Frances Fitzgerald (Fine Gael)

Every time in the past year and also in the run-up to the general election when the subject of co-location was discussed, the Minister and her colleagues said on a number of occasions it was not the intention to dispose of the land in public ownership within the sites of public hospitals and where co-location was being considered. For all this, the Bill as initiated states that a new article is being inserted to amend Article 4 as follows:

(2) The following article shall be inserted after Article 4:

"4A.(1) The Board may, with the consent of the Health Service Executive, enter into an agreement with one or more persons for the provision by any person (in this section referred to as the 'private undertaking') specified in the agreement, on land vested in the Board, of hospital services that are not paid for primarily out of public moneys.

(2) An agreement to which paragraph (1) applies may include provision for—

(a) the construction of buildings and facilities on land vested in the Board for the purpose of the provision of services referred to in that paragraph,

(b) the disposal of land or an interest in land by the Board or the Health Service Executive for the purposes of—

(i) the said construction, and

(ii) the provision of those services by the private undertaking[.]

This seems to be a contradiction of the commitment made by the Minister. She seems to disagree but it appears to me to be a contradiction that private land will now be up for public sale. I refer to the bodies involved in co-location which include the Mount Carmel Group, the Beacon Medical Group, operated by the University of Pittsburgh Medical Centre, which is to be in co-location with Beaumont Hospital, and Synchrony Healthcare, operated by Ramsay Health Care Limited, which is to be in co-location with St. James's Hospital. If this Bill is not giving permission to sell those lands, what is it doing? I ask the Minister to clarify the situation as this is what the Bill's provisions seem to be doing.

A number of issues arise with co-location but one of the concerns at the time of the introduction of this concept by the Minister was the disposal of public lands and this legislation appears to copperfasten that possibility despite the promises made. This is a serious issue regarding co-location.

I regret this legislation is being rushed through the House at the end of the term. There is very little time for real debate to take place on the issues raised by the Bill. While the Minister has assured the House that advice has been sought from the Attorney General, this legal advice has not been published. I call on the Minister to publish the advice because the question arises why this has come to light now. Has it come to light as a result of the co-location issues as opposed to some of the other issues which the Minister raises in the Bill? This is an umbrella-type Bill which deals with the medical practitioners legislation which was only brought to the House a year ago and is already coming back. If this is an example of rushed legislation, it is quite possible that the Bill before us today will also return to both Houses because of the hurried nature of its passage.

The Minister said the Bill is being introduced to deal with a legal anomaly which could result in the 1961 Bill being constitutionally challenged. Is the Minister aware of any possible challenges to any of these 19 bodies named in the legislation and as a result of this constitutional query? Is this the reason for bringing this legislation to the House? We should be provided with adequate explanations for the rushed nature of this Bill as this legislation has been in place since 1961.

I support the need to put on a statutory footing the various bodies associated with the health service. If the need for this emergency legislation is to afford such bodies a statutory basis, however, why not introduce a separate Bill specifically addressing this matter, instead of having it piggy-back, so to speak, on a number of other measures? Why is it necessary to include co-location in this Bill? My colleagues in the other House pursued this issue yesterday and we are still not convinced of any compelling reason this should be dealt with in this legislation.

The departmental note on the matter was somewhat misleading as it outlined that the reference to co-location is merely to put beyond doubt the legal capacity of Beaumont and St. James's hospitals to enter into co-location agreements. The legislation goes well beyond this, however, by establishing the legal capacity for hospitals to enter into co-location agreements and goes further by enabling the sale of public land to private health care operators, many of whom are international operators. This is a shift in Government policy. I question the need for legislation in this regard if legislation was not required in the case of the sale of land at St. Loman's. Why does this legislation need to be brought before the House now when public lands have been sold before in different circumstances which did not require legislation? Is there a difference in the composition of the boards of St. James's and Beaumont hospitals? I ask the Minister to give a clear response on this issue to clear up a number of concerns on this side of the House.

