Dáil Éireann debate -
Thursday, 15 Dec 2022

Vol. 1031 No. 3

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Pearse Doherty

Ba mhaith liom mo chomhbhrón féin a chur in iúl do theaghlach Private Séan Rooney, a chaill a shaol go tragóideach sa Liobáin, agus dá chomhghleacaithe uilig sna Fórsaí Cosanta, Óglaigh na hÉireann.

Tá an ECB leis an ráta úis a ardú arís. Beidh an ráta tar éis dul ó 0% nuair a bhí an samhradh ann go dtí 2.5%. Mar atá a fhios ag an Tánaiste, tá teaghlaigh ag streachailt ó thaobh costais mhaireachtála agus beidh tionchar ag an ardú seo ar dhaoine a bhfuil morgáiste rianúcháin acu agus ar theaghlaigh a bhfuil a gcuid morgáistí díolta do na creach-chistí.

The European Central Bank is expected raise interest rates by another half a percentage point today, which will bring the rate to 2.5%. Somebody on a mortgage of €200,000 will see their repayments increase by more than €3,000 per year. This will have an immediate impact on the 194,000 households who have tracker mortgages. The fate of those on variable rates or whose fixed rates are due to expire lies with the banks and whether they decide in the coming months to pass this interest rate on. We in Sinn Féin have repeatedly made our position on this clear but I will repeat it - the banks should absorb these interest rates in the interest of their customers. They are profitable, have an increased market share and have paid out dividends to their shareholders already this year. Not only that, they are uniquely positioned to profit on the back of rising interest rates, although they should not. They should do the right thing. I ask that the Tánaiste, on behalf of the Government, echo that call.

In October I asked the Tánaiste and his Government to examine options to introduce a targeted, tailored and time-bound mortgage interest relief for struggling mortgage borrowers who are facing, and will continue to face, sharp increases in costs due to interest rate hikes. Will he clarify whether the Government has undertaken any of this work? As he knows, there is another cohort of borrowers who are now at the sharp edge of interest rate hikes. Over the past number of years, tens of thousands of borrowers have had their mortgages sold off by the banks to vulture funds and for years Government Minister after Government Minister has told the Dáil, these same borrowers and the public that vulture funds offered the same protection and safeguards to mortgage holders as the banks. At the time of Permanent TSB selling its split mortgage loans to a vulture fund, the Tánaiste told the Dáil, and assured homeowners, that they would be no worse off.

I never bought that line and now more than ever the truth is laid bare. Vulture funds are aggressively hiking rates higher and faster than the banks. One borrower, who is a mother of three, wrote to us and told us how her interest rate from Pepper has increased from 3.7% to 6.4% Her monthly repayments have been hiked by more than €300 per month, which is over €3,500 per year more that she must pay, in interest alone, and that is before the ECB puts the interest rate up again today. The borrower has rightly said this would not be the case if she remained with Permanent TSB. Another borrower wrote to us. He is also a Pepper customer. His mortgage loan was sold by Permanent TSB. His interest rate has been hiked from 4.5% to 6.5%. In his own words, "This is the sentence we have been served by these vultures… how are we supposed to sustain this… factor in cost of living rises and our two kids, we are very worried about the future". Again, the ECB interest rate hike will put that individual's interest on his mortgage at 7% and in the case of some others it will be more than 7%. There are thousands more such cases. There are 100,000 people who have had their mortgages sold off to vultures. This puts to bed any notions that vulture funds treat borrowers in the same way as banks do.

Does the Tánaiste accept these borrowers who had their loans sold to vulture funds are now in a worse position with the interest rate hikes? Will the Government commit to examining options for a targeted, tailored and time-bound mortgage interest relief? What actions will the Tánaiste's Government take given more and more families are likely to face repayment difficulties in the months ahead?

The Tánaiste

I thank the Deputy. We understand the ECB will make an announcement on interest rates today. We do not know what it is going to be but it is anticipated there will be a further increase in interest rates announced. We hope it is the last one, or failing that, the second-last one. As the Deputy will appreciate, the ECB is independent in its functions and it has a particular remit to bring inflation under control and down to something around 2%. That is the reason interest rates are being increased by the ECB but obviously this is going to be extremely unwelcome news for mortgage holders and other borrowers, who will see the cost of their repayments rise and that is coming at a time when the cost of everything is rising. I am conscious it is going to be unwelcome news and difficult for many families and other borrowers in the period ahead.

To answer the Deputy's question, we do not have any plans at present to reintroduce mortgage interest relief. It existed in the past but did so, generally speaking, at a time when interest rates were much higher than they are even now. It is not something we will rule out for the future but there are no current plans to do so. It would involve reopening the budget and all the consequences that would derive from that.

