Frances Fitzgerald (Fine Gael)

I would like to reiterate some of the points I made earlier about the three matters being dealt with in this legislation. I refer to the changes being made to the roles of the Minister and the HSE, the amendments being made to the Medical Practitioners Act 2007 and the strengthening of the legal basis of various bodies which, according to the Office of the Attorney General, do not have a satisfactory legal basis at present. Fine Gael is concerned about the manner in which three separate issues are being handled together. If it is necessary to regularise the legal basis of certain bodies, we support in principle measures aimed at doing so. We are not satisfied about the way this Bill has been brought to the House, the timeframe that has been set for the consideration of the legislation and the manner in which three separate matters are being dealt with in a combined Bill.

The Bill before the House will ensure there is no doubt about the legal capacity of Beaumont Hospital and St. James's Hospital to enter into co-location agreements. Some hospitals did not have a real choice on co-location because they were finding it difficult to get money for public beds. The money that is being extended to them to develop co-location was not made available to them when they wanted to fund public beds. I question the extent to which some hospitals — not all of them — have genuinely had a free choice in this instance. That underlying question should be up for discussion.

I hope the Department of Health and Children will re-examine the policy of co-location and realise it will undermine the provision of public health care services and widen the gap between the two tiers of our health system. Many things can be done to improve the health care system, but co-location is not one of them. The Minister of State, Deputy Smith, has emphasised today that co-location will create more beds within the system. The Minister, Deputy Harney, has also made that point on many occasions. We do not know, however, who will staff the beds and who will pay to use them. As I said earlier, the co-location programme will not solve the problems in accident and emergency departments or address the lack of tertiary beds and home services which leads to bed blockers.

I am conscious that cutbacks are being made at present. We cannot get home care packages to help people who are in the National Rehabilitation Hospital in Dún Laoghaire, for example. Parents and other family members are willing to help such people, but home care packages are not available to facilitate that. I raised this issue in the committee. It is a serious problem at the moment.

I understand the wish to provide beds at a faster pace, but the long-term effects of the proposal have not been considered. Alternative solutions have been neglected as a result. Possible solutions to the problems in the health care system include the building of new hospitals by private companies which could then be leased by the State; a requirement for universal public health insurance, a system which works well in other countries and would eliminate the two-tier system; and the placement of non-acute services in the grounds of public hospitals, which would reduce the problem of what is termed "bed blockers". There are many other alternatives to the co-location policy which could have been considered. This decision was taken quickly and without consideration of its long-term impact.