In the interest of moving the debate along, I will press the amendment rather than prolonging the discussion. We have had a reasonable amount of discussion on it.
Finance Bill 2008: Report Stage (Resumed) and Final Stages.
Amendment No. 16 has been ruled out of order as it does not arise out of committee proceedings.
That the Bill be recommitted in respect of section 16.
I propose that section 16 be recommitted so that we might discuss the issues involved therein. This matter has been brought to my attention as a possible anomaly of which I was not aware on Committee Stage. I should like the opportunity to get clarification from the Tánaiste on this point.
Does the Tánaiste wish to do that?
I oppose that.
I believe I am entitled to make a short statement. The background to this is that it has been brought to my attention by a company which employs more than 500 staff, that unwittingly the Tánaiste has caught up bona fide arrangements to the effect that Irish-owned private concerns will be disadvantaged in providing opportunities to attract the best staff to do important work at the leading edge of the development of their companies. There are genuine bona fide cases where these arrangements of conversion rights are organised — as they are in many other countries — and by moving to close a loophole, which has been abused, the Minister is unwittingly ruling out bona fide arrangements which have been used by private Irish companies. It is worth being aware that the restriction to apply here does not extend to multinational companies, so it will only adversely affect private Irish companies. As my amendment suggests, it is quite open to restrict the impact of this anti-avoidance measure to genuine abuses and to provide, as I have indicated, to allow bona fide cases, approved on an individual basis by the Revenue Commissioners, which would deal with the genuine instances where this method of payment is used, as in other countries, to incentivise highly qualified and very able managers.
The downside of going ahead with this, according to the representation I have received, is that many companies will be forced to employ non-Irish people from outside the jurisdiction to do this type of work on behalf of developing companies and Ireland will unwittingly have shot itself in the foot.
My reply to the Deputy is that there would appear to have been unapproved schemes going on without the knowledge of Revenue. There are approved schemes, if employers want to incentivise employees, various employee share ownership trusts, ESOTs, for instance, save-as-you-earn share option and approved share option schemes, which enable this practice to be carried out on an approved basis. I cannot accommodate unapproved schemes, which were not brought to the attention of Revenue, and about which it has some information at present. These approved schemes are available to all companies which meet the necessary requirements, including Irish ones. Such schemes must generally be available to all employees on similar terms. The approved share option scheme, however, has some flexibility for key employees as regards the fact that similar terms rule and they can receive more favourable treatment. Therefore if companies have a specific issue they want to discuss with Revenue, they can do so within the parameters of approved schemes, not ones they concoct themselves.
I move amendment No. 19:
In page 25, line 27, after "income" to insert "or capital gains".
This is a largely technical matter. I understand the EU Court of Justice challenged the treatment of income from the UK that Ireland had been in the practising of dealing with in a certain way. There was a successful challenge to that. Section 18, which deals with the tax treatment of certain possessions in Great Britain or Northern Ireland, addresses this issue. We mended our hand following a challenge to the existing practice.
It has been brought to my attention that the same weakness in our system exists in respect of the treatment of capital gains tax. It appears the Government is moving to close the loophole in respect of the treatment of income tax but not the treatment of capital gains tax. The point made to me was that if the weakness in respect of the latter is brought to the attention of the EU authorities, they will make a similar ruling, on foot of which we will have to make a similar adjustment to our tax treatment provisions. We ought to mend our hand in respect of all cases equivalent to the one associated with income tax.
It is the view of the Revenue Commissioners that it is only in the event of a complaint arising in respect of capital gains tax that it will deal with the matter on its merits. We are dealing with the requirement covering income tax, as set out in the court opinion. This change is as a result of a reasoned opinion and infringement notice from the European Commission in respect of income tax payable on UK-sourced income. The Commission stated in particular that:
Ireland has failed to fulfil its obligations under Articles 56 EC and Article 40 EEA by adopting and maintaining legislation which taxes the income on capital invested in the United Kingdom by persons who are not domiciled in Ireland, or being a citizen of Ireland, are not ordinarily resident in Ireland, while exempting such person's income from capital invested in other member States or in the EFTA/EEA States.
The Commission invited Ireland to take the necessary measures to comply with its opinion. The position was reviewed with the Revenue Commissioners and further legal advice was received from the Attorney General. Section 18 is a response to the Commission's invitation and it ensures that we are now in compliance with the Commission's opinion on the matter.
The proposed amendment would make a change to section 73 of the Taxes Consolidation Act 1997, as amended. Section 73 is concerned only with income arising in the United Kingdom and the amendment will therefore have no effect on capital gains tax.
I did not quite follow the Minister's final remarks. The case presented to me was that we have been found to have been treating income earned in the United Kingdom in a discriminatory way in the context of the rules that apply elsewhere in the European Union. Our knuckles have been rapped on this issue. The Minister is moving to mend our hand but he is taking an unduly narrow view of the opinion given that it is acknowledged on all sides that if the same issue arose in respect of capital gains, the same opinion would be issued. In this case, the same view would be forthcoming from the court and the same response would be required of the Minister to amend the Finance Bill. Why are we inviting those who feel aggrieved to make a new challenge before the Minister mends his hand and considering that he now knows the basis of the ruling?
I did not interpret the Minister as disputing the case that the same opinion will apply in respect of capital gains. If I believed the Government held the view that the opinion should not apply in respect of capital gains and that the Minister's defence was robust in this regard, I would be happy to agree with him, test the case and defend the Revenue Commissioners until this was done. However, unless the Minister has such a prima facie belief that he is in the right and that the Commission’s opinion would not apply to capital gains, we should put up our hands and amend our approach.
The view of the Revenue Commissioners is that a complaint should be dealt with on its merits when it arises. Obviously, they see merit in contesting such a complaint.
Will the Minister articulate that merit?
Were it the case that circumstances developed as the Deputy suggests, the Revenue Commissioners might take a different view. On the advice of the Revenue Commissioners, I have outlined the response to the Commission's opinion. The Revenue Commissioners are of the view that, if and when a matter arises, it will be dealt with on its merits. I have outlined the position as matters stand and will proceed according to the advice I have been given in this regard.
We are the legislators, not the Revenue Commissioners. They are entitled to their opinion but the Minister must persuade us that the validity of their opinion is such that we should not make my amendment. To appeal to an authority outside the House that cannot present its case within the House is not good enough. Either the Revenue Commissioners have a robust case that the Minister believes is strong and defensible or they do not. If they did, we would be able to hold the Minister and the Revenue Commissioners, through the Minister, accountable in respect of that case. I do not want to come back into the House only to find that the Revenue Commissioners were spoofing and that they were only trying to make certain taxpayers run through hoops to secure a decision that they, the Revenue Commissioners, believed in their heart of hearts would be secured in any case.
What is the Minister's substantive case to back up the Revenue Commissioners opinion? On hearing it, I will be quite happy to accept it.
I have not heard the case suggesting that I should widen the scope of section 18, as suggested by the Deputy. It is up to the Commission to make a case to change Irish tax law, and that is the advice I have received. On the specific question as to whether I tested the implications beyond the scope of the amendment I received, the answer is that I did not.
I am disappointed. I tabled my amendment in good faith and believed we could have an informed debate on it. We in are in a position in which we do not have sufficient information and in which unaccountable people will tell us what to do. This is not satisfactory. The House is not being treated with the respect it deserves.
I apologise if that is how the Deputy feels. It was not my intention——
I accept that but those who compiled the Minister's brief should have provided him with an answer to my question.
