Jack Chambers (Dublin West, Fianna Fail)
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7. To ask the Minister for Health the reason the HSE has ceased counting the number of private beds in public hospitals; and if he will make a statement on the matter. [20457/17]

Jack Chambers (Dublin West, Fianna Fail)
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What is the reason the HSE has ceased counting the number of private beds in public hospitals and will the Minister make a statement on the matter? We know that since the Health (Amendment) Act 2013 the Government has brought forward a policy of quasi-private hospitals within our public hospital system, which is regressive and has contributed to the significant waiting times. Why has the HSE, as a matter of governance, stopped counting the number of beds? We deserve a full explanation on the matter.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Chambers for the question and I will endeavour to give him as full an explanation as possible. The reason the HSE has ceased reporting the number of private beds in public hospitals is that since 2014, as referenced by the Deputy, all private patients are charged in a similar manner, and the charges set for private patients are no longer set with reference to being in private or semi-private hospital beds.

The Health (Amendment) Act 2013, as Deputy Chambers mentioned, established the basis for this policy, enabling all private patients in a public hospital to be subject to charges. The Act addressed a situation previously identified by the Comptroller and Auditor General whereby when private inpatients were accommodated in public or non-designated beds no private inpatient charges applied, despite the patients having a private treatment relationship with their consultants. This was a matter highlighted by the Comptroller and Auditor General to which the legislation endeavoured to respond. The absence of a maintenance charge in such instances represented a significant loss of income to the public hospital system and to taxpayers at large.

Since 1 January 2014 revised charges are levied on all private patients. The charging regime now distinguishes between the accommodation of private patients in single rooms and multi-occupancy rooms, with the former charged at a higher rate. Analysis I commissioned at the request of Deputy Kelleher is being finalised by my Department. It indicates that changes to the charging structure have not resulted in a significant increase in the proportion of patients treated on a private basis in public acute hospitals. I hope to be in a position to share this with both Deputies in the coming days.

The use of beds in public hospitals is now more closely aligned with the clinical needs of the patients. This change allows for more efficient use of beds, with priority being given to issues such as end of life care, where a person can be given a single room, and infection control, regardless of the public or private status of the patient. The concern the Deputy has about these changes and the impact they have had on an extra number of private patients in public hospitals and the impact on the public health service is something on which I expect to have analysis in the coming days. The initial analysis I have received suggests this has not seen such an increase and, therefore, this is the rationale behind not counting private beds.

Jack Chambers (Dublin West, Fianna Fail)
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Public hospitals should be for public patients and only public work should go on in public hospitals. They should not be quasi-private institutions. Patients receive private care in the public health system and this is not a progressive way to run a public health system. What we have seen with the policy is that hundreds of thousands of people, who have already paid their taxes and who happen to hold health insurance, are being effectively charged twice. This is what the policy stance has changed. Instead of utilising the full capacity of public and private the Government has decided to charge people twice. The fact the Minister does not know and cannot state in the Dáil the number of beds used on a private basis is a serious concern with regard to management control. We know from the health insurers' figures that hundreds of millions of euro of insurance is going to public hospitals to bail them out because of the inefficiency in the current system. It is important the Minister addresses it. There is a recommendation from the health policy reform committee to remove private work from public hospitals. This is an example of how the previous policy was regressive and has impacted on increased waiting times for public only patients.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Chambers. I revert back to my original point, which is this first became a public policy issue in an effort by the Oireachtas to respond to the Comptroller and Auditor General highlighting an important issue. The question for the Oireachtas, and I hope the analysis I will provide to it shortly on the impact this has had on the private-public mix in public hospitals can enable us to arrive at a point where we must decide if we need to review the policy. I have already said I intend, on foot of receiving this analysis, to review the policy to check whether it is having any unintended consequence. This is the prudent and appropriate thing to do.

When Deputy Chambers says our public hospitals should be purely for public patients, and I mean this respectfully, it is quite a profound statement because while it is likely to be the direction of travel the Oireachtas Committee on the Future of Healthcare goes and it is likely to be the direction of travel I and the Government would favour, we do need to be cognisant of the fact the provisional figure in terms of private patient income in 2016 to our public hospitals was €626 million. This is a big hole that I or any Minister would have to fill. It is a lot of money to take out of the public hospital system and take out of our public health service. How we deal with this is something that needs to be dealt with on a multiannual basis.

Jack Chambers (Dublin West, Fianna Fail)
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The Minister needs to deal with it. It is an example of how ineffective Fine Gael has been in setting its health policy. It has introduced effective quasi-private hospitals in our public hospital system and this is regressive. The hole will only get bigger because the incentive for managers is to have increased private output in the context of our public health system, and the people who cannot afford health insurance are being left behind. They are the people who must wait longer, and we see this in the waiting times in our public hospital system.

Public patients are all citizens and if people happen to want private health insurance, they should go to a private hospital. The State should not get those citizens who pay their taxes throughout their lives and charge them twice. It is having an impact on their health insurance premiums. Effectively, they are paying twice. They have paid their taxes and they are also paying health insurance. They have a right to health care in the context of our public health system. The Minister should not be levying middle Ireland with an additional tax and levy, which is what the Health (Amendment) Act does. Of course, it would leave a hole, but the Minister has a duty to fix that and manage the budget of the system properly. It is one of the biggest health budgets in the EU with some of the worst outputs. It is for the Minister to match the gap and provide a vision for the Dáil and stop talking about solutions in months and years to come when he is not in the Department.

Simon Harris (Wicklow, Fine Gael)
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My God, I certainly hope I will be. I will not take a lecture from the Fianna Fáil Party on how to run a health service when I still find myself having to try to unpick some of the structural difficulties with which it left me through the creation of the HSE, which has become an awful bureaucratic scenario that we must pare back.

One of the first decisions taken by this House on a cross-party basis was to set up a cross-party committee. It is accepted that it is going to involve us all in pulling together and that it will take a ten-year period to get this absolutely right. While I have many responsibilities which I endeavour to discharge with enthusiasm and my very best effort, anybody coming into the House to suggest we should abolish one charge has a responsibility to tell us how we would replace it. I am sure that in due course when the election is held - God willing, it is quite a long time away - Fianna Fáil's manifesto will detail how the €642 million that would be removed from the health service budget with the swipe of a pen would be replaced or the services we would not be able to provide.

Let me be clear that I think the Deputy has a fair point that there could be unintended consequences with regard to the current legislation. That is why I am doing two things. At the request of Deputy Billy Kelleher at the Oireachtas Joint Committee on Health, I am carrying out an analysis which will be presented very shortly. I will then review the legislation in that context and revert back to the Deputy.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister should not ensnare me in his policies.