Ivana Bacik (Independent)

I echo the concerns expressed by Senator Fitzgerald about the lack of time we have had to review and scrutinise the provisions of the Bill. There has been undue haste with the way in which it has been brought before us, in particular, because there is such a raft of amendments that the Bill purports to make, not just in the sections but also in the Schedules, and particularly in Schedule 1.

Schedule 1 contains a host of retrospective amendments to different statutory instruments some 30 or more years old. Therefore, to consider the Bill as amending legislation one also needs to look at the amendments that are being introduced in this way through a raft of statutory instruments. That involves procedural difficulties and I would like to have had more time to look through those statutory instruments than the way in which this is being done.

On the wording of the statutory instrument, Senator Feeney referred to the issue of disposal, but "the disposal of land or an interest in land", which is the wording used in Schedule 1 referring to the powers of the boards of St. James's and Beaumont hospitals, could clearly be either by lease or by sale, and Senator Fitzgerald's concerns are well founded in that regard.

I wanted to focus my remarks on the implications of the Bill for co-location, about which the Minister has spoken. Clearly, there was a concern that the board of St. James's and Beaumont hospitals would need a more solid legal basis in order to back up the decisions on co-location that the Minister has favoured. It would be of considerable value to us to see the legal opinions on which the Bill, and especially section 7, has been based.

We have not seen the Attorney General's advice. We do not have an outline of it, nor do we have senior counsel's opinion, which I understand was also given in respect of this. It seems that section 7, if passed, would purport to amend a raft of statutory instruments retrospectively, including SI 187 of 1971 relating to St. James's Hospital board and SI 258 of 1977 relating to Beaumont Hospital board.

Leaving aside for a moment this dubious procedure of engaging in such a substantive series of retrospective amendments of statutory instruments, I want to look at the merits of the co-location idea in itself. In her speech, the Minister indicated that co-location is based on what I would describe as a fundamentally flawed premise, that is, first, the Department of Health and Children was looking originally in 2004, as the Minister stated, "to advise on an appraisal framework which would both encourage private investment in the acute hospital sector...". I would suggest that it is driven, first, by an ideological interest in encouraging private investment in health care.

Second, the Minister stated that there was a concern that the level of private practice in public hospitals was exceeding the ratio of 80:20 which has been previously agreed and that more beds were being given to private patients in public hospitals than had been intended. However, the solution to this is to tackle the two-tier health system itself rather than to reinforce it through co-location. It is clear — this is a view shared by many in the health sector — that co-location will only reinforce the two-tier system and will encourage private investment. I would refer the House to an article in the current issue of the Irish Medical Times which describes the co-location initiative as a plan that allows the private health care sector which dominates the American system to get a stronger foothold in Ireland. Clearly, what we will see is private British and US health care providers moving in here and taking over the running of health care services.

The Irish Medical Times has also correctly stated that although most people were seemingly against the idea of co-location last year, the process began under the HSE directed by the Minister to seek out which hospitals would move towards co-location and would have private buildings on site. St. James's and Beaumont hospitals are two of the six hospitals to which co-location is intended to apply.

The cost of co-location has been one big issue and a major area of controversy. It has been suggested that the cost to the State will be close to €70 million a year over seven years, amounting to €490 million, and that the same amount of money, if spent differently in the health system, could provide more public beds at a lesser cost to this principle of equity of access within the health care system.

According to the Irish Medical Times, co-location opponents, of whom I am one, agree it will result in a two-tier system of health care even more reinforced and substantive than exists at present, it will cost the taxpayer more and it will lead to cherry-picking of easier and simpler services from public hospitals and into private hospitals. There is a concern that no widespread informed analysis of the plan has taken place but most patient and doctor representative groups are against co-location.

Important research has been done which shows that patients tend to receive poorer treatment in for-profit hospitals. Clearly, this is a big feature of the US health care system, but I hope none of us wants to see that emulated or put in place here. Research done in the US, and published in the New England Journal of Medicine, found that for-profit hospitals deliver inferior care at inflated prices, and that for-profit hospitals deliver care that is lower in quality than that provided in not-for-profit ones and yet is more expensive.

In terms of quality of care, in terms of value for money and in terms of undermining the principle of equity of access to health care, we must ask whether co-location can really deliver. The clear evidence is that it cannot deliver equity, it cannot deliver value for money and it cannot deliver quality of care for patients. Section 7 should be opposed on the basis that it facilitates co-location going ahead.