Dáil debates
Wednesday, 25 October 2006
Private Members' Business
Health Services: Motion (Resumed).
5:00 am
Joe Callanan (Galway East, Fianna Fail)
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I wish to share time with Deputies O'Connor, Devins, Fiona O'Malley, Fitzpatrick and Moloney.
Jan O'Sullivan (Limerick East, Labour)
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Is that agreed? Agreed.
Joe Callanan (Galway East, Fianna Fail)
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I wish to speak about services for the elderly. It is the Department's policy to maintain older people in dignity and independence at home in accordance with their wishes and at the same provide high quality residential care for them when they can no longer be maintained in this manner. The Government's commitment to the development of a range of services for older people can be demonstrated clearly by outlining the resources made available in recent years. Between 1997 and 2005, inclusive, additional spending on health care services was in excess of €302 million. Funding is provided through the carer's allowance and carer's benefit. I welcome the changes that have been made to these payments. The carer's allowance was extended to 24 months and the disregard pertaining thereto allows many more people to become eligible. The respite grant is very welcome.
The home help service, which is the cornerstone of community-based care for older people, is delivered as part of the community support service. This service is targeted at high and medium dependency clients according to need. An additional €33 million was allocated for this programme in the budget for 2006 and it is being used to provide 1.7 million more home help hours this year. The HSE has reported that the programme is on target. There has been significant demand for home help due to the increasing number of older people living in the community.
Provision for home help services is critical to supporting older people at home, preventing admissions to acute services, delaying admissions, continuing care and facilitating early discharge from the acute hospital sector to the community.
On community services, there has been a significant increase in the resources made available to the meals-on-wheels service. An additional €10 million was spent on the service in 2004 and additional funding of €2.5 million was provided in 2005, together with a further €2.5 million this year. This amounts to an increase of 50% over the figure for 2004. The meals-on-wheels service is one of a range of services that can support older living in their own homes.
I congratulate Ballinasloe Social Services on its 25th anniversary last week. The chairman, Sr. Alacoque, and the chief executive officer, Theresa Coughlan, are doing wonderful work keeping people out of hospitals.
Funding for nursing home subventions has been increased but we in the west have difficulty with the amount being paid there compared to the east and south. The rate in the west is far less than half that in the east and this is causing serious difficulties for those with parents in nursing homes in the west. I ask the Minister to review the way in which the subvention is paid and to make it fairer.
I welcome the proposals to build a new unit at St. Brendan's Geriatric Hospital in Loughrea and a new community nursing home in Ballinasloe. The new beds will be very welcome as the waiting list for public geriatric care in County Galway is very long. I compliment the staff of St. Brendan's on the great care they are providing to the elderly. I welcome the new health campus for Tuam, which can be used as a step-down facility for the Galway hospitals.
Some €55 million has been allocated for home care packages based on the 1,100 pilot care schemes in place by the end of 2005. They are delivering a wide range of services. It is planned that an additional 2,000 packages will be in place by the end of 2006.
The HSE has advised that 1,800 new clients were in receipt of home care in the first six months of this year. Home care packages are targeted at those in the community who would otherwise require admission to residential care. The packages vary according to the care needs of the individual, which may include the services of nurses, home care attendants, home helps and various therapists, including physiotherapists and occupational therapists. These packages are delivered through the HSE for a range of providers, including the HSE itself, voluntary groups and private sector organisations.
Charlie O'Connor (Dublin South West, Fianna Fail)
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I welcome the opportunity to make a brief contribution to this very important debate. I had intended to spend my five minutes talking about a range of national issues and support my colleague Deputy Fiona O'Malley in respect of Loughlinstown. However, no debate on health, this week or any other week, could go ahead without some mention of Tallaght Hospital, of which I am very proud.
I will not rehash the point I made repeatedly over recent weeks, particularly at meetings of the Joint Committee on Health and Children, chaired by Deputy Moloney. Suffice it to say that this is not just an issue for Tallaght but also for the Dublin region, Meath, Kildare and Wicklow. We need clarity regarding what is to happen. The decision to situate the major children's hospital on the site of the Mater has been made. I live within the shadow of Tallaght Hospital and have been involved in the project since 1988 when I was first appointed to the board by the then Minister for Health, Deputy O'Hanlon. He made a good choice.
Charlie O'Connor (Dublin South West, Fianna Fail)
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He was a very far-sighted Minister for Health.
In 1998, I was involved with the board that opened the hospital. We were very clear that the National Children's Hospital would be an integral part of the Tallaght Hospital operation. We now need to know how to proceed. What will be the future of children's services in Tallaght Hospital? The bottom line for my community, with whom I have marched, is that children's services must be retained at the hospital. As Archbishop Eames told the Taoiseach, they must also be developed.
I will not repeat the points I made at the meetings of the joint committee but it is very important that I make clear my strong views and express my support for Tallaght Hospital. Even if I were not living in or representing Tallaght, I would still take the view that the hospital should be the chosen site for the National Children's Hospital. It meets all the criteria and the HSE decision has confused many people. It was a flawed decision.
Let me make a few other points on the future of Tallaght Hospital. As one will know, it was formed in 1998 through the charter by amalgamating the Adelaide and Meath hospitals and the National Children's Hospital. Its catchment area includes Tallaght, which is the third largest population centre in the country, and also stretches through north Kildare and Wicklow.
I have a number of worries regarding the development of services at Tallaght Hospital. It is important that cancer services remain in the hospital when the proposed cancer services review is completed next year.
There has been much talk in recent times about accident and emergency services, and Tallaght Hospital has had its difficulties in this regard. As one who lives in and represents Tallaght, I believe the new 39-bed transition unit, which was opened recently, is being used mainly by patients from the accident and emergency department whose length of stay is anticipated to be less than five days. I am glad that, since the opening of the unit, the number of patients waiting over night in the accident and emergency department has dropped significantly. We should all welcome this move.
The Minister for Health and Children stated last night that an extra 100 beds will be made available for public patients in Tallaght Hospital arising from the initiative she announced. This is positive news. However, I am unhappy about and agitated over the children's services issue, which needs to be clarified. I want the HSE to outline to the community in Tallaght and elsewhere the future of the services and state how they are to be developed.
Jimmy Devins (Sligo-Leitrim, Fianna Fail)
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I am delighted to have an opportunity to speak on this Private Members' motion on the health service, which has been proposed by the Labour Party.
Joe Sherlock (Cork East, Labour)
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Is the Deputy in favour of it?
Jimmy Devins (Sligo-Leitrim, Fianna Fail)
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As the Minister for Health and Children stated last night, this motion is not just black and white — it is all black, unfortunately. That is no surprise because members of the Labour Party frequently speak about this country's health service in a negative fashion. I often wonder whether they are living in the real world. There are problems in the health service, but they are being dealt with. Over the past 12 months, an increasing number of people who have used the health service have told me how satisfied they are with it. I am sure the other Deputies in the House have had the same experience. One of the most poignant episodes I encountered recently was when I met an elderly lady who had been having treatment for cancer in Sligo General Hospital over a period of time. Her life had not been easy, especially during the recent past, as she had been in constant pain for some time. When I met her some weeks ago, she praised the treatment she received and the courtesy that was extended to her by the staff of the hospital. I have noticed this trend to an increasing extent over recent months. In most cases, people who have had contact with the health service, at primary level or in a hospital setting, have told me they were more satisfied with the service than they were in the past.
