Peter Mathews (Dublin South, Independent)
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The petition for liquidation of Mount Carmel Hospital was ex parte. It was one-sided and it was by NAMA. There were two statements which resulted in the decision. One was that it was hopelessly insolvent while there other was that the 2013 results showed a disastrous trading year. However, this is not true because from October 2013 onwards, there had been a big turnaround as a result of increasing bed occupancy with the HSE relieving the problem by bringing in patients on the waiting lists. Some 2,300 patients were going to be decanted gradually into Mount Carmel Hospital for hospitalisation and after-care treatment.

There were two bids for the hospital to NAMA. One of them collapsed while the other one was for €14 million, €10 million of which would go to the creditors, including the Revenue Commissioners which had agreed to take its portion of that €10 million, and €4 million of which would go to NAMA. However, NAMA did not want the €4 million but wanted €6 million. For €2 million, the following is now the prospect. The VAT and PAYE for 328 employees amounts to approximately €7 million per year while jobseeker's benefit paid to the same number of staff would be €4 million per year, which is a total of €11 million per year. The redundancy payment from the Social Insurance Fund would be €8 million but that is a once-off payment. Contrast the €2 million extra NAMA sought with the €19 million lost to the public purse in year one, with €11 million per year thereafter. This begs the question as to what in God's name NAMA is doing.

There are 130 beds in Mount Carmel Hospital. Some 25 beds are for maternity, with 12 for mothers and 13 for babies, while there are 105 non-maternity beds. The figures do not stack up. The staff costs for the hospital are between 70% and 80% of turnover, which was €29 million. That means that 10% savings in one year would have been €2.3 million, which would have more than counterbalanced the €1 million lost in the last trading year.

It is a bad mistake to close this hospital.

Billy Kelleher (Cork North Central, Fianna Fail)
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I would like to read a letter I received from an employee. It states:

I work at Mount Carmel Hospital and I am obviously devastated by the decision to close the hospital, make my job redundant and send me and the rest of the staff of 300 people to join the dole.

However, I am also astounded at the lack of interest that appears to have been shown towards us and the hospital.

On the one hand, I do understand that to some it is just another business, a private hospital supported by NAMA and effectively owned by people who have less interest in the hospital than its potential for property development.

On the other hand, I cannot understand why nobody who might claim to have an interest in the social and political implications, let alone the economics of delivering on a commitment to a mix of private and public health care resources, seems to be doing anything to intervene.

Mount Carmel had a turnover of €29m last year and an accounting loss of about €1.05m.

With cost-saving measures in place this year, the hospital was on target to deliver a break-even result in 2014, with the possibility of making a small profit.

If the issue is debt, closure looks like an action driven by a short-sighted focus on immediate finance and a short-term view of where and how money is and should be invested in health care.

In the absence of the kind of engagement and discussion that is devoted to other enterprises, it appears to be facilitated by an ability to 'wash our hands' of what this means for the future of the staff, the patients and the longer-term public interest. ...

Earlier this week the minister was speaking about the reduction in public waiting lists. Mount Carmel treated many of these patients last year and was preparing to treat 1,200 more in the first few months of this year. These patients will now go back on to public waiting lists.

Mount Carmel is also currently caring for sick and elderly public patients who were being kept on trolleys in public hospitals. Some of those patients were transferred to Mount Carmel after their operations in the public system.

These patients will now be transferred back to the public hospitals to be 'cared for' on trolleys in A&E.

As a country we bail out banks and we prop up loss making five-star hotels and golf clubs, and get exercised about some quite superficial concerns in the political and social arenas, yet allowing a fully functional hospital to close does not appear to be an issue worthy of the attention of anyone with the wit or will to help or care.

There were offers on the table for NAMA to consider up to last Thursday, two of which were apparently turned down by NAMA, who decided along with Gerry Conlon to go to the High Court and have a liquidator appointed.

Surely it is in the public interest to sell the hospital as a going concern rather than fund redundancy and social welfare payments to over 300 staff.

James Reilly (Dublin North, Fine Gael)
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The closure of Mount Carmel Hospital has left its patients in an uncertain situation. As the Deputies have said, it will result in job losses. As a doctor and as Minister for Health, my primary concern must be the provision of quality care to patients. The HSE is continuing to work with the hospital to ensure patients' choices are respected, their immediate needs are met and there is a seamless transfer to another hospital. As a Government Minister, I am disappointed at the loss of jobs in Mount Carmel Hospital. I recognise that this is a difficult time for the staff. We will endeavour to support staff in their efforts to secure alternative employment. I have been informed by the HSE that an active process in that regard is ongoing as we speak. Many workers in the hospital have particular expertise that is highly sought after in the public system.

As the House will be aware, following receipt of correspondence, a high-level examination was undertaken to assess the feasibility of the purchase of the hospital by the State as a going concern, taking account of the impact its closure might have on maternity service capacity. All evidence shows that birth rates have fallen significantly in recent years. According to the projections of the Central Statistics Office, they will continue to fall until the early 2020s, at least. In view of this evidence, the purchase of Mount Carmel Hospital could not be justified on the basis of a perceived deficit in maternity services capacity. We believe that any available funding would be more appropriately used to resource our current maternity services to ensure they can cope with any additional demand. As I announced in May of last year, it is intended to move the National Maternity Hospital from Holles Street and to co-locate it on the St. Vincent's University Hospital campus. This project, together with the development of the new maternity hospital that is to be tri-located on the St. James's Hospital campus, will give us an opportunity to provide additional capacity in the longer term if required.