I move amendment No. 20:
In page 29, between lines 5 and 6, to insert the following:
22.—(1) Section 201 of the Principal Act is amended by inserting the following subsection after subsection (1)—
"(1A) (a) In this subsection—
‘eligible employee' means an employee, being a person who is being made redundant, who, in relation to a full-time employment, has completed at least 2 years continuous service in that employment or is, for the purposes of the law relating to redundancy, deemed to have at least 2 years continuous service;
‘retraining' means a training course, made available by an employer as part of a redundancy package, that is—
(i) designed to impart or improve skills or knowledge relevant to, or intended to be used in, obtaining gainful employment or in the setting up of a business,
(ii) primarily devoted to the teaching or practical application of such skills or knowledge, and
(iii) completed within 6 months of the termination of employment;
‘redundancy package', in relation to an eligible employee, means any scheme of compensation offered to the employee on termination of his or her employment.
(b) Income tax shall not be charged by virtue of section 123 in respect of the first €5,000 of the cost of retraining an eligible employee where—
(i) such training forms part of his or her redundancy package, and
(ii) the employer makes available such retraining for all eligible employees.
(c) Paragraph (b) does not apply to any retraining provided to either or both the spouse and any dependant of the employer.
(d) Paragraph (b) does not apply to an eligible employee where there is an arrangement or scheme in place whereby an employee may receive the cost of retraining in money or money’s worth, wholly or partly, directly or indirectly, and such employee so receives that cost.”.
(2) Subsection (1) has effect as respects retraining within the meaning of section 201(1A) of the Principal Act (as inserted by this section) made available on or after the passing of this Act.
I move amendment No. 23:
In page 30, between lines 2 and 3, to insert the following:
23.—(1) Section 1041(1) of the Principal Act be amended by inserting the words "in respect of commercial property" in paragraph (a) after the words “Schedule D” and before the word “, or”.
(2) Section 1041(1) of the Principal Act to be amended by inserting the words "in respect of commercial property" in paragraph (b) after the words “terms of the lease” and before the words “, but to a person other than the lessor.”.
This amendment was proposed by my colleague, Deputy Ciarán Lynch, of Cork South-Central. I have already mentioned the matter to the Minister and will therefore be brief in the interest of providing time for amendment No. 24. Under income tax law, tenants with foreign-based landlords are obliged to deduct the landlords' tax and remit it to the Revenue Commissioners when paying their rent. A couple of difficulties arise in this regard. Where foreign-based landlords are renting to tenants in Ireland, many of the tenants are not aware of the Revenue requirement and can be held accountable for not paying the tax that should be remitted to the Revenue Commissioners.
As I stated to the Minister previously, there is a problem with the administration of housing allowances and rent supplements in respect of the HSE and county councils. The policy in different local authority areas seems to vary. Councils were supposed to be taking ultimate responsibly in respect of the rental accommodation scheme but the rate of roll-out has been very slow. Under the existing arrangements, and as is the practice in respect of some rent supplements, if the HSE does not want to know who the landlord is and the landlord turns out to be based abroad, the HSE's client, who is paying the rent, has a duty to deduct the tax at source. Very often the client does not know about this.
A case arose in my constituency last year in which rent was being paid to a foreign-based landlord directly by the HSE. The landlord, who was a doctor from the Indian subcontinent, had been living and working in Ireland but had departed. The HSE was merrily paying away money by direct debit into the doctor's bank account. Tax should have been deducted. When the HSE decided to cut off the rent allowance, the tenant only found out several months later when the doctor had a look at his bank account and discovered he was no longer getting the regular payments. The position in which some tenants find themselves where they have a liability under tax law to deduct the tax at source is an important issue, which I ask the Minister to address. Some of the legal advice services have been dealing with this matter for various clients but to date no resolution has been found.
The Deputy's amendment seeks to confine the provisions of section 1041 of the Taxes Consolidation Act 1997 to commercial property only. Section 1041 applies to all rental income and other lease income received by a non-resident in respect of property located in the State. The section ensures that such income is taxed by requiring the tenant to deduct tax at the standard rate from the gross payment. The tenant is then required to make a return and pay to Revenue the tax that he or she has deducted from the rent. The landlord is entitled to a credit for the tax deducted by the tenant against his or her final income tax liability and is obliged to pay any additional tax that may be due. By excluding property, other than commercial property, from the section the effect of the Deputy's amendment is to remove, without providing for an alternative, Revenue's ability to collect tax from rent paid to non-resident landlords for residential property.
I accept that this provision as it is currently constituted might not be well known to tenants renting residential accommodation from non-resident landlords. However, the provision does have a valid function in that if it was not on the Statute Book, it would be relatively easy for resident landlords to evade tax by establishing off-shore legal entities to hold their residential properties and to receive the rents due on these properties. At present, section 1041 effectively prevents this type of tax evasion. The removal of the requirement to deduct tax without providing for an effective replacement regime would only serve to open up opportunities for tax evasion. While I am sympathetic to the thrust of the Deputy's amendment I am not in a position to open up opportunities to evade tax, nor does she intend to do so, and therefore, cannot accept the amendment.
With regard to the question of reviewing this arrangement, I should point out that the operation and impact of the assessment and collection of taxes are monitored and are subject to review on an ongoing basis as part of the normal work of my Department and the Revenue Commissioners. There are a number of factors that need careful consideration here, not least the need to protect the State from loss through tax avoidance and evasion. As I have already stated, if I were to simply abolish the section, it would probably lead to structures being put in place to pay rents to off-shore entities, with the resultant loss to the Exchequer. However, I will ask my officials, in conjunction with the Revenue Commissioners, to review the issues to see if alternative arrangements can be put in place that minimise the risk of opening up opportunities for tax evasion.
I thank the Tánaiste for that reply. I very much concur with the thrust of his argument. The issue is to try not to create a liability for tenants who, through no fault of their own, become liable for a tax payment of which they, by and large in the ordinary course of business, would not be aware.
I draw to the Tánaiste's attention my amendment No. 53, which I doubt we will reach, about landlords giving information on their tax numbers to the HSE and local authorities so that their tax issues can be pursued centrally and, if they are liable to pay tax, that they should be properly pursued for tax. I hope the Tánaiste might come up with a change in the administrative arrangements which would benefit the Revenue Commissioners dealing with landlords in receipt of tens of millions in rent allowances, particularly from public bodies such as the HSE and local authorities. People are correctly convinced that many of the landlords are avoiding taxes and have done so for years. It is not beyond the wit of the Revenue Commissioners to put forward new arrangements which would tackle the issue at source. I thank the Tánaiste for his reply.
Amendment No. 24 arises out of Committee proceedings.