There are problems in the health care system, as I have said, and they must be addressed. One of the problems I have encountered is the length of time patients have to wait to be called to outpatient clinics. Such problems occur in just a few specialties, because matters have improved recently. We have all noticed the great effect the National Treatment Purchase Fund has had on the length of time patients have to wait for operations. The dramatic reduction in waiting times can be attributed in no small measure to the work of the fund. I wonder whether a similar scheme might be considered for patients who have been on outpatient waiting lists for a long time. Most hospitals operate emergency waiting lists for medical or surgical emergencies. The stress and pain encountered by people whose cases are not considered emergencies, but who have to wait a long time to be called for a first consultation, can be very debilitating in many instances. I would welcome an innovative approach that would help to shorten such waiting lists, perhaps like that adopted in the National Treatment Purchase Fund.
In the remaining time available to me, I would like to speak about the overall work of the Health Service Executive. Along with many of my colleagues from the west, I attended a briefing by the western section of the HSE in Leinster House this morning. Two Deputies left the meeting early, unfortunately. I do not know whether they left because they had other things to do — perhaps their departure could be considered as a walk-out. I said at that meeting, as I have said in this Chamber on previous occasions, that I have an excellent relationship with the people who work for the HSE in Sligo and Manorhamilton. If I have a problem or a query, it is attended to in a speedy and courteous fashion. I might not always like the answers I am given, but I cannot deny that the staff of the HSE are available and responsive. It seems there are difficulties in the communication between the various local offices and the central governing body of the HSE. I accept that such matters have improved, but it was not before time. I ask the Minister for Health and Children to use her offices to facilitate further improvements in this regard. The HSE was established to offer the best possible service to the users of the health system — patients and their families. Any logjam or lack of communication between local services and national issues must be avoided. I commend the Minister's amendment to the House.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I am pleased to have an opportunity to speak about this motion. It is important to be guided by an ideology in politics, but we need to ensure we do not become slaves to our ideologies. The Minister for Health and Children is always criticised, unfortunately, by those who accuse her of being a slave to, or guided by, a particular ideology.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I suggest that the Opposition is completely enslaved by its ideology. The initiative of the Minister for Health and Children in increasing the number of public beds in this country has been completely misinterpreted. I prefer to call it a "reclamation project" because it involves the reclamation of 1,000 public beds, exclusively for the public health service, and needs to be recognised as such. Those who use some warped form of logic like to refer to it as privatisation, however, which does not make any sense. Some 1,000 beds, which are currently subsidised and designated for exclusive use by the private sector, are to be returned to the exclusive use of the public health system. That is what this initiative is actually all about. Those who interpret this policy in any other way are doing it a disservice. They are scaring the public by suggesting that the number of available beds is decreasing.
Joe Sherlock (Cork East, Labour)
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The Deputy does not believe in privatisation at all.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I cannot believe that the Labour Party wants to perpetuate a system that provides for reserved and subsidised private beds in the publicly funded system.
Finian McGrath (Dublin North Central, Independent)
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I blame Deputy Fitzpatrick.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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The Labour Party should think about what it is looking for. I am not sure it has really thought through its position.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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It has given a knee-jerk reaction to a policy initiative that is demonstrably delivering treatment to and shorter waiting times for the public. That is an example of ideology getting in the way of the perception of service delivery. The Minister's National Treatment Purchase Fund initiative has proven that services can be bought privately in certain circumstances. Why not buy them in such circumstances? What difference does it make to someone aged 60 or 80, for example, who has been waiting for a hip operation for many months or years?
James Breen (Clare, Independent)
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They might have been waiting that long in an accident and emergency department.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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They do not care who is delivering the service as long as they are getting it. That is what is important. The duty of the Minister for Health and Children, the Government and the Parliament is to improve the provision of services to all the citizens of this country and to ensure they get the best value and the best service available. That is what the Minister, Deputy Harney, has proven capable of doing and she will continue to do so.
Finian McGrath (Dublin North Central, Independent)
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She has not delivered.
Michael Ahern (Cork East, Fianna Fail)
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We will see in a few years time.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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If anybody else is in charge of the health care service following the next general election, we will wait and see whether they will halt the progress that is well under way.
Finian McGrath (Dublin North Central, Independent)
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She has not delivered in nine years.
John Curran (Dublin Mid West, Fianna Fail)
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She has delivered in most areas.
Michael Ahern (Cork East, Fianna Fail)
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The Government has delivered.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I noticed when I was——
Finian McGrath (Dublin North Central, Independent)
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She has not delivered on the health issue, as Deputy Curran knows.
John Curran (Dublin Mid West, Fianna Fail)
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She absolutely has.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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——listening to the radio this afternoon that Deputy Twomey was in conversation with the Minister.
Finian McGrath (Dublin North Central, Independent)
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I will tell the Deputy the facts.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy O'Malley, without interruption.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I thank the Chair. When Deputy Twomey was in conversation with the Minister, he declined to take the opportunity to indicate that he would halt the progress that is under way.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I suppose part of the reason he declined to take that opportunity is that he has not yet cut a deal with his putative partners in government.
Liam Twomey (Wexford, Fine Gael)
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Nothing was declined. The Government will not say how it will pay for its policy.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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That is not a point of order.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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The difficulty is that the people cannot wait for a health policy to be thrown together——
Liam Twomey (Wexford, Fine Gael)
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The Deputy should tell the truth.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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——by two parties which will not be able to make up the numbers to form a Government.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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Such a Government would possibly be supported by the Green Party, but we do not know what its policies are.
John Gormley (Dublin South East, Green Party)
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The Deputy should take the time to familiarise herself with them.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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The people do not have time to wait for such policies be drawn up.
John Gormley (Dublin South East, Green Party)
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The Deputy does not know what she is saying.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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Progress is well under way under the systems which have been in place for some time.
Liam Twomey (Wexford, Fine Gael)
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We do not know the Progressive Democrats' policies.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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Can the Chair advise me of the amount of time that is remaining?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy has one minute remaining.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I do not want to take too much time.
Séamus Healy (Tipperary South, Independent)
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The Deputy should sit down.
Liam Twomey (Wexford, Fine Gael)
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The Members are laughing at her.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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The project that is under way is truly a project of reclamation. Far from privatising the health service, the Minister is restoring to the public health service some public beds which will be exclusively for the public use. It is time for the Opposition parties to be honest and clear about that fact. They should acknowledge the good work that the Minister is doing.
Liam Twomey (Wexford, Fine Gael)
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Why is the Minister afraid to answer my questions?
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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The Minister is not remotely afraid of the Deputy.
John Curran (Dublin Mid West, Fianna Fail)
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Deputy Twomey should ask a straight question.
Finian McGrath (Dublin North Central, Independent)
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I blame Deputy Fitzpatrick.
Liam Twomey (Wexford, Fine Gael)
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Questions cannot get much straighter than those I have asked the Minister, Deputy Harney.
