James Reilly (Dublin North, Fine Gael)
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Question 83: To ask the Minister for Health and Children the impact the revised programme for Government commitment to proceed with the current programme of co-location limited to already committed projects under the existing project contractual agreements will have on her co-location project; and if she will make a statement on the matter. [39346/09]

Arthur Morgan (Louth, Sinn Fein)
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Question 87: To ask the Minister for Health and Children the cost to date in 2009 of the co-location programme; the number of public hospital beds that have been freed up as a result of the programme; and if she will make a statement on the matter. [39274/09]

Lucinda Creighton (Dublin South East, Fine Gael)
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Question 99: To ask the Minister for Health and Children her views, in view of the commitment in the programme for Government that co-location will be limited to already committed projects, on whether co-location is viable; and if she will make a statement on the matter. [39310/09]

Lucinda Creighton (Dublin South East, Fine Gael)
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Question 122: To ask the Minister for Health and Children the number of beds which will be provided by committed co-location projects under existing project contractual agreements; and if she will make a statement on the matter. [39311/09]

Mary Harney (Dublin Mid West, Independent)
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I propose to take Questions Nos. 83, 87, 99 and 122 together.

The renewed programme for Government reaffirms the Government's commitment to the current co-location programme. The procurement process which is under way will continue. Projects will be developed within the terms of those project agreements which have been signed or which may be signed.

It is an essential requirement that each co-location project demonstrates clear value for money to the taxpayer. There is a requirement on each of the preferred bidders to pay a non-refundable deposit to the HSE on the signing of the project agreement. The intention of this requirement is to allow the HSE to recoup the expenses that it has incurred in this context.

The Finance Act 2009 provides that the schemes of capital allowances for all private hospitals and certain other health facilities will be terminated, subject to transitional arrangements for projects already in development. Provided that a co-located private hospital project conforms to the requirements of these transitional arrangements, and otherwise satisfies the general requirements of the scheme of capital allowances, the tax relief will apply. The value of the tax relief in each case will depend on the level of qualifying capital expenditure. I would add that additional revenues will accrue to the Exchequer from the extra activity generated by the construction of the hospitals, the employment arising and the related services provided on which taxes will be paid.

Preferred bidders have been selected for the Beaumont, Cork University, Limerick Regional, St. James's, Sligo and Waterford Regional projects. The total number of beds proposed in these six facilities, exclusive of critical care capacity, is in excess of 1,200. Project agreements have been signed in respect of the first four of these developments and the proposed capacity associated with these projects comes to 917 beds altogether.

Brendan Howlin (Wexford, Labour)
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I call Deputy Ó Caoláin.

James Reilly (Dublin North, Fine Gael)
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A Leas-Cheann Comhairle-----

Brendan Howlin (Wexford, Labour)
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The order of the questions on my list is different. I should have called Deputy Reilly first.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thought the Chair was being ultra generous.

Brendan Howlin (Wexford, Labour)
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The questions are listed in reverse order on my list.

James Reilly (Dublin North, Fine Gael)
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Back to front - how does one spell NAMA back to front?

Deputy O'Sullivan put the issue succinctly at the outset of the debate on this issue. Four years and four months have passed and not a single bed has been provided. Some 21,000 people gave up their health insurance during this year. The VHI estimates that by the end of next year the number will have increased to 200,000.

Co-location projects with signed agreements and planning permissions are entirely dependent on the Beacon Medical Group. When does the Minister expect the first sod to be turned and the first bed to be available? How many non-refundable deposits have been paid and received by the HSE? I ask the Minister to consider that this not only a flawed but a failed policy. It has not delivered, by the remotest stretch of the imagination, the fast-track provision of beds. We know that there are modular units that can be built and put on site in six months. Approximately three years and ten months ago we could have additional beds if we had not gone down this nonsensical route.

Mary Harney (Dublin Mid West, Independent)
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The Deputy is wrong on one point. The HIA has informed me that 12,000 people have dropped out of health insurance this year. Out of a total of 2.2 billion, that figure of 12,000 represents a very small number by any standard. People have switched from one provider to another. People have left the VHI to take out insurance with some of its competitors. The VHI may have lost 4%, 5% or up to 6% of its market share, but that business has gone to its competitors.

