Richard Bruton (Dublin North Central, Fine Gael)

In principle, I welcome the amendment. However, I wish to make a number of points in connection with it. It is important when addressing health issues that we promote diversity of provision, a strong voluntary sector, a quality public sector and that we allow for private sector development.

Another issue is access. I am concerned that a large swathe of our provision will be based on the notion of access based solely on affordability. It is a serious concern in respect of the hospice in particular, the culture of which is not access based on ability to pay but access based on need. Against this background, the provision provides that 20% only will be public patients and 80% will be private patients. I do not believe this is appropriate. If, as the Minister says, this scheme will provide a new source of high quality hospice care, we should be planning that more than 20% of clients will be public patients. What we want to promote is diversity of provision but equality of access. We want to see more public patients getting access to facilities we support through a 42% subsidy under the tax code. That we are providing a 42% subsidy but only 20% of clients will be public patients is something of an imbalance in this provision. I hope that in practice, when hospice services develop under this provision, it will not be the case that 80% of clients will be those who can afford to pay and 20% will be people supported by the Health Service Executive. This would not be in keeping with the tradition we have sought to promote within our health service. It is a mixed health service but it is one that should be based on equality of access and, increasingly, that is not the case. We have seen the erosion of this element in our care system. All of us, as representatives, deal with constituents and are aware of the inequity of access to services for people dependant on the State to provide. We should not be building into this legislation a provision that will become the mainstream of our provision in this area.

I accept there is a national strategy in this area but I must confess I have not seen it. The Minister should tell us more about it. It is important to know to what extent our hospice service will be voluntarily, publicly or privately operated by way of tax incentivised provisions. We want diversity of provision and fair access. The context is all important. I accept the Minister's point that this service would not be developed quickly enough in the public sector. I have had personal experience of private sector nursing homes, some of which are run to the highest standards and wherein the culture is excellent. However, as legislators, we cannot be unaware of the fact that people without the required expertise have entered the nursing home business as investors.

Many important sections in this legislation provide that the HSE will ensure operators accord with national standards. We cannot allow a repeat of the situation whereby inadequate standards were provided partially because those who entered the sector were motivated by tax incentives rather than a core commitment to the service. The Minister is correct that many people involved in the voluntary hospice sector see this as a good vehicle for advancing their work. Subject to the creation of the proper protections, this is a good scheme.

As Deputy Kenny mentioned earlier, we have some concerns in respect of the decision to include a threshold of a minimum of 20 inpatient beds. There is a desire to see smaller community-based hospices. I do not believe we should be setting a threshold in this area. As far as I am aware, the opinion of those involved in the hospice movement is that we are setting the threshold too high given successful models of hospice care closer to their communities will provide less than 20 beds. Given the HSE powers in respect of approval and the level of oversight which the Minister assures us is being provided, I do not believe we need to insert an artificial ceiling that restricts it in this way.

There are a number of other issues on which I would like clarification from the Minister. The Bill provides for the disqualification of certain people from being beneficiaries including companies and those involved in hospice operations. We can all understand why property developers are excluded. Perhaps the Minister will clarify if this is a condition of State aid rules from the EU or if we are providing that people who run a hospice and are part of the hospice movement should be consciously excluded from being a participant in ownership of the facilities being incentivised. Is this based on State aid rules to comply with EU requirements or our own decision? I do not understand why in principle we would want to exclude people with a commitment to running hospices from being potentially involved as part owners and obtaining some benefit from this incentive.

The 15-year rule which now applies was previously a shorter period having been extended by the Minister in previous years. I am interested to hear the Minister's comment in this regard. There are arguments for and against this. We must ensure, in providing tax incentivised schemes of 42% tax relief that we are getting long-term commitment rather than short-term investment. I am interested to hear the Minister's view on this and on what the HSE, in its national strategy, says about this rule. Will the Minister continue to apply what appears to me to be a strange anomaly, namely, if the person obtaining the tax relief has rental income no ceiling will be applied in respect of benefit whereas a person with non-rental income will be restricted to €31,700. Why do we continue to provide that those with a big rent roll can roll-over effortlessly into more of these tax incentive schemes while those who have earned income are capped? If the purpose of this is the use of tax relief to promote the hospice movement and not to favour particular types of tax individuals, we should ensure there is a level playing pitch.

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