John Curran (Dublin Mid West, Fianna Fail)
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She is not afraid to answer questions.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I call Deputy Fitzpatrick.
Liam Twomey (Wexford, Fine Gael)
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She is afraid to answer them. She cannot even answer the questions I have asked her.
Dermot Fitzpatrick (Dublin Central, Fianna Fail)
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Deputy Twomey is usurping my time.
Dermot Fitzpatrick (Dublin Central, Fianna Fail)
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We have an outstanding Minister for Health and Children and I commend her. She has undertaken a trojan task since coming to office.
Finian McGrath (Dublin North Central, Independent)
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This is a trojan horse.
Dermot Fitzpatrick (Dublin Central, Fianna Fail)
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We can see the fruits of this coming through now. Deputy Finian McGrath may not believe me but I am a general practitioner and have seen the amazing changes in the health services since the Minister took office. This is not to denigrate her predecessors who dealt with serious problems and massive inertia in the health board system. The Ceann Comhairle has experience in this regard and if he does not nod in agreement he will understand what I am referring to.
I have the highest regard for Deputy O'Connor and his defence of Tallaght. He made a strong speech in support of Tallaght hospital and the retention of the children's hospital facilities there. However, there is no danger to Tallaght hospital and it will not lose the children's hospital facilities. What we are discussing is the development of a tertiary hospital on the north side of Dublin city.
Finian McGrath (Dublin North Central, Independent)
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Hear, hear.
Dermot Fitzpatrick (Dublin Central, Fianna Fail)
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I thank Deputy McGrath for his support. This is where the bulk of essential surgical, medical and emergency expertise is based, with a tradition going back centuries. The Rotunda Hospital was founded over 250 years ago. I was a member of that hospital's board for some years and was delighted and honoured to serve there. The ethos at the Rotunda Hospital is nearer that of Tallaght hospital than the Mater hospital, Beaumont Hospital, Blanchardstown hospital or Temple Street children's hospital. Yet a recent statement indicates they wish to move their facilities to a Mater hospital campus. A body of expertise and experience is being assembled on the north side of Dublin city with a dedication to the treatment of people unrivalled in Ireland.
I conducted some research recently and found that over 70% of those arriving at hospitals, including the seriously injured, came on foot or by public transport. We will build a metro station under the Mater hospital so talk of access to the new tertiary hospital facility is facetious to say the least. The tertiary hospital discussion has been muddied by people with vested interests, not all of which are in the best interests of the patients they purport to look after.
Deputy Finian McGrath will be interested to hear that neurosurgery facilities for children under five years of age will move to Temple Street children's hospital. This is not because neurosurgical facilities there are better than at Beaumont Hospital, but because over the years a body of expertise, knowledge and experience in anaesthesia dealing with seriously ill children has been built up.
Séamus Healy (Tipperary South, Independent)
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Is there anywhere else in the country other than Dublin? I know of a man from Clonmel who has been unable to gain access to Cork's neurosurgery unit for the past month.
Dermot Fitzpatrick (Dublin Central, Fianna Fail)
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I do not represent the Deputy's constituency. He is well able to look after his own. Let us forget politics and how it arises in medicine; the well-being of the patient must be our primary concern. This Minister for Health and Children is the first to put the patient first and politics second.
John Moloney (Laois-Offaly, Fianna Fail)
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I welcome the position the Minister has taken on this issue and I do not understand why Deputies are agitated and oppose this proposal. Rather than failed policies, a combination of excellent policies have come from the Minister and previous Fianna Fáil Ministers in recent years.
This issue is a reflection on the success of the economy whereby we invite the private sector to become involved in resolving the health service difficulties that have arisen over the years. Through this investment throughout the State we will see more public beds available and, more importantly, better use of health services.
Take, for example, the proposed policy of locating private hospitals on public land. This is something I entirely support and cannot understand why Deputies perceive difficulties with it. In my constituency there is a large land bank beside Portlaoise hospital and I hope to see a private hospital on that ground. I recognise the combination of technical and medical expertise, with other services, that can be used in the private and public sectors to resolve the issue of waiting lists and present greater bed capacity. I wonder why Deputies are opposed to this idea. I even began to wonder if Deputies feared we might resolve the health difficulties too quickly.
Liz McManus (Wicklow, Labour)
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Does the Deputy mean they might be solved in the next six months?
John Moloney (Laois-Offaly, Fianna Fail)
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I believe in the combination of these policies with the Minister for Health and Children inviting the participation of the private sector. Some years ago there was a huge problem relating to beds for the elderly in private nursing homes.
John Moloney (Laois-Offaly, Fianna Fail)
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I do not know what happens in Dublin but in rural areas there are no difficulties in this regard due to the involvement of the private sector in providing nursing home capacity. I can see the same outcomes resulting from this.
Liam Twomey (Wexford, Fine Gael)
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That will be news to the Minister of State at the Department of Communications, Marine and Natural Resources, Deputy Browne.
John Moloney (Laois-Offaly, Fianna Fail)
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I am only concerned with looking after the area of Laois and Offaly. I do not go near Wexford as there is no point. Where I come from the involvement of the private sector has produced excellent dividends and has reduced waiting lists. I can see the same happening with this matter.
Public hospitals and consultants are paid more for private patients in public-funded hospitals through the taxpayer and I believe this is an opportunity to provide extra beds in the system. I wonder how the change of heart came about because previously we were very used to the involvement of the private sector in public health. Take the designation of private and semi-private beds in public hospitals, which is something we have been aware of for years. We had no problem with income tax relief on private health insurance premiums. The same goes for income tax relief on medical and dental expenses and the National Treatment Purchase Fund.
I do not see the proposed initiative as one party in government advancing its ideology. I see it as a building block that will help solve the accident and emergency crisis, bed capacity issues and so on. This is something that should not divide the House; we should welcome it. Local authorities often have difficulty rezoning land banks around hospitals, though the argument is frequently made that rezoning for residential purposes will create funding for hospitals which can cause annoyance in local communities. This initiative could resolve such issues. Land that heretofore belonged to a hospital campus can now be properly used by the Department of Health and Children. This will solve health issues and make better use of health funding. I fully support the Minister for Health and Children's proposal and believe it is one of many Government initiatives to address the health issue. I wish this Administration had more time left to bring all these elements together and resolve the difficulties facing the health service.
John Gormley (Dublin South East, Green Party)
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I see Deputy Fiona O'Malley is leaving. I was about to be very generous by acknowledging that any Minister for Health and Children has an unenviable task. It is not an easy job.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I will stay for this.
John Gormley (Dublin South East, Green Party)
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People in the Opposition may say they would like that job but it is, without doubt, difficult because there are many competing interests. We now have the medical means and technology to keep people alive far longer than previously, and the longer they live the more treatment they will require in the course of a lifetime. This consumes more money. This is why we currently find ourselves in difficulty, but we are not alone. Many countries throughout the European Union and elsewhere have difficulties in their health services. For example, the oft-lauded French system will, by all accounts, be broke within 15 years. That is the stark reality many countries must face.
Having been generous, I need to make some critical remarks.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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I wondered how long the Deputy could maintain his tone.