Approximately half of our population has private health insurance and I envisage in that region will continue to have it.

James Reilly (Dublin North, Fine Gael)
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The VHI does not believe that.

Mary Harney (Dublin Mid West, Independent)
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It may have issues around its membership, about which it is concerned, but we are talking about the overall market. As the Deputy has told me on many occasions previously, he is not interested in which insurance company people belong to and neither am I. Competition in the market has been a very good thing. During the last recession in the 1980s very few people dropped out of private health insurance and some 37% of the population had such insurance at that time.

This policy was enunciated as a way of providing capacity because our public hospital system needs investment. We need more single rooms to ensure the control of infection in particular. We do not have resources available to make that investment. That is a fact. It does not matter who is in this seat, such resources are not available.

Because of the fragmentation of our health service, the massive investment that has taken place during the past decade, in particular, has been targeted at priority areas. One of the key priorities currently is long-term care where many of our current public stock does not and cannot meet the standards laid down by HIQA. That must be a priority for public investment.

People have opposed this policy from the start. It is opposed because the funding will come from the private sector. It was supposed to be the great bonanza for investors. If it was such a great bonanza , it would have been easy for people to get the money much sooner than now. There are big risks associated for the investors and that is why the banking situation has not been easy, particularly with the current difficulties.

Brendan Howlin (Wexford, Labour)
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A number of Members wish to speak on these questions.

Mary Harney (Dublin Mid West, Independent)
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I accept that. I cannot look into my heart and tell the Deputy when the first sod will be turned, but I can tell him, as I said in reply to Deputy O'Sullivan's earlier question, the Beacon Medical Group has spoken about this recently and mentioned that it envisages the first facility will be in place in 2012.

I understand two or three projects have paid over the non-refundable deposit. I understand in one case the deposit was €350,000. When project agreements are signed, the deposit must be paid over at that point. That is my understanding.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Since the Minister came up with what I can only describe as her disgraceful co-location programme, every time we have raised the shortage of acute hospital beds, she has continually referred to this co-location programme proposition as the means to free up additional public beds in our public hospitals currently occupied by private patients. Does she recall that when we first engaged on this issue she indicated that 1,000 additional beds would be so created across the public health system? Does she further recall that when I challenged her in this Chamber in 2007 to indicate the number of beds that would be involved at each co-located hospital, she said she was not in a position to give an answer. That was her reply. Is it the case that two years on from that exchange between us in the Dáil that day, not a single square metre of concrete has been poured and as a consequence, not a single further public bed has been created by this project that the Minister holds so dear?

Will the Minister agree to call an end to what I can only describe as a very expensive farce on her part? Will she admit that this never had anything to do with the creation of further public beds but was all about creating further opportunity for those who see health care as a means for creating profit? How can the Minister justify continuing with this collocation programme when we see a disgraceful situation where children are being denied access to the beds and resources they need to protect their interests, while patients are in Crumlin's hospital for children which only recently highlighted once again-----

Brendan Howlin (Wexford, Labour)
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I must call the Minister.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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How can the Minister justify this approach when €231 million-----

Brendan Howlin (Wexford, Labour)
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Please, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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-----would have provided those 1,000 beds in the public health system?

Brendan Howlin (Wexford, Labour)
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A number of Deputies have indicated their wish to get in on this question. It is supposed to be one minute for a question. Each of the speakers so far has taken three minutes.

Mary Harney (Dublin Mid West, Independent)
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I will try to obey the Leas-Cheann Comhairle. First, there was never any doubt about how many beds were involved. If I did not have the information to hand, it was available. I can give it to Deputy Ó Caoláin rather than waste time. In Beaumont, it is 157 inpatients, 54 day beds, and so on. I can give him the information.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister had not got it two years ago.

Mary Harney (Dublin Mid West, Independent)
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I am sorry. I may not have had them before project agreements were signed when we had gone to tender but there was never any doubt about each project agreement.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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How many are in place?

Mary Harney (Dublin Mid West, Independent)
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Deputy Ó Caoláin knows none of them have happened yet. If it was the great bonanza for profit makers that he seems to think, they all would have happened overnight.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Much has changed.