When it comes to variable interest rates, it is a commercial decision of the banks and other lenders to set those and they will have to take into account a number of factors. When interest rates go up, the cost of borrowing for banks goes up as well, because banks get much of their finance from the ECB and there could also be an impact on deposit rates too. However, my message to the banks is they should not use rising interest rates as an opportunity to increase profit margins, and that is the message we will convey to them with regard to interest rates. It was the case for a very long time that interest rates paid by Irish borrowers were very much higher than the European average. We have seen that narrow in recent months because many of the banks have not passed on the increases, which is welcome.

When it comes to funds I will have to talk to the Minister for Finance and then come back to the Deputy. My understanding is when loans or mortgages transfer, the contractual terms remain the same and cannot be changed unilaterally. Provided the person adheres to the contract the lender must honour the contract, but the Deputy is telling me that is perhaps not the case. Certainly, if he has individual cases or examples, I would be happy to examine them and take them to the Minister for Finance for further examination.

Deputy Pearse Doherty

The funds are not breaking the contract. They always had the ability to do this, just like the banks have the ability to pass on interest rate hikes, which they are not doing because they have long-term interest. The funds have no such interest. That is why family homes should never have been allowed to be in the hands of vulture funds. We have people who are going to get another letter after today, the fourth such letter since the summer, saying the interest rate on their mortgage has increased again. For people that is going to put an extra €4,000 in interest on the repayment of their mortgage. For many families, that tips them over the edge. When families are sitting down at the end of the day, it does not matter whether that is €4,000 to heat the home or €4,000 to keep a roof over their heads, it is money they have to find somewhere.

There is a particular need now to examine the issue of mortgage interest relief that can be tailored, that can look at the increase we are seeing, which is brought on by inflation, which is a result, in the main, of the war in Ukraine and the issues with energy and so on. Therefore, just as with other one-off, time-bound measures, we need to look at a relief for mortgage holders on the huge interest spike they face right now.

An Leas-Cheann Comhairle

Go raibh maith agat.

Deputy Pearse Doherty

There are people facing into Christmas who do not know how they are going to meet January's mortgage bill.

An Leas-Cheann Comhairle

I call on the Tánaiste to respond.

Deputy Pearse Doherty

I really think the Government needs to intervene. I heard what the Tánaiste said - and will finish on this-----

An Leas-Cheann Comhairle

Go raibh maith agat.

Deputy Pearse Doherty

-----that the Government has not ruled it out completely but I encourage it at least to examine options.

An Leas-Cheann Comhairle

Go raibh maith agat a Theachta. We are way over time.

Deputy Pearse Doherty

We have prepared options with the Parliamentary Budget Office. We are happy to share them with the Minister for Finance and I encourage the Tánaiste to take action on this matter.

The Tánaiste

I thank the Deputy. I absolutely appreciate that interest rates going up will be very unwelcome for tens, if not hundreds of thousands, of families across the country. Those with tracker mortgages, for example, will receive that letter, the fourth such letter in only a few months telling them their repayments are going up. The same will apply to people on variable rates and that is not welcome. As the Deputy will appreciate, the ECB makes its decisions independently of European governments. It is raising rates in an effort to bring down inflation which, if successful, will be of benefit to everyone. However, that is no consolation to people who have seen their repayments rise, and rise very sharply, over the past couple of months.

We passed a budget in this House only a few weeks ago and that did not include the reintroduction of mortgage interest relief. As the Deputy noted, it is not something we are going to rule out. It existed in the past when interest rates were, generally speaking, much higher. We will be happy to look at any proposals the Deputy has but I do not want to raise false expectations. The budget was only agreed recently and we have only just signed off on the Finance Bill. To reopen the question of the public finances after only a few weeks, indeed before the budget even comes into effect, would have other consequences we would have to consider.

Deputy Ivana Bacik

I am conscious, as I think we all are, that this is the Tánaiste's last Leaders' Questions in his current role. I want to bring to his attention the publication just this morning of the final report of the Oireachtas Joint Committee on Gender Equality, which I had the honour of chairing. Our report is entitled Unfinished Democracy: Achieving Gender Equality. What we have set out to do in this report is devise an action plan for the implementation of the 45 recommendations of the Citizens' Assembly on Gender Equality, which amount to a blueprint for achieving a truly gender-equal Ireland. At the launch this morning, we saw the audiovisual room packed with stakeholders, civil society groups, academics and many of those who engaged with us and indeed many members of the citizen's assembly. I expressed our thanks as a committee to the assembly, to Dr. Catherine Day who chaired the assembly and to all the stakeholders who engaged with us.

What we heard from those present was a real desire to see the report implemented, to see the actions we recommended taken up by the Government and progressed over the coming term. There are some clear measures there that need to be acted upon urgently.