John Gormley (Dublin South East, Green Party)
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The current Minister introduced the HSE. At the time, I said that it would become another layer of bureaucracy and lead to less transparency and accountability. This is exactly what has happened. The current Minister has also presided over the accident and emergency units. It is ironic that the Minister has struck a blow for equality — regardless of whether one is insured or uninsured, one stands a good chance of ending up on a trolley.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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Does the Deputy note the progress made in accident and emergency units?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow Deputy Gormley to continue without interruption.
John Gormley (Dublin South East, Green Party)
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Accident and emergency units, particularly in some parts of this city, are overflowing. Deputy O'Malley mentioned progress. I would like her to explain that progress to some of the people waiting on those trolleys.
I have tabled a question to the Minister asking what preparations have been made for the winter. Promises were made not just by the Minister, but also by the HSE——
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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Did the Deputy not see the statement made by the IMO last week?
John Gormley (Dublin South East, Green Party)
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——and very little progress has been made. We have a capacity problem which the Minister and the HSE refuse to recognise.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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They are seeking to address it.
John Gormley (Dublin South East, Green Party)
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It is not rocket science. Bed capacity in this country has been reduced by 25% over many years and our population has increased by 25% in the meantime. Therefore, we have a problem and need to address it by providing more capacity.
The Deputy's spin on this was wonderful. She said more capacity could be provided by investing in the private sector.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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We are claiming private beds for public use.
John Gormley (Dublin South East, Green Party)
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The Deputy's heartfelt plea and concern for public patients tugged at my heartstrings. It amounts to nothing but spin. The Deputy's party represents the private sector; the party is concerned with the private patient.
Fiona O'Malley (Dún Laoghaire, Progressive Democrats)
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Our party is one that presents opportunities and solutions.
John Gormley (Dublin South East, Green Party)
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If the Deputy really believed in equality, and in the lot of the public patient, why will she not advocate a common waiting list? Would that not make sense? Those who have money get treated first and those that do not have money are left until last. This is the reality. The Deputy's party would not introduce such a waiting list. The Deputy asked what the Green Party is about. We really believe in equality. Nobody has the guts to stand up and call for a common waiting list. This is where the real inequality lies in our system and it is totally and utterly unacceptable.
Many of our accident and emergency units are clogged up at the weekend with people who have consumed too much alcohol. Many illnesses we observe in our hospitals are related to alcohol consumption. In terms of absenteeism and anti-social behaviour, the consequences of alcohol consumption are costing us billions of euro every year. The Minister of Health and Children and the Government have not faced up to that reality.
The alcohol products Bill was promised by Deputy Martin when he was Minister for Health and Children. It was on the programme of promised legislation but was removed at the behest of the alcohol industry. That was both irresponsible and wrong. Facing up to the realities of alcohol consumption is something that most Deputies here would advocate. Warnings should be put on alcohol bottles. The revival of this Bill is something about which Deputy O'Malley should speak to her party colleague, the Minister.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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On behalf of Sinn Féin, I support the motion in the name of the Labour Members. The privatisation of our hospital services by the Fianna Fáil-Progressive Democrats Government is something we in Sinn Féin have been campaigning strongly against for months. On Saturday last, we organised a major rally in Dublin demanding health care rights for all. One of the main themes was our opposition to the Minister of Health and Children, Deputy Harney's outrageous plan to allocate land at public hospital sites, as well as massive tax breaks, to the developers of private for-profit hospitals.
On 9 August, we held protests at most of the ten sites nominated for this co-location plan. Today, a new private hospital, subsidised by the Government with tax breaks, was opened in Sandyford in Dublin. This is run by Beacon, part of the Beacon-Triad group with a massive parent health care company in the United States. It is reported that the parent company has had to pay $1.7 billion to the US Justice Department arising out of civil and criminal cases against it. These same privateers are among the bidders to develop private hospitals on six of the Minister's ten sites. All the Minister and the Taoiseach can do when they are asked about this in the Dáil is parrot the company's denial. However, the facts are there and I believe they will come back to haunt the Government. More importantly, if they persist with this plan, the privateers will further damage our ailing health services.
Today, on the same day as this new Beacon Hospital opened, we learned that planning permission has been granted for a luxury new private hospital in the grounds of Adare Manor in County Limerick. We are told it will be set in rolling parkland with 100 private rooms, each with a flat screen television and Internet access. It will have six operating theatres, two radiology suites and 30 consultant suites. An Irish-American businessman and BMI Healthcare, a leading private hospital company in Britain, will operate it. These developers have also submitted bids for the co-located private hospital in the grounds of Limerick Regional Hospital.
Are members of the Fianna Fáil Party happy that the two-tier system of hospital care in this State is now being reinforced by their Progressive Democrats Minister for Health and Children? The Fianna Fáil election manifesto, on which they sought their mandate in 2002, pledged to end the two-tier system. Are they happy with circumstances where older people who have worked all their lives and are in poor circumstances in their twilight years must endure the indignities and dangers of our public hospital accident and emergency units and wards while the privileged few can book into luxury hospitals with televisions and computers in every room? Is that the legacy of a party that calls itself republican?
The Labour Party motion is worthy of support and I commend it on tabling it. I now turn to their colleagues in the proposed rainbow alternative. I find it curious that the Fine Gael Deputies did not co-sign the motion as has been the practice lately. Today, on the "News at One" on RTE radio, I understand Fine Gael's health spokesperson, Deputy Twomey, for whom I have great respect, avoided the question of whether he, in Government, would stop or reverse the Minister, Deputy Harney's private hospital co-location scheme. He was not specific and precise in his reply.
Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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If that is the case, belated though it is, it must be welcomed. He was careful in his speech last night to repeatedly express his support for private medicine. He should listen more carefully to Dr. John Barton of Portiuncula Hospital, one of the strongest critics of privatisation in our health services and, I understand, a would-be party colleague of Deputy Twomey here after the next general election.
I welcome what Deputy Twomey said about ending private hospital co-location schemes. He is obviously supporting the motion. I urge him to oppose the use of tax incentives to promote, as the motion states, the development of private super-clinics. I have not seen that in Fine Gael policy so far, but I welcome the party's support for the Labour Party motion which includes that reference. However, another Fine Gael Deputy has welcomed the luxury Adare hospital which is subsidised by tax incentives. We need clarity. What is Fine Gael policy and what will be the policy of a Fine Gael-Labour-led administration if one is ever formed? We need to know if they will end tax breaks for private hospitals. That must be spelt out because the public deserve to know.
A world class health service cannot be provided while the public purse subsidises both public and private health care. The private system will always win and under this Minister that is absolutely the case. The system will be world class but only for the privileged few while the rest of us will have to struggle with second class service. That is unacceptable.
Sinn Féin unashamedly supports a universal, publicly provided health service with access for all based on need alone. That is the critical position and I hope it is the Labour Party position and that, in time, good sense will come to Fianna Fáil.