The Deputies will be aware that one of my priorities as Minister for Health is the development of excellence in patient care and safety, thereby leading to better outcomes. It is recognised that for optimal clinical outcomes, maternity services should be co-located with adult acute services, and in the case of neonatology and foetal medicine should be tri-located with adult and paediatric services. There should also be a high volume of patient throughput in accordance with international norms. A low-volume, stand-alone maternity hospital such as Mount Carmel Hospital does not allow for this.

Mount Carmel Hospital provides other inpatient services apart from maternity services. As others have said, during 2013 the HSE secured additional treatment capacity as necessary in Mount Carmel Hospital, as well as in other public and private hospitals. It is important to note that the projected number of treatments outsourced in these facilities represents less than 1% of the total number of annual scheduled outpatients appointments and less than 0.5% of the total number of inpatient and day-case appointments undertaken nationally. The HSE will continue to avail of the support and services offered by other public and private facilities where capacity is required and available.

As I have said, I am committed to improving patient safety and outcomes across all areas of the health service. In this regard and with particular reference to maternity services, my Department is developing a new national maternity strategy which will determine the future model of services to ensure women have access to safe high-quality maternity care. This strategy will reflect the best available evidence to ensure all pregnant women can make appropriate and informed choices and can access the right level of care and support 24 hours a day. Arrangements are being made with alternative hospitals to ensure as seamless a transition as possible for the patients of Mount Carmel Hospital in accordance with their choices. All inpatients who are currently in the hospital will continue to receive all necessary and appropriate care until they are discharged.

Peter Mathews (Dublin South, Independent)
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I acknowledge and respect what the Minister has said. The bottom line is that this decision was made by NAMA after an offer of €14 million was received. I am reliably informed that €10 million would have been used to pay off the creditors and the remainder would have been available to meet NAMA's €6 million test. That means there is a differential of €2 million. As I have explained, there will be a loss of €19 million to the public purse in the first year following the closure of Mount Carmel Hospital, when factors such as the loss of jobs and staff are taken into account. Therefore, the net cost to the State of the decision not to proceed in this manner - all of the other aspects of this issue that have been mentioned also need to be considered - will be €17 million. That is not on.

We need to hear the figures. NAMA needs to come in. I wanted a NAMA response to this Topical Issue matter rather than a medical response. The hospital's beds are being used to look after 2,300 patients on the waiting list. Some 1,100 public patients have been treated at the hospital already, thereby taking them off the waiting list. A further 1,200 patients are in the course of being treated and addressed, thereby taking them off the waiting list and relieving the pressure on trolleys. There were 309 people on trolleys in Dublin last Monday. Much of this pressure could be relieved. Thirteen or so geriatric patients with cognitive difficulties, who went into Mount Carmel Hospital a few weeks ago, have been shunted out again. The turnaround at the hospital had started before this decision was made. The financial documents show that it would have more than broken even in 2014. NAMA needs to explain this bad decision.

Billy Kelleher (Cork North Central, Fianna Fail)
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I agree with Deputy Mathews that NAMA should be answering questions on this issue.

Peter Mathews (Dublin South, Independent)
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Yes.

Billy Kelleher (Cork North Central, Fianna Fail)
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I mean no disrespect to the Minister when I say that. I do not doubt his commitment to the retention of as many of this country's medical facilities as possible. When one reads the NAMA business plan, one must compare the manner in which it is allowing this wonderful facility to be closed with the manner in which it consistently shovels money into golf courses and five-star luxury hotels, thereby undermining and undercutting private family-owned hotels. I would like the Minister, even at this late stage, to consider what Deputy Mathews and others have said about the net cost to the State of the closure of the hospital when factors like social welfare payments and the loss of revenue are taken into account.

Peter Mathews (Dublin South, Independent)
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We are talking about €11 million a year.

Billy Kelleher (Cork North Central, Fianna Fail)
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It defies logic. I can understand that the Minister is considering the matter in the context of his individual budget. A little creativity on the part of NAMA and the State, based on an examination of the net cost of the closure of the hospital, would assist this hospital to trade its way out of its difficulties.

Peter Mathews (Dublin South, Independent)
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It could do so.

I accept the Deputies understand this is a NAMA decision to close what it regards as a loss-making entity it was unprepared to support further. I have discussed the matter with the Minister for Finance who made it clear to me that had it continued trading it would be guilty of reckless trading.

Peter Mathews (Dublin South, Independent)
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That is impossible.

James Reilly (Dublin North, Fine Gael)
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Notwithstanding what Deputy Kelleher has said about NAMA's activities, that agency showed a profit last year.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is all the more reason it should have funded it.

James Reilly (Dublin North, Fine Gael)
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NAMA has been very co-operative in helping coherence in Government. In other words, when we were considering the National Maternity Hospital moving to St. Vincent's University Hospital, we looked at the buildings that had been built for a private hospital and other purposes - it may not quite have been for a private hospital, but that was one of the possibilities. However, IDA Ireland had another multinational client and we backed away. IDA Ireland was very successful through Mr. Barry O'Leary, whom I congratulate on his retirement, in securing more jobs for that part of Dublin. We will now build a new co-located hospital for the National Maternity Hospital there.

While it is sad to see Mount Carmel close, in 2004 there were 16 private-hospital bodies and today there are 22. There is always this movement within a sector as needs and demands change. I do not have full and intimate detail of all that transpired there once it was bought by a developer and the debts that might have accrued. However, I certainly know that the Department and the HSE undertook an extensive appraisal of how that hospital might represent value to the health system and clearly came to the decision that it was not in the best interests of the health services to acquire it as a going concern, as I made clear in my opening remarks.

We need to ensure that the patients attending there are looked after in a seamless fashion with the minimum distress. We need to do our best to help to relocate the many excellent staff, as we would not like to see their special skill sets lost.