Barry Andrews (Dún Laoghaire, Fianna Fail)

I am taking this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I take this opportunity to congratulate Councillor Cormac Devlin on the birth of his first daughter last Saturday. I believe the Senator was referring to Caoimhe Devlin.

The Health Acts 1947 to 2008 set out the framework for the provision of public acute hospital services by, and on behalf of, the Health Service Executive. The principal remit of public acute hospitals, including public maternity hospitals and units, is to provide hospital and maternity services to public patients.

Any person ordinarily resident in the State is entitled to public hospital services on the basis of full eligibility or limited eligibility. In the case of maternity services, expectant mothers are entitled to avail of free public hospital services.

The health system also enables patients to be treated in a public hospital where they opt to be the private patient of a hospital consultant. However, to protect access for public patients, the legislative framework limits the proportion of private activity which can be undertaken in public hospitals. One of the Government's central objectives in negotiating the new hospital consultants' contract was to improve access for public patients to public hospital services.

One of the mechanisms used to control private activity in public hospitals is the bed designation system which was introduced in 1991. Under this system, approximately four out of every five beds are designated for the use of public hospital patients. The percentage of beds designated as public or private varies somewhat between individual hospitals. This system allows for private patients requiring immediate admission to be accommodated in a publicly designated bed where no private bed is available.

The proportion of private work which a hospital consultant may undertake is also subject to control. The new consultant contract arrangements provide for a total prohibition on private practice for consultants holding the type A public-only contract. Type B holders may undertake private activity in their employing hospital. Type B and type C holders may undertake private activity off-site. Approximately 560 of the 1,550 consultants who have accepted the new contract have opted for the public-only contract. The new arrangements also provide for the enhanced management and strict monitoring of hospital consultants' work to ensure the permitted ratio of private activity is not exceeded.

The Minister for Health and Children is satisfied these new arrangements, with the other measures in place, will ensure greater equity of access for public patients and a proper balance between public and private activity in the public hospital system.

Where a person wishes to avail of hospital services on a private basis, this is subject to their being under the care of an admitting consultant whose contract permits private practice and to a private bed being available at the time of admission. In such circumstances, where a private bed is not available, a patient may still be admitted but will not be deemed to be a private patient in respect of hospital accommodation arrangements.

The Minister asked me to emphasise the Government's commitment to protecting an appropriate proportion of public hospital capacity for public patients. A consequence of this policy is that, although a private patient may wish to be accommodated in a private bed, it may not be possible to facilitate this in every case.