The co-location policy brings us much closer to Boston than to Berlin in our approach to the health service. I know this is the Minister's philosophy and it is another step towards the Americanisation of the Irish public health system. She has not addressed the significant concerns about the impact of co-location on the financing of the public hospital system. There are concerns about training and about how professional teams will move between the two systems. People on the front line have many questions which have not been answered.

I refer to the VHI annual report for 2006 which explicitly stated there was no need for further private beds. The Minister stated in the Dáil yesterday that the new privately managed facilities will be used for public patients to supplement rather than supplant public service provision. In many ways, the Minister's plans in this area will supplant rather than supplement the public service provision and could lead in the longer term to a real undermining of public service provision in the health service. The Minister might be better off providing the 3,000 extra public acute beds which were promised more than six years ago.

I have referred to the Medical Practitioners Act which was rushed through the Oireachtas in 2007. Why was this issue not dealt with at the time? What new information has come to light with regard to the Medical Practitioners Act? Have concerns about the Act been expressed by the Medical Council? Why is there a need to address it one year later?

This legislation proposes a different arrangement for the new children's hospital. I reiterate the concerns expressed by many about the site chosen by the Minister.This issue was recently raised at the Joint Committee on Health and Children where Professor Drumm discussed the transport issues but was far from reassuring to the people of west Dublin and beyond who currently use Tallaght and Crumlin hospitals, both of which are going to close as a result of the decision that was made to locate the new children's hospital on the Mater Hospital site.

I reiterate my concerns about the golden hour, which is a well established principle which states that some children in emergency situations need to get to hospital within an hour in order to have their lives saved. Children's lives are put at risk by the proposal to leave the south west and west side of Dublin and patients from Kildare without an overnight paediatric bed. If the Minister is intent on going ahead with the proposal to open a facility in Tallaght it should be a 24-hour facility, not one that is open from 9 a.m. to 5 a.m. or 9 a.m. to 8 p.m.

The Bill also attempts to address issues within the Health Act 2004. Again, that Act was presided over by the Minister when she established the HSE. In many cases the Minister is replacing the word "Minister" with "HSE". It would have been appropriate to have a discussion about the relationship between the Minister and the HSE in terms of accountability and responsibility. When it emerged that many women were being recalled by the Midlands Regional Hospital in Portlaoise it was evident that there was no line of accountability between the Minister and the HSE. It was very unclear as to who was responsible.

Effectively, what we had in the committee was two groups of personnel, the Minister and her staff from the Department of Health and Children and senior staff members from the HSE. One side clearly did not know what the other was doing. There was no line of accountability or responsibility. It is proposed to make the roles interchangeable in the Bill even though we have not had a debate about who is responsible. That is the key issue. We need more accountability, responsibility and clarity about who is in charge.

It will be difficult to regain the confidence that has been lost, especially in regard to breast cancer facilities. That is not something which is possible to recover easily. A concerted effort is required to build up confidence in the system in order that women feel they can rely on the assessment and diagnosis they receive. One of the key aspects of handling this matter is to answer the question of who is in charge of what issues and where the responsibility lies.

I regret the fact that three different areas are being addressed in the Bill. I also regret the lack of time. As Senator Alex White indicated this morning, it is not just a case of more time in this House, it is also necessary to provide more time in order to allow the media report what is being done so that there can be reaction to it and that those who are interested in this area can have an opportunity to talk to parliamentarians and give their response to the legislation. All of that is being denied by the way the Minister has chosen to introduce the legislation.

The Minister called for a Tallaght strategy-type approach to the health service in certain areas. She has been in a position to introduce the kind of changes she wanted without any Tallaght strategy and that has not been done. Introducing legislation in this manner, without publishing the legal advice and without giving adequate time between the different Stages of the Bill is not treating the Houses of the Oireachtas in the way they should be treated. This is not the way to introduce legislation and expect support for it.