Dáil debates

Thursday, 29 March 2007

Priority Questions

Hospitals Building Programme.

5:00 pm

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Question 1: To ask the Minister for Health and Children the status of her co-location project to have private hospitals on the grounds of public hospitals; and if she will make a statement on the matter. [12265/07]

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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Question 2: To ask the Minister for Health and Children the terms of the tendering process for co-location of private hospitals on public hospital grounds; her mandate for pursuing this policy; the time-line for signing off on this process; and if she will make a statement on the matter. [12267/07]

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 1 and 2 together.

In July 2005, following Government approval, I issued a policy direction to the Health Service Executive to develop co-located private hospitals on the sites of public hospitals. The aim of this initiative is to transfer private activity from within the public hospital system to new privately-financed and managed facilities and thereby free up approximately 1,000 additional beds for public patients.

The Health Service Executive is at an advanced stage in a public procurement process on the co-location of private hospitals on the sites of public hospitals. I understand that the HSE proposes to issue invitations to tender to the short-listed bidders in the next few days and that tenders are to be returned by the end of April. The HSE will then evaluate the tenders and the successful bidders should be selected in May. Following that a "standstill" period of two weeks is required by procurement law before project agreements can be signed with the successful bidders.

There will be a rigorous value for money assessment of all proposals. Any transaction will be on a commercial basis and will fully protect the public interest. In addition, there will be full adherence to public procurement law and best practice.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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It has been two and a half years since I first stood here facing the Minister in my role as Fine Gael spokesperson on health and children and today will probably be my last day in the present Dáil standing facing her in this role.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I hope Deputy Twomey will be re-elected. He should not be so pessimistic.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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In the present Dáil, it most definitely will be our last time facing each other on this issue. In case we do not get that opportunity again, I wish her well in the election.

As the Minister will be aware, there is outright opposition from my party to the co-location plan. It is a bad plan. I dislike the way the Minister is going about it. She should not sign these contracts unless she has a new consultants' contract. I want to know will that be the case and will she hold off on signing this. I am also concerned that the HSE has full authority in this regard. If that is what she is stating, the HSE could sign these contracts on the day of the election, regardless of what the Government elected that day feels about this. That is a frightening concept.

The Minister is turning her back on the public health care system in seeking this solution and we need to look at a few matters in that regard. First, I ask the Minister to clarify the full costs of this to the taxpayer. If the public system had to pay for these beds it would cost approximately €1 billion. The Minister states that the solution delivers these 1,000 beds in a roundabout way to the taxpayer for €400 million, which is the amount of the tax concessions she is giving for the construction of these private hospitals. Has she taken into account the €286 million estimated in 2007 in charges for maintenance in private and semi-private accommodation in public hospitals and how will this €286 million be replaced for the taxpayer, who must now make up that shortfall within the €14 billion that is spent on the public health care system?

More importantly, it brings to mind what the Taoiseach stated in December last when BUPA was pulling out of Ireland, that he was not going to let BUPA screw the old people. In this situation, because the Minister is not dealing with reforming the public system and making it work, one can see from the Health vote which we dealt with on Wednesday last that each person pays a significant amount of money. We are paying €4.9 billion——

Deputies:

Define the question, please.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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What will this cost the private patient in the long term? The private patient will now end up paying not only €268 million which will be transferred to the private sector but, according to Mr. Finn when he was in front of the Joint Committee on Health and Children, probably double that figure. Does the Minister accept that private patients may find their premiums increasing dramatically because a sum in excess of €500 million will be required?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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First, I thank Deputy Twomey for his good wishes for the forthcoming election. I am not certain we will not have another health Question Time before the Taoiseach goes to the President to dissolve the Dáil. I return his compliments and wish him and all the spokespersons well in the election.

The purpose of this policy is to free up approximately 1,000 beds that are ring-fenced for private patients to use for public patients. The capital cost of providing these beds in a co-located facility is less than 50% of the traditional cost. The cost to the eight hospitals of not getting the money from the insurers is €96 million, as we heard yesterday from Mr. Finn. Therefore, we get 1,000 beds for €96 million. That is incredible value relative to the cost of financing beds. Of course, the reason for that is the nurses, the managers, the administrators, all the people who work with the diagnostics, etc. are already on the public payroll.

I do not understand an approach that favours capital allowances for private hospitals but not if they are beside public hospitals. The reason for this plan is to free up these beds. It is also to keep the doctors on site. It is not an efficient use of key manpower in the health care system to have doctors working in two, three or four hospitals. Travel time alone is an issue. There are a great many issues involved.

