Brendan Smith (Cavan-Monaghan, Fianna Fail)

I join the Minister, Deputy Harney, in congratulating the newly elected Members of the House who are present this evening. I welcome back the Members who served in the 29th Dáil and wish them well during the life of the 30th Dáil.

As the Minister stated, the provision of private health care is a long-established feature of health care provision in Ireland. It involves a wide range of health practitioners and health care facilities, including general practitioners, dentists, pharmacists, chiropodists, private nursing homes and private hospitals. It has historically complemented the public health care system. This Government is committed to exploring fully the scope for the private sector to provide additional capacity in the health system. The key objective is to provide the required extra capacity, be it by the public or private sector.

A number of Government policies and initiatives support the co-existence of public and private health care. These include the designation of private and semi-private beds in public hospitals; income tax relief on private health insurance premia; income tax relief on medical and dental expenses; the work of the National Treatment Purchase Fund; and capital allowances for investment in the development of facilities such as private hospitals and nursing homes.

As the Minister stated, there are more than 13,000 beds in the 53 public hospitals. Some 2,500 of those beds, or approximately 20%, are designated for use by the private patients of consultants. However, the level of private elective admissions, that is, planned rather than emergency admissions, to public hospitals is currently running at approximately 35% of the total. This impacts consistently on the ability of public patients to gain access to public hospitals.

It is Government policy, as stated in the programme for Government, to implement the plans for the co-location of private hospitals on the sites of public hospitals, thereby freeing up beds for public patients. The co-location initiative was founded on the principle that all patients ordinarily resident in the State should continue to have access to public hospitals. However, access should be based on medical need only and possession of private health insurance should not influence how quickly one gains admittance to public hospitals or the treatment one receives when one is in a public hospital.

The development of private hospitals on the campuses of public hospitals is all about improving access for public patients to beds in public hospitals that are currently used by private patients. The idea is to migrate private patients from public hospitals to co-located private hospitals and thereby free up capacity for public patients and ease pressures on public waiting lists and accident and emergency departments. The private patients of consultants on the co-located sites will transfer to the new co-located private hospitals. Co-location-type arrangements have existed for many years at both the Mater Hospital and St. Vincent's Hospital in Dublin. The arrangement appears to have operated satisfactorily from the perspective of both public and private patients.

Co-location is the quickest and least expensive means of improving access for public patients. No capital outlay is required as the beds are already in place. In addition, the beds are already staffed and the backup services and facilities required to support them are in place. There will be a loss of income to the hospitals from private health insurers. This is a small price to pay in order to provide 1,000 beds for public patients. This loss of income will be mitigated, in part, through income the hospital will obtain from leasing the land to the private co-located hospital.

The co-located hospital will be capable of treating all of the private patients that are currently in the public hospital. The private co-located hospital will take patients from the public hospital's accident and emergency unit who require to be admitted and who have opted to be private patients of the consultant. The private co-located hospital will accept direct admissions to wards or to medical or surgical admission units from primary care centres and general practitioners 24 hours per day. The private co-located hospital will assist in improving access to research, development and teaching. It will be a separate legal entity and will assume all legal and operational risk.

The new competitive dialogue procedure, which became effective in February 2006, was the procurement process used for the project. On 23 May 2006, the HSE published a notice in the Official Journal of the European Union inviting expressions of interest for the development of co-located private hospitals, the provision of associated hospital facilities and the provision of certain medical services on 11 public hospital sites in Ireland.

Following an assessment of the expressions of interest, the HSE pre-qualified a number of bidders in respect of ten sites. Our Lady of Lourdes Hospital, Drogheda, was removed from the process due to the review of hospital configuration in the north east.

During the next stage of the process, the HSE engaged in competitive dialogue with the short-listed bidders with a view to identifying the hospital's core requirements, a service delivery model for each individual site. A number of bidders withdrew from the process for a number of sites for commercial reasons. This resulted in no bidders remaining for Letterkenny General Hospital and University College Hospital, Galway.

Based on the assessment carried out by the HSE, a set of minimum requirements was developed for each site. Such requirements prescribed a minimum threshold to be achieved in respect of the minimum service delivery model to be provided by the co-located hospital on each of the sites.

Between May and June 2006, the HSE issued pre-qualification questionnaires to all parties that expressed an interest in tendering. The HSE received responses from interested parties and undertook an evaluation of those responses.

In September 2006 the HSE issued an invitation to the successful candidates to participate in dialogue following the pre-qualification process. The invitation to participate in dialogue constituted a formal invitation to bidders to enter into a dialogue process with the HSE on the project. The pre-qualified tenderers submitted outline proposals to the HSE which it evaluated.

Subsequently, an invitation to continue in dialogue was issued to short-listed bidders, who were selected under the evaluation criteria set out in the invitation to participate in dialogue to be invited to continue in dialogue with the HSE. This document also set out details on the requirements for each hospital at each site and the criteria that would be used to evaluate tenders.

Invitations to tender for St. James's Hospital, Beaumont Hospital and Cork, Limerick, Waterford and Sligo hospitals issued on 19 April 2007. The invitation to tender for Connolly Hospital, Blanchardstown, issued on 11 June 2007. The board of Tallaght Hospital agreed on 22 June to continue its participation in the initiative.

The bids for the six sites were returned on 17 May 2007. Each bid was scrutinised by the HSE compliance team to check whether it conformed to the invitation to tender and whether it met the minimum requirements. All bids that satisfied the assessments for conformity with the requirements of the invitation to tender and met the minimum requirements were evaluated by the project evaluation group by applying the award criteria set out in the invitation to tender which was originally formulated on the basis of the policy direction issued by the Minister on 14 July 2005. These criteria covered value for money, financial sustainability, governance framework, service delivery, protecting the public interest, quality and innovation

The HSE will appoint the successful bidders in respect of St. James's Hospital, Beaumont Hospital and Cork, Limerick, Waterford and Sligo hospitals at the beginning of July.

Public procurement process requires that there is a standstill period of two weeks following notifications to successful and unsuccessful bidders before agreements can be signed. Successful bidders will have to apply for planning approval and undertake detailed design work. The entire process has been subject to the review and approval of an independent process auditor separately appointed by the chief executive officer of the HSE.

Establishing value for money in respect of this project has been a key objective of the HSE throughout the process. This was achieved by ensuring the bids received were able to satisfy value for money assessment criteria and also ensuring the financial offers received were better than the market value of the land to be leased to the successful bidders. The Government is committed to improving access for public patients to hospital care. It is not about who provides the service, whether public or private providers, but rather the range of services provided and their capacity to meet the needs of the population, their quality, the safety of the patient and the efficiency of the services provided.

Private patients of consultants have priority access to public hospitals at the expense of public patients. As the Minister outlined, she intends to give early effect to commitments in the programme for Government to ensure greater equality in access and care between public and private patients. The interests of public patients will be protected and promoted through the co-location initiative.

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