Fergal Browne (Fine Gael)

I welcome the Minister of State to the House. I move:

That Seanad Éireann condemns the Government for pursuing a policy which will give away the lands of public hospitals to private hospital developers; and calls on the Government to:

—abandon its plans to give the lands of public hospitals to private developers;

—ensure that the lands on public hospitals are kept for public health facilities; and

—instead use the public lands to build much needed public health facilities such as more in-patient beds and more step-down and rehabilitation facilities for the elderly.

While Fine Gael is not against the concept of the private sector being involved in health care, we have a difficulty with public land being given to the private sector. We have a difficulty with this approach for a number of reasons. Given this Government's inability to manage projects we have every reason to be concerned. At Beaumont Hospital a public private partnership involving a carpark went way over budget and time. It benefitted only the private developer and was not of use to the public or the taxpayer.

My colleague, Deputy Paul McGrath, has done much work on the area of the Kinnegad and Kilcock motorway bypasses. The company involved invested €40 million and borrowed a further €150 million. The taxpayer has put €268 million into the project and is liable for tolls estimated in the region of €600 million over the next 30 years. That cost will rise considerably.

This Government has not negotiated good deals with the private sector in the past and in this case, because public land is being handed over, it will restrict the future development of hospitals. We have a simple ideology, that public hospitals and lands should be kept for public beds and facilities. We do not agree with the Government's policy and I do not believe that Fianna Fáil agrees with it. It is being pushed by the PDs. In the Sunday Independent recently Mr. JohnDrennan wrote about the privatisation of the health service by stealth under the Tánaiste and Minister for Health and Children, Deputy Harney, and he is not far wrong.

There have been many announcements about public and private bed levels and most people are confused. In November 2001, the Government's national health strategy promised an additional 3,000 beds and 650 beds by the end of 2002. In January 2002, four months before the general election, we had a bed review report. The then Minister, Deputy Martin, promised 3,000 acute hospital beds over ten years, and this was due to be "the largest ever expansion of acute beds for public patients".

In June 2002, the Fianna Fáil-Progressive Democrats programme for Government referred to expanding the number of public hospital beds in line with a programme to increase total capacity by 3,000 during the period of the strategy. By October 2004, the Taoiseach told the Dáil that 900 beds had been funded, but had the embarrassment of having to admit that the 900 beds of which he spoke may not have been beds and it later emerged that this figure included trolleys. The next day the Tánaiste told the Dáil that none of the 900 beds was a trolley. This was contradicted the following month when a journalist, Ms Maev-Ann Wren, made an FOI request which revealed that a bed or a day place is "a device or arrangement that may be used to permit a patient to lie down, recline or recover in the course of an elective day admission".

By May 2005, the Department of Health and Children progress report on the 2001 health strategy referred to provision being made for 900 additional inpatient or day beds. In early 2005, Professor Brendan Drumm of the HSE stated that we do not need more beds, which contradicts everything that has been said so far. In July 2005, the Tánaiste told the Oireachtas Joint Committee on Health and Children that she intends to provide 1,000 of those beds by decanting 1,000 private beds in public hospitals into private facilities on public hospital grounds. It is worth noting that 2,500 of the 12,900 beds in the acute hospital system in public hospitals are private beds. One can understand why the public is confused, as is the Government, I suspect.

While Fine Gael is not opposed to private individuals being involved in health care, we have a problem with them using public land. The Tánaiste justifies this by saying that by freeing up public land she will remove private beds from the public health system. There have been quite a few mixed reports on that issue. I was interested that Dr. Fergus O'Ferrall, director of the Adelaide Hospital Society, the Adelaide and Meath Hospital, Incorporating the National Children's Hospital in Tallaght, stated that this proposal makes neither health policy sense nor economic sense. He states that patients will not have the same quality of care because they will not have the comprehensive teams and services available to those in private beds in our public hospital systems. He said that those occupying public beds will also get poorer care because consultants will not be around as much as they are when public and private beds are in the same hospital. That is an important point. The Tánaiste's plan is to free up 1,000 beds by moving 1,000 of 2,500 private beds in public hospitals into new "for-profit" private hospitals over the next five years. These hospitals will be required to offer at least 20% of beds to public patients at a discount of 10% or more. Fine Gael and the Labour Party believe that public land belongs to the people. We will use that land for public beds, particularly step-down beds.

Senators expressed differing opinions during a recent debate on accident and emergency units. Those in hospital should be allowed to move home or to a step-down facility in order to recover after operations. They should not clog up hospitals. Fine Gael has pledged 600 beds in the Dublin area. This can be done within 30 months and would help to alleviate the scandalous situation of people on trolleys in accident and emergency units.

The Finance Acts of 2002 and 2003 were altered to allow investors to write off the entire cost of the construction or refurbishment of private hospitals against their tax bill using accelerated capital allowances. For every €100 million invested, the taxpayer will contribute €42 million. This is effectively a gift from the State and will not result in the public ownership of the hospital. Families will inevitably end up paying more.

The proposed new hospital beds will attract a subsidy of €190,000 per bed in tax relief. The Tánaiste admits that VHI members could face an increase of 66% in hospital charges as a result of this policy. Fine Gael asks what ordinary families receive in return for the extra cost burden. We have seen examples of public private partnerships that did not work in the field of education. They were completed late and over the budget allocated, which cannot be justified. The average household pays €3,000 to fund public hospitals but the Tánaiste has failed to provide a full hospital service. As a result, she has collected some €1,800 more per family than in 1997. Furthermore, families have been forced to pay €1,300 on private health insurance because they cannot guarantee a health service without it.

The key to public private partnerships is that risk is transferred to the private sector. These private hospitals will receive a 42% subsidy on the building and a 20% subsidy on its operation. No accident and emergency units will be included because the hospital will concentrate on routine work rather than complicated, costly cases. The Comptroller and Auditor General did not give a glowing report of the handling of the saga involving the car park at Beaumont Hospital.

The hospitals to which the Tánaiste refers depend on generous tax relief and massive indirect public subsidies through reliance on the public hospital system. The Tánaiste does not refer to the separate laboratory or X-ray facilities, CT and MRSI scans, or post-operative intensive care units to be provided in the hospitals. If public facilities continue to be used for private patients, the public patient may have to wait longer for diagnostic tests and procedures.

Furthermore, the Tánaiste stated that consultants in public hospitals will be permitted to treat private patients in new private hospitals. In order to maximise income, consultants will have to spend more time in private hospitals and less with those in public beds. Accident and emergency units are expensive and no private hospital in the country provides accident and emergency services similar to public hospitals. Private hospitals tend to choose services that are most cost effective and easy to manage. Fine Gael has no problem with private hospitals but questions why land from public hospitals is given away for such a minor return. It does not represent value for money.

Last week representatives of the Medical Council appeared before the Joint Committee on Health and Children. It stated that private hospitals are not subject to the same degree of regulation as other hospitals. One does not require a licence to operate a private hospital, a situation that has inherent risks. Fine Gael objects to public land being given to private developers for their gain, not for the taxpayers' gain or that of the patient.