I move amendment No. 24:
In page 33, between lines 30 and 31, to insert the following:
25.—(1) The Principal Act is amended—
(a) in section 268—
(i) in subsection (1)—
(I) by deleting "or" where it last occurs in paragraph (k) and by substituting “centre, or” for “centre,” in paragraph (l), and
(II) by inserting the following after paragraph (l):
"(m) for the purposes of a trade which consists of the operation or management of a qualifying specialist palliative care unit,",
(ii) by inserting the following after subsection (1D):
"(1E) Where the relevant interest in relation to capital expenditure incurred on the construction of a building or structure in use for the purposes specified in subsection (1)(m) is held by—
(a) a company,
(b) the trustees of a trust,
(c) an individual who is involved in the operation or management of the unit concerned either as an employee or director or in any other capacity, or
(d) a property developer (within the meaning of section 843A) or a person who is connected with the property developer, in the case where either of such persons incurred the capital expenditure on the construction of that building or structure, or such expenditure was incurred by any other person connected with the property developer,
then, notwithstanding that subsection, that building or structure shall not, as regards a claim for any allowance under this Part by any such person, be regarded as an industrial building or structure for the purposes of this Part, irrespective of whether that relevant interest is held by the person referred to in paragraph (a), (b), (c) or (d), as the case may be, in a sole capacity or jointly or in partnership with another person or persons.”,
(iii) by inserting the following after subsection (2B):
"(2BA) In this section—
‘palliative care' means the active total care of patients who suffer from illnesses or diseases which are active, progressive and advanced in nature and which are no longer curable by means of the administration of existing or available medical treatments;
‘qualifying specialist palliative care unit' means, subject to subsection (2BB), a building or structure—
(a) which is a hospital, hospice (within the meaning of section 47 (as amended by section 16 of the Public Health (Tobacco)(Amendment) Act 2004) of the Public Health (Tobacco) Act 2002) or similar facility which has palliative care as its main activity,
(b) which, before entering into a legal commitment for its design, commissioning, construction or refurbishment, is approved by the Health Service Executive, with the consent of the Minister for Health and Children, as being in accordance with national development plans or national needs assessments for palliative care facilities,
(c) which has the capacity to provide—
(i) day-patient and out-patient palliative care services, and
(ii) palliative care accommodation on an overnight basis of not less than 20 in-patient beds,
(d) in respect of which relevant data is provided to the Health Service Executive, for onward transmission to the Minister for Health and Children and the Minister for Finance, in relation to—
(i) the amount of the capital expenditure actually incurred on the construction or refurbishment of the unit,
(ii) the amount, if any, of such expenditure which has been or is to be met directly or indirectly by the State or by any other person by way of grant or other financial assistance,
(iii) the number and nature of the investors that are investing in the unit,
(iv) the amount to be invested by each investor, and
(v) the nature of the structures which are being put in place to facilitate the investment in the unit,
together with such other information as may be specified by the Minister for Finance, in consultation with the Minister for Health and Children, as being of assistance in evaluating the costs, including but not limited to exchequer costs, and the benefits arising from the operation of tax relief under this Part for qualifying specialist palliative care units,
(e) in relation to which an undertaking is given to the Health Service Executive—
(i) to make available annually, for the palliative care of persons who have been awaiting day-patient, in-patient or out-patient palliative care services as public patients, not less than 20 per cent of its capacity, subject to service requirements to be specified by the Health Service Executive in advance and to the proviso that nothing in this subparagraph shall require the Health Service Executive to take up all or any part of the capacity made available to the Health Service Executive by the unit, and
(ii) in relation to the fees to be charged in respect of the palliative care afforded to any such person, that such fees shall not be more than 90 per cent of the fees which would be charged in respect of similar palliative care afforded to a person who has private medical insurance,
(f) in respect of which the Health Service Executive, in consultation with the Minister for Health and Children and with the consent of the Minister for Finance, gives an annual certificate in writing during the period of—
(i) 15 years beginning with the time when the unit was first used, or
(ii) where capital expenditure on the refurbishment of the unit is incurred, 15 years beginning with the time when the unit was first used subsequent to the incurring of that expenditure,
stating that it is satisfied that the unit complies with the conditions mentioned in paragraphs (a) to (e).
(2BB) (a) Subject to paragraphs (b) and (c), a qualifying specialist palliative care unit includes any part of the unit which consists of rooms used exclusively for the assessment, treatment or care of patients.
(b) A qualifying specialist palliative care unit does not include any part of the unit which consists of consultants’ rooms or offices.
(c) A qualifying specialist palliative care unit does not include any part of the unit in which a majority of the persons being maintained are being treated for acute illnesses.”,
(iv) in subsection (9)—
(I) by deleting "and" at the end of paragraph (h) and by substituting “2006, and” for “2006.” in paragraph (i), and
(II) by inserting the following after paragraph (i):
"(j) by reference to paragraph (m), as respects capital expenditure incurred on or after the date of the coming into operation of section 25 of the Finance Act 2008.”,
(b) in section 272—
(i) in subsection (3)—
(I) by deleting "and" at the end of paragraph (h) and by substituting “subsection (2)(c), and” for “subsection (2)(c).” in paragraph (i), and
(II) by inserting the following after paragraph (i):
"(j) in relation to a building or structure which is to be regarded as an industrial building or structure within the meaning of paragraph (m) of section 268(1), 15 per cent of the expenditure referred to in subsection(2)(c).”,
(ii) in subsection (4)—
(I) by deleting "and" at the end of paragraph (h) and by substituting “expenditure, and” for “expenditure.” in paragraph (i), and
(II) by inserting the following after paragraph (i):
"(j) in relation to a building or structure which is to be regarded as an industrial building or structure within the meaning of paragraph (m) of section 268(1)—
(I) 15 years beginning with the time when the building or structure was first used, or
(II) where capital expenditure on the refurbishment of the building or structure is incurred, 15 years beginning with the time when the building or structure was first used subsequent to the incurring of that expenditure.",
(c) in section 274—
(i) in subsection (1)(b)—
(I) by deleting "and" at the end of subparagraph (vii) and by substituting "expenditure, and" for "expenditure." in subparagraph (viii), and
(II) by inserting the following after subparagraph (viii):
"(ix) in relation to a building or structure which is to be regarded as an industrial building or structure within the meaning of paragraph (m) of section 268(1)—
(I) 15 years after the building or structure was first used, or
(II) where capital expenditure on the refurbishment of the building or structure is incurred, 15 years after the building or structure was first used subsequent to the incurring of that expenditure.",
(ii) in subsection (2A)(a)—
(I) by deleting "or" at the end of subparagraph (v) and by substituting "section, or" for "section." in subparagraph (vi), and
(II) by inserting the following after subparagraph (vi):
"(vii) is in use for the purposes of a trade referred to in paragraph (m) of section 268(1).”,
(iii) in subsection (2A)(b)(i), by substituting “(v), (vi) or (vii)” for “(v) or (vi)”
(d) in Schedule 25B—
(i) by inserting the following after clause (VI) of paragraph (a)(i) of the matter set out opposite reference number 13:
"(VII) section 268(1)(m) (inserted by the Finance Act 2008),”,
(ii) by inserting the following after clause (VI) of paragraph (a)(i) of the matter set out opposite reference number 15:
"(VII) section 268(1)(m) (inserted by the Finance Act 2008),”.
(2) This section comes into operation on such day or days as the Minister for Finance may by order or orders appoint and different days may be appointed for different purposes or different provisions.
This amendment inserts a new section 25 in the Bill which provides for a new scheme of capital allowances for capital expenditure incurred on the construction and refurbishment of qualifying specialist palliative care units. The scheme has similar terms, conditions and exclusions to those which apply in the case of qualifying private hospitals and qualifying mental health centres.
There are gaps in the supply of and demand for palliative care facilities which vary from region to region. I am putting this scheme in place to encourage private sector investment to fill some of those gaps but only where proposed developments of palliative care facilities are in line with the longer-term public health policy objectives in this area. As with other similar schemes which I have reviewed in recent years, I will keep this scheme under review to ensure that it meets the requirements I have in mind for it.
For expenditure to qualify under the scheme of capital allowances, the development of a facility must have pre-approval from the Health Service Executive — with the consent of the Minister for Health and Children — as being in line with national development plans and needs assessments for palliative care facilities. Among other requirements, a qualifying facility must have a minimum of 20 inpatient palliative care beds.
The HSE must also certify, on an annual basis for 15 years from first use, that a facility has satisfied the terms and conditions in the legislation. A claw back of the allowances will apply if a facility is sold or ceases relevant use during this 15-year period.
Relief for eligible capital expenditure incurred will be available at the rate of 15% per year in the first six years with 10% in year seven. Eligible expenditure is net of any grants or other financial assistance received towards development costs.
The restriction on the use of tax reliefs by high income individuals applies to investors who avail of capital allowances under the scheme.
Approval from a State-aid perspective is required from the EU Commission. Therefore, the scheme will come into operation by way of commencement order once that approval has been obtained.
I reiterate the point I made on the Order of Business, that the motivation behind this is quite upfront and in keeping with the views of the hospice managers' association which is anxious that this facility be available, in addition to other efforts to source income through direct Exchequer issues or through voluntary fund-raising, which happens because of the voluntary hospice movement's strong support in all communities.
