Frances Fitzgerald (Fine Gael)

I welcome the Minister of State to the House. He has had a busy few weeks on the child care issue and this is other difficult legislation. I wish to make a number of points on co-location. It would appear to be an extraordinary Irish solution to an Irish problem in the health care system. I fundamentally disagree with what the Minister of State has said and the Minister's policy on co-location. The Minister is adamant that co-location deals with the issue of private beds in public hospitals. I strongly believe that the solution to that problem is not the building of co-located private hospitals. It is a fundamental error of approach by the Government, driven by Progressive Democrats ideology, which does not sit that comfortably with aspects of Fianna Fáil policy despite that party's support for it.

While we clearly need more public beds, despite what the Minister of State has said about it having been discussed a number of times in the House, there was never a detailed policy discussion on the move to co-location as the solution to the problem of private beds in public hospitals. The Irish health care crisis can be seen in the major unmet demand for health care. It manifests itself in different areas, including waiting lists for acute care, and a bed occupancy rate of 100% when the optimal is 85%. This has major implications for treating MRSA in terms of isolation beds and units for people with that illness, and the treatment of this disease is one of the greatest scandals of our time. Having recently met the lobby group that works to highlight the issues of MRSA and while it has not really hit the headlines, what is happening to individual patients in hospitals is a scandal. We have failed to tackle the issue at a national level and have not set sufficiently high targets for dealing with MRSA. It is an issue to which the House should return.

The crisis also manifests itself in accident and emergency units with people left on trolleys or hard chairs for long periods. Bed block is a term I do not like. The answer to all these issues does not lie in co-location and moving to the privatised model behind it. Some hospital groups support co-location. I am sure the Minister and her officials have considered this matter. Information is available about some of those groups which have broken regulatory practice in the United States and have had fines imposed on them totalling millions of dollars. Are there issues about those hospital groups being given such a key role?

I put this out as part of an agenda which should be examined. I am seeking reassurance that the Department of Health and Children and the Minister have examined this aspect of the issue. It may be that the regulatory system in the United States is so strong that it is inevitable health providers may get into trouble and it may not be as it seems. I want to name it and ask that the Department come back with a response on this issue of co-location at some time in the future.

An expert from Australia made the point that co-location was put in place in Australia over a period of ten years whereas we are planning to introduce it in Ireland over five years. The timeframe is an issue when so many other private hospitals are already in receipt of tax breaks to build private hospitals on greenfield sites. As the VHI has stated, it is doubtful whether as many private hospitals will be required in such a short period of time. In Australia many small, independent private hospitals were forced to close because there was not enough demand for private services. One co-located private hospital also shut down because it was not profitable.

I support what Senator Prendergast said about the questions which have not been examined by the Minister and the Department. There is a soundbite and a mantra about co-location. However Senator Prendergast has raised the issue of the impact of co-location on medical training of front line staff such as nurses, midwives, doctors, registrars and senior registrars and how training will be affected by the existence of a two-hospitals system. Many of those working in the front line have serious concerns about the impact of co-location, not just on training but also on the funding for public hospitals. The financing of public hospitals may be affected by the changes implied by co-location. We need to have more information from the Minister about the funding of public hospitals following co-location.

Where are those involved in serious accidents and those with long-term illnesses cared for? Is it in a private hospital or is it in the public health service? If an elderly parent has a long-term illness, such as Parkinson's or Alzheimer's, where do they end up being treated? If somebody is involved in a serious road traffic accident, he or she is brought to the accident and emergency department of a public hospital. The public hospital service caters for these long-term conditions and emergencies. There is a real danger that cherry-picking of work will happen when co-location is in place. Our public hospitals will require significant funding as a result but instead money will be directed into these private hospitals. I have no problem with private hospitals and private health care if that is what people choose to pay for through health insurance or if private companies choose to develop it. What I do not want to see is the blood drained out of our public health system in the interests of a model of co-location. This concern is shared by many experts in the field and by many commentators. If we are going to move to co-location, the very least I would expect in both this and the other House is a detailed debate providing answers to these questions and not a hasty announcement made in 2005 and pushed through as a policy before the general election.

This Bill raises these issues, although the Minister has stated this Bill is not being introduced as a result of the issues associated with St. James's and Beaumont hospitals.

These are just some of my concerns. Co-location will have very serious implications for the development and funding of our public health service and for the way in which it is perceived by the patients. Not all the proposed sites for co-location may proceed but these issues which I have raised are of concern to people worried about the future direction of our health service. This Bill provides us with an opportunity to comment on this issue in this House in some ways for the first time. It is not too late for further debate and time should be provided in both Houses for detailed discussion on some of the issues outlined and which arise as a result of the Minister proposing this legislation concerning St. James's and Beaumont hospitals.