James Reilly (Dublin North, Fine Gael)
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Question 4: To ask the Minister for Health and Children if she made Professor Brendan Drumm and the Health Service Executive aware of the loss of income to hospitals in fees from private patients admitted by new type A public-only consultants, which is estimated to cost in the region of €50 million; and if she will make a statement on the matter. [20549/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not believe that there will, in fact, be a loss of €50 million to public hospitals arising from the new consultants' contract, and I will set out the reasons. A central objective of the new consultants' contract is to improve access for public patients to public hospital services. It ensures, for example, for the first time in public hospitals, that patients needing outpatient or ambulatory diagnostic care will be seen on the basis of medical need, with no distinction between public and private status.

Consultants holding the public-only, type A contract do not undertake any private work and no patient admitted under the care of such a consultant can be accorded private status. Public hospitals may not, therefore, impose a private accommodation charge where a patient is admitted under the care of a type A consultant, nor may another consultant involved in the treatment of such a patient charge a fee. Approximately 560 of 1,550 consultants who have accepted the new contract have this type A contract.

Public hospitals earn income from health insurance companies for private patients admitted only to designated private beds. The only way that the HSE could be at a loss of €50 million, as a result of the new consultants' contract, would be if designated private beds in public hospitals went unoccupied by private patients for a significant part of the year. I do not expect that to happen, because approximately 1,400 consultants will still be in a position to treat private patients in public hospitals. It can be expected that the 980 consultants on the new contract who are allowed private practice, plus the approximately 400 consultants remaining on the old contract, will continue to admit and treat sufficient numbers of patients, so that there will be little, if any, loss of private bed income to the hospitals concerned. Thus, in practical terms, I do not expect a €50 million loss, or any material loss, to public hospitals as a result of the new contract.

James Reilly (Dublin North, Fine Gael)
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Then the Minister disagrees with her Government colleagues who raised the matter at the Committee of Public Accounts. I do not accept what she said, in the sense that if a person is admitted under a particular consultant who is on-call on the night, who is a type A consultant, that patient will be a public patient and that income will be lost to the hospital. Time will tell which of us is right.

Let us consider what has happened in the past, especially in regard to other undertakings that have been given, such as, for example, the plan in 2008 to reduce the reliance on outside consultants. In 2007, a total of €16.45 million was spent in that area and the princely sum of €100,000 was saved in 2008. Can the Minister explain why additional funding for outside consultants is required when she has more than 113,000 people working in the HSE?

Mary Harney (Dublin Mid West, Progressive Democrats)
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There is a misunderstanding. The hospital does not get a fee for every private patient who goes into a public hospital. A hospital only gets a fee for a patient if he or she is in a designated bed and only approximately 20% of beds are private beds. Sometimes half the numbers of patients in a hospital can be private patients but the hospital does not get any fee for them. It can only charge the insurer for the people in the designated private beds. That is a fact. The doctor on the other hand can get a fee regardless of where a patient is located. We sought to eliminate some of the perverse incentives that existed. I make no apology for saying that if taxpayers fund a public hospital in the State, pay for the capital infrastructure, pay for all the staff and the diagnostics then there should not be preferential treatment for one class of citizen over another.

The reliance on consultants is being reduced all the time. Out of a €16 billion budget, by any standards the amount spent on outside consultants is relatively small. We do not have all the expertise in the public sector. It is not uncommon across the public sector in Ireland, Northern Ireland, the United Kingdom, and across Europe, including the Netherlands, for outside expertise to be recruited from time to time to advise and help. It would not be cost effective to have that expertise within the public system.

James Reilly (Dublin North, Fine Gael)
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I find it interesting that the Minister compares us to the North of Ireland, the United Kingdom and other countries. It might be interesting to do a comparative study to find out what they spend on outside consultants in health, and also to compare the number of people they have working within their health service who are engaged in PR and other advisory roles. Will the Minister carry out such a study?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The administrative costs of the Health Service Executive and the National Health Service, NHS, are approximately the same at 16% of the budget. As Deputy Reilly is aware, the NHS is outsourcing a significant amount of activity to the private sector. My point is that we should become less obsessed with who pays who to do what. We should be more concerned with patients and getting access for patients to good quality treatment, which is what we are seeking to do.