Mary Harney (Dublin Mid West, Independent)
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For the information of the Deputy, UMPC has taken over 40% of Beacon. It is a not for profit organisation with a considerable international reputation. I presume most here will be aware of its reputation in the United States and beyond. Therefore, not all of these projects are being developed by what Deputy Ó Caoláin would call "the profit motive".

On capacity generally, we have a fragmented public health system. If we were to start from a greenfield site we would not put in place what has been in place. We all know that. The delivery of quality safe care to patients to best international practice is not possible if one has a fragmented system.

Deputy Ó Caoláin opposes everything as being a disaster, but there are many international experts looking at our cancer plan, admiring and supporting it, and seeking to have it replicated elsewhere.

Brendan Howlin (Wexford, Labour)
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The Minister is the one who is straying now. It is hard enough to confine ourselves to the question.

Mary Harney (Dublin Mid West, Independent)
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On the infrastructure that this will provide, keeping all of the consultant manpower on the one site and allowing the public and private facilities to work hand-in-hand as they do in other facilities in the country that are collocated-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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More like hand in our pocket.

Mary Harney (Dublin Mid West, Independent)
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The reality is that under contracts of employment negotiated long before I or Deputy Ó Caoláin ever came into this House, consultants have certain rights in relation to private patients. The idea here is to free up these facilities for the public patients.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That means, to change.

Brendan Howlin (Wexford, Labour)
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Thank you, Minister. You only took twice the allocated time.

Pádraic McCormack (Galway West, Fine Gael)
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Do any plans still exist for collocation at University College Hospital, Galway? Some time ago Galway City Council gave permission for a four-storey research facility there which has subsequently been appealed to An Bord Pleanála. Is that considered any part of collocation?

Considering that collocation could not even be fitted on the grounds of University College Hospital, Galway, how will this proposed research facility be facilitated there if permission is eventually granted?

Brendan Howlin (Wexford, Labour)
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I am afraid that is a separate question.

Pádraic McCormack (Galway West, Fine Gael)
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It is to do with collocation. I want to know the collocation part of it.

Brendan Howlin (Wexford, Labour)
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A research facility is not a hospital collocation. Perhaps the Minister would revert to the Deputy. I do not expect her to have that.

Mary Harney (Dublin Mid West, Independent)
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I do not mean to be smart-ass with Deputy McCormack, and I am not trying to be, but he, among others, lobbied me from Galway to have that cancer research facility included as part of collocation.

Galway city has many private facilities. It has the new Galway Clinic in place in recent years. Besides the logistical issues of the university hospital site he mentioned, capacity from the private sector does not exist.

Jan O'Sullivan (Limerick East, Labour)
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To get final clarity on this, can I take it as read, assuming the private finances are supplied, that Beaumont, Mid-west Limerick, CUH and St. James's hospitals will go ahead with tax breaks? Can the Minister clarify whether Waterford and Sligo hospitals, where project agreements are being prepared, will go ahead with tax breaks? Can she clarify whether Connolly and Tallaght hospitals, which are at earlier stages, will go ahead with tax breaks? Was the deputy leader of the Green party, Deputy Mary Alexandra White, right in stating that most of the planned collocation hospitals would wither on the vine because there seems to be a difference of opinion in Government on all of this?

Pádraic McCormack (Galway West, Fine Gael)
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The Greens are always right.

Mary Harney (Dublin Mid West, Independent)
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I want to make clear that I am not certain all of the hospitals will avail of tax breaks.

Jan O'Sullivan (Limerick East, Labour)
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Would they be entitled to them?

Mary Harney (Dublin Mid West, Independent)
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There are transition arrangements which the Minister for Finance announced. My understanding is, if memory serves me right and subject to correction, that anyone who has applied for planning permission by the end of this calendar year will be facilitated. My understanding is that at least one of the projects where a project agreement has been signed will not be availing of tax breaks.

Pádraic McCormack (Galway West, Fine Gael)
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Applied for, or granted, permission?

Mary Harney (Dublin Mid West, Independent)
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Applied for.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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In light of the fact that none of these has gone ahead and there is obviously a major scarcity of bed space at present, which has clearly shown up in what has happen in Our Lady of Lourdes Hospital in Drogheda where the crisis is desperate, would the Minister reconsider her action where she has closed off so many beds in other hospitals?

