints, what does it take to start an investigation?

Will the Minister tell the House exactly what land bank will be left after co-location on each of the sites and the proportion this represents on each site? It is crucial that a significant amount of land is set aside for the expansion of additional public facilities on the grounds of these hospitals. One wonders how we can ever build the necessary number of respite beds when such an amount of land is being handed over for private hospitals. Will the Minister guarantee in each case that the full commercial value of the land being leased is assessed by independent valuers?

Does the Minister intend publishing a new legislative basis for this arrangement? Is she proposing any form of registration or licensing system for the operation and governance of these new hospitals? Will a scoring system apply in each of the bids so that we can know exactly how these bids were won? The Minister should set out how the HSE proposes to assess the capacity of each consortium to provide quality medical care to patients and how they propose monitoring their capacity to do that on an ongoing basis.

We know from the debacle over Eircom some of the unforeseen consequences of privatisation. For example, will a successful consortium be entitled to sell the co-located hospital to a third party whenever it wishes? There is also the question of insurance. Will any insurance liabilities accrue to the State from the operation of these hospitals? Specifically, who will be responsible for the medical insurance of doctors operating within this hospital system?

It appears likely that some hospital consultants, working in public hospitals, will be investors or will have some financial interest in the proposed co-located private hospitals. Does this not lead to a risk of a serious conflict of interest? How does the Minister propose to deal with such a potential conflict of interest? Furthermore, what protocols does she propose to put in place to ensure that complex, difficult and expensive cases which arise in the co-located private hospital will not be transferred to the public hospital? What does she intend to do in respect of long-stay patients where a serious medical difficulty arises following treatment in a private hospital? Can the Minister make clear what level of regulation of patient safety there will be in the new co-located private hospital?

Throughout this process, the Taoiseach and the Minister have frequently stated that the co-location option is the best and quickest way to deliver more hospital beds. Both say it is much faster than the public sector. They seem to forget they have been in Government for the past ten years and we still do not have the much heralded 3,000 acute beds promised as far back as 2001.

Let us put this issue of the failure to deliver quality public services directly at the door of the Government, which has been in office for ten years. Since it has failed to deliver the necessary hospital beds, it has selected a quick fix solution which has potentially devastating long-term consequences for public health. There is no evidence, nationally or internationally, to support the contention that investor-owned private hospitals are more efficient than public hospitals. It is the continuing failure of the Government to deliver a proper system which requires a majority of our citizens to take out private health insurance. The same people, who have seen the cost of their health insurance double during the past ten years, will be asked to pay up for this untested model of care.

The motion tabled by my party represents a real litmus test for the Government. I appeal to those Members who said unequivocally before the general election that they opposed this measure to take a stand tonight and tomorrow and vote against the Government on this issue because once we go down this route there will be no turning back.

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