Dáil debates

Tuesday, 24 October 2006

Private Members' Business

Health Services: Motion.

6:00 pm

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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I move:

That Dáil Éireann, believing:

that the Irish people are entitled to a health service that will deliver excellence, equality and efficiency;

that a person's financial means must not be a barrier to him or her receiving the most appropriate and best medical treatment; and

that health must be treated as a community service;

expresses its serious concern at the growing pattern of privatisation of medical services under the current Government and the increasing trend towards reliance on for-profit medicine;

deploring, in particular:

the decision of the Minister for Health and Children and the Government to promote the building of private for-profit hospitals on the grounds of existing voluntary and public hospitals;

the continued use of tax incentives to promote the development of private super-clinics;

the increased use of beds in private nursing homes, for which no statutory scheme of regulation and inspection is in place; and

the running down of the publicly provided home help service and the decision to contract a US based company to provide home help services for the elderly;

calls on the Government to abandon this strategy as it will exacerbate the two-tier system of health care, whereas the goal should be to deliver an integrated service, and to:

move immediately to provide at least 1,500 community care beds for patients who currently and inappropriately occupy acute hospital beds;

publish a coherent programme for investment in additional acute hospital beds in not-for-profit hospitals, as promised in the health strategy published in 2001;

mandate the Health Service Executive to pursue strategies that will make greater use of existing beds, including more ward rounds by consultants and better discharge planning;

abolish tax incentives for super private clinics and use the monies thus freed up, as well as lands on public hospitals, where appropriate, to construct community care facilities;

establish an independent inspectorate to implement a rigorous programme of inspection in all nursing homes and community care facilities; and

invest in a modern home help service and establish a programme to train and employ a significantly greater number of public health nurses whose services are so valuable to elderly patients.

I wish to share time with Deputies Howlin and Costello, by agreement.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Is that agreed? Agreed.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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I thank my Labour colleagues for agreeing to table this motion. It is important that we discuss in our national Parliament what we want as a people from our health service. Ask anyone in the street what they want when they become sick and the answer is unequivocal. It would be the same as what any of us in this Chamber would want for ourselves and for those we love, namely, to be able to get medical care when we need it and not because we can afford it, to be able to access a hospital bed without delay and with dignity, to receive top-class attention in a hospital that is clean, efficient and health promoting, to come home when we are able or able enough to do so with supports close at hand, and when our time comes to be able to die in conditions which respect our vulnerability at the end of our lives. That is what people want from our health service. The public desire is clear. It is diametrically opposed to the desire of private developers and business interests to make the biggest profits possible from health care. There is no shame in that because that is what they do. However, there is no glory in it either, although there are some on the Government side who glorify the market to a ludicrous degree. The leopard does not change its spots because of any glossy or soft-focus marketing of private health care and the pure and simple objective remains to make money.

On occasion, the making of money can coincide with the public interest but it does not always do so and when it comes to health care, the two interests rarely coincide. The Labour Party recognises that a role exists for the private sector but the over reliance on that sector espoused by this Government is not good for patients. The experience in general has been that the impact of large scale privatisation of health is socially regressive and very costly, yet we have a Government so wedded to the market that it makes the choice to follow the private route even when the best advice is to do otherwise. This is clearly a choice made by Fianna Fáil and the Progressive Democrats. By funding for-profit hospitals out of the public purse, they choose a quick fix solution despite poor returns for the taxpayer and a deepening divide between the public and private systems of health care. Having done so, they hope to divert attention from their inability to introduce progressive changes and real improvements in health.

The Minister for Health and Children is at least consistent. After all, she carries a lot of ideological baggage. Her leader has argued the case that inequality is good for society, her party stands by the principle that greed is good and her policy of featherbedding private health care businesses reflects her world view. The Labour Party fundamentally disagrees with the Progressive Democrats agenda. We are opposed to the privatisation of our health services and we will, if returned to Government, bring this wasteful and ill-thought scheme to an end. We will strengthen and expand the public and not-for-profit hospital sector and bridge the gap between public and private patients.

The Minister has prepared no proper analysis for her scheme and she will not do so because no analysis will support her case. In fact, the only argument in favour of such a plan would arise if the Government was unable to find the capital to invest in health care but we all know that is not an issue at present. If the Minister wants to convince us, she should publish the results of cost benefit analyses being carried out on her scheme. The Department of Finance seems to have no difficulty with stalling other health projects through sanctions, yet it blithely allowed this scheme to proceed despite an estimated first year cost of €2 billion. Today, I sought information from the HSE but, once again, it was impossible to extract any details which would help me prepare this speech.

The Minister's proposal was made for ideological rather than logical reasons because she has an almost foolish attachment to Boston over Berlin. Logic would warn us to keep as far as we can from US health care system, yet she is trying to bring us closer to it. Health care in the US is extremely expensive and deeply unfair. Approximately 40 million Americans who lack health cover are locked out of an unequal health system in an unequal society. In Ireland we spend €1,950 per person per annum on health, a sum which the Minister seems to consider excessive. Does she even know that health care largely provided by for profit interests in the US costs €5,535 per person? Due to the unequal nature of US society, health outcomes are relatively poor in terms of life expectancy and infant mortality.

The Tánaiste should be told that, far from inequality being good for us, a fair society is a healthier society. The US demonstrates the link between inequality and low health outcomes which a massive investment in health has failed to address. Almost 16% of GDP in the US is spent on health care because of the private nature of the health service and almost 50% of the world's expenditure on health occurs in the US. Despite that, the Government persists with private solutions in order to disguise its failure to deliver a decent health service, let alone a world-class one. The Minister will no doubt argue, as she has done before, that handing over scarce public lands to private interests along with enormous tax breaks is not privatisation. It looks, sounds and acts like privatisation but the Minister does not see it in that way. She maintains that all she is doing is freeing up private beds in public hospitals to provide more capacity. However, her claim is simply not true. She is creating additional private beds to those in our public hospitals. Private patients will still be entitled to access beds in public hospitals and they will continue to do so. After all, 68% of all patients come through accident and emergency departments, a figure which includes public and private patients. It is untrue to claim that private patients will no longer present at public hospitals.

Speaking at a private health care conference, the Minister stated: "It is not privatisation to cease the practice whereby 20% of new public beds built with public capital are reserved for private use." However, she never told us how she intends to stop patients from exercising their rights. There is no evidence to indicate that the addition of private beds will liberate beds for public patients on a like by like basis. We simply do not know whether that is the case and the Government has not bothered to find out. We do know, however, that the taxpayer will pay for a net increase in private beds. The likelihood is that we will end up with an overly doctored class of private patients who enjoy additional privileges and pay higher insurance premia, while public patients will continue to wait in line. There is an Irish phrase which, roughly translated, means "to grease the bum of the overfed pig". That, it seems, is the goal of this Government.

It is worth reminding ourselves that we are citizens of a republic. During this year, the 90th anniversary of the 1916 Rising, we have spent much time debating many aspects of our history. We need to begin a debate on the meaning of being a citizen in this republic and the rights that citizenship confers on us as individuals, such as rights to education, health care and a roof over our heads. Must we accept these rights do not matter because it is all about "bling bling" or that gold credit cards are the passport to good health care? The Labour Party will not be drawn down that path. If returned to Government, we will end this crazy misuse of public resources and bridge rather than broaden the divide between public and private patients.