Unfortunately, there are parts of the country which do not have up-to-date palliative care facilities. There are palliative care facilities in various acute hospitals where beds are being made available, but in the south east, the north east and the midlands there are no specialist palliative care facilities. There is a policy, a national plan for palliative care facilities, laid out in this area. Obviously, this proposal is not to provide competition but to ensure that we bring forward these palliative care beds in line with HSE and departmental policy and the plans in situ.
In no way is there any other motivation behind this other than to try to achieve it in the manner which, although not quite the same, was applied for private nursing home bed provision. Large shortages were identified and tax relief for private nursing home beds came on stream with the resultant provision of up to 30,000 beds, if memory serves me correctly, in quite a short space of time. I do not know where we would be in the nursing home area had we relied on public procurement provision solely to meet that demand within that timeframe. I doubt very much we would have reached that complement.
This is quite specific and quite limited and is in keeping with previous provisions. HSE approval is required for it to be deemed a qualifying expenditure. The contention that this is some effort to assist the construction industry is unfortunate. This is not the point at all. While I do not mind people having strong views on matters, I ask that they do not ascribe those sort of motivations to me.
In principle, I welcome the amendment. However, I wish to make a number of points in connection with it. It is important when addressing health issues that we promote diversity of provision, a strong voluntary sector, a quality public sector and that we allow for private sector development.
Another issue is access. I am concerned that a large swathe of our provision will be based on the notion of access based solely on affordability. It is a serious concern in respect of the hospice in particular, the culture of which is not access based on ability to pay but access based on need. Against this background, the provision provides that 20% only will be public patients and 80% will be private patients. I do not believe this is appropriate. If, as the Minister says, this scheme will provide a new source of high quality hospice care, we should be planning that more than 20% of clients will be public patients. What we want to promote is diversity of provision but equality of access. We want to see more public patients getting access to facilities we support through a 42% subsidy under the tax code. That we are providing a 42% subsidy but only 20% of clients will be public patients is something of an imbalance in this provision. I hope that in practice, when hospice services develop under this provision, it will not be the case that 80% of clients will be those who can afford to pay and 20% will be people supported by the Health Service Executive. This would not be in keeping with the tradition we have sought to promote within our health service. It is a mixed health service but it is one that should be based on equality of access and, increasingly, that is not the case. We have seen the erosion of this element in our care system. All of us, as representatives, deal with constituents and are aware of the inequity of access to services for people dependant on the State to provide. We should not be building into this legislation a provision that will become the mainstream of our provision in this area.
I accept there is a national strategy in this area but I must confess I have not seen it. The Minister should tell us more about it. It is important to know to what extent our hospice service will be voluntarily, publicly or privately operated by way of tax incentivised provisions. We want diversity of provision and fair access. The context is all important. I accept the Minister's point that this service would not be developed quickly enough in the public sector. I have had personal experience of private sector nursing homes, some of which are run to the highest standards and wherein the culture is excellent. However, as legislators, we cannot be unaware of the fact that people without the required expertise have entered the nursing home business as investors.
Many important sections in this legislation provide that the HSE will ensure operators accord with national standards. We cannot allow a repeat of the situation whereby inadequate standards were provided partially because those who entered the sector were motivated by tax incentives rather than a core commitment to the service. The Minister is correct that many people involved in the voluntary hospice sector see this as a good vehicle for advancing their work. Subject to the creation of the proper protections, this is a good scheme.
As Deputy Kenny mentioned earlier, we have some concerns in respect of the decision to include a threshold of a minimum of 20 inpatient beds. There is a desire to see smaller community-based hospices. I do not believe we should be setting a threshold in this area. As far as I am aware, the opinion of those involved in the hospice movement is that we are setting the threshold too high given successful models of hospice care closer to their communities will provide less than 20 beds. Given the HSE powers in respect of approval and the level of oversight which the Minister assures us is being provided, I do not believe we need to insert an artificial ceiling that restricts it in this way.
There are a number of other issues on which I would like clarification from the Minister. The Bill provides for the disqualification of certain people from being beneficiaries including companies and those involved in hospice operations. We can all understand why property developers are excluded. Perhaps the Minister will clarify if this is a condition of State aid rules from the EU or if we are providing that people who run a hospice and are part of the hospice movement should be consciously excluded from being a participant in ownership of the facilities being incentivised. Is this based on State aid rules to comply with EU requirements or our own decision? I do not understand why in principle we would want to exclude people with a commitment to running hospices from being potentially involved as part owners and obtaining some benefit from this incentive.
The 15-year rule which now applies was previously a shorter period having been extended by the Minister in previous years. I am interested to hear the Minister's comment in this regard. There are arguments for and against this. We must ensure, in providing tax incentivised schemes of 42% tax relief that we are getting long-term commitment rather than short-term investment. I am interested to hear the Minister's view on this and on what the HSE, in its national strategy, says about this rule. Will the Minister continue to apply what appears to me to be a strange anomaly, namely, if the person obtaining the tax relief has rental income no ceiling will be applied in respect of benefit whereas a person with non-rental income will be restricted to €31,700. Why do we continue to provide that those with a big rent roll can roll-over effortlessly into more of these tax incentive schemes while those who have earned income are capped? If the purpose of this is the use of tax relief to promote the hospice movement and not to favour particular types of tax individuals, we should ensure there is a level playing pitch.
Before I call on Deputy Burton, I ask members to bear in mind that nine members have indicated they wish to speak on this amendment.
The hospice movement and hospice managers must accept what is available and on offer to them. The Minister spoke about the HSE and the Department. However, a policy directive from the Minister for Health and Children, Deputy Harney, states her desire for private investment in this area, as was the case in respect of co-location. As I understand it, with the difficulties now being experienced in respect of the budgetary situation, only limited capital funding is on offer from the Government for hospice construction. I attach no blame to anybody involved in the development of hospices. I have been involved in fund-raising for hospices and have carried out work in connection with them over a long period of time. I understand that if this is all that is available, it is better than nothing but let us make no mistake about it, the mechanism and manner in which the Minister has introduced this is wrong.
He announced his budget in the first week of December. We are now in the first week of March. There was a long Committee Stage. Press conferences and so on were held. Briefings by officials in the Minister's Department about his thinking in respect of the Finance Bill were held. Various organisations were able to lobby and give their views.
We are now rushing in yet another amendment to a health policy dictated by the Progressive Democrats. If people in the hospice movement wish to avail of this because it is the only thing on offer, that is fine and perfectly understandable. Everybody in this Chamber wants to see more hospice provision, particularly more palliative care to deal with pain management for people with terminal illnesses.
I said yesterday that I have considerable personal experience of dealing with this issue. When I was a teenager, my mother was ill for three years. Hospices and palliative care were not available then even for people in the extreme pain which she suffered. Twenty years later, the home hospice palliative care movement had developed enormously for her older brother who did not have to die in the condition that she, unfortunately, did. This is an important moral issue, as well as a practical issue, from the point of view of what we provide for people in extreme pain with terminal illnesses who need care.
One of the problems with this debate, which is probably why so many Deputies have joined us this morning to debate it, is that the amendment states there should be a minimum of 20 beds. This is probably fine for units in major urban centres like Cork, Dublin and perhaps Limerick. However, it may discriminate against newly approved developments in the smaller centres. This is why there should be a detailed debate about it. Some of the Deputies here will be able to confirm whether this includes Castlebar, Tralee, Kilkenny, Drogheda, Cavan, Wicklow, Kildare and other areas. Even larger units like Waterford, Tullamore and, in my own area, Blanchardstown, where there has been massive community involvement for the past seven years in trying to develop a hospice, could be affected. Blanchardstown may have to develop in phases. We now have the land after a long campaign. This land was secured from the Government, for which we are very grateful. There has been intense participation by the entire community there.
It is very difficult to know why the Minister simply opted for that particular format and simply took the private hospitals provision, which was introduced by Charlie McCreevy five years ago who said he acted on foot of representations from a GP in his constituency with an interest in a private hospital. As has happened with this amendment, the former Minister introduced this measure just before Report Stage. We just spotted it in time. The Minister did not notify us and we have not been given any opportunity to amend or discuss this.