Catherine Murphy (Kildare North, Independent)
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I welcome and support this Private Members' motion. I want to focus on the privatisation of care and the need for health to be treated as a community service. Not only are we moving toward more private hospitals, clinics and nursing homes, we are moving towards a franchise approach to the delivery of home care. We built a home help system through the health boards over many years. It stemmed from volunteerism and was subsequently recognised by a small payment, although the work that was done was never fully rewarded. Often the home help did significantly more hours than he or she was paid for. Instead of building on that system, however, we are moving towards the introduction of a franchise approach.
The website of the Comfort Keepers franchise has a banner that reads "In-home care for seniors and loved ones". It continues:
People are living longer. Society is becoming more mobile as children are living farther away from their parents. Two income families are becoming the norm so nursing homes and assisted living centres are bursting at the seams. While at the same time, an incredible number of elderly people are looking for any means available to avoid going into those nursing homes and retirement centres. They want to remain in their homes. This provides an untapped market for owners of a Comfort Keepers franchise.
The services the company offers include meal preparation, transport to doctors' appointments, light housekeeping and, in some cases, personal care such as bathing, dressing and mobility. A franchise with the company costs around €26,000 plus establishment costs. The company operates in America, Canada, Britain, Ireland, Australia, New Zealand and Singapore. In highlighting this I am questioning the philosophy that drives such decisions. We are truly becoming the 53rd state. While there is much to be admired about America, its health service is not something to emulate.
Séamus Healy (Tipperary South, Independent)
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I support the Labour Party motion. In addressing the motion, I say shame on the Taoiseach, who last week had the audacity to blame health service workers for the mess his Government and Ministers have made of the health service in this country. I can tell the Taoiseach that health service workers, with whom I have worked for 21 years in the acute services, work above and beyond the call of duty. The Taoiseach and Government should place the blame where it lies — on the shoulders of the Taoiseach, the Government and the procession of Ministers for Health and Children over the last ten years.
This motion calls for the Irish people to be entitled to a health service that delivers excellence, quality and efficiency and that financial means must not be a barrier to receiving the highest quality of care. A number of areas where there is a shameful lack of attention must be addressed. The BreastCheck programme has not been fully rolled out, particularly in the south. In south Tipperary there is a long waiting list for services such as orthodontics. The standards in the service are totally out of date and huge numbers of children cannot avail of it. Their parents are forced to pay thousands of euros for their children. I regularly come across elderly people looking for hearing aids; the waiting list for a 78 year old man for a hearing aid is 15 months.
Paudge Connolly (Cavan-Monaghan, Independent)
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I welcome the opportunity to speak on this motion and I support it. People referred to change for the better earlier. The people of Monaghan have not seen change for the better, as 10,000 residents who recently took to the streets would attest. While this debate is about public and private hospitals, we in Monaghan are not in a position to reject either type. I would accept either and would help to identify a site for one.
The recent Teamwork report on hospital services in the north east is supposed to be a national blueprint but the report fails in a number of areas. There was no consultation with consultants, staff or GPs, those at the coalface. They were left out of the loop but these are the people who are expected to deliver these services. It was a case of Teamwork knows best.
We were told by Professor Drumm that Teamwork ignored all previous reports. That was careless, to put it mildly, or perhaps the group simply dusted down a version of the failed British model. It is incredible that Teamwork also ignored CAWT, the cross-Border health body. We are supposed to accept this as the best way forward but I find that difficult.
We are also supposed to accept the closure of intensive care units in each of the four hospitals in the north east and their move to Our Lady of Lourdes Hospital in Drogheda. Is that the best way forward, to send people to a hospital that regularly has 10% to 15% of the national trolley count and appeals to people not to attend because it is full to the gills? Professor Drumm has said that the people of Monaghan are scaremongering, even though 17 people died when the hospital was taken off call. Thankfully it is back on medical call, although I would like to see it on surgical call.
Tonight's debate is about public and private hospitals. Before any decision is made, I call on the Government to consider the system operated by InterHealth Canada, a private company that builds hospitals for the public health system. There are models in Canada, the UAE and the Turks and Caicos Islands. The company opened an NHS hospital in Cheshire on 5 October.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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There are less than two minutes remaining in the slot.
James Breen (Clare, Independent)
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I will try to get through my contribution as quickly as possible.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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At 7.50 p.m. I must move to the Labour Party.
Paudge Connolly (Cavan-Monaghan, Independent)
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On a point of order, we have only used six minutes and 15 seconds.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy is getting a bonus because the Government side had 30 seconds to spare so the Independent Deputies are getting the benefit of that time.
James Breen (Clare, Independent)
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Now the Government is in pre-election mode and the budget is almost upon us, I presume we can expect to see grandiose public announcements of promises and proposed projects aimed at curing all the ills in our health service. The reality, unfortunately, is very different.
Successive Ministers for Health and Children in this Government have failed to provide a quality care service for the Irish people. My constituency of Clare provides as bleak a picture as can be found anywhere. This week a Fianna Fáil Senator announced that a CT scanner would soon be installed in Ennis General Hospital. In June I asked the Minister when we could expect to see this machine. Despite the usual promise of an early response from the HSE, no reply ever materialised. The non-reply has become a frequent feature of the HSE. If the scanner is to arrive, I will welcome it but in early September the same Senator promised that architect's plans for Ennis General Hospital would be lodged with Clare County Council within two weeks but no such plans have been lodged.
In Clare, under this Government, there are plans to downgrade Ennis General Hospital's accident and emergency department, leaving the whole of the county dependent on Limerick for doctor-led accident and emergency services. In east Clare there is no 24 hour cover.
Any child seeking orthodontic services faces a trip to Limerick, necessitating extra time off work for a parent who wishes to gain access to this service. There is little hope of treatment due to the shambolic approach of the HSE in recruiting orthodontists. But for the goodwill, commitment and efficiency of Dr. Ted McNamara, young people in the area would have no orthodontic service at all.
Anyone requiring orthopaedic surgery faces a similar fate, having to travel to Tuam, even further away, for assessment. There is then a long wait before treatment. This week I was informed by the hospital in Tuam that the consultant dealing with cases from County Clare has retired and has not been replaced. Consequently, public patients from Clare are now an even lower priority.
There are no maternity services in Clare and the maternity hospital in Limerick has a fine new extension but no staff to run it. It is time the Government took strong action. Proper community based support centres and teams should be established in strategic geographical locations to limit the time lost before emergency assessment and initial treatment are provided. It is time to change the training culture for surgeons and consultants. Shift work must be made part of their working conditions in order that theatres can be used seven days per week, including nights and weekends, to eliminate shameful waiting lists.
Jack Wall (Kildare South, Labour)
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I wish to share time with Deputies Burton, Sherlock and Lynch.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Is that agreed? Agreed.
Jack Wall (Kildare South, Labour)
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I welcome the motion and congratulate the Labour Party spokesperson on health, Deputy McManus, on tabling it. What difference will the Government's strategy on health make to constituents who seek assistance in having care provided for their loved ones? It will not make an iota of a difference to senior citizens because they will continue to attend accident and emergency departments seeking treatment, notwithstanding statements by Ministers that such people should be fined.