Overdependency on the private sector will lead to the cherry-picking of patients. For-profit hospitals choose profitable procedures and services rather than those which meet greatest need. This trend will be facilitated further if private hospitals are placed next to public ones. Private hospitals rarely have accident and emergency departments and usually lack services and equipment for severely ill or injured patients. Their proximity to public hospitals will enable the private operator to rely on tax supported services for costly aspects of patient care. As a recent report produced by the Irish Congress of Trade Unions pointed out:

The public hospital is the safety net that protects a community with a private hospital. If a private hospital performs badly or closes, the community will look to the State to come to their aid. The experience of Leas Cross private nursing home confirms that where there are private facilities the investors are not the only ones bearing a risk.

It is small wonder that stockbrokerage firms have advised investors that private hospital developments are good investment prospects in Ireland. When the scheme was announced it was met with whoops of jubilation by investors. "It is the answer to our prayers; we could not have written it better ourselves" is how one private health care promoter responded. Why would they not celebrate? For every €100 million invested the Irish people will contribute €40 million, a gift from a Government that cannot deliver to low income families the 200,000 medical cards it promised. However, it has no difficulty subsidising fat cats.

In reality the cost to the taxpayer is quite enormous. These are not the words of a red-clawed socialist, although they could be, they are the words of the man whom the Minister has appointed to the most senior post in the Health Service Executive. Time and again Professor Drumm has expressed his opposition to the Government scheme as clearly as the man can do in the circumstances. In October 2005 he warned:

The pendulum will leave the public health service and that for me would be disastrous. I really believe health care should be provided in as many facets as possible through the publicly funded system.

He sketched out the dangers on the Government proposals in stating:

We need to be extremely careful that we do not drive to the front gates of our hospitals and find the road left to the nice flowered structure with a fountain in front where those that can afford it go to that structure and someone goes sheepishly in the other direction towards the HSE hospital.

In reality that is exactly what will result if this scheme proceeds. That is the point of a private hospital; the more marked the divide the more attractive the private option and the worse will be the effect on the public hospital system. The attractions are not all based on hard medical evidence. There is mounting proof that the outcomes for treatments in for-profit hospitals compare unfavourably with those of not-for-profit ones. However, patients will still be beguiled by the flowers and the fountain.

Currently we need to employ more hospital consultants in certain specialties in our public hospitals. Since 2003, for example, only one additional accident and emergency unit consultant has been appointed. Private hospitals will become attractive options for those specialists who are frustrated with the problems and restrictions in the public system. Not only financial return but also better conditions will siphon away doctors who currently work within the public sector. Meanwhile public hospitals will lose vital funding they receive for looking after insured patients as they do at present, which is likely to lead to a downward spiral.

It is not just in the hospital system that the Minister is imposing her will to privatise. One of the hallmarks of the Government record is that since 1997 there has been a shrinking of public provision in care for the elderly and in community services. Since 1997 the number of community nursing beds has been reduced by hundreds of beds. As the Government struggles to make up the shortfall we are witnessing an increased reliance on private nursing homes to fill the gap. There are many excellent private nursing homes which fill an important need but surely even the Government has to learn from experience. There is an urgent need to ensure high standards and quality control of private nursing homes.

After all these years, we still do not have a satisfactory regulatory system of private and public nursing homes. We on this side of the House have grown weary raising this issue with the Government, yet there is still no sign of a full, effective statutory authority that will protect elderly and frail people in residential care. The current inspection system does not inspire confidence. The HSE asks us to trust it and places its minimalist reports up on the Internet. Most people would have more confidence in the opinion of Martin Hynes's conclusion of the current system of inspection as being "fragmented, disjointed, with no evidence of joined-up thinking". Mr. Hynes is the person who first blew the whistle on Leas Cross, yet his critique continues to be ignored. Eighteen months ago the Taoiseach promised an inspectorate independent of the HSE, and we are still waiting.

When a crisis occurs, as it did in the Leas Cross nursing home exposure by the media, the public rightly expect a response from the Government. Promises were rightly made by the Taoiseach and the Minister for Health and Children but then, wrongly, they were broken. Last May the Health Service Executive received the Professor O'Neill report into Leas Cross. Last May, the Minister for Health and Children could and should have published it. She has failed to do so to this day and it is her greatest failing. On the one hand, she is so excessively reliant on the private sector, yet on the other she is lethargic in her approach to proper regulation and strong oversight on the facilities that she is enriching.

All this is having a demoralising effect on those working within the health service. There is seepage from the health service of public provision that is often almost invisible except to those who experience it directly. Public health doctors disappear into a layer of bureaucracy and are not replaced. The anecdotal evidence is legion. A dentist in my county of Wicklow left and was not replaced. It was only when parents discovered their children were not being treated that the loss was discovered because accountability has been stripped from the system with the establishment of the Health Service Executive. There are vacancies in a range of health professional posts that are not being filled.

I was contacted by a general practitioner recently who works in the north east. He is clearly a good family doctor and wanted someone to hear what was happening on the ground. His medical practice provides blood tests for patients who need them and the samples were, until recently, tested in the laboratory at Our Lady of Lourdes Hospital in Drogheda. Now the laboratory is unable to keep up with demand and has sought one extra staff member and some equipment from the HSE. However, instead of meeting that need the HSE decided to pay, at heaven knows what expense, for testing of blood samples to be transferred to a private clinic in Kildare and another one in Britain. According to the doctor it is not as good or as speedy a service as the public one. The HSE seems infected by the privatisation bug which is being spread by the Minister to a point where rather than developing further a tried and trusted service in Our Lady of Lourdes Hospital, the HSE made the choice to export blood samples to Britain. The family doctor is frustrated in what he sees as an enormously wasteful solution to a simple problem.

I have promised to table a parliamentary question on the cost of this change but, knowing the Minister and the HSE as I do, I reckon it will take until Christmas to get the reply and probably much longer, if ever, to get the information I want. The silliness of replies to parliamentary questions never fails to amaze. Recently I asked if the minutes of the HSE management meetings for July and September 2006 had been signed off yet. In a functional world the answer would be a simple yes or no, but in the dysfunctional world of the Minister of Health and Children the answer was:

Section 6 of the Health Act, 2004 states that the Health Service Executive is a corporate body. In view of this, the matter of minutes from Health Service Executive management meetings is a matter solely for them. Accordingly, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have this matter investigated and to have a reply issued directly to the Deputy.

This is heartbreaking stuff. It is as simple as lifting the phone, asking whether the minutes have been signed off and getting me the answer. The problem is that, as long as the minutes are not signed off, it is not possible to obtain answers to freedom of information requests regarding decisions that have been made. People probably do not appreciate this fact. We receive our replies and are supposed to be satisfied with the kind of gobbledegook contained therein.

Earlier this year, we witnessed another example of the Minister's determination to promote the private over the public. The Government instituted home care packages to help elderly patients to stay in their homes. This is a very worthy objective and we all support it but even in this area the Minister is intent on favouring the private over the public. She launched the American Comfort Keepers franchise in Ireland and spoke glowingly of the role of private companies in home care. Since the launch there have been complaints in some instances and there is no proper regulatory system to protect patients at home. A senior trade union official, who has been very concerned about the status and extremely shabby treatment of home helpers in the public sector, described this trend as part of a parallel private home help system that would fit into the Minister's wider privatisation plans.

