Vol. 613 No. 3
132 Mr. Gormley asked the Tánaiste and Minister for Health and Children the purpose of a contribution of €30,000 made to the Irish Stillbirth and Neonatal Death Society from lottery funds; and the purpose of a separate payment of €30,000 to ISANDS by the Health Service Executive. [3086/06]
The Irish Stillbirth and Neonatal Death Society, ISANDS, provides support services to parents and families of babies who are stillborn or who die around the time of birth. The society has been funded by the former Eastern Regional Health Authority and, latterly, the Health Service Executive, HSE, since 2001.
In 2005, the HSE grant amounted to €35,000. In addition, a once-off grant of €30,000 was provided by my Department out of national lottery funding. It is a condition of this grant that certification of expenditure be submitted to the Department as soon as possible after the end of the 2005 financial year. My Department is advised by the executive that the approved funding was used by the society in 2005 to help support its activities, including telephone support for bereaved families, publication of newsletters and services of remembrance.
I think the Tánaiste will agree with me that ISANDS carries out tremendous work. The purpose of my question was to ask why the society received a once-off payment in 2005. The society takes 5,500 calls per year. In addition, it must hold meetings throughout the country, hire hotel rooms, which often cost approximately €300 per night, and send off newsletters to its members and others who have been bereaved. Such newsletters cost approximately 96 cent each to post, which amounts to approximately €2,000 in total.
The society has spent approximately €79,000 on its excellent work at the old holy angels plot in Glasnevin cemetery, where 50,000 babies are buried in unmarked graves. It is shocking to think that the society depends on the Dublin mini-marathon to raise approximately €13,000 per year. It may not be a significant electoral issue but 500 families experience this trauma every year. People often face delayed trauma many years after the original event. These people often need the service provided by a support group and ISANDS provides them with such a service on a voluntary basis.
Can the Tánaiste assist ISANDS in any way? The former Minister for Health and Children, Deputy Martin, stated that he would provide ISANDS with an office. Will the Tánaiste give me a commitment that she will provide the society with proper office facilities and proper annual funding so it can conduct its business? What is the function of the Tánaiste's national lottery fund? How much does it contain and how is it dispensed?
I strongly support ISANDS, which I met in Glasnevin a few months ago. Like Deputy Gormley, I know of many people affected by stillbirth who receive considerable consolation and support from ISANDS. According to the HSE, ISANDS's annual requirements are in the region of €35,000. The society has not yet received funding for 2006. I am not aware of the commitment made by my predecessor, Deputy Martin, but I will examine the matter. The commitment is not included in the brief I received for the question.
The national lottery grant from the Department of Health and Children is advertised. The Department receives approximately €5 million per annum from the national lottery. There are usually ten times more applications than the available funding can cover. It is a slice of grants from the national lottery in any one year that is made available to the Department. The grant always goes towards once-off expenditure items and generally goes towards capital expenditure. For some reason, the society received no money in 2003 and experienced a serious shortfall. I understand the national lottery grant helped to clear this shortfall. I am happy to meet ISANDS and will be very sympathetic to any particular requirements it may have.
Does the Tánaiste agree that insult was added to injury when stillbirth was not included in the Madden report? In 2005 and 2004, ISANDS was inundated with calls from people who experienced additional suffering because of the organ retention scandal. Funding must be a priority. I would appreciate it if the Tánaiste made every effort to assist these people.
ISANDS is more than aware of my support for it. The Madden report recommended the establishment of a working group to examine how its findings in respect of organ retention could be applied to stillborn children and adults. We are in the process of establishing this working group and will invite ISANDS to be a representative on it, which will be very important.