The Health Service Executive and Minister for Health and Children have done nothing to facilitate home care for senior citizens. At a meeting on the HSE held in Leinster House 2000 earlier today, I was astonished to hear Fianna Fáil Party Deputies describe the home care package as a disaster. They could not understand how it worked and did not know how to seek information about it. Opposition spokespersons noted that people will have to incur debt to cover the cost of home care packages because the HSE has not yet got its act together to make home care payments.
Similar problems arise with regard to disabled person's grant and essential repairs grant. If people had appropriate facilities, they would be able to stay in their home and would not attend accident and emergency units and hospitals, and would not regularly contribute to overcrowding in our hospitals. The HSE is involved in two aspects of the disabled person's grant. First, it has a role in the assessments carried out by occupational therapists. It may also provide a top-up grant once a local authority approves a grant. This would be good if it worked but the HSE will refuse to award a top-up grant to assist an applicant seeking to have facilities installed to improve his or her quality of life at home because it waits until a local authority signs off on the initial loan. As a result, if the facility sought by the applicant is deemed to be above the threshold specified in the 2000 regulations, the applicant must try to raise a loan.
Senior citizens are not in a position to secure a loan of €8,000 or €9,000 but when they apply to the HSE for a top-up loan they are informed the application will not be considered until the disabled person's grant has been signed off by the local authority. This means the disabled person's grant cannot be drawn down by the applicant because no builder will take on a job if its costs are not fully covered by the grant.
The same problems arise with the essential repairs grant. Senior citizens who wish to stay at home are unable to obtain grants which would enable them to do so. In addition, no new claims for home help services are being accepted because of an unresolved industrial dispute. The poor legislation on nursing home subventions before the House will not address problems in this area but will create further problems for senior citizens who wish to remain at home.
At the same time, prime lands in public hospital grounds are being sold. In my area, independent living units for senior citizens have been provided. Instead of building private hospitals, would it not be preferable if the HSE made land available to provide independent living accommodation for senior citizens? This would give them security and comfort in the knowledge that help was close at hand. There is no logic in the argument made by the Government side. Unless we clean up our act as regards providing care and supports to senior citizens, the crisis in accident and emergency departments will persist.
Joan Burton (Dublin West, Labour)
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I thank my colleague, Deputy McManus, for raising this important issue. One of the features that mark out a society is how it treats its poorest members and those in greatest need, particularly in areas such as health. The Government's approach has been characterised by a form of schizophrenia. Fianna Fáil appears to want to take a populist approach in which it emphasises health services for everybody whereas the ideology of the Progressive Democrats requires that public services be privatised, even if they function well. The mechanism by which the latter party has chosen to do this is to provide extraordinarily generous tax breaks for people who invest in the health care industry.
The issue is no longer one of health care but one of investment opportunities, property development and the health care industry. Labour Party members are not foolish. While we are aware that in today's economy and in the era of globalisation the health care industry has become global, the issue here is to decide what is best for Ireland.
Last night, the Minister referred to Dean Swift founding a hospital at St. Patrick's Cathedral as a private initiative several hundred years ago. The truth is that well-off or religiously inclined people provided for the common and public good at that time. Dean Swift did not take a punt on an investment worth €100 million in the grounds of Blanchardstown hospital. He was motivated by a concern to provide for the poor and indigent in Dublin.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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He left the money in his will.
8:00 am
Joan Burton (Dublin West, Labour)
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The Minister of State probably shares my concerns. The Minister alluded to Dean Swift's involvement in establishing a hospital. It was a private hospital under a charitable structure which reflected the fact that he was a Protestant clergyman. Like the Rotunda Hospital, a number of voluntary hospitals and the religious hospitals founded from the 19th century onwards by various Catholic religious orders, the hospital established by Dean Swift was a private institution formed for the public good. It is important to clarify that point.
The tax breaks for investors will benefit prominent individuals such as Mr. Goodman who has considerable expertise as a trader in cattle and beef on international markets. Mr. Goodman has amassed a large fortune and is a great businessman. Hospital care requires an ethical framework and its purpose must be to provide the highest possible standard of long-term public care for the maximum number of people. The tax breaks apply to buildings; they do not relate to care but to investment in the built structure. The buildings must be retained for up to 15 years. After a long debate with the Minister for Finance, he extended to 15 years the period that the institution, old person's home, sports injury clinic or hospital must stay as a caring institution. All the international evidence, including the New England Journal of Medicine and the studies carried out in the United States, show that the quality and outcomes of care in an institution, whether publicly or privately owned, which has a basic framework of providing for the public good, are of a far higher order than in an institution or hospital which has been developed simply and solely to take advantage of tax breaks for buildings.
Blanchardstown Hospital has had a great tradition of care since it was founded in the 1950s. Given the extraordinary population of the area it is amazing that the hospital has no dedicated tertiary facilities for children. Blanchardstown has a huge and growing population which requires services such as visiting consultants and so forth. This could be done through public provision and not only through a private hospital.
Joe Sherlock (Cork East, Labour)
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I wish to discuss the Health Act 2004. This was passed by the Dáil to provide for the construction of private health care facilities, including hospitals and nursing homes, on the grounds of public hospitals. Fianna Fáil Ministers and Deputies are implementing this legislation in the interests of the wealthy. This is being said by the public. The public is also saying the Fianna Fáil Party is being easily led on this question.
It is proposed to build a private hospital on the grounds of Cork University Hospital. Contrast this with Mallow, where a day procedure unit was promised in 2002 and has not yet been provided. Moreover, Mallow General Hospital serves a population of 90,000 to 100,000, with rapid growth in the area. In some instances people must wait up to two years for public services but consultants will tell patients that if they were private patients they would be treated within one or two weeks. That is not an exaggeration but a statement of fact.
Despite this, however, I am informed by the Health Service Executive that plans are underway to review the provision of acute general hospital services in the southern region, which includes Mallow. I have made repeated requests for the terms of reference of that review but to no avail. Perhaps the Minister of State will let me have those terms of reference. I am also informed that the committee undertaking the review will be chaired by a professor who is already the subject of an investigation by the Higher Education Authority relating to Cork University Hospital. The Minister should think about how that person will emerge from the investigation being undertaken by the HEA. It could be a serious matter.
More people are being forced into private nursing homes because of the lack of community beds yet the Government and the HSE have made no effort to standardise the subvention provided across the country.
Kathleen Lynch (Cork North Central, Labour)
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I have listened to the debate since last night and clearly Deputy McManus has her finger on the pulse. The reaction to the debate has been significant. The reaction from the Government is even more significant. It is like rearranging deck chairs on the Titanic. As happened with regard to the child care issue during the last by-election, the Government did not know there was a problem until it met the people.
I will speak about the constituency of Cork city which I and the Labour Party represent. Hopefully, we will have increased representation after the next election. There are many problems with the health service in Cork city but I will deal with three. I received a letter recently from a consultant to whom I had written about an elderly gentleman who needed a hip replacement. I will not mention further details. The letter states:
It is with great regret that I have to say that the number of Orthopaedic Surgeons and staff at this hospital is the same as it was when I was an SHO. There are no immediate plans for any increase in surgeons or operating space to deal with the unacceptable waiting times.
The only plan articulated in the last few months was a referral of 300 (out of 3,000) on a waiting list to the NTPF.
