Mary Harney (Dublin Mid West, Progressive Democrats)

Yes. I reiterate some of the comments I made in my opening remarks on the legislation. When we were advised by the Attorney General on 26 October that we should bring forward, as a matter of urgency, legislation to put beyond doubt the legal status of the 19 bodies still in existence that had been established under the 1961 Act, there was an onus on me, as Minister, and my officials to do that. There was great complexity involved due to the number of statutory instruments. Forty bodies in total were established during that period and all those bodies had to be checked and the statutory instruments had to be examined. Notwithstanding that, the legislation was prepared very quickly.

Sometimes emergency legislation deals with a specific technical loophole in a single legislative measure. Earlier this year we had to introduce amending legislation to deal with risk equalisation. If memory serves, we were able to draft and publish that legislation in a matter of days. In this case, however, there was equally strong advice from the Attorney General that, because there is a legal doubt, one should not put people on notice. These bodies are not akin to the bodies under the local government Act of 1971. These bodies expend over €900 million of taxpayers' money and employ huge numbers of staff. They have contracts with many organisations.

It was not a question of not trusting the Opposition but of the legal advice I am obliged to accept on how I handle these issues legally. I did that. Equally, when the Opposition Members asked me last Thursday if I would make the Attorney General's advice available, I made a commitment to talk to him. I did so at length by telephone and he wrote to me stating that the advice should not be made available. I am obliged to accept that advice. Advice of that kind is never made available. The Attorney General made the strong point that those giving advice from the Bar Council would have to be put on notice, in advance of giving their advice, that it would be the subject of public examination. They give their advice in a privileged way.

The parties in this House have legal advice available to them. Political parties are far better resourced now than they were previously. I assume the parties have the same legal advice that is available to me, although obviously not from the Attorney General. However, the Attorney General went to the bother of getting counsel opinion on these issues.

We brought forward the legislation as quickly as possible. Given the scale of the public money involved, as well as the number of organisations, their staff and contracts, it was clearly in the public interest not to give long periods of notice during which litigation could be initiated. As I said last week, we are not aware of any litigation pending; it is not a case of us not telling of it. No litigation is pending and we do not wish to put people on notice for long periods of time, during which they can litigate where they might have a legal grievance with any of the bodies.

On issues surrounding the Medical Practitioners Act, the Medical Council came to us after that Act was passed in April with legal advice on the issue of complaints. Patients making complaints would not be familiar with medical language or methodologies, so if the preliminary inquiry committee examines, for example, a complaint about a doctor who treated somebody badly and issues come to light in the context of its examination which were not the subject of the initial complaint, the Medical Council wants the freedom to pursue them. It would seem strange if it was prevented by a legal technicality from pursuing an issue that came to light in the course of a preliminary investigation that was not the subject of the complaint simply because the complainant was not well versed in medical language. A chicken and egg issue also arose in that a registrar is needed to elect the new Medical Council, whereas the Medical Council is needed to appoint a new registrar.

These small technical and transitional issues have arisen because we want to commence the Act on a phased basis. We are moving from the current regulatory regime to a very different one, comprising fitness-to-practise inquiries which will be held in public as a matter of course, lay majorities and competence assurance requirements on all doctors. The legislation provides for powers of preliminary examination so that issues do not have to go before full fitness-to-practise inquiries. It was a fundamental overhaul of the 1978 Act and clearly it is important that it is commenced on a phased basis as soon as possible next year. When the opportunity arose of a Bill coming to the House, it was prudent on our part to use it rather than bring separate legislation early next year to deal with Medical Council issues.

There has been no policy change on co-location. At present, 20% of the beds in public hospitals, which are completely funded by taxpayers, are ring-fenced for patients with private health insurance or who are self-payers. Patients who do not have private health insurance cannot access those beds. They cost us €300 million per year in nurses and staff salaries. The insurance forgone is approximately €74 million, so €226 million in taxpayer subsidies is used to staff beds which are only available to private patients. I do not consider that to be fair. When taxpayers provide public facilities, access should be on the basis of medical need rather than on a preferential basis for those with private health insurance. We want to convert those beds to public use for all patients.

Equally, however, we recognise that half the population has private health insurance and that many doctors work in both the public and private systems. Instead of doctors working on and off-site in three or four hospitals, it is better they work on-site. St. Vincent's and the Mater are co-location hospitals for this purpose, with public and private hospitals located side by side. In the case of St. Vincent's they are under common governance.

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