James Reilly (Dublin North, Fine Gael)

We know that schools built under public private partnership which were supposed to save 6% ended up costing 10% more than if they had been built by traditional methods. The PPP model is far from proven and requires much more debate than what is allowed today.

Much like this Bill, it is fair to state that the entire co-location plan has been guillotined. It is supposed to release 1,000 beds. How will these beds be funded when the insurance stream of income has been lost to the public hospital? This plan has come from the Government without consultation. There was no Green Paper, no detailed cost-benefit analysis and no Dáil scrutiny. It was established in the recent general election that there is no mandate for the co-location policy. Handing over public land to private, for-profit hospitals does not have the support of the people — 56% of the people voted against it.

The guillotining of this Bill 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, removing the possibility for those same public hospitals to expand on the grounds they had very wisely kept beside them when they were first built.

Under the new system, two hospitals will co-exist on each site with two types of patient — one public, one private. New co-located private hospitals will pick and choose the procedures they offer and competition between patients for limited intensive care beds will apply. Key medical personnel will be lured from public to private hospitals and public hospital development will be sidelined while hospitals are roped into 60 and 70 year leases. The new model represents a nightmare scenario for our health care system and a Government that has washed its hands of the development of public hospitals.

If the Minister succeeds in causing a dislocation between those who fund the service — that is, the taxpayers — and those who use it most, the chronically ill and elderly, we will see a rapid acceleration in the demise of public hospitals in favour of private ones. We will be well on the road to what Deputy Gormley, before he was a Minister, referred to as the American system. Despite the fact that 16% of America's GNP is spent on health, it is the most inequitable system in the western world with 60 million people uninsured and facing financial ruin or even death should they fall ill. According to the recent docu-drama "Sicko", 18,000 people die annually in the good old USA because they have no health insurance.

The main source of revenue of the new co-location hospitals will be health insurance premiums. It is likely that insurance rates for co-location hospitals will be far in excess of the current rates paid. In addition, the new rates will undoubtedly drive the cost of health insurance up thus making private health insurance unaffordable.

The VHI's publicly stated policy has been that there is no need for any further private beds. In its 2006 annual report the VHI stated:

The single biggest challenge facing private healthcare in Ireland is the unprecedented increase in private hospital capacity which has been encouraged by generous tax relief for such investment. VHI Healthcare has questioned the wisdom of such tax incentives particularly since there does not appear to be any significant demand from the public sector to use these new facilities. The cost of financing the new capacity will place huge pressure on our objective to provide our members with quality healthcare at affordable prices.

The VHI has its own agenda but nonetheless it will be interesting to see how all these private hospitals are going to survive. Will the NTPF be their main source of income?

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. It is highly unlikely that they will complete this complex project when they have still not delivered the much heralded 3,000 public acute beds promised back in 2001. In five years, they managed just over 1,000 of the promised acute hospital beds.

As well as underpinning 19 agencies, this rushed legislation is also addressing deficiencies in the Medical Practitioners Act 2007 and in the Health Act 2004 which established the HSE. Both of these Acts were put through the House by the Minister for Health and Children, Deputy Harney. She claims that she is in the middle of a major reform programme of the health service and that she wants to finish the job. Reform is generally understood to mean changing things for the better but instead the last few months have seen the imposition of a staff recruitment ban and cuts to critical frontline and community health services.

The HSE is the Minister's creation. She shaped it, legislated for it, and established it quickly rather than taking the time to get it right. In setting up the HSE, the Minister promised it would deliver efficiencies and value for taxpayers' money but instead she has allowed bureaucracy to spiral out of control, so much so that the Minster for Finance now has to put a stop to it. We all saw the articles in The Sunday Tribune and yesterday's Irish Independent about the Minister for Finance writing to the Minister, Deputy Harney, expressing concern about her ability to manage her Department's budget in the more financially restricted times that now exist as the economy slows down under this Government.

On top of its bureaucracy, the HSE has superimposed a lack of accountability and an avoidance of responsibility while putting media spin before operational performance. It has lost the confidence of the public, most of its own staff and many Deputies, including some on the Government benches. While the Minister and others, including the HSE, blame the work practices of its staff, it is the action of the Minister herself and the senior management of the HSE which is now the problem. They put conformity to their systems ahead of patient safety and welfare. They treat patients as job lots. Their attempt to blame the former Midland Health Board for the fiasco in Portlaoise is now seen to have been nothing more than a pathetic smokescreen.

The HSE has given us cutbacks, cancelled operations, removed home-care packages for disabled children, removed home help for the elderly, closed wards and reduced transport capacity, yet the Minister wants us to devolve more power to this body. She wants to distance herself even more from her responsibilities.

The Medical Practitioners Act was rushed through the House earlier this year but why were these amendments not included in the original legislation some months ago? Maybe it is because the legislation was rushed though the House at such a pace. We are now repeating the same mistake. It is more than likely we will find ourselves standing here at some stage next year rectifying the deficencies of this rushed legislation.

Perhaps the Minister can provide clarification on the amendments proposed for the Medical Practitioners Act. What problems is she seeking to head off by these amendments and who wished to have them introduced?

Section 18 of the Bill amends section 59 of the Medical Practitioners Act by inserting the following section:

(1A) The Preliminary Proceedings Committee may, for the purposes of considering whether there is sufficient cause to warrant further action being taken in relation to a complaint, take account of such matters relating to the registered medical practitioner the subject of the complaint that arise from its investigation of the complaint as it considers appropriate.

Did everyone get that? This amendment suggests that if a separate issue, unrelated to the initial complaint, comes to the attention of the preliminary proceedings committee, it can be considered as part of the cause to warrant further action. It is not clear from the legislation, however, if doctors will be notified of this complaint or if they will be allowed the opportunity to respond to the complaint. Perhaps the Minster could clarify this point.

I ask the Minister to remove all mention of these other Acts from this Bill and focus on the Attorney General's advice, addressing it to the area he wished it to be addressed to, namely the 19 bodies. She should allow a more considered and ordered debate on other issues such as co-location, the Medical Practitioners Act 2007 and the HSE Act 2004. We could then wish the Minister a happy Christmas and offer her full co-operation. Otherwise, however, we will have to oppose the Bill.

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