By far the most significant of these plans is the scheme to develop private hospitals on public lands, essentially in the car parks of public hospitals. These will be partial hospitals creaming off profitable work and leaving costly long-term care to the taxpayer. The two-tier system will be further institutionalised and locked into the system. There will be no incentive to have continuity of care or develop an integrated service where the money follows the patient regardless of his or her income. It is pure Progressive Democrats ideology in action. It is noteworthy that Fianna Fáil Members are willing to fall in like sheep behind a policy that fails to deal with the important challenges that must be faced so as to meet the public desire for fairness and efficiency in the health service. I would have thought Fianna Fáil would have adopted a different approach but it has offered no criticism and has not expressed an alternative view.

We have great doctors, nurses and other staff in our system who are committed to patient care and looking after people on the basis of need. They deserve better. When I visit hospitals, I find it striking to listen to the needs of the staff, which can include increased space in the accident and emergency unit, more acute beds or more step-down beds. Not one person I have met in my travels around the country has sought the building of a private hospital beside a public one. Individuals raise their eyes to heaven when I mention it and ask what I think of it. They know it is not a good idea because they are working in the health service and trying to meet the needs of patients while dealing with the restrictions and pressures that exist. They deserve better and this is why the Labour Party has tabled this Private Members' motion, for which we seek full support to ensure that what is done in the health service truly meets the needs of patients and those who care for them.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I am very glad of the opportunity to support this critical motion and I congratulate Deputy McManus on its comprehensiveness and clarity. This is not one of the run-of-the-mill debates we have during Private Members' business about a particular identified need or an undelivered facility required in one part of the country or another; rather, it presents one of the rare opportunities the House gets to decide the shape of our future health service.

Health care has been at the top of the agenda for the past ten or 15 years. Taoisigh have campaigned in elections and discovered it is very much at the top of the agenda of the vast majority. Sooner or later, all of us will test the effectiveness of the health service. Our nearest and dearest, or ourselves, will be dependent on it one day or another and therefore it is critically important that we get it right.

I was dismayed when I read the Government's amendment to the Labour Party's motion. It calls on the House to support the Government's policy of encouraging the public and private sectors to work together, and to support the co-location initiative to develop private hospitals on the campuses of public hospitals. I regard that as health apartheid. There is no mandate for it from the people and I genuinely believe it will be resisted by the vast bulk of citizens.

The amendment calls on the House to note that the HSE is engaged in a public procurement process to develop private hospitals at ten public hospital sites. Members of all parties — but perhaps not from the Progressive Democrats as I do not recall whether they were present — met the senior executive of the HSE to ask who is calling for this public procurement process. We did not get an answer immediately but eventually that it was on the direction of the Minister and her Department. This approach represents an historic new direction in health care. Although it may be true that private health care has always been a feature of health care provision in Ireland, as the Minister invites us to acknowledge in the amendment to the motion, it is true of a different Ireland in which we built up a health service on an ad hoc basis. It featured at a time when religious orders provided services the State could not afford to provide, some of which were later subsumed into the system. We got along because we had to get along, with an element of private service and an element of public service. However, we now live in a new and different Ireland.

I intend to focus on the acute services but, as Deputy McManus stated, there obtains across the whole health service a philosophical attitude to the effect that health care is regarded as a commodity to be delivered by the market and not as an aspect of a public service to be delivered on the basis of need. That is the inescapable truth.

What the Government has embarked upon is radical, new and highly ideological. It is traditionally claimed that those on the left want to upset things with radical ideology, yet the most ideologically driven party in this House — the one with the least support — is the Progressive Democrats. It is driving an ideological agenda to deliver privatised medicine. Health care is to be privately delivered and owned, a commodity to be bartered in the marketplace, paid for by those who can afford it and queued for by those who cannot.

The exemplar of decent health care standards, to which most developed European countries have looked since the 1940s, is the United Kingdom's National Health Service. It has been considered a unified, integrated, world-class health system. Apparently the concept of a unified, integrated, world-class health system, free at the point of delivery, is no longer Ireland's objective. Ireland could never afford this goal in the past but it can afford it now. We are no longer debating the difference between Boston and Berlin, at least in health care, because we are already serving up the clam chowder in our private hospitals. This profound mistake will ingrain inequality, in the form of a two-tier hospital service, in this country for years to come. There is little public knowledge or awareness of the major shift that has led to the bedding down of a two-tier health care system. I honestly believe this approach is contrary to the overwhelming bulk of public opinion, including the public opinion that supports the major party in government.

If this policy is not abandoned, we will have parallel hospitals on adjoining campuses — one hospital for people who are insured, or who can pay, and another hospital for the rest of the people. I do not doubt that private hospitals will tender for some categories of public patient work, but they will not tender for difficult or long-term work that involves caring, for example. It will be paid for by some future version of the treatment purchase scheme. Public patients — the lesser mortals — will have to endure a sufficient waiting period before they can earn admission. The simple and inescapable truth is that as long as there are two parallel systems of health care delivery, the public system will always be seen as less important than the private system. If that were not the case, there would be no incentive for people to pay for health insurance. If the public system offered an identical standard and speed of care, who would pay to go private? The Tánaiste, Deputy McDowell, has said that "a dynamic liberal economy like ours demands flexibility and inequality in some respects to function". He added that such inequality "provides incentives". We will provide such incentives if we continue to base our health service on in-built inequality.

Similar problems are encountered when one examines how our society cares for the elderly. Families are being told to find private nursing homes for their elderly loved ones who are sick, so that acute hospital beds can be freed up. Every weekend, I deal with people who are distraught because they have been told to find private beds somewhere for their family members, who are too ill to go home. I do not know whether the Minister, Deputy Harney, has had the same experience at her clinics. I live in a large constituency. Patients who are based in Wexford town are sometimes referred to beds in New Ross, Gorey or somewhere in south-west Wexford. Such people deserve better at that stage of their lives. We should provide better services for them because we can afford to do so. Where are our First World public long-stay hospitals for the elderly? Why is it not our objective to provide such services at a time when, for the first time in our history, we can afford to offer a decent regime of publicly funded and staffed geriatric facilities, thereby allowing elderly people to live close to their home bases? Given that experience elsewhere has taught us that the standards in the private sector are less than optimum, why are we demanding that the market should provide such services for profit?

I have exhausted my time. I had hoped to refer briefly to Wexford General Hospital, but I will do so on another occasion. I would like to make a philosophical point in conclusion. The Minister for Health and Children knows I have great personal regard for her ability and her acumen as a politician. I genuinely believe that what is happening in health care under her stewardship is a profound shift. It will cause major hardship and will bed down inequality in the delivery of health care for generations to come. I hope the public is alert to what is happening.

Photo of Joe CostelloJoe Costello (Dublin Central, Labour)
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I compliment Deputy McManus on proposing this important motion, which relates to one of the central reasons we are here — to improve the quality of life of all our citizens. I am afraid the Progressive Democrats are serial privatisers. That is the sum total of the Progressive Democrats ideology. The approach of the Labour Party in this regard differs fundamentally from that of the Progressive Democrats.

When the Minister for Health and Children, Deputy Harney, took over that portfolio two years ago, her major task was to solve the accident and emergency shambles. She published a ten-point plan, which was to bear fruit within six months, but then sank without trace. Two years on, the accident and emergency units in many of our major hospitals are sad places for the old, sick and vulnerable to find themselves as we move into the winter season.

