Brendan Smith (Cavan-Monaghan, Fianna Fail)

As already indicated, the purpose of these provisions is to put beyond any doubt the capacity of St. James's and Beaumont hospitals to enter into co-location arrangements. During the period 2003 to 2004, the Department of Health and Children came under considerable pressure from the former Mid-Western Health Board to sanction the development of a private hospital on the grounds of Limerick Regional Hospital. The Department also became aware that the boards of Beaumont and St. James's hospitals in Dublin were preparing proposals for the development of private hospitals on their sites. The Department arrived at the view that there was a need for a comprehensive and consistent approach to the assessment of any proposals for private developments on public hospital sites. Prospectus was engaged by the Department in the autumn of 2004 to advise on a framework which would encourage private investment in the acute sector and promote and protect the public interest.

Around the same time, the Department was becoming increasingly concerned at the extent to which the level of private practice in public hospitals was exceeding the ratio of 80:20 agreed with the medical organisations. Approximately 2,500 beds in public hospitals, representing 20% of the total, are designated for use by private patients. The level of private elective admissions, namely, those that are planned rather than emergency admissions, was, and still is, running at approximately 35% of the total, however. This has an impact on the ability of public patients to access public hospitals and it contributes to waiting lists for public patients and problems in accident and emergency departments.

A combination of factors had led to a position where private patients were receiving priority access to public hospitals at the expense of public patients. At the same time, the Exchequer and the State were spending considerable sums on sending public patients to private hospitals via the National Treatment Purchase Fund. This situation called for innovative thinking and out of it the co-location initiative emerged.

Co-location is seen by the Government as the quickest and least expensive means of providing significant additional capacity for public patients. No capital outlay is required because the beds, having been funded by the Exchequer, are in place. In addition, the beds are staffed and the back-up services and facilities required to support them are in place. A target of transferring 1,000 private beds to the private sector over a period of five years was seen as attainable. The Government accepted that there would be a loss of income from private insurers but this was seen as a small price to pay to free up 1,000 patients for public patients. The Government endorsed the co-location initiative in July 2005. A policy directive was issued to the HSE on 14 July 2005 mandating it to implement the initiative.

I may have omitted to deal with a particular point made by Senator Fitzgerald earlier. It was stated previously in the House that the land on public hospital sites to be used for the development of co-located hospitals will be leased to the private partners. The public procurement process has proceeded on that basis and the private partners are well aware that there is no question of the land being sold to them. The land for the co-located hospital at Beaumont is owned by the hospital board, whereas that at St. James's is owned by the HSE and is leased to the hospital board.

The phrase "disposal of land" in Article 4A(2)(b) was the subject of detailed discussions between officials of the Department of Health and Children and the Parliamentary Counsel. The advice of the Office of the Parliamentary Counsel is that the language used in Article 4A is the appropriate formula in respect of dealings in land. I reiterate that the land for co-located hospitals will be leased and Article 4A is designed to permit this and no more.

Senator Prendergast inquired about the functions of the Health Information and Quality Authority, HIQA. The authority's functions and remit are being extended and rolled out. As a former nurse, I am sure the Senator will appreciate that the establishment of the HIQA is an important element in the reconfiguration of the delivery of health services and in ensuring standards reach the requisite level.

I had the opportunity to meet Tracey Cooper, the new chief executive of HIQA, and some of her senior colleagues. In my opinion, they have the capacity and the determination to do an excellent job and deal with all matters coming under their remit. They will be provided with the resources. Everyone has a genuine interest in ensuring all patients, regardless of the sector of health system in which they find themselves, are given the highest standard of treatment at all times. The HIQA has the power to investigate services provided by the HSE or on its behalf, either by private sector or voluntary sector interests. The office of the chief inspector of social services, which is part of the HIQA, will inspect private and public nursing homes. At present, only private nursing homes are inspected by the HSE.