Frances Fitzgerald (Fine Gael)

In reply to my query regarding the disposal of land, the Minister of State indicated that detailed discussions took place between the Parliamentary Counsel and the Department. This suggests some questions needed to be asked in respect of the language used. I wish to put down a marker that, regardless of the advice received by the Minister of State, to me the phrase "the disposal of land" refers to the sale of land. If I was presented with the detailed legal advice, I might be convinced that the position is otherwise.

I am concerned that private consortia will be able to buy what used to be public land on public hospital sites. That is what it looks like to me. While I bow to the legal information available to the Minister of State, I have not seen it.

I would like to respond to the Minister of State's comments about the value of co-location. The Department of Health and Children has emphasised in its guidelines that accident and emergency departments will not be a feature of co-located hospitals. Significant investment and re-organisation are needed in our hospitals' accident and emergency units. Waiting times are unacceptable, as we know, although there have been some improvements. The facilities available in such units often are sub-standard. The co-location plan will have a minimum impact on this aspect of the accident and emergency crisis in hospitals.

The crisis could be alleviated if we placed an increased emphasis on primary care services, especially services offered outside office hours. The Health Service Executive has made some progress on this issue in north Dublin, but it needs to be addressed throughout the country. Most primary care in Ireland is provided privately, which does not improve access to services in the hospital sector, mainly because the VHI does not cover primary care. Progress could be achieved in this area if we were to award tax breaks to clinics and physicians which offer a 24-hour service. This would encourage primary care providers to make such a service available, thereby reducing the pressure on accident and emergency units. The problems in such units constitute one of the big crises in the hospital service. Co-location will not offer a response or a solution to this difficulty.

It should be pointed out also, in the context of the debate on the section of the Bill relating to co-location, that the profitability of the co-located private hospitals will depend on the attitude of the VHI which is the main provider of private health insurance in this country. Professor Drumm, who is the chief executive of the Health Service Executive, has said that private hospitals will be billed for all patients who are sent to public hospitals for part of their treatment. It seems clear that he is against co-location but refuses to comment on it beyond an operational perspective.

The VHI recently refused to cover services provided at a new private hospital in Galway, resulting in the hospital running at a loss. If it refuses to reimburse all new private hospitals, such as the co-located hospitals we are discussing, to the extent they require, they will obviously start to encounter significant funding problems. If the VHI agrees to reimburse private hospitals to the extent demanded by them, its costs will increase which will lead, in turn, to higher premiums. It is inevitable that the policy of co-location will lead to higher premiums. The 50% or more of the population who have private health insurance will not thank the Government when their premiums increase as a result of co-location. I do not doubt that premiums will get more expensive, which will mean people will have to spend more money on health insurance and less money in other areas of the economy. It will price some people out of the health insurance market, which will put an increased strain on public services and intensify pressure on a system that is already overloaded.

Private hospitals obviously are aware of the pitfalls ahead. The Bon Secours group recently pulled out of the consortium that won the contract to build a private co-located hospital in Waterford. The policy of co-location is ill thought-out. There has not been a proper examination of its potential effects on the public health system. I regret that it will undermine that system. Senators on the Government side have argued that it will increase bed numbers — I do not doubt they are genuine — but I maintain that it is ill thought-out and ideologically driven. It shows a lack of commitment to the public health service. The co-location policy is couched in terms of the provision of 1,000 extra beds, but it will privatise and Americanise our system. It demonstrates the willingness of the Government to move closer to Boston than to Berlin. I do not believe it reflects the wishes of the people of Ireland. The impact of co-location will be felt for generations to come. It sends out a message that will undermine the public health system. I have tabled these amendments to address the points I have highlighted.