Liz McManus (Wicklow, Labour)

It is usual to congratulate a new Minister for Health and Children at the start of a Dáil, and I am more than happy to wish Deputy Harney well on her return to what is clearly a demanding post. However, I also wish that she would take some time to reflect. As a Deputy who saw her party decimated, she will understand that it has suffered most cruelly at the hands of the voters. Is it too much to ask that she learn some lessons from that experience?

One of the most contentious issues of the last election was the privatisation of the health service. That was spearheaded by the Progressive Democrats and adopted by Fianna Fáil; now it has been embraced by the Greens. However, as this motion outlines, that policy did not win majority public support in the election. The co-location of private hospitals on public lands is the most pernicious and extreme example of the Minister's determination to hand over significant elements of the Irish health service to the private sector.

The Minister has promoted herself — and members of her party promote her — as courageous enough to take on vested interests in health care. However, the curious thing about that claim is that her definition of vested interest extends only to doctors and health care workers. Far from being taken on, the predatory interests of the for-profit developers have been feather-bedded by the Minister to an extraordinary degree.

To be strictly accurate, that trend began before the Minister's appointment, but it was during her period of Cabinet influence. When a constituent approached the then Minister for Finance, former Deputy McCreevy, and asked for a handout, he received it in the form of tax relief on a private health facility. More handouts to the private sector followed the extension granted via the Finance Act 2002.

However, it was Deputy Harney who issued an instruction to the HSE in 2005 to facilitate the handover of scarce public lands to private, for-profit developers who would benefit from generous tax breaks. No analysis was ever carried out, no debate initiated, and no cost or health impact assessment conducted. That decision was ideological, but I once again note the Minister of State presenting it as a cheaper and quicker way to provide the desperately needed beds that the Government promised in its health strategy but never delivered.

The truth is that co-location is not cheaper and not necessarily quicker than providing public beds. There is a real cost through tax breaks. The cost is estimated at €70 million for seven years, which is almost half a billion euro. It has been estimated — our figures were based on Department of Finance ones — that one could provide around 1,200 public beds for the same money. There is a serious cost in the loss of income through insurance to the public hospitals. This cost in revenues forgone to public hospitals as a result of co-location is estimated to be €145 million per annum and possibly as much as €200 million per annum. There is a cost in the loss of public lands. We are all aware of the inflated cost of land at present. It is a finite resource and most sensible people would consider it folly to hand over such a scarce public resource in this way. There is a cost in the duplication of services and facilities because of an unnecessary fragmentation of provision of two structures on the one site. Private patients will be asked to pay the full economic cost of their care in the co-located hospitals and that will lead to a steep increase of at least 40% in their current private health insurance.

The Department of Finance, which one would expect to be very forthcoming in its support of this, in its memorandum dated October 2006 expressed serious concerns about the cost of this policy in terms of the loss of trained staff. Later on it expressed concerns about the soaring cost of private insurance and also about the failure to assess the land value issue.

The other argument of speed of delivery is similarly flawed. Mr. Tom Finn of the HSE claimed it would take 16 years to build a public hospital. That really tells us something about attitudes in the HSE and in regard to how the Government approaches this area. The reality is quite different. In Wexford General Hospital, 21 hospital beds were provided within 12 months. As soon as the hospital got the go ahead, it delivered the beds within 12 months. I was in Letterkenny General Hospital and an entire cancer oncology department was provided in 18 months. Perhaps the Minister is not aware of this but systems of construction on a modular basis can provide new facilities extremely quickly. However, that is not the kind of news she wants to give. She would prefer to give us the myths.

The Minister sent the order to the HSE in mid-2005. It is now 2007 and not a contract has been signed. According to the memorandum from the Department of Finance, it would take at least three years to provide these hospitals. Now the Minister is talking about 2011. That is hardly a fast track process but what is worrying — I referred to this earlier — is that the entire process may be tested in the courts if a developer is not accepted and feels hard-done-by.

