Denis O'Donovan (Fianna Fail)
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I welcome the Minister for Health, Deputy Leo Varadkar.

Sean Barrett (Independent)
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I, too, welcome the Minister. The last time I met him in person was at the funeral in Dundalk last Thursday. I was with him this morning via the use of technology during his interview on "Morning Ireland" on the care of people in hospitals outside the jurisdiction.

I tabled this issue for discussion in the Commencement debate having read in a newspaper article that Baggot Street Hospital was to be sold for €14 million. According to Department of Health archives, there were 193 beds in the hospital, which equated to a capital cost of approximately €73,000 per bed. In terms of their replacement, according to data from the HSE capital spending programme, the cost of the provision of 50 beds at Tralee General Hospital is €9.4 million, while the cost of the provision of 100 beds in Ballincollig hospital is €19.47 million, which equates to approximately €190,000 per bed. I am concerned about the bad value being obtained by the Department of Health in the sale of Baggot Street Hospital, particularly in the context of the Minister's remarks this morning on having to send people abroad, the widespread recognition - there is no one more avid in recognising it than the Minister - of lengthening hospital waiting lists and future shortage of capacity in hospitals. Prima facie,it does not appear to be a good deal to sell the 193 bed spaces at Baggot Street Hospital for €14 million. Is it worth investigating whether it would be more useful to retain them in the system, in which, as the Minister will agree, they are badly needed?

Having read the data, I estimate that approximately 674,000 bed days have been lost in the city centre of Dublin following the closure of the Adelaide Hospital, Sir Patrick Dun's Hospital, Dr. Steeven's Hospital, Mercers Hospital, the Meath Hospital, St. Vincent's Hospital on St. Stephen's Green, the National Children's Hospital, Jervis Street Hospital and the Richmond-St. Lawrence's Hospital. Following the sale of Baggot Street Hospital, a further 62,000 possible bed days will be lost. It is also proposed to remove beds from Holles Street Hospital and the Rotunda Hospital. Based on an analysis of the last population census in Dublin, prepared by Mr. Jamie Cudden of Dublin City Council, Mr. Brian Hughes of the Dublin Institute of Technology and Mr. Declan Redmond and Mr. Brendan Williams of the School of Geography in UCD, we are moving hospitals away from the direction in which the people are moving.They found a 62% increase in Dublin city centre between the 1991 census and the 2011 census. They stated that the increase reflects the high level of apartment building in the inner city from the late 1980s onwards.

They point out that the rest of the Dublin City Council area had a decrease of 1.2% in the population between 1991 and 2011. We all want hospitals near where people live, which is increasing in the city centre, and where people work, which happily is increasing in the city centre. Is this deal justifiable given the need to have hospitals near where the people are and an area of rapidly increasing population? I was surprised to read what the three scholars found about the increase in the population in the centre of Dublin. Prima facie, it does not look like good value for money to do so, given the cost of replacing those beds elsewhere.

In his interview with Cian McCormack this morning, the Minister welcomed anything that throws up cost comparisons. I had tabled the motion before I heard the Minister speak, but it is in that spirit. I agree with him; if it turns out that what we have before us today does not make financial sense, at least we will have discussed the hypothesis. He said that anything like that strengthens his case for spending. He mentioned keeping taxpayers' money in Ireland when he has debates with his colleagues. It could also shorten waiting lists and strengthen his case for more funding.

In that spirit that we are all on the one side on this particular issue, does the closure make sense given the location of the patients? Does it make sense given the cost of beds in our health service?

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Barrett for raising this matter and for giving me the opportunity to advise the House on the proposed sale of the old Baggot Street Hospital complex. This facility, like much of our health-care infrastructure, dates from around the mid-1800s. As a consequence it is of limited use as suitable accommodation for the delivery of modern health services. The complex also contains a number of protected structures.

Therefore, given the age of the complex and its protected status, the cost of upgrading the buildings to meet modern standards for health-care accommodation would be prohibitive. If it were still in use as an inpatient hospital, we would be planning to rebuild it on a new site, as we are with other hospitals of a similar vintage, like the Rotunda, Holles Street and Temple Street, for example, all of which will be replaced by new modern hospitals in the next ten years.

The inability of older facilities like Baggot Street Hospital to respond to changing health-care needs and medical technologies impedes the efficient delivery of modern health care and the development of clear care pathways. Old facilities also have much higher recurring costs. The costs of meeting sustainability targets on energy alone would be prohibitive. The national energy efficiency action plan sets a public sector energy efficient target of reducing energy usage by 33% per annum which is to be achieved by 2020.

In addition, the HSE must comply with the Government's green procurement guidelines. These require public bodies to ensure that a minimum building energy rating of B3 is achieved in all new build and leased buildings from January 2012. From January 2015 the minimum rating is A3. We have to reduce the number of environments where inadequate infrastructure is determining how resources are spent.