In respect of Deputy Bruton's point about how property developers and related persons, such as managers of hospices, are involved, I assume this is due to EU rules. The draw for property developers is to get construction going. They will make their profit on the construction and the investors will then make their profit and enhancement of their rent on the investment and tax breaks they get.
As a result of my long connections with hospices, I am aware that philanthropy is not very extensive in this country. There are many people who have made money but there are very few large-scale philanthropists. Some people are involved in philanthropy and are to be commended on what they do but very few people who have made large amounts of money are involved in this area to the degree that people are in the US.
The next point, on which there has, again, been no debate, strikes me as very odd. There are a number of people in business who have given a considerable amount of time and resources to hospices, many of whom have been influenced by the death of children within their family circle or the circle of people they know. They have been terribly generous and they know who they are. Why could the Minister not have said that those kind of donations and bequests to hospices would be matched euro for euro by the Government? That might be a much more attractive way of releasing money for the development of smaller hospice development about which we are talking in towns, particularly those in smaller rural areas. There is a capacity there to release more funding to the hospices if the Minister had exercised some imagination and was not stuck on the Minister for Health and Children's ideologically driven, Progressive Democrat model which states that, at all costs, care in Ireland must be as privatised as possible even where people have terminal illnesses.
My problem with this is that internationally the hospice movement has largely been a not-for-profit movement. It is not just the development of beds in hospices that is important. The really important factor is the development of palliative care where people only go into hospices for one night or a weekend but get pain relief and arrangements for this relief which make it possible to bring a degree of quality to the end of their lives and the lives of their families and those caring for them.
The Minister may simply be acting on the instructions of the Minister for Health and Children but he is to be faulted for his lack of imagination and unwillingness to open out to the other parties in this House who would all have something to contribute. Fine Gael, Sinn Féin and the Labour Party are here, as are many Fianna Fáil backbenchers. We all want to contribute positively to the growth and development of the hospice movement and want to see the different areas and communities around Ireland being helped and facilitated. We have no opportunity to amend or even to debate this.
From a technical point of view, the fact that this relief is being introduced must mean that it is intended for hospices to rent the property, perhaps through sale and leaseback arrangements. I do not know if this is the case so perhaps the Minister could elaborate on that. Hospices would occupy these facilities as the bulk of the tax relief now available is for offset against rental income because of the caps on people who do not have significant rental income. The traditional model has been for the hospices which are run on a voluntary basis to fund-raise and acquire and build the properties. All the churches have played a part in the background with land. In the case of Blanchardstown, the State recently played a role in terms of the provision of land. The hospice in Raheny was built on land once owned by the Capuchin Friars, while the hospice in Harold's Cross was built on land once owned by the Sisters of Charity. Most tax relief relates to the building costs rather than site costs so what will be the status of a property built on land donated or sold at below market rate by the church or other organisations for a worthy cause? What are the issues relating to the Commissioners for Charitable Bequests and Donations?
While the hospice need not be in private hands, a voluntary organisation can still rent the space it occupies. There will be issues around the full market rent which investors will expect to receive because only by achieving the full market rent will they maximise their tax break from the hospice which is being given by the Minister in order to promote construction.
There are also issues to do with the longer term ownership of the land and the implications this would have for a voluntary body. If the State is effectively subsidising higher market rent in order to maximise the tax break for the investors, it would be interesting to see exactly where the net benefit to the State arises. If the Minister is strapped in his capital budget, he may say it kick starts some building and he may say to hospice managers that some building is better than no building at all and this is an understandable argument. If the development is designed to introduce a for-profit element into hospice care, then a debate is needed about the issues that require safeguarding, particularly when one considers the pain and suffering that many patients endure near the end of long illnesses and the ethical and other considerations that arise. We do not want to hear stories of unnecessary pain and suffering similar to those we have heard coming from private nursing homes. When the private nursing home provision was slipped in, the Labour Party warned that this would be attractive to people with an interest in development who were not necessarily experts in care and unfortunately this is how it has turned out to be. Nobody wanted to see this happen but we have the history of what happened at Leas Cross.
In order to gain tax relief, the investor will be obliged to hold the investment for a period of 13 years while the relief is over 15 years. After this time they will wish to dispose of their interest in the property and in that scenario, when they want to dispose of the building, what are the implications for the hospice and its patients? If I was on the board of one of the hospices, this would be done by a sale and a lease back with a reversionary clause and a nominal fee to the hospice. However, who is to say? There is no requirement in this legislation that the long-term interests of the hospice movement be protected. We are relying on Deputy Mary Harney who will be gone in 13 years; if we have our way she will be gone long before 13 years. What will happen then?
I would be interested to see the nature of the arrangements that this legislation will spawn. With the tax relief available for offices, potential tenants were offered a lease period equivalent to the tax life of the building with an option to buy at an agreed price when the tax life came to an end. My guess is that this is what a lot of organisations might move to. If similar arrangements develop with the hospital and hospice tax reliefs, what is the real benefit for the State with regard to the investment, other than start-up? Would the State not be better off providing a grant directly to the hospice to purchase and build its property equivalent to the tax it will forego? This would cut out the middle man who will in all likelihood wish to sell the property at full cost back to the hospice or the State at the end of the tax life of the investment.
Whatever the Minister may argue, this section is all about the investor. I refer to the Minister's provision in the amendment which also relates to current situations:
(e) in relation to which an undertaking is given to the Health Service Executive—
(i) to make available annually, for the palliative care of persons who have been awaiting day-patient, in-patient or out-patient palliative care services as public patients, not less than 20 per cent of its capacity, subject to service requirements to be specified by the Health Service Executive in advance and to the proviso that nothing in this subparagraph shall require the Health Service Executive to take up all or any part of the capacity made available to the Health Service Executive by the unit,
I know of very good nursing home proprietors right around the country who have been in the business for a long time and who provide excellent standards of care. They are not investors but have been involved in nursing home provision for a long time. They have added additional units to take up the tax breaks and the incentives available and they have been advised by banks to do this. However, they cannot get the HSE to commit to funding the packages for people waiting to leave acute hospitals. I could take the Minister around the country and show him various homes which I have visited recently and where this situation has applied. I remind the Minister that the national rate of private health insurance is about 53% but as I understand it, because incomes are lower along the western seaboard, the level of private health insurance is lower than in the eastern seaboard area. If hospices are developed in the mid-west and west, what guarantee is there that the Health Service Executive will have any requirement under this amendment, to provide places for public patients?
If this matter had been debated properly, we might have been able to agree a provision to increase the amount of hospice and palliative care available. There are serious problems with the Minister's proposal. The figure of 20 beds will create severe difficulties. I refer to places such as Castlebar, Tralee, Kilkenny, Drogheda, Cavan, Wicklow, Waterford, the Minister's own area of Tullamore of which he will be aware, and Blanchardstown. The plans of the hospice management group are not clear yet. The State has given us the land. The Minister for Health and Children wants to go back to her co-location plan which is driven by Progressive Democrats ideology. I do not think it is driven by the thoughtfulness which I am aware is present in many Fianna Fáil people. I have been involved in assisting in hospices and I know that people help not because they are affiliated to any particular party and they come from all political parties.
I am acutely aware that palliative care is needed. Every single extended family in my constituency has been touched in one way or another by cancer. I do not want only those who are rich to be able to afford palliative care. I do not want those people who are on very low incomes putting themselves into debt, in some cases serious debt, to try and buy proper palliative care for their loved ones in their last days on this earth. This amendment is pathetic.
