Paschal Donohoe (Fine Gael)

——it was difficult for people to get their minds around and understand this issue. This summer I was delighted to see a book review in The Irish Times, written by the Minister, of The Other Invisible Hand by Julian Le Grand. This book sets out the theoretical and policy foundations upon which the idea of co-location is based. Professor Le Grand published another book called Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens, which expounded these views in more depth. I took some time to read these books to understand the policy framework of the co-location concept. The idea is that a diversity of providers can come together within a policy framework to deliver a better outcome for citizens, whether they be patients, pupils or elderly people.

Professor Le Grand lays out four criteria required for this to work, which are missing from the current co-location framework. The first is that the State, rather than the person accessing the care, must bear the cost of this care. In the case of health care provision within the UK and elsewhere, this is happening within a general health insurance model. If a patient in the UK accesses a foundation hospital, for example, which is the equivalent of a co-located hospital, he or she does not pay because it is paid for out of his or her tax contributions. There is a general health insurance model within which the idea of providing diversity of service is embedded. If a private patient uses a co-located hospital in Ireland, his or her health insurance premiums will increase over time because he or she will eventually be charged the full economic cost of the care. This is in opposition to the idea of ensuring service provision is free at the point of use.

Regulation is strongly advocated in this system. It will ensure that everybody operating within the service is adhering to the standards and protocol set out by the Government but as my colleague, Senator Twomey, said earlier the very organisation charged with doing that in the health service, the Health Information and Quality Authority — the Minister must be congratulated on setting up that organisation and it must be congratulated on the quality of its recent report — will be unable to go into these new hospitals. How will we ensure the quality of care is maintained in respect of all people using these services?

Professor Le Grand emphasises the importance of avoiding cherry-picking to ensure hospital services or skills are not only available to wealthy people or to those already in fairly good health and to avoid the need for institutions having to deal with the very sick or those unable to afford care. As everybody on this side of the House has pointed out, that will not be the case with co-located hospitals because the majority of those who will use them will have private health insurance, which I welcome — I have private health insurance, as does nearly half the population — as opposed to those who do not.

Professor Le Grand stresses the importance of ensuring that citizens have all the necessary information on the services they use and that they can use that information to pick the service. I had to make a choice regarding a hospital I had to use recently and the only information I had to go on was one or two reports from HIQA and local information, rumours and feedback from my neighbours. That is not good enough when one is deciding which hospital to use. We are talking about hospitals which are using €15 billion in funding.

Those of us on this side of the House are right to oppose the Bill because we do not have enough time to do our job properly. The co-location idea, which will be brought in under this Bill, will drive a nail through the proposal to bring in a diversity of people to provide policy services to people here. The co-location model does not meet the criteria other countries use to make a policy like this one successful. These views have not been generated in an insincere manner to curry favour with the electorate or whoever. We have taken the time to examine the idea and to articulate these views here and elsewhere, which is our job.