133 Mr. Coveney asked the Tánaiste and Minister for Health and Children the person who is in charge of the implementation of her plan to build private hospitals on the sites of public hospitals; and if she will make a statement on the matter. [3016/06]
135 Mr. Allen asked the Tánaiste and Minister for Health and Children if it is her view that the issue of whether private beds are built on public hospital sites is a matter for the Health Service Executive (details supplied); and if she will make a statement on the matter. [3014/06]
140 Ms Lynch asked the Tánaiste and Minister for Health and Children the number of proposals the Health Service Executive has received to build private hospitals on public grounds to date in 2006; the location of same; the number which have been accepted; and if she will make a statement on the matter. [3031/06]
199 Mr. Coveney asked the Tánaiste and Minister for Health and Children the role of her Department and the Health Service Executive in her plan to build private hospitals on the sites of public hospitals; and if she will make a statement on the matter. [3050/06]
207 Mr. Allen asked the Tánaiste and Minister for Health and Children if it is her view that what the private sector does with developments in terms of its hospital structure is very much between Government and the private sector (details supplied); and if she will make a statement on the matter. [3015/06]
I propose to take Questions Nos. 133, 135, 140, 199 and 207 together.
The Government is committed to exploring fully the scope for the private sector to provide additional capacity in the health system. In this context, my Department issued a policy direction to the HSE last July aimed at freeing up additional beds in public hospitals for public patients. This will be achieved through the development of private hospitals on the sites of public hospitals and the transfer of private activity to those hospitals, thereby freeing up capacity for public patients in public hospitals.
The initiative is expected to provide up to 1,000 additional beds for public patients over the next five years. It brings together different elements of Government policy in a coherent and practical way with the aim of increasing bed capacity for public patients, encouraging the participation of the private sector in generating extra capacity, maximising the potential use of public hospital sites, promoting efficiency among public and private acute service providers, promoting greater competition in the supply of hospital services and offering improved quality and choice to all patients.
Attached to the policy direction was an assessment framework which the HSE has been requested to follow in respect of proposals to locate private hospital facilities on public hospital sites. It requires that the evaluation should have regard to a detailed assessment of need and existing and planned capacity on a particular site and within the relevant region. It should also provide for a rigorous value for money assessment of any proposal which would take account of the value of the public site and the cost of any tax expenditure. In addition, it will make clear the need for adherence to public procurement law and best practice.
Since the publication of the policy document by my Department in 2005, the HSE has received expressions of interest from six major companies for the development of private hospitals co-located with public hospitals. Each company expressed an interest in more than one site. The HSE has ultimate responsibility for the implementation of this policy and I expect to see progress in this regard over the coming months. The chief executive officer of the HSE has stated to the Joint Committee on Health and Children that the Government's policy regarding private hospitals on public grounds has never been an issue for the HSE.
I take it that the HSE is responsible for implementing this plan. However, the proposals issued by the HSE in respect of the new consultants' contract only mention public-only contracts. The Tánaiste will find it difficult to square the circle if public-only contracts are the only contracts up for negotiation. The new private hospitals must be run by consultants who have either private-only contracts or public-private contracts. The fact that we could not get right for six months the tendering for the out-of-hours general practitioner service in north Dublin does not bode well for the Tánaiste's plans for private hospitals. It does not bode well if consultants are to have public-only contracts and these private hospitals are to be supported by the HSE, which is very lukewarm about the proposal. How can the circle be squared?
Is the HSE responsible for hiring consultants at the moment? Comhairle na nOspidéal no longer exists. Who is responsible for approving and implementing consultant positions? Is it the responsibility of some official in the HSE or can the HSE simply appoint consultants as it suits it as soon as the consultants' contracts have been renegotiated?
The HSE is responsible for hiring consultants and Comhairle na nOspidéal has been subsumed into the HSE since the end of December last, which makes sense.
Consultants are currently contractors in the health care system and are not employees of the hospitals. We wish to move to them being employees. A public-only contract commits the individual to work on all patients that come into a specific hospital for a particular salary. There would be no incentive with regard to remuneration received for a doctor to take one patient over another, and this would be a desirable scenario.
There are roughly 2,000 consultants at the moment. There are approximately 500 consultants in what is termed as category 2, which means they work on-site in public hospitals and off-site in other places. There are approximately 1,500 consultants in what is termed as category 1. These can carry out public and private work on one site. Very few do not have a private practice. It has been decided that no more category 2 consultants will be employed. Private hospitals must move to employing their own staff.