I would have half expected such a proposal from the Fianna Fáil and Progressive Democrats end of this Government but I am absolutely amazed and astounded that the Green Party has gone along with this proposal. I am absolutely astounded that Independent Deputy Finian McGrath is going along with this proposal. It is beneath contempt for the Greens and Deputy McGrath, who on many occasions sat on these benches and slated the Government for its policies over recent years. Since 2003, when the then Minister, Mr. Charlie McCreevy, brought in this gifting of taxpayers' money to these developers of private hospitals, we have had many debates. Because of the public outrage over the scandalous notion introduced in 2003 I thought that would be the end of it. I did not really expect it to come back again. It is a mark of the arrogance of the Government that here it is yet again. Here is more gifting developers with public money. The Government is shovelling money over to private developers to provide an essential service that should be available as of right for our people.
How much will this cost the Exchequer? I am told the amount already given to developers for the development of private hospitals is unknown and unquantifiable. Will the funds given under this provision be quantifiable? Will any measures be put in place to allow us ascertain in 12 months or two years how much it will have cost the Exchequer? I am told that is the position with what has happened already. This money from the Exchequer should be retained to develop proper health care services for our people.
Cancer patients are waiting for up to 18 months for an examination. They cannot even have an examination to know how serious their condition is for a period of 18 months. The Taoiseach tells us it is the consultants' fault and the doctors' fault. As he is not a doctor it is not his problem. He claims these consultants who are putting people on waiting list are responsible. How pathetic is it to come in here and tell the House such nonsense?
The Government and its predecessors have presided over ten years of an otherwise successful economy. It claims credit for making it a booming economy. I do not accept that. However, I accept that a jackass could have run this company as well as that Government and its predecessors have done for the past ten years. A jackass could have done what they did because they left no proper social infrastructure in place. The health service has been in crisis for eight or ten years and the Government is doing nothing about it. No proper public transport is in place and there are no proper education facilities. I could take the Tánaiste to half a dozen facilities around my constituency that are falling apart and in need of renovation. The Tánaiste thinks he and his colleagues have done a good job with this economy in the past ten years. The biggest disappointment for me is that the Green Party and Independents are backing him in the endeavour he is proposing today.
Yesterday we touched on the notion of social conscience and the Tánaiste came back to me, for which I am glad. There is more social conscience in a cat's arse than there is in the entire Fianna Fáil parliamentary party.
Please withdraw that remark.
They might not have robbed banks, but they robbed the people and gave the bank owners the people's money. That is what the Government and its predecessors have done over ten years now. What else have they done? They have presided over thousands of people dying on hospital trolleys and old people dying in their homes because of a lack of home support and a lack of proper help being given to those people to maintain their health and welfare in their homes. What is the Tánaiste telling us? There is no change in policy. He obviously believes what he has done up to now is grand and perfect, and is continuing with it. Tax exiles can declare they are tax exiles and walk away. We know that a few years ago one character walked away with in excess of €36 million that was owed to the taxman. Of course he walked off with that.
This amendment represents an absolute scandal. I agree there should be palliative care for people who need it and, God knows, we all know enough of them. However, we do not want families going into debt. If it is needed it should be paid for out of the public purse by the taxpayers who, I believe, would be happy to do so to ensure those people most in need of that care can get it in their last days on this earth. I believe they are entitled to it and what the Tánaiste is proposing is an absolute scandal. Why would I expect any different from a Tánaiste and a Government over this partial Parliament in this little semi-statelet over which he is presiding? It is pathetic and the Tánaiste and the Government have had their day.
I do not understand one matter to which the Tánaiste referred yesterday. How did Fianna Fáil get the support it did in last year's general election, for which I commend it? Yesterday I addressed the issue of how I believed it got that support, which was partially through its tax offers and scaring people on the economy. By God, it is a mystery to me why people have not seen through the Fianna Fáil Party long before now.
Long may the Deputy suffer under that inhibition.
After 2003 and all that has happened it takes some brass neck to come back here with an amendment like this. It is nothing short of scandalous.
The Dóchas centre in Our Lady of Lourdes Hospital in Drogheda is a one-stop shop for cancer patients, mostly women. Last year 102 new patients presented in the centre. It is regarded by people in the region who have used that service and by many of us who, luckily, have not needed to use it in any way, as a state-of-the-art facility. However, the Government is withdrawing that service and shipping it up to Beaumont Hospital, an already overcrowded site. It is going to be even more overcrowded because the Government has changed its mind and is taking away the long-promised psychiatric unit and allowing private developers to build a co-located hospital. The Government is happy with that and is standing over it in the belief that it is acceptable. I do not believe it is acceptable — it is disgraceful.
Regarding the Dóchas centre, many breast cancer patients need to pop into hospital for a minor procedure that may last for five or ten minutes. There was almost no queuing and patients were in and out in a few minutes. With the removal of that service to Dublin, those patients will need to travel to Dublin and sit in a queue for several hours that would have only taken a few minutes in their home town. That is what the Government is presiding over. I am amazed at the brass neck of tabling such an amendment again. We all want palliative care to be available. It should not be available only for the rich. Poor families should not need to put themselves into debt to buy it or else do without it. The Tánaiste should withdraw his amendment immediately.
I welcome the amendment. I compliment the Tánaiste and Minister for Finance on his innovative proposal regarding the further provision of hospice or palliative care. The banner headlines achieved by Deputy Burton have been somewhat subdued today given that representatives of the hospice movement have now endorsed the proposal. All those with whom I have consulted welcome it very much. I have been in close contact with the hospice movement over the years.
Regarding the outburst and breaking into a sweat by Deputy Morgan, if it was not for him and his fellow travellers we would have had considerably more money to invest in many projects over the years instead of needing to spend it on security to protect the State.
That is the weakest argument I have heard in a long time.
The Deputy has had his say.
Nobody interrupted Deputy Morgan.
More is the pity.
They were sorely tempted.
Sinn Féin in its time over the past 35 years opposed everything. It opposed our entry into the European Economic Community and every treaty. It is all no, no, no and being critical. That is the extent of its contribution to the State. We needed to spend hundreds of millions of euro to protect the State against its activities.
There are important issues regarding the hospice movement. I agree with Deputy Burton that some people have provided wonderful facilities over the years. We compliment them on this. The Bill provides a further opportunity to provide additional and extended hospice and palliative care in many locations. To date, many have become benefactors to the hospice movement and they, too, are to be complimented. They are appreciative and supportive of the movement and I acknowledge their efforts, especially in my region.
While this measure offers a further opportunity to provide extra services, I am concerned about the 20-bed limit which could reflect negatively in my area. I have discussed the matter with Deputy Calleary as we are both affected. Castlebar hospital is to have a 14-bed hospice unit, while Roscommon County Hospital will have an eight-bed unit. Collectively, that makes up 22 beds. The Roscommon hospice movement is providing the service, albeit at two locations. Where such a body provides services at two locations, it should be seen as constituting a 20-bed plus development. I make that simple suggestion in the interests of fairness and hope the Minister and his officials will be in a position to accept the idea.
There have been some bad cases concerning nursing homes but, as Deputy Bruton said, so many people are providing wonderful care in nursing homes. The disgraceful things that happened at a couple of locations cannot and will not be allowed to recur. I hope the HSE now has an inspection system in place to prevent such a recurrence.
The amendment states proposals for capital allowances for palliative care units must first be approved by the HSE. By and large, I welcome the Minister's proposal and he is right to introduce it at this time. I am glad to see that there is broad agreement on it, although I am not surprised that some individuals and parties may have their own views. It is important to provide hospice care. We must avail of any opportunity to provide extra space, beds and units. There is now such an opportunity and the Minister should be complimented on availing of it. His predecessor, Mr. McCreevy, was responsible for providing some 30,000 extra places by taking a political decision to support the private nursing home sector. We would not have those places if he had not taken that decision. The same initiative is being shown now thanks to the Minister's innovative proposal. I commend the amendment to the House.
