Joan Burton (Dublin West, Labour)

I am disappointed with the Minister's response. It is obvious that he is not prepared to allow the vast amounts of money the Department of Finance is committing to these projects, on behalf of taxpayers, to be examined. The valuation of these projects should be examined at this time for two reasons. The financial structure of the projects will remain changed for the foreseeable future. The cost of financing them has increased significantly. I will set out why I am worried about the lack of cost-benefit analysis. In every town and county in Ireland, there are people whose existing operations involve this kind of activity, which is based on tax breaks. Such people might have the potential to expand their operations involving this kind of activity further, or might have new ventures involving such activity in the pipeline. The failure of the HSE, which costs us approximately €15 billion or €16 billion per annum, to undertake an integrated cost-benefit analysis of these projects, which are heavily tax-funded, is unbelievable. I remind the House that the HSE's activities are being funded from the public's decreasing financial resources.

As I said earlier, the HSE's strategy involves reducing to 14 the number of acute facilities in this country. I accept that the HSE has not explicitly stated it is pursuing a strategy of having a smaller number of larger acute facilities. It is clear that such facilities will be the main engine of treatment for people in many counties who need to be cared for in a nursing environment. I refer to people who are recovering from operations, for example, or people who have long-term medical conditions that do not require much hospital-based treatment.

Throughout the country, people in local communities are worrying about the impact of HSE policy on their small and large local hospitals. This private initiative is a key counterpart of what the HSE is proposing. It seems incredible that the Minister is not prepared to conduct a thorough review of the implications of the initiative on Government policy. I appreciate that the Minister inherited the policy from his predecessor. This short-sighted and wrong policy was one of the Progressive Democrats' contributions to the development of overall Government policy. It is having a disastrous impact on the provision of health services in communities throughout the country.

We do not have enough time to debate the role of tax incentives in economic policy. I have always said there is a limited role for tax incentives. They should be clearly identified and strictly time-based. We have ended up with the worst of all possible worlds. I think the Minister is wrong, even at this late hour, not to provide for a thorough economic cost-benefit analysis of the tax breaks provided for health projects and the various exemptions provided for different kinds of health provision. One of the Minister's predecessors, Charlie McCreevy, said one year that he had got the idea for one of these initiatives from a doctor he had met briefly. The previous year, he had taken the advice of a physiotherapist who had suggested he should throw an old tax break at the physiotherapy sector. I am sure the Minister's officials remember the measures in question. It was a crazy way of making decisions.

While we are talking in a narrow sense about tax policy, it should be borne in mind that this provision will have a huge bearing on health policy. We spend more money on the health sector than on any other sector. The Minister has spoken about the impact of health and social spending in the broader context of the recent emergency budget. It is important to provide for a system of cost-benefit analysis if we are to ensure that our health system is fit for purpose, that we can afford the system and that the system provides for all the people in every community in the country. It is crazy that there is no imaging equipment in our local hospital in Blanchardstown. It was provided in a new private hospital, which is the subject of tax breaks, two and a half miles down the road. One gets caught in a traffic jam when one tries to get from one hospital to the other. Our local hospital in Blanchardstown must pay to ship patients to the private hospital down the road when routine modern imaging tests and other tests need to be performed. It spends up to €2 million a year on transporting people by taxi and ambulance to the private hospital. Nurses and ambulance personnel have to spend their time going from one hospital to the other. The private hospital charges the public hospital in Blanchardstown for the service. This is also happening in other parts of the country. While people are delighted to have access to any service at all, it is economically crazy to organise services in this manner. I do not understand why the Minister is not prepared to conduct a proper cost-benefit analysis of the system.

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