I think that any specialist grouping that has looked at the situation in Cork would recommend a ratio of 1 per 30,000 which would lead to a total number of 15 Orthopaedic Surgeons to deal with Cork patients. As long ago as 1994 Comhairle recommended the immediate appointment of 2 surgeons to bring the complement to 8.
Regrettably I can see no immediate end in sight, however I think that representation should be made to the HSE that a ratio of 1 surgeon per 100,000 is unacceptable in this day and age and that the immediate appointment of additional surgeons and theatre space to operate on them is immediately required to deal with this problem.
There is a waiting list of four years to get an appointment to see the surgeon. That is the situation for people who cannot pay and who are in chronic and severe pain. If the Government Deputies continue to tell us that we have an excellent health service, they should read that letter.
Cork also emerges poorly in reports with regard to type 1 diabetes. Approximately 200 children are being treated for the condition in CUH. Until recently, there was a part-time nurse, part-time consultant, part-time dietician and part-time psychological service. There are now two nurses, one of whom is being paid for by the private sector. Although this is a great advance that is gratefully accepted by the parents involved, is this the road we should take? Not only will there be private hospitals, but medical staff will be put into our hospitals by private companies. Their only job will be to monitor how their particular drug is doing.
It is outrageous that parents with children as young as 18 months who are diagnosed with type 1 diabetes are being sent home with a syringe and an orange and told to practise with them. That is not good enough. The outcome for children in the Cork area is not good and is worse than the outcome for children in the Dublin area. However, this Minister for Health and Children does not believe that anybody outside the Pale deserves a health service.
Cork city was promised a new blood transfusion service building to serve the south. It must be ten years ago or longer since that promise was made. Since then there have been two international reports on the issue and a fiasco in the blood transfusion service. Only for the good work of a doctor in Cork that problem would not have been recognised. The nurses in the blood transfusion service in Cork are still operating out of a building where buckets are used to catch the rain leaking through the roof. It appears that because the service in Cork discovered the reason for the infection of blood products and the transmission of hepatitis C to mothers, it is being crucified and there is no end in sight. When will we get what was recommended by two international panels and what the remainder of the country is demanding to ensure that the supply of blood in this country is safe? Is the Minister of State going to inform us that everything is rosy in the garden?
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I wish to put the record straight in respect of the co-location initiative. It is legitimate to conclude that Labour is opposed to the co-location of public and private hospitals and that Fine Gael is in favour of private hospitals, provided they are not co-located with their public counterparts. That seems to be the position of the respective parties offering themselves as an alternative Government.
Pat Rabbitte (Dublin South West, Labour)
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We deserve a more serious response than that.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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The Deputy will receive that response. Labour will not entertain these hospitals and Fine Gael will keep them out of the way.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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That is my summary of this debate.
In practical terms, this means that both parties are quite happy with a system where 45% of elective operations in the public hospital, Tallaght, in Deputy Rabbitte's constituency are private. The Government wants a better deal for public patients. We will free up new beds for public patients at ten public hospitals and we will purchase services for public patients to continue to reduce waiting times for operations, dialysis and MRI scans.
Deputy Twomey claimed that the co-location initiative will cost €2 billion. He maintains that €1 billion in insurance premiums will be transferred to the private sector. If €1 billion is being paid by insurers to public hospitals, that is news to everyone, including me, the hospitals, the Oireachtas, the Comptroller and Auditor General and the boards of the VHI and BUPA.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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The €1 billion paid out by insurance companies is the total of all their payments in respect of tests, bed charges in private hospitals, fees for consultants and outpatient fees. Bed charges in respect of all 2,500 private beds in public hospitals is only one aspect. If Deputy Twomey had read the documentation produced last year in respect of this initiative, he would have seen that the income foregone for the 1,000 beds is calculated at approximately €145 million. The Government stated that this income would be offset by lease payments to the State.
The €2 billion to which Deputy Twomey refers includes what he assumes will be a free transfer of State land. There will be no such transfer. The land will be leased and will earn income for the State. Currently, there is a zero return on that land to the State or to the health system. The flow of money is, therefore, wrong. Many Members previously served on health boards and beheld their vast land banks. It is time we took action and made that land pay a return to the Exchequer and the health service.
Liam Twomey (Wexford, Fine Gael)
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Why is it not used more appropriately?
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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Deputy Burton referred to the Exchequer cost of capital allowances and asked a legitimate question. The Deputy, like the Minister for Health and Children, also referred to Dean Swift. I am obliged to agree with Deputy Burton in respect of one point, namely, that Dean Swift left money in his will to St. Patrick's Hospital as an act of philanthropy. This was a posthumous act of generosity and was not an inter vivos transaction.
Liz McManus (Wicklow, Labour)
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The Minister of State should bring that matter to the attention of the Minister.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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In respect of the cost of capital allowances, we have stated from the outset that we can achieve 1,000 new public beds for a tax cost of approximately €420 million, less than half the full cost. This estimate is conservative and does not take account — in favour of the Government argument — of the VAT and income tax that will accrue to the Exchequer during construction. This rationale is frequently used for film relief, which has attracted strong support on all sides of the House. There is, therefore, no €2 billion. Deputy Twomey's calculations are wrong.
The Minister published the policy direction and supporting documentation relating to this area last year. The latter include details of the investment appraisal framework suggested by Prospectus Consultants for the HSE. I assure the House that, in respect of each co-location proposal, a rigorous value-for-money assessment will be carried out by the HSE to demonstrate the net benefit to the State. The Minister has required this of the HSE from the start and no project can proceed without the value to the State being demonstrated first. The National Development Finance Agency is assisting the Department of Health and Children to ensure that the financial assessment method being applied by the HSE is robust.
Our policy is to achieve the best possible care for all people, using the mix of public and private finance and provision that has been a long-standing feature of our health services.
Liam Twomey (Wexford, Fine Gael)
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If the Minster of State is so sure of his information, why has it not been given to Members on this side of the House?
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I appeal to the Fine Gael and Labour parties to come together and present the people with an honest alternative in respect of this issue.
Liam Twomey (Wexford, Fine Gael)
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The Minister of State should be more honest.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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The Deputy's party——
Liam Twomey (Wexford, Fine Gael)
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I have been seeking information of this sort for six months and the Minister of State has refused to provide it. He is making it up as he goes.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I have provided the Deputy with the information this evening.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Twomey is trespassing on the time allocated for the Labour Party's reply to the debate.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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The Deputy's party cannot continue to oppose the co-location initiative on the basis that private hospitals should be situated elsewhere, while its potential partner in Government does not want private facilities located beside their public counterparts. The two parties are coming from opposite ends of the ideological spectrum. The solution we propose is the only practical one of its kind in respect of bed capacity and the maximum efficiency of hospitals that is available and in the interests of public patients.
Pat Rabbitte (Dublin South West, Labour)
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I wish to share time with Deputy McManus.
I thank Members on all sides of the House who contributed to this extremely important debate. We have just heard a very mischievous contribution from the hybrid Minister, Deputy Brian Lenihan. The trouble with bright people who have reached the Minister of State's stage of life being elected to the House is that they can be thrown any type of brief and be asked to argue any side of the case.
Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I will take that as a compliment.
Pat Rabbitte (Dublin South West, Labour)
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It is intended as such.
The Minister of State does not believe a word of what he just said. He must recognise that Deputy McManus has identified an attempt to engineer a major shift in our health care system towards a for profit model. That is the net issue. The Minister for Health and Children, frustrated at her failures, is attempting to shift the balance of the existing system towards a for-profit model and the Minister of State is well aware that this will be expensive, inefficient and unfair, and will not be in the interests of either taxpayers or patients. That is the scale of the issue with which we are faced. The Minister of State is aware of the public-private mix in our system and knows the history behind the existence of such a mix. He is also aware that the motion is not complaining about the traditional public-private mix, rather it is complaining about the fundamental attempted shift in the provision of health care.
What is happening will undoubtedly exacerbate the problems relating to the two-tier health service that is in place. There is little point in the Minister of State pretending to misunderstand the motion. There is also little point in him pretending that he has not heard, on the doorsteps in his constituency, people's tales of woe, not only regarding their overall concern regarding the crisis in accident and emergency services, trolley queues etc., but also in respect of the fundamental unfairness of offers being made to constituents, taxpayers or citizens with access to the private system to have their treatment fast-tracked while those in the public system must wait indefinitely. In supporting the Minister for Health and Children, the Minister of State will exacerbate that two-tier system and I suspect that he knows that is the case.
The Minister received a fair wind from this side of the House. The scale of distress about the quality of our health service administration meant that people hoped she would be successful in addressing some of the bottlenecks, dealing with the crisis in accident and emergency departments and, in particular, dealing with the problem of queues of people on trolleys. She has failed and she is now striking out in an ideological way to sell off scarce public land for the construction of private hospitals. Entrepreneurs — some of them in the medical profession — will get a massive tax break for building private facilities on scarce public land, the effect of which will be to exacerbate the two-tier health service that currently exists.
Her frustration is understandable. She featured in my local newspaper this week, boasting about the success in tackling the accident and emergency issue in Tallaght Hospital. What actually happened was that the local management of the hospital made provision for 40 extra beds to treat accident and emergency cases in the teeth of opposition from the Department and the Minister. The Minister is now claiming this as one of the jewels in her sparse crown of achievement. I suspect that the Minister of State knows that this quick fix solution will not work. It is the wrong solution. It is not feasible to implement and it will exacerbate the two-tier health service. It will be costly for the taxpayer and will contribute to the running down of the public health service. In any event, it will not work because under the legislation that exists in this country, every citizen is entitled to a hospital bed. Private patients will continue to come through the accident and emergency system into public beds. The consultants will not evacuate them as their contract entitles them to practice in public hospitals.
The Minister of State said that 45% of elective operations in Tallaght Hospital were private. That is higher than I thought, but is not surprising when one thinks about it as the consultants are incentivised to do precisely that. The Government is now set to incentivise them even more. Does the Minister of State think that consultants will evacuate public beds in order to transfer the patients across the corridor to the new shiny hospital? It will not happen. What will happen will be that staff will migrate to the private service and the public health service will be required to pick up the slack. The private sector will cherry pick the straightforward procedures and the complex medical procedures and older people with multiple problems will be left to the public health service. We have scarce public land and we need that land for the construction of step-down care and community care, which is part of the solution to the accident and emergency problem. We badly need the provision of more beds in acute hospitals. The money should be going on these projects and not on incentivising the private sector with massive tax breaks.
I cannot but be impressed with the consultants that I meet around the country. However, the common contract negotiations are dragging on interminably and unconscionably long. The existing contract looks like they wrote it themselves and maybe they did. It must be addressed. There is no sign that this Minister has the skill or the patience to do it. Her predecessor did not even try. The general question of fees in the medical profession is another problem. This morning, the Taoiseach admitted that the promise of providing 200,000 medical cards had been broken. The Government created the doctor-only medical card, but only 12,000 have been taken up. It has not been made known to people that they exist. Meanwhile, people go along to their GP and pay ever-increasing prices. The cost of seeing a GP has risen by 97% since 1997. Some GPs have mainly a medical card client base, but others have the opposite. Some GPs treat people for nothing while others do the opposite. We all know of parents who are afraid to visit the GP because they cannot afford another fee. Until some order is imposed, there is no reason not to resort to a maximum prices order, like for many other professional fees.
Instead of addressing any of these issues that go to the heart of why we have ongoing problems in the health service, the Government is determined to exacerbate the two-tier health service, to dispose of valuable, scarce public land to the private sector, and to engage in the sophistry that we will continue to own the hospitals. We will do nothing of the kind. If the private owners decide to go to the Middle East and advertise for patients at an economic rent, there is nothing the Government can do about it. If they decide to turn the hospital into a supermarket, there is nothing the Government can do about it. Once a scarce public asset is disposed, then that is it. Further division will be created, staff will be induced to enter the private sector and the public sector will be left with the difficult areas. That is why this debate is critical. The people have not yet woken up to the fact that the Minister for Health and Children is trying to engineer a fundamental shift in our health care system to for-profit health care provision. That is not in the interests of our people.
Liz McManus (Wicklow, Labour)
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I thank my Labour Party colleagues for their thoughtful contributions to this debate. I also thank Fine Gael Deputies and Deputies from the Technical Group. However, I would most of all like to thank the Fianna Fáil backbenchers for their contributions. Their united silence was very telling. They did not speak about the privatisation agenda and it is clear they are more in touch with the people than the Minister and the Minister of State, who defended the crazy scheme of handing over scarce resources at taxpayers' expense to private investors. Deputy Moloney was a loyal last man standing in defending the Minister, but he is the Chairman of the Joint Committee on Health and Children.
This is an act of desperation. The Government is facing into a general election and its members know that people will ask them on the doorsteps what happened to all of the promises. What happened to the commitment to end the waiting lists? What happened to the 200,000 medical cards? The accident and emergency crisis still lumbers on. The HSE produced figures today which show that 200 people are on trolleys, 62 of them waiting for over 24 hours, with 24 of them waiting even longer. That is unacceptable, but that is the record. The amendment put forward by the Government shows just how threadbare its standing is on the issue. It talks about HIQA and about regulating nursing homes. None of these things has been done, even though time and again we have asked the Government to release the legislation so that it can be debated in this House and to produce the regulatory framework that is urgently required to ensure that people are protected.
I spoke today to the mother of Michelle Tallon, a mentally handicapped young woman who lost her life in a hospital. The decision at the inquest was that death was due to medical misadventure. This is one patient's tragedy. This woman does not know where to turn. There is no ombudsman or proper regulatory framework for public hospitals or public nursing home beds. None of the commitment made by the Taoiseach in the aftermath of Leas Cross has been delivered. Instead there is a proposal to which the Minister is committed, to privatise what she can within the health service.
It is not good for the health service and it is not good for the majority of patients to have this kind of demarcation and separation and the institutionalisation of a two-tier system. It is a squandering of an opportunity and the Minister of State knows it. He knows that we deserve better. Those of us who are sick, ailing and elderly deserve much better from a Government that has not delivered on its promises and is setting out to destroy the best in our health service. Shame on you.