Brendan Howlin (Wexford, Labour)
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I am afraid that is well beyond the scope of the question. I call Deputy Reilly for a final supplementary question.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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The Minister has the right to answer that.

Brendan Howlin (Wexford, Labour)
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I will not stop the Minister if she wishes to comment.

James Reilly (Dublin North, Fine Gael)
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Far be it from me to stand in the way.

Mary Harney (Dublin Mid West, Independent)
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I will answer it. On what has happened in Drogheda, Drogheda is following best international practice. When there is an outbreak of something like C. diff, one closes off a hospital to visitors if that is what is required to make the hospital safe. That is normal practice. It does not only happen in Ireland. If the Deputies read any international press, which I am sure they do from time to time-----

James Reilly (Dublin North, Fine Gael)
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It did not happen by accident.

Mary Harney (Dublin Mid West, Independent)
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-----they will see it is common practice in many other countries.

Pádraic McCormack (Galway West, Fine Gael)
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It is normal practice to ensure that it does not happen.

Mary Harney (Dublin Mid West, Independent)
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Notwithstanding the bed pressure, activity this year is ahead of last year.

Brendan Howlin (Wexford, Labour)
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I call Deputy Reilly for a final supplementary question on this.

James Reilly (Dublin North, Fine Gael)
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It is all very well to speak of following best standards and practice in terms of how one deals with it when it happens, but if the Minister applied best standards in terms of not having the place overcrowded having closed down half of the facilities in the north east-----

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Hear, hear.

James Reilly (Dublin North, Fine Gael)
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-----she would not have this situation in the Drogheda hospital, which is a hospital that has suffered from many disquieting scandals over the years.

After four years and four months - if the Government remains in office the Minister may be in office until 2012 - the Minister has become well known for plans for the future as a substitute for action today. I have no faith that 2012 will deliver either a sod, a bed or anything else for us in private. The Minister must acknowledge that this is a poor return for her tenure and in terms of adding additional beds, when there are 700 closed to date due to cutbacks.

What real action she the Minister take in terms of the quite considerable health budget available to her to bring about real change in the hospitals to increase our capacity. We are spending nearly €5,000 per man, woman and child in this country.

Brendan Howlin (Wexford, Labour)
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The Deputy is giving information rather than seeking it.

James Reilly (Dublin North, Fine Gael)
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What will the Minister do about this? She has told the House that we do not have money. However, we are spending €5,000 per man, woman and child in this country. They spend only €3,500 in Holland where they do not have this problem. They do not even have the hand-washing dispensers in the hospitals, and I asked why. The response was that they do not have a problem. They do not have the problem because when the patient is admitted he or she goes into a room and until his or her status, as far as MRSA, C. diff or anything else is concerned, is known, he or she does not circulate in the hospital.

Mary Harney (Dublin Mid West, Independent)
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Every reform we try to introduce is opposed by Deputy Reilly.

James Reilly (Dublin North, Fine Gael)
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I supported the Minister on cervical checks. I supported her cervical vaccine.

Mary Harney (Dublin Mid West, Independent)
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When we tried to reduce the cost of delivering drugs to patients, he even opposed that.

James Reilly (Dublin North, Fine Gael)
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No, I did not.

Mary Harney (Dublin Mid West, Independent)
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He did. I saw his "chaos, disaster, the wrong policy".

James Reilly (Dublin North, Fine Gael)
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I did not oppose it.

Mary Harney (Dublin Mid West, Independent)
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Deputy Reilly cannot look for more for everyone who works in the service.

James Reilly (Dublin North, Fine Gael)
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Do not rephrase it.

Mary Harney (Dublin Mid West, Independent)
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He cannot look for more, as he is good at doing. Every vested interested is represented in this House by Deputy Reilly. If he is to be the spokesman for the main Opposition party-----

James Reilly (Dublin North, Fine Gael)
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The people I represent, including the patients-----

Brendan Howlin (Wexford, Labour)
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Please, allow the Minister.

Mary Harney (Dublin Mid West, Independent)
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-----and he aspires to be Minister for Health and Children, I expect a bit better from him.

On many of the reforms, whether it is HIQA, the fair deal, the hygiene standards, the cancer control programme or changing how we remunerate pharmacists, everything has been opposed by Deputy Reilly. That is a fact.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We have learned not to have such expectations.