There are 2,500 private beds in public hospitals, for which the hospitals get paid by insurers in any one year. One Dublin hospital only gets paid for approximately 20% of the beds, although 46% of the beds are used for private work. This is an incredible statistic at one level. The idea behind the hospital initiative is to remove private beds from the public hospital system and convert these to public beds for use by public patients. This is the reverse of how it is being presented in some quarters. The role of the HSE is to assess applications, and there have been six different expressions of interest. The HSE will shortly formally go to tender to receive expressions of interest.
The HSE will have to consider whether needs are being served in a particular area. It may be the case that there is adequate private provision in a specific area and it may not make sense to create another private facility. It may also be that capacity is such in a public hospital that it would not make sense to have another facility co-located. In the context of a new contract, these hospitals may well supply services and occasionally supply staff to the public system, rather than the other way around, or the public system supplying private facilities with staff.
We will be in transition for some time as the existing consultants' contract has no review clause and is therefore a legally binding document for all consultants who have it until they retire. The timeframe is at least another 20 years or more depending on whether one takes the view of these consultants retiring at age 60 or 65. Our current cohort of consultants have a legally binding contract that entitles them to public and private practice, either on-site or off-site. This is the transitional arrangement we will have for the next 20 or 25 years, unless everybody opts for a new contract, which is unlikely despite being desirable. It would not be attractive enough for those who have a big private practice.
We wish to see a new contract focused on patients not on whether patients will pay in public hospitals. We wish to see a review clause in the contract as it is not desirable to have a contract which is not subject to review at least every five years to ensure it is meeting the needs of the health care system. There is no difficulty in what is being put on the table for discussion. We need to employ, as I acknowledged earlier, more than 2,000 more consultants in the health care system over the coming years. We should employ them on the basis of a contract that serves the needs of the public health care system in a better fashion than the current contract arrangements.
Does the Minister accept that what she is doing is deepening the divide between public and private patients within the health service? This will surely raise questions for her with regard to entitlement. She must be aware that everybody in the country, including the Minister, is entitled to access public care. Is she being naive in thinking that by building private hospitals on public land, private patients will automatically go to the private hospital despite being entitled to go to a public hospital? Private patients will presumably continue to exercise this entitlement. Does the Minister intend to take away this entitlement from people with current health insurance? This would be a major action and the Minister should comment on it.
With regard to capacity building in the public hospital sector, does the Minister recognise the financial loss in providing generous tax breaks to the private and for-profit sector? This is essentially a new player in the provision of Irish health services. A generous attitude is being taken by the Minister, as well as the Minister for Finance, Deputy Cowen, in this regard. This is a loss to capacity building where it is needed most, in the public hospital sector.
Does the Minister accept that the sector is not competitive? The Minister has the idea that these hospitals will compete, but there will not be competition between the two unless a system similar to that of the US is implemented. Private hospitals there must provide accident and emergency services. How can a public hospital compete with a private hospital when the public hospital is required to provide accident and emergency services and correctly does so for everyone, regardless of whether a patient has health insurance?
I have a question regarding the loss to acute public hospitals. These are currently able to garner some of their income from private patients so will the shortfall be made up? How will the Minister prevent cherry-picking by the private hospital sector, which will be looking for profit? Profit and making money for investors will be the motive and nobody can complain about it. How will the Minister prevent a scenario where hospitals carry out many procedures that are not a high priority but are lucrative? Meanwhile, public patients will attempt to cope and access care in a public hospital sector that is deprived of necessary funding and incapable of competing with private hospitals that have tax breaks and do not have a requirement to provide accident and emergency services. There is not a level playing field, although this is an argument put forward by the Minister.
The Minister should consider what she is doing because this is ultimately not the way to go. This process will create further division and inefficiencies with regard to value for money in the health service.
The Deputy appears to misunderstand what is happening. Everybody is entitled to access our public hospital system and I wish to see that continue. However, I wish to see patients selected into a public hospital system on the basis of medical need, not on the basis of whether they have private health insurance. This is what currently happens. There are 2,500 private beds in the public hospital system. Of the workload of one Dublin hospital last year, 46% was elective work on private patients. Approximately 31% of the hospital's accident and emergency cases were private patients. This is not fair to the public hospital system.