The idea here is that one is supposed to complement the other. In Waterford, Sligo and other places, as Deputy Twomey heard, they will use the same entrance. These hospitals, by virtue of the tax allowances, must make services available for public patients at a discounted price. They must accept all patients, not just private patients, from the accident and emergency department. There will be service level agreements between the public and private providers where they will work with each other. They will share profits with the public hospital. This is a win, win situation. That is why it is so strongly supported in all those hospitals.

Deputies:

I ask the Minister to bring her reply to a conclusion.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The greatest guarantor of keeping the cost of health insurance down is competition. One does not keep the cost of health insurance down by restricting the capacity of private beds. If one does that, one is insuring people who cannot get services. That does not make sense. In all markets competition drives innovation and keeps prices down. That is why I welcome the entry to the Irish market of Quinn Direct. As there is a question about insurance, I will deal with that matter then. The changes we must make here to make this market more competitive will guarantee that all consumers with private health insurance get better value for money.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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First, is the Minister aware that there is significant public and, indeed, professional opposition to this project, that she does not have a mandate for what she is doing and that it is surely better practice to ensure that the election is held before any irrevocable decisions are made?

Second, I challenge her statement here that the aim of this plan is to transfer private activity and ask her how she intends to do that. Every patient in the State has an entitlement to a public bed. The vast majority of patients, regardless of whether they are public or private, who come into public hospitals come through accident and emergency departments. If a private patient gets a bed in a public hospital, how does she intend to remove him or her?

What exactly is the loss of funding that will be experienced by public hospitals, which will still see some private patients in beds but will not be able to charge them for those beds? I note, for example, that Beaumont Hospital stated in its most recent report that 40% of its private capacity was used to provide for emergency and isolation cases.

Will the Minister outline the exact position with regard to the consultants' contracts? Does she expect the contracts to allow consultants to work in both types of hospital and to provide private and public care, as is currently the case? How will that be different from the current arrangement, apart from the distance factor? Will she make the terms of the tender available to the Members of this House?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I do not accept that I have no mandate. The Government made a policy decision in 2005 and it is a matter for the HSE to implement it. We do not put the implementation of policy on hold in advance of or during elections.

Everybody is entitled to access the public hospital system. Universal coverage is available in Ireland, which is not the case in other places. At present, however, not everybody accesses the system on the same basis. Those with private health insurance — I understand Deputy McManus published data in that regard — have easier access to the public hospital system, which is not good. I believe everybody should be equal and that is why I disagree with, for example, charges for accident and emergency services. When it comes to the public hospital system, which we are all entitled to use, we should allow access based on medical need and not because some of us have insurance and therefore can get into beds that are ring-fenced for private patients. Recently, I wrote to the HSE to recommend the prioritisation of these beds, many of which are in small or single rooms, for infection control purposes where necessary.

With regard to the charge to the hospitals, I said in my reply to Deputy Twomey that the eight hospitals concerned received €96 million last year for the beds being moved from public to private hospitals. That figure will be the revenue cost to the hospitals, excluding the moneys raised from leasing the land, which exceeds the commercial valuation because of the advantages offered by collocation.

The current contract of employment for consultants, which cannot be broken other than by agreement, gives consultants the right to 20% private practice on public hospital sites. In all eight hospitals, the intention is that the consultations will carry out work on the site and not in the public hospital, in line with their contract. We are seeking to negotiate a new contract with the consultants and the Government extended the period for negotiations by a further three weeks to 17 April because of the optimism expressed by the chairman of the talks. We want to see public-only contracts for public hospitals, which I understand has been well received, and a range of other contracts. Certain existing contracts will have to be red-circled because they cannot be broken except by agreement. I hope we can have a new contract of employment which attracts many of the existing consultants to work in teams under clinical directors and to provide greater flexibility, longer days and different rosters, all of which have been very successful in other hospitals around the world.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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Will the Minister make the terms of the tender available to us?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I do not know whether that information is commercially sensitive but I have no problems with making it available. There are a number of bidders on each site and the HSE is following the new procedures introduced by the Department Finance of negotiating in advance. The process has continued for the past year and has been very successful in terms of addressing many of the issues which concern public hospitals.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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Was that a "Yes"?

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I do not know whether issues of commercial sensitivity arise. There is no question of hiding anything.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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I look forward to receiving a reply.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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Yesterday, Mr. Finn addressed the Select Committee on Health and Children in private session and it is fair to say he was very open in his remarks.