Leo Varadkar (Dublin West, Fine Gael)

I congratulate Deputy Mary Harney on her appointment as Minister. Responsibility for health is a difficult job and it is testament to her courage as an individual and her dedication as a politician that she sought the job despite her party's result in the election.

I join with party colleagues in expressing my concern about the co-location proposal and my opposition to it, not just on the basis that it has no mandate, which is the case, but more important on the basis that it is bad public policy. The policy is bad for three principal reasons.

First, it will lead to the perpetuation of the two-tier health service. Freeing up 1,000 public beds by providing 1,000 private beds misses the point. What we should be trying to do is move towards a system where there are no private or public beds and no private or public patients in the health service. The best way to achieve that is through a system of universal health insurance, as is done in many other countries, whereby all patients are effectively private patients and money follows the patient. By going down the route of this co-location plan, the Minister is making it harder for future Governments and generations to achieve that. She is making it especially difficult by introducing a new vested interest into the health care system in the form of up to ten private hospitals.

The second reason I am opposed to this proposal is that it will result in the downgrading of our existing public hospitals. New beds, new facilities, new radiology services and new laboratories will inevitably go to the co-located hospitals rather than public hospitals. For example, the Connolly Hospital in Blanchardstown has been waiting for almost 15 years for the implementation of phase 2, namely, the provision of new radiology and new laboratory facilities. We know what will happen inevitably is that this investment will not be delivered; it will now turn up in the co-located hospital instead.

In yesterday's debate the Minister stated Tallaght had not been bullied into making its decision in favour of co-location, but that is untrue. Most members of that board are opposed to co-location but it was clear to them that if they did not agree to co-location, they would not get the beds or investment they need. Essentially, hospital boards now have a gun to their heads and they are being told that if they do not back the Minister, Deputy Harney's co-location plan, there will not be investment in their hospitals. That is not to mention the loss of revenue to them, which by the Minister's own estimation is €80 million per year for six hospitals. I do not know how much it will be if there are nine or ten co-located hospitals.

The third reason is a personal one. I am not sure the Minister has considered the fact that by introducing co-location we will introduce a two-tier admissions policy in accident and emergency departments. I am most concerned about this issue. Essentially, an SHO or registrar admitting a patient in an accident and emergency department will for the first time have to make a distinction between a private patient and a public patient. It will be necessary for the doctor on duty to talk to both the private hospital and the public hospital to see if a bed is available in one or the other. If there is a space in the private hospital, the patient may get admitted; if there is no space, he or she will not get admitted in the public hospital either.

It may also be necessary to talk to two different consultants, one in the private hospital and one in the public hospital where there may be different thresholds for admission depending on whether the patient would bring in money. That is an ethical minefield for doctors. Currently, the accident and emergency department is the only place in a hospital where patients are treated equally. The Minister has proposed to get rid of this last area of equality in the health service by making a distinction between patients in accident and emergency departments at the point of admission.

To sum up, this policy has no mandate from the people, it will reinforce the two-tier health system, downgrade public hospitals, cost the taxpayer millions and lay a new moral and ethical minefield for doctors admitting patients in accident and emergency departments. It is a bad policy for the taxpayer, public hospitals, patients and society. I appeal to Deputies to support the motion.

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