The public hospital system received approximately €200 million from insurers in 2003, although work valued at €581 million was carried out. This is not a good return. Private hospitals account for 40% of open heart surgery. I am not arguing that private hospitals are the panacea for all illnesses in the country. However, converting 1,000 private beds for use by public patients makes much sense from the perspective of the public patient. It does not make sense that some people can access the public hospital system more quickly than others.
Everybody is equal in the accident and emergency area. This is because no extra fee is given to the consultant on the basis of whether a patient has health insurance. This is a bone of contention with accident and emergency consultants. However, we cannot have preferential treatment at accident and emergency level. Unfortunately, if anybody has a financial incentive in preferring one patient over another, it very often happens.
To the best of my knowledge, in health care systems all over the world, including Sweden, one of the most socialised countries in Europe, many private operators have been brought in to run public hospitals.
I can imagine the reaction I would get if I announced that here but that is what they have done. The Labour Government in the UK has announced and begun to implement a policy whereby 15% of all elective work will be done by private operators. Patricia Hewitt, in an interview with the Financial Times yesterday, said it was for reasons of efficiency, so there is a role for both approaches. We must ensure the public hospital system treats patients and is not obsessed with whether they have private health insurance or are in a position to pay more than others. I cannot conceive any way to make that happen as long as there is an incentive to take one patient in preference to another, which is what sometimes happens. It is not satisfactory and leads to cancellations, difficulties and unnecessary delays for too many public patients.
The Tánaiste and Minister for Health and Children famously said Ireland was closer to Boston than Berlin. Given the sheer inequity of the US health service why does she support the Americanisation of ours? Does she agree that a for-profit motive is at work in the US that leads to profit before people? Has she heard Dr. Risteard Mulcahy and Mr. Maurice Nelligan on the subject? They say that public patients are under-treated and private patients are often over-treated because money is involved. The gap will widen in such circumstances and it is not good for the patient. Have they got it wrong and misunderstood the Tánaiste? Have we who agree with them also misunderstood the concept?
Is the Tánaiste and Minister for Health and Children aware that the Minister for Finance is unable to tell us the cost to date of tax relief for developers of private hospitals? In response to a parliamentary question last month he was unable to tell me the names and locations of hospital developments that have benefited. Is the Tánaiste aware that the Minister for Finance, her colleague, confirmed that the criteria for qualification for these tax reliefs were based only on the capacity of each hospital and not on any assessment of public health need at local, regional or national level? Does the Tánaiste not agree that the money spent on these reliefs would be far better employed in direct investment in our public health system? Does she not agree that these reliefs enrich those who are involved in private hospitals and such facilities for profit only? Does she not agree that fact and the fact that she perpetuates the system runs contrary to her statement of last month, when she said: "The reality is that if you have private health insurance or can afford to pay you have speedier access to our health system and that is something I want to change"? They are fine words but how is the Tánaiste's approach achieving that?
If I take 1,000 private beds out of the public hospital system and convert them to public use that would be a major achievement. Deputies opposite seem to suggest I leave it as it is.
We do not.
Absolutely not.
Every party supports tax relief for films and other things such as urban renewal which have all been worthy schemes that have achieved fantastic results. We do not, however, seem to be capable of supporting, through tax measures, sensible investment in the health care system. If we can attract investment into the health service through private financing we would be very foolish not to consider such opportunities. We should only support them if they suit a public hospital system because it would not be sustainable in every situation.
At the moment private hospitals are emerging in various places completely outside the public hospital system. This is a measure whereby the public and private systems can work closely together to provide services for patients and the conversion of up to 1,000 private beds for use by public patients is just such a measure.
It is the Americanisation of our health services.
We must conclude questions.
Converting private beds to public beds is nothing to do with the American system. The Deputy does not know what he is talking about.
Has Mr. Nelligan got it wrong? Has everybody misunderstood?
He was a big investor in a private hospital, or am I wrong?
Written answers follow Adjournment Debate.