The central part of the Minister's approach is to follow the lead of her Progressive Democrats colleagues, Deputies McDowell and Parlon, who have trawled the land banks and buildings of their Departments to sell property to the highest bidder. The Tánaiste, Deputy McDowell, has disgracefully sold the offices of the Department of Justice, Equality and Law Reform in St. Stephen's Green and has moved into rented accommodation, as if it were his God-given right to do so. Likewise, he is preparing to sell the most historic prison in the country, Mountjoy Prison, to the highest bidder without consideration for its heritage or the fact that it is likely to be demolished. The Minister of State, Deputy Parlon, is selling a treasure trove of State assets as part of his decentralisation splurge. He is jacking up the price of land throughout the country as he acquires sites for new offices for people who do not want them. One of the Minister for Health and Children's first acts was to conduct an audit of the land in her Department that might be flogged to the private sector. That was one of her earlier statements.

The mindset of the Progressive Democrats is that State land is real estate to be sold to the private sector, rather than to be protected and developed for future generations of Irish citizens. The new proposal for resolving the accident and emergency crisis and the bed shortage is to develop private hospitals on public lands in public hospitals. Ten such hospitals have been identified and targeted by the Minister. The development of these new private hospitals will be incentivised by tax reliefs which will cost taxpayers approximately €0.5 billion in today's prices. Every €1 spent by speculators and developers will lead to a refund of approximately 40 cent. The Finance Acts of 2001 and 2002 allow the developers of new private hospitals to sell the capital allowances associated with the cost of developing the hospitals to external investors and thereby raise equity in the marketplace. The legislation allows the capital allowances to be made available in respect not only of private hospitals, but also of sports injury clinics, nursing homes and private convalescent clinics. We are not yet finished with this proposal. The Health (Nursing Homes) Amendment Bill 2006, which passed all stages in the Dáil last week, will cause fear and consternation in the minds of elderly, infirm and disabled people whose homes are liable to be sold to pay for their care in nursing homes.

The public health service is quickly becoming a private health service under the stewardship of the current Minister for Health and Children. She believes that all the problems in the health sector can be solved by private sector intervention. The Minister should realise that the objective of the private sector is profit — it will always put profit before people. The State will pay a fortune to promote private sector involvement in health provision while the sector remains unreformed and inefficient. The president of the Irish Medical Organisation, Dr. Christine O'Malley, put it well in today's The Irish Times, when she was asked, "If you could grant three wishes for the health service, what would they be?". Her response was:

Put doctors and other health professionals back at the heart of health service planning. Develop extra acute hospital beds in acute medical units and ringfence surgical beds to allow GPs to refer directly to hospital wards as they used to be able to do. Make people recognise that despite subsidies, Irish private hospitals remain niche specialists that don't treat A&E patients.

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Progressive Democrats)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"— welcomes the Government's commitment to promoting high quality health services and in particular to the setting up of the independent Health Information and Quality Authority which will drive the quality agenda in the health services;

notes the proposed statutory role of the Office of the Chief Inspector of Social Services in inspecting and maintaining registers of residential centres for people with disabilities, children in need of care and protection and older people, including private nursing homes;

recognises the fact that private healthcare is and has always been a feature of healthcare provision in Ireland;

commends the Government on the measures it is promoting to improve access for public patients to acute hospital care;

supports the Government's policy of encouraging public and private sectors to work together in the provision of health care for the benefit of the entire population and encourages further innovation and initiative in this regard;

supports the co-location initiative to develop private hospitals on the campuses of public hospitals in order that up to 1,000 beds currently reserved for private patients may be re-designated for use by public patients in a most cost effective way;

notes that the Health Service Executive is engaged in a public procurement process to develop private hospitals at 10 public hospital sites;

notes the increase of 1,200 in the number of inpatient beds and day treatment places since the publication of the Health Strategy in 2001 and the plans to open new acute hospital units;

notes that an independent review of the scheme of capital allowances for investment in private hospitals recommended its continuance as a means to address supply shortages and reduce costs;

welcomes the introduction by the HSE of a broad-based Winter Initiative which is designed to ensure that the services required to address the particular demands of the winter season are in place and operating optimally, including the co-ordination of services in relation to discharge initiatives, continuing care and home supports;

commends the Minister for Health and Children for the provision of over 900 long-stay beds in private nursing homes in the last two years and acknowledges that all private nursing home beds are subject to registration and inspection;

commends the Minister for Health and Children for providing funding to provide a further 1.75 million home help hours this year and a tripling of home care packages to 3,000 and notes that the HSE is improving and enhancing the service by using a range of additional providers including voluntary groups and the private sector;

acknowledges and supports the important role of public health nurses, who are a key element in the delivery of community based health services, and notes that the HSE sponsors 130 staff to train as public health nurses each year at a cost of over €5.2 million;

acknowledges that the HSE is currently engaged in contracting 800 additional nursing home beds as part of the Winter Initiative; and

acknowledges that the HSE is finalising proposals for the provision of 350 additional public beds in the Dublin region and an additional 200 such beds in Cork also."

Some might say the motion from the Opposition puts everything in black and white. Some could say it is devoid of colour and shades to reflect the diversity of health services and patient choice in Ireland today. That would be kind because the motion is not just black and white, it is all black. It betrays an attitude that private involvement in health is all bad. In a similar vein, 12 years ago, Deputy Liz McManus accused the then Minister for Health, Deputy Howlin, of having made slavish concessions to the private sector.

It is as if, in Labour Party eyes, only public sector doctors take the Hippocratic Oath. It is as if the vast majority of general practitioners were not self-employed in a direct relationship with two thirds of the population. It is as if Dean Swift had not set up a private hospital more than 200 years ago that is still in operation, and has been joined by many others over the years. It is as if thousands of beds in public hospitals had not been reserved for private patients under previous Ministers and Governments. It is as if the private nursing home subvention scheme had not been introduced by a Labour Party Minister for Health, Deputy Howlin, and perpetuated unchanged by a Fine Gael Minister. It is as if 52% of the population did not choose to pay for health insurance.

The fact is, we have a mixed public-private system of finance and of provision of health services. If any party does not want that, and wants to base policy on a public service monopoly, let them have the courage of their convictions and say so. Let them propose a ban on private interactions between patient and doctor. Let them ban the purchase of private nursing home places for older people. Let them close the National Treatment Purchase Fund, NTPF, and ban the State from purchasing badly needed treatments for 50,000 public patients who used to wait very long times. Let them refuse to allow a public patient use a private magnetic resonance imaging, MRI, scanner. Let them forbid the Health Service Executive to purchase kidney dialysis treatment for patients in the south east. Let them overturn European market freedoms and ban hospitals that seek to make a profit. Let them also forbid doctors in partnerships from making profits. Let them take themselves, but not us, back to North Korea.

The Government and I believe we can make better use of both public and private finance and health providers to provide a better health service to the whole population. The job of a Minister for Health and Children is to achieve the best possible health outcomes for the whole population, not just to fund and organise exclusively publicly provided health services, as seems to be the approach of the sponsors of this motion.

Health policy encompasses all sources of finance, all types of health providers and all patients. Private health care is a long established feature of health care in Ireland, in almost every county. It involves general practitioners, dentists, pharmacists, chiropodists, private nursing homes and private hospitals, now used systematically by the National Treatment Purchase Fund. Our GP service, in particular, is a public-private mix that works very well for all patients who use the same facilities and are seen by the same doctors. It works far better for patients than the models in some other countries which have a more nationalised GP service. It takes almost a week in some parts of the UK to see a GP.

