Joan Burton (Dublin West, Labour)

The hospice movement and hospice managers must accept what is available and on offer to them. The Minister spoke about the HSE and the Department. However, a policy directive from the Minister for Health and Children, Deputy Harney, states her desire for private investment in this area, as was the case in respect of co-location. As I understand it, with the difficulties now being experienced in respect of the budgetary situation, only limited capital funding is on offer from the Government for hospice construction. I attach no blame to anybody involved in the development of hospices. I have been involved in fund-raising for hospices and have carried out work in connection with them over a long period of time. I understand that if this is all that is available, it is better than nothing but let us make no mistake about it, the mechanism and manner in which the Minister has introduced this is wrong.

He announced his budget in the first week of December. We are now in the first week of March. There was a long Committee Stage. Press conferences and so on were held. Briefings by officials in the Minister's Department about his thinking in respect of the Finance Bill were held. Various organisations were able to lobby and give their views.

We are now rushing in yet another amendment to a health policy dictated by the Progressive Democrats. If people in the hospice movement wish to avail of this because it is the only thing on offer, that is fine and perfectly understandable. Everybody in this Chamber wants to see more hospice provision, particularly more palliative care to deal with pain management for people with terminal illnesses.

I said yesterday that I have considerable personal experience of dealing with this issue. When I was a teenager, my mother was ill for three years. Hospices and palliative care were not available then even for people in the extreme pain which she suffered. Twenty years later, the home hospice palliative care movement had developed enormously for her older brother who did not have to die in the condition that she, unfortunately, did. This is an important moral issue, as well as a practical issue, from the point of view of what we provide for people in extreme pain with terminal illnesses who need care.

One of the problems with this debate, which is probably why so many Deputies have joined us this morning to debate it, is that the amendment states there should be a minimum of 20 beds. This is probably fine for units in major urban centres like Cork, Dublin and perhaps Limerick. However, it may discriminate against newly approved developments in the smaller centres. This is why there should be a detailed debate about it. Some of the Deputies here will be able to confirm whether this includes Castlebar, Tralee, Kilkenny, Drogheda, Cavan, Wicklow, Kildare and other areas. Even larger units like Waterford, Tullamore and, in my own area, Blanchardstown, where there has been massive community involvement for the past seven years in trying to develop a hospice, could be affected. Blanchardstown may have to develop in phases. We now have the land after a long campaign. This land was secured from the Government, for which we are very grateful. There has been intense participation by the entire community there.

It is very difficult to know why the Minister simply opted for that particular format and simply took the private hospitals provision, which was introduced by Charlie McCreevy five years ago who said he acted on foot of representations from a GP in his constituency with an interest in a private hospital. As has happened with this amendment, the former Minister introduced this measure just before Report Stage. We just spotted it in time. The Minister did not notify us and we have not been given any opportunity to amend or discuss this.

In respect of Deputy Bruton's point about how property developers and related persons, such as managers of hospices, are involved, I assume this is due to EU rules. The draw for property developers is to get construction going. They will make their profit on the construction and the investors will then make their profit and enhancement of their rent on the investment and tax breaks they get.

As a result of my long connections with hospices, I am aware that philanthropy is not very extensive in this country. There are many people who have made money but there are very few large-scale philanthropists. Some people are involved in philanthropy and are to be commended on what they do but very few people who have made large amounts of money are involved in this area to the degree that people are in the US.

The next point, on which there has, again, been no debate, strikes me as very odd. There are a number of people in business who have given a considerable amount of time and resources to hospices, many of whom have been influenced by the death of children within their family circle or the circle of people they know. They have been terribly generous and they know who they are. Why could the Minister not have said that those kind of donations and bequests to hospices would be matched euro for euro by the Government? That might be a much more attractive way of releasing money for the development of smaller hospice development about which we are talking in towns, particularly those in smaller rural areas. There is a capacity there to release more funding to the hospices if the Minister had exercised some imagination and was not stuck on the Minister for Health and Children's ideologically driven, Progressive Democrat model which states that, at all costs, care in Ireland must be as privatised as possible even where people have terminal illnesses.

My problem with this is that internationally the hospice movement has largely been a not-for-profit movement. It is not just the development of beds in hospices that is important. The really important factor is the development of palliative care where people only go into hospices for one night or a weekend but get pain relief and arrangements for this relief which make it possible to bring a degree of quality to the end of their lives and the lives of their families and those caring for them.

The Minister may simply be acting on the instructions of the Minister for Health and Children but he is to be faulted for his lack of imagination and unwillingness to open out to the other parties in this House who would all have something to contribute. Fine Gael, Sinn Féin and the Labour Party are here, as are many Fianna Fáil backbenchers. We all want to contribute positively to the growth and development of the hospice movement and want to see the different areas and communities around Ireland being helped and facilitated. We have no opportunity to amend or even to debate this.