I wrote to the Minister on 1 June asking for clarification on the statutory basis of her policy direction and I am still waiting for a reply. In the letter I pointed out that, in relation to the status of a ministerial direction, its subject matter must relate either to the Health Act 2004 or some other enactment and the subject matter must concern some matter or thing which the 2004 Act states is to be specified or determined by the Minister. I wrote that I would be grateful if she would let me know, as a matter of some urgency, how the letter of 14 July 2005 is believed to meet both of these two conditions — the second one in particular — in other words, in what specific way does the co-location of private hospitals on public hospitals' sites amount to a matter or thing in relation to which the Minister has a power under the Health Act 2004 to make specifications or determinations and so derive a power to issue directions under section 10. I am still waiting for that reply and it is important we get it. I would appreciate it if we could get it before this debate ends tomorrow night.

We have an example of private investment in the public health service which is called Beaumont car park. The Comptroller and Auditor General produced an entire report on the car park at Beaumont Hospital. If we had a system that served the public, the car park would generate income for the hospital. Instead, it generates income for private developers while its cost of construction was €13 million more with tax breaks than it would have been had the State built it itself. I fear we will end up in the same sorry mess but on a grander scale on foot of Deputy Harney's folly.

There is no doubt we will see a different approach to patients in for-profit hospitals. We will see procedures carried out that are quick and make money. Nothing the Minister does will change that basic difference between a for-profit hospital and a public hospital established to be dedicated to patient care. Because of the different ethos, cherry-picking will occur no matter what requirements the Minister introduces. To point that out is not to criticise the profit motive, but rather to state a fact. We will see a very different form of bed to the kind that exists for private patients in public hospitals currently. It is not a question of comparing like with like. However, the perverse incentives that operate in our two-tier system currently will be transferred to the new model. The fact that the incentives will operate in two-different locations on one site will not make a blind bit of difference. The money following the patient is the key and that will only apply to insured patients of whom there will probably be fewer as the cost of insurance is to rise as the Department of Finance has pointed out. There will be no empowerment of public patients whom money will not follow.

Given the problems in our public hospitals currently, it is scarifying to see the budget limits being set. Crumlin, Temple Street and the Mater Hospitals are suffering. The budget the HSE provides is not keeping up with demand. The experience of many years tells us that when hospitals reach the limits of their budgets, they simply close down services. They close wards and stop appointments, which are phenomena we may well see happen again. The danger is especially acute given the ending of the stream of income to public hospitals which has come through insurance. When the insurance money ceases, public hospitals will become completely dependent on the HSE whose budgets even now are failing to keep up with medical inflation, the demands of a growing population and increasingly expensive new technology and treatments. The two-tier system creates difficulties not alone for patients but for doctors in the context of medical ethics.

We must acknowledge the most pernicious aspect of the Minister's proposal. At a time when we have the resources to create a good quality health service for all the people, we have a political outlook which is determined to create conditions in which future integration of the health service will be far more difficult than it is currently. While integration represents a difficult challenge, it is the policy most Irish people would prefer. Had they the option, they would choose a service in which people were treated equally and with respect and dignity over the divided system we have currently. However, we are not to be provided with that. We will have what Professor Drumm outlined at the beginning. We will see the return of the old dispensary style of health care. It was formerly the case that the dispensary provided a poor-quality, undignified service for those who were too poor to go privately while the general practitioner provided for private patients. It was Erskine Childers, a Fianna Fáil Minister, who changed all of that. We now have a Fianna Fáil Government reintroducing and exacerbating a two-tier system in our hospital service. The dispensary model will now be the HSE public hospital where people will be treated in a markedly different way to what happens in a private hospital. This serves the patients extremely poorly and the excellent staff we have across the board in our hospitals are extremely disenchanted by the approach adopted by the Minister for Health and Children, Deputy Harney.

In many ways one feels a certain sense of despair that the lessons which were presented in this election in terms of people who voted for an alternative view to co-location have not been heeded. We have back in place a Minister who simply does not listen to the people and this is most regrettable.

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