In an improving property market, the HSE sees an opportunity to leverage the sale of Baggot Street Hospital. The proceeds of the sale will deliver accommodation for primary care and community services in central Dublin. The balance of the proceeds will fund modern accommodation for mental health services. The new primary-care and community-care facilities and the redevelopment of the old hospital complex will revitalise the surrounding area.

It is Government policy to enable people to easily access a broad spectrum of services in the community through their local primary care team. Therefore, the development of primary-care health services is central to the Government's objective to deliver a high-quality, integrated and cost-effective health-care system. This ensures health care is delivered in the most appropriate and economic setting. Our key objective is to ensure that the right facilities are provided to support best practice models of care, and that they are suitably located, efficiently designed and appropriately procured to serve the health needs of communities. In addition to providing the most appropriate health care to the local resident population, those employed in the surrounding area may also access these services.

Sean Barrett (Independent)
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I thank the Minister as always. I am concerned that the big increase in the city centre population is not being factored into much of our planning for the future of the city centre. In addition, those who work in the city centre need access to hospitals.As a person who lived in the city centre for a long time, I am aware that hospitals such as the Adelaide had a significant place in the local community. Such hospitals were really valued as institutions. Hospital beds have moved out of the city centre at such a rate, even though the population is moving back in. Reference was made to energy costs. The cost of replacing 193 beds is substantially in excess of what we will get for selling the 193 bed places. I am concerned that sometimes there is too much emphasis on the age of buildings in terms of Irish hospitals when the waiting lists reflect people wanting more staff, which I know the Minister has addressed and on which he has reported to this House. Is there an edifice complex? Is the HSE determined to rebuild the entire hospital stock when people would like more doctors and nurses? Is the capital budget put under full appraisal? Reference was made by the Minister to energy costs but the wage costs, the medical costs and the cost of people being on waiting lists are greater.

I do not know how far the sale has progressed but perhaps in the light of what the Minister said this morning and the high cost of sending people abroad, if they avail of their entitlements under the European laws to which he referred, we might adopt a revised attitude to dispensing with old hospitals, in particular in areas where so many of them have been shut down and turned into office blocks and given over to other uses. One could ask whether some of those decisions were short-sighted.

When the Minister was responsible for transport, I discussed with him the re-opening of the railway line between Connolly Station and Heuston Station. Instead of Dr. Steevens' hospital becoming the headquarters of the HSE, and an office block, it would have been an ideal location for a hospital because people from all parts of the country, from Dundalk to Tralee, could go to the station across the way. I would welcome more planning in terms of those issues. I am sure I will discuss this matter with the Minister from time to time but there are factors that must be taken into account. I thank the Minister, as always, for his reply and I wish him well in his post and in his endeavours. Perhaps this particular sale does not support the goals which we jointly share. Go raibh maith agat, a Chathaoirligh. I thank the Minister.

Leo Varadkar (Dublin West, Fine Gael)
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I have not had a chance to visit Baggot Street yet but I am due to visit it in the next couple of weeks and to take a look at the place for myself. To the best of my knowledge, it is not used as an inpatient hospital any more, it is used for other services. Perhaps some short-stay services are provided but it is not used as an acute hospital, so to do what Senator Barrett proposes would mean turning it back into an acute hospital. That would have a very high cost associated with it, which the HSE Estates believes is greater than to build something from scratch.

There are big problems with the old hospital buildings. Very often one has 20 to 30 beds to one toilet and because the buildings are old, it is very difficult to put in additional toilets. While that sort of thing might have been acceptable in the past, that is no longer the case. Increasingly, our building standards for hospitals require people to be either in private rooms or to at least have 3 m on either side of their bed for infection control, which cannot be achieved in an old building. Such buildings also have very high running costs. There are enormous difficulties getting medical gases in because one has to pipe through stone walls sometimes. In addition, much of the new equipment, including the big X-ray machines, cannot fit through the doors and into the rooms in old hospitals where the only equipment they might have had in the old days was an X-ray machine.

The point the Senator made about the city centre and the fact the population is moving back there is worthy of consideration. Most of the old city centre hospitals, in effect, moved out to the suburbs. If I remember correctly, Jervis Street was one of the ones that went out to Beaumont and the Adelaide and the Meath hospitals went out to what is now Tallaght hospital. That reflected the fact that at the time, the suburbs were burgeoning and the city centre was emptying out. As the Senator rightly pointed out, good planning, good transport and common sense suggest that we should move people back into the city centre in the years to come. That process is already under way. If we were to increase the bed stock in the city centre area, it would make more sense to put new wings and new blocks into the likes of the Mater, St. Vincent's and St. James's hospitals.There are already three major hospitals not far from Dublin city centre. Accordingly, putting in a fourth one, with all the costs associated, would have to be considered. An opportunity does potentially arise over the next five to ten years because several existing city centre hospitals will become vacant. These include Crumlin, Holles Street, the Rotunda and Temple Street. Consideration will have to be given as to how they could be used for alternative health care purposes.

Sean Barrett (Independent)
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I thank the Minister for giving his experience as a hospital doctor which is better than that of any economists.