I endorse everything Deputy Finneran said and welcome the amendment. It is not for property developers — despite the usual phrases thrown around — but for the provision of beds and to encourage benefactors. Deputy Finneran outlined the proposal by the Mayo-Roscommon hospice which has been approved by the HSE. This document will require prior HSE approval; therefore, under this legislation there will be no recurrence of incidences that happened in the private nursing home sector. The conditions the HSE imposes on hospices are rigorous. Everyone who works with the hospice movement knows the standards of care involved.
Deputy Finneran mentioned that 14 hospice beds were being provided in Castlebar and eight in Roscommon. They are being provided simultaneously and lot of work and planning have gone into their provision. Given that the board of management of the Mayo-Roscommon hospice is in charge of both facilities which are being developed together and owing to the unique nature of the combined structure of the hospice movement in both counties, the proposal should be considered as encompassing a 22-bed development. The benefits under this arrangement should be applicable to it.
While I welcome the general thrust of the amendment, it is disappointing that we only received it a couple of days ago. I find it difficult to understand why it was not introduced prior to Committee Stage in order that we would have had time to debate it properly and examine its various elements. I agree with all the comments made about the hospice movement. We have the renowned Milford hospice centre in Limerick which provides a brilliant service. Probably everyone in the region has a family member or friend who has availed of that service.
I wish to deal with a couple of points concerning the amendment. The Minister referred to section 3(c)(ii) which requires a minimum of 20 inpatient beds. Deputy Bruton also referred to this point but why is there a minimum limit? Under the terms of the Nursing Homes Act 1990, a person can qualify for a nursing home place as long as he or she has more than two dependants. Equally, the 1998 legislation on private convalescent facilities contains no stipulation on the number of beds required. The only stipulation concerning housing units for the aged or infirm is in the Finance Act 2002 which provides for a minimum of 20 units but that is in a different context because this amendment concerns palliative care units. The Minister should re-examine the section with a view to allowing each application to the HSE to stand on its own merits; otherwise we could have a situation where parts of the country will lose out, depending on the size of units involved. Why should some people be disenfranchised because they have access to a 12-bed rather than a 20-bed unit? I cannot understand why it is necessary to set such a limit when it does not apply to nursing homes. The Minister should consider this point.
Section 3(e)(i) refers to the need for 20% capacity for public patients. However, I agree with Deputy Bruton that this figure is too low. We want to provide a service with equal access for all. Therefore, I ask the Minister to review this section and perhaps table an amendment to permit a higher level. My understanding is that if he so wishes, he could allow oral amendments to be discussed today. This should be done in the interests of putting something in place that would work for both public and private patients. The Minister should insert the same eligibility provisions that apply to nursing homes, which refer to a person with two dependants. This would require a change to section 3(c)(ii).
Deputy Burton mentioned rents and said this measure was being driven purely in terms of investment. When applications are being made to the HSE, it is critically important that there be no restriction on supply. If, for example, the HSE states it will only give approval for one unit in a particular area, that may lead to a monopoly. In a situation where there is more than adequate supply, the service must be community based. There cannot be a situation where it is available in one community but not in another.
This particular amendment cannot be implemented unless the commencement order is in place, for which approval from the EU is required. I have raised this issue before. How long will it take to secure that approval? It is critical that it is implemented as quickly as possible.
It is a pity that we have not had adequate time for this debate and that it will be guillotined in 15 minutes. This is critical legislation that affects people's everyday lives, but it is being rushed through. I ask the Minister to take on board our proposal to omit any stipulation in regard to the number of beds, as is the case in respect of nursing homes, increase the 20% threshold for public patients and ensure there is no restriction on supply.
I welcome the opportunity to speak on this amendment. Deputies Bruton and O'Donnell highlighted a weakness in the amendment in respect of the 20-bed threshold. Deputy O'Donnell made the valid point that there is no such limit in regard to nursing homes. There is an inherent protection in the amendment in that it requires the approval of the Health Service Executive for a project to go ahead. It is not a question of units being developed at every crossroads. It is extremely difficult to secure HSE approval.
Deputies Finneran and Calleary referred to projects in Roscommon and Mayo. An eight-bed unit is being developed in Roscommon and a 14-bed unit in Mayo. These projects would not have commenced without the commitment of the Mayo Roscommon Hospice Foundation, which was obliged to commit the largest percentage of the capital funding. After much arm twisting, the HSE eventually approved the projects but only on the basis that the Mayo-Roscommon Hospice Foundation would pick up part of the initial running costs. We still have no decision from the HSE in regard to the ongoing running costs, and this is holding up the projects. Premature announcements have been made in regard to this funding but I hope the HSE will finally sanction it as soon as possible.
This amendment will not facilitate the projects in Mayo and Roscommon, for which the bulk of the capital funding came from the voluntary sector and the public. Moreover, as I said, most of the funding for the initial running costs of both operations also came from voluntary contributions. It is important that we recognise and support the tremendous work being done by hospice groups throughout the State. The Government must not turn its back on these projects.
I am concerned that the reason for the imposition of a 20-bed threshold is some type of hidden agenda in the implementation of the national cancer care strategy. The location of the proposed centres of excellence means there will be no services north of a line from Dublin to Galway. The 20-bed threshold proposed by the Minister would restrict the provision of palliative care facilities to large population bases of approximately 200,000 to 250,000. This means that counties with smaller populations will never have the opportunity to avail of these provisions. The Minister and I both come from counties with small populations so I assume that is not the agenda behind this proposal. I ask him to reconsider this provision on the basis that the current proposal will only facilitate large catchment areas and population centres. We see the impact this has already had in respect of the centres of excellence, with counties like Mayo and Sligo left out of the loop.
Another issue is the percentage breakdown of public and private patients, the so-called 80:20 split. I agree with Deputy Bruton that this represents a total imbalance. The ethos behind the hospice movement is that everybody should be treated equally according to need, not on the basis of the health insurance cover they may have. That is even more so the case in Mayo and Roscommon where a significantly lesser percentage of the population has private health insurance. The objective of the Mayo-Roscommon Hospice Foundation is to ensure the eight-bed and 14-bed units are available to everyone regardless of health insurance cover. I ask the Minister to review this aspect of the proposal.
Deputy Bruton referred to the monitoring of standards. It is totally unacceptable that private hospitals, some of which have already availed of various supports and incentives provided by the Government in regard to sites and so on, do not come under the jurisdiction of any type of monitoring agency. This is a national scandal. It is fundamentally important that these facilities are placed under the supervision of the Health Information and Quality Authority, HIQA. Likewise, palliative care facilities must also be subject to independent monitoring via the HIQA. The service provided by the hospice movement throughout the State is excellent. There has never been a complaint about the quality of service provided by the Mayo-Roscommon Hospice Foundation. However, there have been incidents in other areas where disputes have taken place, facilities have lain idle and so on. That must not be allowed to recur. It is important that this protection is put in place.
There are also ethical issues in regard to pain relief and near death situations.
Yes, there are serious ethical issues in that regard over and above the monitoring required of the standard level of care. Every Member regularly receives complaints about the operation of the health service, particularly in respect of acute hospitals and nursing homes. In most cases, nothing is done to address these complaints. I hope the establishment of the HIQA will bring a change in this regard. It is of fundamental importance that such protection is in place for the people who use these facilities.
I urge the Minister not to ignore the tremendous work being done by the Mayo-Roscommon Hospice Foundation, an organisation that put its neck on the line in getting the projects in Mayo and Roscommon off the ground. It experienced great difficulty in securing HSE support before the latter eventually provided sites for the two projects. I am concerned that a situation will arise where this particular incentive is focused on large population centres to the detriment of smaller community facilities.
The objective of palliative and hospice care is to keep the services as close as possible to patients and their families. The Government and the Health Service Executive are taking an alternative view of regional acute hospitals, with smaller hospitals and accident and emergency units being closed and centres of excellence established. It would be wrong if the hospice movement and palliative services were forced down the same road. The Minister is facilitating that development. I do not believe that is the Minister's intention and I urge him to re-examine this amendment and re-draft it to facilitate smaller projects like those in Roscommon and Mayo.