This Government is committed to using fully the scope for the private sector to provide additional capacity and services in the health system. There are a number of Government policies and initiatives that support the co-existence of public and private health care. They include the designation of private and semi-private beds in public hospitals, income tax relief on private health insurance premiums, income tax relief on medical and dental expenses, the work of the National Treatment Purchase Fund, the co-location initiative to free up to 1,000 beds for public patients and capital allowances for investment in the development of private hospitals and nursing homes.

The policy of this Government is to achieve the best for all patients using the mixed public-private system we have. Far from preserving the public-private mix on ice, that means change in the way it works. I am committed to ensuring private practice within public hospitals will not be at the expense of fair access for public patients.

There are 13,000 beds in the 53 public hospitals and 2,500 of those beds are designated for use by private patients. The figures I have given the House previously show that in most public hospitals, the designated ratio of private work, approximately 20%, is greatly exceeded, sometimes accounting for up to 40% of inpatient activity. For example, 46% of elective work in Tallaght Hospital last year was for private patients. This means some public hospitals are increasingly being run as private fee earning opportunities. Changing this is the very opposite of privatisation: it is reclaiming public beds and public facilities for public patients.

It is high time to start changing the system of reserved, subsidised private beds in publicly-funded hospitals. When the private sector is willing to finance the facilities, to manage the service and to fund the running costs 100%, why stop it? What compelling reason is there for the State to insist the public sector must pay all the capital cost of reserved private beds in public hospitals and more than half of the running cost? The State pays for the nurses, management, support staff and service staff dealing with private beds. The co-location initiative will free up to 1,000 of these beds for public patients.

The Health Service Executive is now undertaking the procurement process to select a consortium to build and operate a private hospital on each of ten public hospitals. The new private hospitals will be procured by utilising the new competitive dialogue tendering process. It involves a three stage process including a pre-qualification stage, a competitive dialogue phase within which solutions are identified and discussed and a final tendering stage.

The HSE has seen much of interest in the initiative. It has pre-qualified a number of bidders for each site and is now in the process of evaluating outline proposals and short-listing bidders for each site. The site will be made available to the successful bidder at the full market value. Each proposal will undergo a rigorous value for money assessment, the public interest will be fully protected and each proposal will fully adhere to public procurement law and best practice.

I expect innovative proposals from the private sector to maximise the use of public hospital sites and foster full co-operation between private and public hospitals. This procurement process will be completed in the early months of next year.

As we see contracts completed for St James's Hospital, Beaumont Hospital, Connolly Hospital and Tallaght Hospital in Dublin, and in Galway, Cork, Limerick, Waterford, Sligo and Letterkenny, I expect local populations will be very keen to see the new facilities and new public beds open. I also expect that what is opposed in theory today at national level, will be supported in practice next year at local level. Some of the loudest local calls for public patients to be treated at off-site private facilities at Limerick and Waterford, for example, have come from members of parties opposite who oppose this plan at national level.

There has been much misinformation about this cost effective plan. Far from creating a new two tier system, the new facilities will be required under the Finance Act to offer their services to the State for purchase at a discount. The NTPF has shown how the purchasing of treatments can work to benefit nearly 50,000 people and it has opened private hospitals for public patients, breaking down a two tier barrier in our system. In addition, while managed separately, the private hospitals will connect physically on site with the public hospitals and there will be opportunities for shared services.

There will be no sweetheart deals or bailouts. The lease of land will be on fully commercial terms and no public land will be given away. If anyone wants to claim that there is more value for patients to be gained from grass and empty lawns at public hospitals, they can attempt to do so. Under this plan, we will maximise the value of the land to the public sector.

The operators of the new facilities will have to bear all the financial risk and they will be compelled to manage their services efficiently. There will be no guaranteed State contracts, and any service arrangements with the State will be competitively priced. This is a financially sound proposition. Only the most twisted logic, and there has been some, could suggest it is more cost effective for the State to continue to meet 100% of the capital cost of private beds and half the running cost.

Arrangements will be put in place whereby consultants will be able to work at these facilities. As stated in the policy direction, this will be subject to better work practices being put in place in each public hospital. Many consultants at individual hospitals are keen to do this already and have expressed their support for this arrangement to me. This initiative does not introduce for-profit hospitals into Ireland; for-profit hospitals exist here already and are used by private and public patients. We have a mixture of not-for-profit and for-profit independent hospitals in Ireland and this mix will continue. The largest private operator in the country, Bon Secours Ireland, is a not-for-profit organisation.

The co-location initiative does not require an operator to be a for-profit hospital. I expect there will be strong interest from not-for-profit hospitals in winning some of these contracts. They, too, must raise finance to expand their activities and that finance, unless it is a charitable donation, has to be repaid. The finance invested has tax advantages for investors, but those tax advantages are not in any way dependent on whether the hospital is operated on a for-profit or not-for-profit basis.

The motion from the Labour Party proposes the abolition of this capital allowance for investment in hospitals. It describes the position, pejoratively of course, that there is no provision whatsoever in our tax code for "super-private" clinics. However, the motion does nothing to explain why it is more socially just to give capital allowances for film productions than for hospitals. The motion calls for the Government to publish a programme for investment in additional acute hospital beds. We have done so; it is called our capital investment framework for health and it is a €3 billion programme. We will have invested more than €2 billion in acute hospitals under the current national development plan. There are 1,500 more publicly-funded acute hospital beds now than in 1997, a rate of annual increase that is about six times that of previous governments. Current plans include provision for another 450 beds in addition to those released by the co-location initiative. We are also committed to developing an entirely new tertiary children's hospital.

It is no wonder that the motion looks to the Government to provide new beds since the combined Labour and Fine Gael parties failed, as recently as two weeks ago, to make a commitment to any number of new hospital beds in their A&E document. The motion also seems to forget that it was the Labour party that set up the social services inspectorate without any statutory powers and no scope to inspect public nursing home places.

The motion's call for the Government to move immediately to provide 1,500 community care beds for patients currently in hospital is also miscast and out of date. I do not know what sort of government would move immediately to acquire new community beds but rule out private nursing home providers on ideological grounds. This year so far, the HSE, with my support, has sourced more than 500 beds and will acquire 200 more by the end of the year. In all, 1,350 beds are being arranged. There is no ideological bar here — beds are being acquired in both public and private facilities. Far from running down home help services, this year we are expanding all services for older people, particularly home helps and home care packages. The full year cost next year of this expansion will be €150 million. This year, 1.75 million more home help hours are being provided, with 3,000 home care packages. Whatever works best and fastest for patients is being done, using all providers, public and private.

The Government is investing one quarter of all current expenditure in health. We are investing more than €500 million annually in health capital. With this, we are funding approximately 75% of all health spending in the economy. This is the OECD average. The American model is different with 60% coming from the private sector and 40% from public sources. These patterns of high public investment will continue in a coherent framework where both public and private providers will be challenged to deliver top quality health care of all types to all patients.

