Pearse Doherty (Sinn Fein)

Following the Attorney General's advice to the Government that primary legislation must be enacted as a matter of urgency to protect the 19 existing bodies established by Ministers by statutory instrument under the 1961 Act, we need to give some leeway. If the legal advice, which should be made available to the Opposition, is correct, then to ensure the continuation of the work of these bodies this legislation is necessary and should be supported.

However, several unanswered questions must be addressed. One major element of the Bill that cannot be supported by Sinn Féin is the extension of the powers to the boards of St. James's and Beaumont hospitals to facilitate the Government's infamous private for-profit hospital co-location plan. It is ironic that the first reference in legislation to co-location should come in a Bill designed to protect the State from a constitutional challenge on the grounds that an Act gives too wide-ranging powers to the Minister. There has been neither a thorough debate or legislation on co-location. It will lead to a significant change in our health care and hospital system that will reinforce the system's two-tier nature and swing State policy towards privatisation. For all this, no Oireachtas approval has been sought for co-location.

The lesson from the Bill's introduction is the danger that arises when the power of Ministers and the Cabinet is taken too far. On many occasions concerns have been raised about Bills which give extensive powers to Ministers through ministerial orders. The role of the Oireachtas in democratic decision-making and scrutiny of legislation has been weakened.

When important bodies are established and funded to the tune of many millions of euro by the State, they must be established by legislation with the entailing checks and balances and democratic accountability. The record of the Government, and the Minister, on accountability is lamentable, however. The Government established the Health Service Executive, HSE, as a buffer against accountability in two directions — from Oireachtas Members and communities.

The Government has signalled its refusal to remove the sections it inserted in the Bill designed to facilitate co-location. The Schedule proposes to amend ministerial orders and give them legislative force. This will mean giving powers to the boards of St. James's and Beaumont to proceed with co-location. Therefore, Sinn Féin cannot support the Bill.

Only one word applies to the minds who came up with the private for-profit hospital co-location scheme — the title of Michael Moore's latest film, "Sicko". These are the people who set the agenda for health care policy in the State. They are the Minister for Health and Children, Deputy Harney, and her advisers, fully backed by their Fianna Fáil and Green Party colleagues in the Government.

Protestant and Catholic organisations — the Adelaide Hospital Society and the Jesuit Centre for Faith and Justice — joined forces in June 2007 to warn against the trend in health care policy that co-location represents. Their jointly published report stated co-location "sends out a powerful message about Government backing and support for the existing two-tier hospital system". It continued:

[It] represents a significant threat to the fundamental values of care and justice, which require that health provision is seen first and foremost an essential service, which should be available on the basis of need.

A Government which sponsors such a scheme can never be relied upon to deal with the underlying inequalities which contribute significantly to ill health in society.

Authoritative opinion in the front line of hospital care claims 3,000 additional hospital beds are needed to replace beds taken out of the system in the 1980s and to cater for the 25% population increase since then. The Government claims it will increase bed numbers by 1,500 but no fewer than 1,000 of these are to come from the co-location scheme facilitated by this Bill. The Minister claims 1,000 private beds will be transferred from public hospitals to the private co-located hospitals, thus freeing up that number of public beds. She has never answered the parliamentary question of my colleague, Deputy Ó Caoláin, on how many beds will be transferred at each hospital site. Co-location cannot provide the additional beds required.

The Doctors Alliance for Better Public Healthcare has stated:

[I]n general, private medicine does not provide emergency or urgent care which makes up the overwhelming majority of cases treated as in-patients in public hospitals ... Most patients admitted as in-patients to public hospitals are not suitable for care in a private hospital, including most patients admitted via A&E. That is why there are patients with top level health insurance on trolleys in public A&E departments while there are beds empty in nearby private facilities.

Co-location has been opposed across the political spectrum and the health services. It is driven not by patient need but by private profit, reinforcing the public-private apartheid in our two-tier health care system. It introduces corporate medicine on a large scale into the State and will have profound and damaging long-term consequences for the health system.

The Government is abusing the good will of the Opposition by introducing these measures to facilitate co-location. Sinn Féin therefore cannot support the Bill as it stands unless the Government removes the offending sections.