I warmly welcome this amendment. Like Deputy O'Donnell, my experience is principally of the Milford Hospice, which is an excellent one. I do not know its bed capacity but it is certainly greater than 20. Hospices are different from private nursing homes. They have a particular focus. I have enormous admiration for the work of the hospice movement.
I was interested to see in yesterday's Evening Herald a socially progressive commentator welcoming the Minister’s measure as having considerable potential and providing relief for the hospice movement. Therefore, we should not look at this measure through ideological spectacles. I accept that units need a certain critical mass but, like Deputy Finneran, I believe that requirement should be interpreted and implemented in a flexible manner——
Deputy Mansergh is in agreement with Fine Gael.
——so that units can come together in smaller counties. Similarly, the 80:20 ratio of private to public patients could be taken in the context of existing provision because the balance in the health service as a whole is not far from 50:50. We have, for better or worse, a hybrid health system which encourages people who can provide for themselves to do so. One might argue against that but it was settled 50 or 60 years ago.
This is an excellent use of tax breaks. I see absolutely no incompatibility with long-standing Fianna Fáil policy. I can well imagine that it would be introduced, regardless of who our partners in Government were. There is a certain allergy in parts of the House to the very notion of private profit but our whole mixed social market economy operates on that basis.
Very crude criticisms were made of the Government's economic policy by a party which does not have any coherent economic policy that I am aware of. I was shocked, although not surprised, to hear any Deputy refer to this as a partial parliament in a semi-statelet. I have always had great difficulty understanding so called republicans who do not recognise this Republic. It throws into context the party in question's presenting itself as the champion of sovereignty and democracy when it is clear that the Deputy opposite does not recognise the sovereignty of either this State or its people. The European Union in the past 35 years has had much more respect for sovereignty and democracy in this country than the party opposite.
I fully support the principle behind what the Minister is trying to achieve. However, a hospice is not similar to a nursing homes or private hospital. The hospice movement allows people to spend the last days of their lives in a different atmosphere. Patients do not spend long periods in hospices, unfortunately, and they know their days are numbered. Therefore, the more local the hospice, the better. It is important that patients remain in their own environment, visited by friends from their own locality. Those qualities of the hospice movement should be protected. Therefore, I fail to see why the Minister has imposed a minimum size, as though a hospice were a commercial enterprise similar to a private hospital. Health Service Executive approval should be sufficient to protect the purpose of the tax break.
The tax breaks should be project based. This is the point being made by the Deputies for Roscommon and Mayo. In my own area, the Blackrock Hospice is regarded as a project. People whose relatives have died in the hospice have an opportunity to give something back to it. Tomorrow is Daffodil Day. The lifting of the restrictions proposed by the Minister would be a wonderful present from the House to the hospice movement.
A hospice and palliative care policy is in place and this amendment is designed to be in line with it.
It will discriminate against two thirds of the country.
In fairness, I have listened——
In fairness, we have had almost no opportunity to debate this.
I would like to reply. I am not going to be allowed to reply.
We are not going to listen to the Minister laying down the law to us now——
I am not laying down the law
——with his substandard amendment slipped in at the last minute.
I gave notice on Committee Stage that I would bring forward this amendment on Report Stage. The amendment was brought forward late in the day because of the decision to work with the Department of Health and Children.
The provision of the new scheme of capital allowances specifies pre-approval of any proposed development in this area by the HSE with the consent of the Minister for Health and Children. This pre-approval will ensure the development of palliative care units covered by capital allowances is done in accordance with existing policies and strategies in this area.
All specialist palliative care services are delivered free of charge to public patients.
They will not necessarily get places in these units
The specialist inpatient units——
That is what the amendment states.
Please, Deputy. I am entitled to make a few remarks in reply to the many Deputies who have made a contribution.
This is codology.
The specialist inpatient units have a number of private health insurance beds. Where patients have private health insurance, the health insurance company is billed directly for accommodation costs in the specialist inpatient unit. Both public and private patients are seen by the consultant in palliative medicine. All consultations with the consultant in palliative care are delivered free of charge to public patients. Consultations with private patients incur a charge billed directly to the private insurance company.
A baseline study undertaken by the Irish Hospice Foundation found regional variations across the country in the provision of hospice specialist palliative care services. In particular, there are apparent gaps between supply and demand in a number of locations. There are 131 external beds in hospices and specialist care units against a recommended level of 390. This represents a deficit of 259. The programme for Government contains a commitment to removing the regional disparities in the provision of funding for palliative care, ensuring that the needs of all those who require palliative care are met.
Legislation requires the pre-approval of any proposed development in this area by the HSE with the consent of the Minister for Health and Children. The 20 beds issue arises from discussions with the Department of Health and Children to ensure the long-term feasibility of units. Population size and catchment area recommendations in various reports are for eight beds per 100,000 of population. This is a minimum level to ensure that units develop in accordance with policy for this area. With regard to the specific issue raised by Deputies Finneran, Calleary, Naughten and others, if a project receives approval from the HSE, from a tax point of view the same company running both facilities with an aggregate figure of 20 beds could qualify for relief. It is a matter of obtaining prior HSE approval in the first instance.
As it is now 1 p.m., I am required to put the following question in accordance with an order of the Dáil of this day: "That the amendments set down by the Tánaiste and Minister for Finance and not disposed of, including those in respect of which recommittal would in the normal course be required, are hereby made to the Bill, that Fourth Stage is hereby completed and that the Bill is hereby passed."
- Ahern, Michael.
- Ahern, Noel.
- Andrews, Barry.
- Andrews, Chris.
- Aylward, Bobby.
- Behan, Joe.
- Brady, Áine.
- Brady, Cyprian.
- Brady, Johnny.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cowen, Brian.
- Cregan, John.
- Cuffe, Ciarán.
- Cullen, Martin.
- Curran, John.
- Dempsey, Noel.
- Devins, Jimmy.
- Dooley, Timmy.
- Finneran, Michael.
- Fitzpatrick, Michael.
- Fleming, Seán.
- Gogarty, Paul.
- Gormley, John.
- Harney, Mary.
- Haughey, Seán.
- Hoctor, Máire.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Killeen, Tony.
- Kirk, Seamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Brian.
- Lenihan, Conor.
- Mansergh, Martin.
- McEllistrim, Thomas.
- McGrath, Finian.
- McGrath, Mattie.
- McGuinness, John.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M. J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Flynn, Noel.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- Power, Peter.
- Power, Seán.
- Scanlon, Eamon.
- Treacy, Noel.
- Wallace, Mary.
- White, Mary Alexandra.
- Allen, Bernard.
- Bannon, James.
- Barrett, Seán.
- Breen, Pat.
- Broughan, Thomas P.
- Bruton, Richard.
- Burton, Joan.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Coveney, Simon.
- Crawford, Seymour.
- Creed, Michael.
- Creighton, Lucinda.
- Deenihan, Jimmy.
- Doyle, Andrew.
- English, Damien.
- Enright, Olwyn.
- Feighan, Frank.
- Flanagan, Charles.
- Flanagan, Terence.
- Gilmore, Eamon.
- Hayes, Brian.
- Hayes, Tom.
- Kehoe, Paul.
- Lynch, Kathleen.
- McCormack, Pádraic.
- McGinley, Dinny.
- McHugh, Joe.
- Mitchell, Olivia.
- Morgan, Arthur.
- Naughten, Denis.
- Neville, Dan.
- Noonan, Michael.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Keeffe, Jim.
- O’Mahony, John.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Penrose, Willie.
- Perry, John.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Ring, Michael.
- Sheahan, Tom.
- Sheehan, P. J.
- Sherlock, Seán.
- Shortall, Róisín.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Upton, Mary.
- Varadkar, Leo.
- Wall, Jack.
The Finance Bill 2008, as passed, is a certified money Bill and will be sent to the Seanad as such.