It makes sense to use the public and private systems together. While the private sector does not provide all the answers to our health care problems, it has a complementary role to play. Many private providers in Ireland, like the Bon Secours hospitals or St. Vincent's Hospital, are not-for-profit organisations. They provide the bulk of the private beds that currently exist in our private hospital facilities. Anyone who would suggest converting into public beds 1,000 of the 2,500 private beds that currently exist in public hospitals is privatising the health system. Why are all the nursing, management, clerical, catering and support staff paid for by the taxpayer? Why is 100% of the capital cost of providing those beds funded by the taxpayer? Only one group of employees, consultants, get paid for seeing those patients. Surely this does not make sense. Seeking to minimise this in public hospitals and convert those beds for public patients, and have private beds and nursing staff funded and managed privately makes eminent sense to increase capacity in the health care system. The co-location model is important. It will keep doctors on site instead of having to travel around a couple of different hospitals. This makes eminent sense for the public and private systems.

I commend the amended motion to the House. I forgot to say at the outset that I am sharing time with the Minister of State, Deputy Tim O'Malley, if it is in order.

8:00 pm

Tim O'Malley (Minister of State, Department of Health and Children; Limerick East, Progressive Democrats)
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I welcome the opportunity to address the House on issues relating to the provision of services for older people. I acknowledge the significant investment made by the Government for the care of older people, and palliative care, by the provision of €110 million additional revenue funding in the budget announcement for 2006 and a further €40 million in 2007.

The Government is committed to maintaining older people in dignity and independence in their own homes and, in accordance with their wishes, for as long as possible. It is also committed to providing high quality long-term residential care for older people when living at home is no longer possible. People are generally living longer these days and even though most are leading healthy independent lives, the number of people in need of long-term care is increasing. There is a strong demand for long-stay places and it is imperative that the nursing home places on offer, both public and private, are of a high order and appropriate standard to meet the needs of our older population.

The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations 1993 set out the standards to which the private nursing home sector must adhere for the purpose of registration under the Health (Nursing Homes) Act 1990. These apply to all beds in private nursing homes whether contracted, subvented or not.

This year, the Minister for Health and Children carried out a public consultation process on the draft scheme and heads of a Bill to establish the Health Information and Quality Authority, HIQA. The office of the chief inspector of social services with specific statutory functions was also established within the authority. The intention is to bring a Bill to Government for approval this session.

The establishment of HIQA is a key feature of the health services reform programme. HIQA will be a vehicle to strengthen quality assurance and information in the health system. It will set standards on safety and quality of services provided by the Health Service Executive and service providers. It will monitor and advise the Minister and the HSE on the level of compliance with those standards. It will investigate services at the request of the Minister or the HSE. At the request or with the approval of the Minister, it will review and make recommendations in respect of services to ensure best outcomes for the resources available. It will operate accreditation programmes. It will evaluate and provide advice to the Minister and the HSE on the clinical and cost effectiveness of health technologies. It will evaluate information and data and identify deficiencies in respect of that information. It will set standards on information and data, including governance arrangements.

In line with commitments made in the health strategy and the new social partnership agreement, Towards 2016, the remit of the social services inspectorate is being widened to include residential care for people with disabilities and older people. The functions of the chief inspector of social services will be to establish registers for residential centres for people with disabilities, children in need of care and protection and older people, including private nursing homes. The chief inspector will have powers to inspect centres, register them, attach conditions to registration and cancel a registration. The chief inspector will also inspect the Health Service Executive's performance of its functions in respect of foster care services, boarding out of older people and inspections of pre-schools. When it is necessary for older people to move into long-term residential care, it is important that they have a choice of top quality nursing home care. For this reason, a working group has been established by the Department to develop appropriate standards for residential care settings for older people. Membership of the group comprises officials from the Department, the HSE, the SSI and the Irish Health Service Accreditation Board. The group has developed draft standards for the inspection of both public and private residential care for older people. It is intended that these draft standards will be the subject of a public consultation process in the coming months.

The Government's commitment to the development of a comprehensive range of services for older people and palliative care can be demonstrated clearly by outlining the resources made available in recent years for service developments. Between 1997 and 2005, additional spending on health care services for older people was in excess of €302 million. In addition, the Minister for Health and Children, Deputy Harney, announced a €150 million package to expand and improve services for older people and palliative care in 2006 and beyond. This has resulted in a major improvement in home and community-based support for older people. A comprehensive health and social care service is being developed, in a way that is reliable and that respects and values older people. This is the largest ever increase in funding for services for older people.

These initiatives set out the Government's continued commitment to older people and putting older people at the centre of health policy now and in the future. The investment package is focused on caring for people at home, in accordance with their expressed wishes. It is a major step in focusing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and also reflects the growing independence of older people who want to stay living in their communities.

This new investment involves additional resources of €150 million in a full year, €110 million in 2006 and €40 million more the following year. Reflecting the new emphasis on home and day care, almost three quarters — €109 million — of the full year costs are being committed to community care supports.

This investment is a response by the Government to older peoples' preference to be cared for at home rather than going into residential care. Very often that may require some additional home help or more developed home support, including various therapy services. All the evidence shows that families caring for elderly relatives continue to provide care in partnership with the support services put in place for those that require it.

The budget day package provides for a number of initiatives. The home help service plays a very important role in keeping people at home for as long as possible. An additional €33 million was allocated to this service in the budget for 2006, €30 million of which was for 2006 and will provide a further 1.75 million home help hours.

Home care, including the home help service, is delivered through the HSE in partnership with a range of providers including the executive itself, voluntary groups and the private sector. This has long since been a policy in home care. While public nursing home provision continues to be expanded, it is necessary nonetheless to continue the working partnership with private and voluntary providers to ensure the highest level of additional service delivery possible.

There are, however, no plans to privatise the home help service or give priority to private companies over public or other home care providers. The most important factor in delivering home care and home help is not who provides the service but that an appropriate level of service is delivered in as flexible a manner as possible which is highly responsive to the real needs of the individual.

A comprehensive collective agreement between health employers and SIPTU was finalised in 2000 regarding the terms and conditions for employment of home helps. This agreement provided for a significant improvement in the pay and conditions of employment for home helps. They now receive the same benefits as all other staff in the health services, which include premia pay, paid annual leave and paid sick leave.

It was agreed with SIPTU in February 2006 to establish a high level group with an independent chairman to address, in partnership mode, issues pertaining to the standardisation of home help services, including clarification on the nature of the service and standard criteria for entitlement, among others.

Home care packages deliver a wide range of services and have been piloted successfully in several regions in recent years. They include the services of nurses, home care attendants, home helps and the various therapists, including physiotherapists and occupational therapists. A home care package will vary according to the care needs of the person so that, for example, there might be a greater emphasis in some packages on home care assistants while other packages may require a greater level of therapy and nursing.

The priority is older people living in the community or who are in-patients in an acute hospital and who would need to be admitted to long-term care without this support. The home care packages are also available to those older people who have been admitted to long-term care and who now wish to return to the community. In addition, the packages will be offered to people who are already using existing core services, such as home helps, but need more assistance to continue to live in their community.

As with the home help service, the packages are delivered through the HSE by a range of providers, including the Health Service Executive itself, voluntary groups and the private sector. About 1,100 home care packages were provided to people at the end of 2005. By the end of this year, a total of 2,000 additional home care packages will have been provided. The HSE has advised that 1,800 new clients were in receipt of home care packages in the first six months of 2006. The 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a care package on a temporary basis.

An additional €20 million was allocated to the nursing home subvention scheme for residents of private nursing homes. The additional €20 million is a 2006 full-year cost and is going towards supporting increasing numbers entitled to basic nursing home subvention, reducing waiting lists for enhanced subventions and bringing greater consistency to the different levels of enhanced subvention support throughout the country.