From a technical point of view, the fact that this relief is being introduced must mean that it is intended for hospices to rent the property, perhaps through sale and leaseback arrangements. I do not know if this is the case so perhaps the Minister could elaborate on that. Hospices would occupy these facilities as the bulk of the tax relief now available is for offset against rental income because of the caps on people who do not have significant rental income. The traditional model has been for the hospices which are run on a voluntary basis to fund-raise and acquire and build the properties. All the churches have played a part in the background with land. In the case of Blanchardstown, the State recently played a role in terms of the provision of land. The hospice in Raheny was built on land once owned by the Capuchin Friars, while the hospice in Harold's Cross was built on land once owned by the Sisters of Charity. Most tax relief relates to the building costs rather than site costs so what will be the status of a property built on land donated or sold at below market rate by the church or other organisations for a worthy cause? What are the issues relating to the Commissioners for Charitable Bequests and Donations?

While the hospice need not be in private hands, a voluntary organisation can still rent the space it occupies. There will be issues around the full market rent which investors will expect to receive because only by achieving the full market rent will they maximise their tax break from the hospice which is being given by the Minister in order to promote construction.

There are also issues to do with the longer term ownership of the land and the implications this would have for a voluntary body. If the State is effectively subsidising higher market rent in order to maximise the tax break for the investors, it would be interesting to see exactly where the net benefit to the State arises. If the Minister is strapped in his capital budget, he may say it kick starts some building and he may say to hospice managers that some building is better than no building at all and this is an understandable argument. If the development is designed to introduce a for-profit element into hospice care, then a debate is needed about the issues that require safeguarding, particularly when one considers the pain and suffering that many patients endure near the end of long illnesses and the ethical and other considerations that arise. We do not want to hear stories of unnecessary pain and suffering similar to those we have heard coming from private nursing homes. When the private nursing home provision was slipped in, the Labour Party warned that this would be attractive to people with an interest in development who were not necessarily experts in care and unfortunately this is how it has turned out to be. Nobody wanted to see this happen but we have the history of what happened at Leas Cross.

In order to gain tax relief, the investor will be obliged to hold the investment for a period of 13 years while the relief is over 15 years. After this time they will wish to dispose of their interest in the property and in that scenario, when they want to dispose of the building, what are the implications for the hospice and its patients? If I was on the board of one of the hospices, this would be done by a sale and a lease back with a reversionary clause and a nominal fee to the hospice. However, who is to say? There is no requirement in this legislation that the long-term interests of the hospice movement be protected. We are relying on Deputy Mary Harney who will be gone in 13 years; if we have our way she will be gone long before 13 years. What will happen then?

I would be interested to see the nature of the arrangements that this legislation will spawn. With the tax relief available for offices, potential tenants were offered a lease period equivalent to the tax life of the building with an option to buy at an agreed price when the tax life came to an end. My guess is that this is what a lot of organisations might move to. If similar arrangements develop with the hospital and hospice tax reliefs, what is the real benefit for the State with regard to the investment, other than start-up? Would the State not be better off providing a grant directly to the hospice to purchase and build its property equivalent to the tax it will forego? This would cut out the middle man who will in all likelihood wish to sell the property at full cost back to the hospice or the State at the end of the tax life of the investment.

Whatever the Minister may argue, this section is all about the investor. I refer to the Minister's provision in the amendment which also relates to current situations:

(e) in relation to which an undertaking is given to the Health Service Executive—

(i) to make available annually, for the palliative care of persons who have been awaiting day-patient, in-patient or out-patient palliative care services as public patients, not less than 20 per cent of its capacity, subject to service requirements to be specified by the Health Service Executive in advance and to the proviso that nothing in this subparagraph shall require the Health Service Executive to take up all or any part of the capacity made available to the Health Service Executive by the unit,

I know of very good nursing home proprietors right around the country who have been in the business for a long time and who provide excellent standards of care. They are not investors but have been involved in nursing home provision for a long time. They have added additional units to take up the tax breaks and the incentives available and they have been advised by banks to do this. However, they cannot get the HSE to commit to funding the packages for people waiting to leave acute hospitals. I could take the Minister around the country and show him various homes which I have visited recently and where this situation has applied. I remind the Minister that the national rate of private health insurance is about 53% but as I understand it, because incomes are lower along the western seaboard, the level of private health insurance is lower than in the eastern seaboard area. If hospices are developed in the mid-west and west, what guarantee is there that the Health Service Executive will have any requirement under this amendment, to provide places for public patients?

If this matter had been debated properly, we might have been able to agree a provision to increase the amount of hospice and palliative care available. There are serious problems with the Minister's proposal. The figure of 20 beds will create severe difficulties. I refer to places such as Castlebar, Tralee, Kilkenny, Drogheda, Cavan, Wicklow, Waterford, the Minister's own area of Tullamore of which he will be aware, and Blanchardstown. The plans of the hospice management group are not clear yet. The State has given us the land. The Minister for Health and Children wants to go back to her co-location plan which is driven by Progressive Democrats ideology. I do not think it is driven by the thoughtfulness which I am aware is present in many Fianna Fáil people. I have been involved in assisting in hospices and I know that people help not because they are affiliated to any particular party and they come from all political parties.

See this speech in context