A total of €8 million was provided in the budget to cover the cost of 250 extra nursing home beds which the HSE has sourced from private nursing homes. The HSE has provided over 900 long-stay beds in private nursing homes in the last two years and is currently engaged in contracting 800 additional nursing home beds as part of the winter bed initiative.

Extra funding was also provided, as part of the budget investment package, for a range of other community supports, including day and respite care, which are an integral part of delivering a comprehensive community service for older people; meals on wheels, which again is part of the range of services which help support older people to continue living in their own homes; and sheltered housing, which provides a real alternative to residential care and reflects the desire of older people to live with as much independence as possible.

In addition to services for older people, €9 million was provided in the budget day package for specialist palliative care, including home care and community initiatives in 2006.

It is clear from the package that the Government is firmly committed to developing services for our older people. The emphasis on developing home care packages and the increases in the home help and meals on wheels schemes and other community based supports are assisting older people to remain in their own homes and communities for longer, in accordance with their wishes. In addition, additional funding has been provided to the nursing home subvention scheme to go towards supporting the increasing numbers entitled to subvention and to reduce waiting lists for enhanced subvention.

The Health (Nursing Homes)(Amendment) Bill 2006 is currently being debated in the Oireachtas and is designed to ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and to help the HSE to implement the scheme on a standardised basis across the country.

The Government is currently considering policies on long-term care. Several principles underlying this policy were agreed with the social partners in Towards 2016. These principles specify, for example, that there should be one standardised national needs assessment for older people needing care. The use of community and home-based care should be maximised. Sheltered housing options will be encouraged. Where residential care is required, it should be quality care and there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. The level of support for residential care should be indifferent as to whether that care is in a public or private facility. The financial model to support any new arrangements must also be financially sustainable.

The Government's commitment to older people is clear. The focus is on supporting older people in their homes and communities for as long as possible, and at the same time supporting those who require residential care if the time comes that such is the most appropriate care required. The Government is committed to ensuring high quality care to all older people in public, private and voluntary nursing homes and is working towards having the best standards and inspection processes in place to achieve this. By its investment programme this year, the Government has demonstrated its commitment to older people. We acknowledge that we must continue to develop policy in this area to meet the growing demand for services.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I wish to share time with Deputy Neville.

The Fine Gael Party has no problem with private medicine. General practice, where public and private patients are treated equally, is the most successful of the public private partnerships and many of our private hospitals work well.

I agree with Deputy McManus that the House needs to debate this motion. Two weeks ago, I wrote an article in one of the medical journals, the Irish Medical News, on the topic of private hospitals. I know the Minister for Health and Children, Deputy Harney, was made aware of the piece because her advisers inform her about everything written by Deputy McManus or me.

Given that the Minister chose not to answer any of the questions put to her, the Government cannot be accused of lying on this issue. Having listened to him give an economist's view of the health service, it is difficult to believe the Minister of State, Deputy Tim O'Malley, holds office in the Department of Health and Children.

Tim O'Malley (Minister of State, Department of Health and Children; Limerick East, Progressive Democrats)
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Is Deputy Twomey not interested in the facts concerning services for older people?

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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The Minister of State should answer the questions I ask him if he is so intelligent and sure of his brief. The initiative on private hospitals will result in the transfer of €2 billion of capital and current assets from the public sector to the private sector. Where is the cost-benefit analysis carried out by the Department on this initiative and why has it not been made available to Members? The Department of Finance will not sanction a project in the Department of Health and Children which costs more than €30 million without first receiving a cost-benefit analysis. The extensions to Our Lady of Lourdes Hospital and Mullingar General Hospital did not proceed this year, despite budgetary allocations having been made for this purpose, because cost-benefit analyses were not submitted to the Department of Finance. The Minister tried to make hay about the private provision of dialysis services to the population of the south east. The plan to provide Beaumont Hospital with a dialysis unit will not proceed because the Health Service Executive did not submit a cost-benefit analysis to the Department of Finance.

The Minister of State informed me that the HSE is not a political organisation. Political interference in the HSE is widespread but there is no political responsibility. The Department is not being held to account for a decision to move €2 billion in taxpayers' money out of the public system. For example, no policy paper or cost-benefit analysis was produced on this initiative. I believe this crazy proposal was written on the back of beer mat when the Minister was out at night with her friends. If the Minister of State does not agree it is daft, he should prove the contrary. As Deputies ask week after week, let us see the proof.

Professor Drumm, as the Accounting Officer of the Health Service Executive, should be sacked this time next year if he does not produce a cost-benefit analysis on this proposal. Similarly, Mr. Michael Scanlan, the Secretary General and Accounting Officer of the Department of Health and Children, should be sacked if he does not provide a cost-benefit analysis of the proposal. The Minister is good at sacking Secretaries General but the general public should sack the Government. The Progressive Democrat Party talks a great deal about how it looks after taxpayers' money. It is the height of incompetence that the Minister has nothing to show how €2 billion will be spent.

It is possible that this initiative is no more than a pre-election charade by the Health Service Executive and Departments of Health and Children and Finance. Perhaps Professor Drumm knows in his heart that the proposal is rubbish and he is stringing out the issue until the general election in the knowledge that the Progressive Democrats will no longer be in power when a new Government is formed. Patients are being misled that a great initiative will proceed. How many loops must be jumped through in terms of qualifying even for pre-qualification? Certainly, there are enough loops to stretch out the proposal for five or six months. Patients and investors must ask themselves some hard questions because they may be being led down the garden path. Who is pulling the wool over their eyes?

Besides the taxation and financial implications of this daft approach, what are its implications for patients, those who will be most affected by this crazy, beer mat policy produced by a PD-led Government in which the Fianna Fáil Party has fallen asleep? As a result of it, consultants will spend their days in private hospitals looking after private patients. We already experience a problem of a small number of consultants who neglect their public patients and give their time to private patients. Given that private hospitals do not have the same number of doctors and nurses on duty as public hospitals, consultants will be compelled to stay in private hospitals during the day to look after their patients. As a result, less experienced doctors will be left to look after patients in public hospitals during the day.

What will happen at night? As the Minister of State will be aware, the standard of doctors on duty in private hospitals at night varies considerably. As private hospitals are not compelled to have doctors in training on duty, one cannot be sure of the quality of doctors working in them. While some of them are excellent, others are a little suspect. Fortunately, however, this is not a major problem because unlike public hospitals most private hospitals do not engage in intensive surgery. However, once an additional 1,000 private beds come on stream, more surgery will be performed in private hospitals without standards being in place.

The Government has not introduced standards for inspecting nursing homes and only minimum standards are in place for inspecting doctors. In addition, it failed to introduce a composite insurance scheme, despite a recommendation in the report of the inquiry into various matters in Our Lady of Lourdes Hospital that the Government get its finger out. This crazy policy puts patients at risk, even if the Government is not aware of it.

What will happen to the premiums of private patients? In the past decade, throughout which the current coalition has been in power, premiums have doubled for VHI and BUPA policy holders. Thanks to the Progressive Democrats, the Government proposes to introduce a free-for-all in which the insurance companies can make as much money as they like. I hate to think what will happen to VHI and BUPA premiums in the next five years if the Progressive Democrats return to power and continue to force through this crazy policy. It is possible, however, that this may be a ruse to fool people into believing that action is being taken. If that is the case, the Minister is playing politics with people.

On another matter about which the Minister is unable to answer questions, what is the current status of the consultants' contract? This time last year, the Minister stated she would introduce public-only contracts for consultants. What happened to that commitment? Did the Progressive Democrats fall asleep? The proposal has fallen by the wayside. The Minister's current policy is a waste of time and money because it could not work if public only contracts were in place.

As a supporter of private medicine, I believe the Minister's policy on private medicine is daft and makes no sense. It is time she got her finger out and produced background information on this initiative with a view to persuading the Opposition it has substance.

With regard to community care beds, I acknowledge that while they cannot do everything, the majority of those involved in the private nursing home sector are doing a great job. The Minister received a set of standards for private nursing homes from a Government body in November 2005 but did not publish them. As a result, the private nursing home representative bodies had to publish their own standards in June this year. We are still waiting for the Minister to publish the standards she has chosen to sit on.

The Minister of State should not talk about protecting elderly patients. The Minister of State has done the least to protect elderly patients during the term of this Government. He has been a shocking disgrace. He promised much but delivered nothing.

Eligibility and provision on entitlement have moved nowhere since the publication of the health strategy in 2001. I understand why elderly patients prefer to remain at home. With this Government in office, I would not wish to send anybody into a nursing home. The Government has no respect for these patients and will not protect them. The Health and Social Care Professionals Bill has been postponed until 2007. The social services inspectorate will not be a statutory agency until the legislation is passed but that will not happen until the next Government takes office. It will not happen under this Government.

The legislation the Minister is trying to sneak in under the radar will take their homes from elderly people. However, Age Action Ireland has sent a letter to every Fianna Fáil Deputy to alert them to what the Minister is doing. I wonder what they will do when the legislation is voted on in two weeks. The Minister is taking away their homes and there is nothing else to it. The Leas Cross report, which the Minister refuses to publish, shows that the Government and the HSE are a disgrace. They have neglected patient care in an unbelievable manner. That is why they are hiding behind lawyers and claiming the report cannot be published because of the people who are named in it. The only people named in it as a disgrace, and I have read it, are the Government and the HSE.

There is also the report on P. J. Walsh, the elderly man who was allowed to bleed to death. I asked the Minister, Deputy Harney, priority questions about it but the answer was so comprehensive that I have had to submit six further parliamentary questions to get answers. If I get an answer from the Minister, Deputy Harney, to a question, I will be bowled over. I never get answers, only waffle. After the two speeches this evening, I am sure I will be able to put down another 20 parliamentary questions.

The Minister cannot claim that the home care packages look after patients. There are no occupational therapists, community physiotherapists or speech therapists for patients in the community who have suffered strokes. The home care package gives the idea that patients are being looked after. Elderly patients are being sent home from hospital with PEG tubes, where a tube is inserted into the person's stomach and they are fed with a bottle through that tube. One must be careful that one does not put in too much, that one does not put the substance in too fast or that one does not make the patient sick.

Elderly men and women in their 70s and 80s are being asked to look after spouses on PEG feeding. They are not qualified nurses and they were not qualified 20 years ago. However, the HSE says that if they get a nurse, it will give them the home care package. It is stretching the imagination to consider this a progressive policy. It is dangerous and patients' lives are being put at serious risk. The Minister is paying no attention to what is happening. She is simply full of waffle and daft proposals. The home care packages will work for a certain number of people but they are not the ultimate solution the Minister thinks. She is putting patients at serious risk.

With regard to the 800 additional nursing home beds the Minister is currently contracting as part of the winter initiative, I believe she is looking for the beds in Westmeath and, perhaps, in east Galway. There are no nursing home beds available anywhere else. Where the Minister is sourcing the 800 beds will be the subject of another parliamentary question. I heard on the grapevine that she is seeking these beds in Westmeath, which will be great for a family from Fingal, Ballymun or Darndale. The family will have to visit their elderly relative in a nursing home 30 miles beyond Athlone on the Galway road. I am sure plenty of people will be willing to take those beds.

The Minister has allowed this bad situation to build up and is now trying to deal with it through the winter initiative as a pre-election problem. The Minister has neglected to deal with the problem in the last couple of years and has made a right mess of the health service. In the amendment, the Minister commends the Government on the measures it is promoting to improve access for public patients to acute hospital care. Three to five years waiting for an orthopaedic appointment is not improving access to acute hospital services. It is a two to three year wait for ENT services.

Procedures to test for cancer and heart disease are not being carried out. They are regularly cancelled because the Minister has made a mess of the acute hospital service. She claims to be doing something about the trolley crisis but she is disregarding other patients. It is the most cynical attempt I have seen by a Government to try to win an election. It is cynical and sickening. We support the motion because we wish to speak the truth about what is happening.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I am pleased to support the Labour Party motion. Of course, the Irish people are entitled to a health service that will deliver excellence, equality and efficiency and in which a person's financial means is not a barrier to receiving the most appropriate and best medical treatment. The health service should be treated as a community service.

The Minister of State, Deputy Tim O'Malley, is responsible for disability and mental health services but he did not mention mental health in his speech. One in four people at some stage of their life will suffer a psychiatric illness. The level of service in the psychiatric services is deplorable, yet throughout the Minister of State's speech on the health service, he did not mention psychiatric services. Mental illness can be debilitating and occasionally life threatening, as is the case with physical illness.

The impact of conditions such as depression, anorexia or schizophrenia extends beyond the individual to families and communities and can be the cause of great unhappiness. Although mental health is central to our well-being, the treatment of mental illness and the promotion of good mental health do not receive the same attention, investment and resources as physical illness.

It is over 20 years since the report on the mental health services, Planning for the Future, was adopted as Government policy. The cornerstone of the recommendations in that report was the establishment of multi-professional teams for service delivery in the psychiatric services. However, as the report from the Mental Health Commission stated two months ago, nowhere in this country have fully staffed teams been delivered. Community based care was another central feature of Planning for the Future. However, admission rates do not reflect a substantial shift in focus to a community approach and readmission rates are persistently high.

Large tranches of the 20 year old report have still not been implemented. The Government must be held accountable by the public for its failure to implement this national policy and the reduction in the proportion of the health budget allocated to mental health from 11% in 1997 to 7% in 2006. This report was accepted as party policy 22 years ago but was not implemented. Last January, a new report, A Vision for Change, was accepted and the Minister says it will be implemented. How can we have confidence that it will be done if a 22 year old report, 50% of which was included in A Vision for Change, was not implemented?

There are still not enough beds for those who need them, resulting in young teenagers being treated in adult psychiatric wards. This happens in the Minister's constituency in Limerick. There are still no early intervention programmes which would make a real difference for those who develop serious illness.

Fine Gael and the Labour Party have committed themselves, in government, to delivering an effective and well resourced mental health programme that will be directed as a policy towards recovery. Recovery involves a way of living a satisfying, hopeful and productive life even within the limitations caused by psychiatric illness. The proposed policy of Fine Gael and the Labour Party will build and foster positive mental health across the community and provide accessible, community based, fully staffed, multi-disciplinary services for people with mental illness. The provision of these services will be brought at least to a par with the provision of general health services, both in hospital and community services.

The commitments include putting in place multi-disciplinary community mental health teams, thus reducing the need for inpatient care. Early and consistent intervention is the most effective way of helping those experiencing mental illness to recover or to manage their personal situation. The Minister must close the psychiatric institutions that are inappropriate for their purposes, as he promised in March 2005. However, a reply to a parliamentary question I tabled last May — 14 months after the announcement was made — indicated that not one institution was identified.