I am seeking from the Tánaiste and his Government a commitment on recommendations 1 to 3 of the citizens' assembly. Those recommendations relate to constitutional change, both to the equality guarantee in Article 40.1 of the Constitution, to make it more inclusive and refer specifically to gender equality, and crucial changes to Article 41 of the Constitution, that is, the family article. The citizens' assembly asked us to do three things with Article 41, namely, take out the gendered language that currently refers to women and mothers as having lives and duties within the home; create a more inclusive definition and protection for care within the Constitution; and extend the definition of family beyond the current narrow definition based on marriage.

In our work, hearings and deliberations, the committee devised a single set of wording to be put to the people by way of referendum that would achieve the desires of the Citizens' Assembly and create a more inclusive and more equal document. It is probably the first time an Oireachtas committee has devised wording for the Constitution. We were able to do so through the extensive consultation and engagement we have had, particularly with the Tánaiste, the Taoiseach and other Ministers, including the Minister for Children, Disability, Equality, Integration and Youth, Deputy O'Gorman, on the idea of a constitutional referendum. We are all very conscious that there has been a number of false starts on this referendum. There have been previous attempts to delete the gendered or sexist language from the text but they have come to nothing because there has not been a cross-party or cross-civil society consensus on this. We have come a long way towards achieving that. Will the Government commit to holding a referendum on those three recommendations in 2023, as all members of our committee have asked?

The Tánaiste

I very much look forward to reading the report over the recess and will do that. I was grateful for the opportunity to speak before the committee some weeks ago. I recognise Deputy Bacik's work as Chairperson, and all the members of the committee for the work they did. Politicians and parliamentarians often do not get credit for the kind of work that gets done in committees but it is often the work that is most valuable, rather than what happens here in the Chamber. It was in my previous role that the decision was made to establish a citizens' assembly on gender. That was decided weeks after the referendum to repeal the eighth amendment, as the next important step in advancing equality between men and women. It has taken quite some time to get to this point, to have the assembly and have the Oireachtas committee do its work and make its report.

I can certainly give the Deputy a commitment that responding to the report will be on the agenda of the Government in 2023. We will respond to the recommendations in a structured way and in early course. I am in favour of constitutional change to provide a modern definition of family in our Constitution and to remove gendered language. It is extremely useful to have this report because referendums are easy to lose and often hard to win. The fact that we have cross-party wording is very helpful in that regard. I cannot make a commitment today on a referendum next year. It is something that will have to be discussed with the new Cabinet and the new Attorney General. However, I can give the commitment that this is work I really want to make progress on and follow through on. While I do not agree with every recommendation, the citizens' assembly did a great body of work that points to the way forward. The committee built on that and we want to ensure we move this agenda forward next year. I will certainly commit to a structured and meaningful response to all the recommendations in early course.

Deputy Ivana Bacik

I thank the Tánaiste for his undertaking to give a structured response. That is very welcome. I again thank my colleagues on the committee who engaged so constructively and intensively in the work we carried out. There was an immense range of issues that we had to cover in a short timeframe. We had a superb secretariat working with us on that and I thank them as well. I am also conscious that we will have the opportunity to debate the report in both the Dáil and the Seanad in the new year. I reiterate that we have done a very signifiacant amount of work to achieve a singular set of wording that could be put to the people by way of referendum and that we believe has moved us on in respect of that pathway to holding a referendum on this. I understand the Government will want to ensure there is a clear consensual basis for moving forward with that referendum but I think our engagement has provided a good pathway on that. We also produced an interim report on this in July. We engaged with stakeholders since that report was published and that is what has led us to this clear recommendation for constitutional change. I again urge the Tánaiste to take up that challenge and ensure that referendum is held within the next 12 months.

The Tánaiste

We will take up that challenge. Just in the past few months, we have introduced legislation around the gender pay gap and we are seeing that come into effect now. That will help us understand better what the gender pay gap is in businesses and organisations and how it can be closed. The Minister, Deputy O'Gorman, is bringing legislation through at the moment on work-life balance, which will benefit men and women but will benefit women in particular. In addition, there will be a significant reduction in childcare costs in the new year, which will benefit families but will benefit women in particular and will help more women get back to the workplace sooner if they want to. This Government has a good record in advancing this agenda. The same applies to the representation of women on company boards, where we have gone from 15% to over 30% and are aiming for parity. This is an issue the Government will want to pursue in 2023 and 2024. We will certainly give early consideration to the recommendations. It will hopefully be possible to have a referendum next year but I do not want to make that firm commitment without consulting with the Government and the new Attorney General, once he or she takes office.

Deputy Michael Lowry

As we celebrate the centenary of the establishment of An Garda Síochána, it is appropriate to reflect on its current standing. Over the past 100 years, members of the Garda have served us with distinction and pride. We owe them a sincere debt of gratitude for their outstanding commitment and dedication. Over the years, the force has developed and expanded. It has constantly embraced new methods and technology. It is in a persistent battle to keep ahead of sophisticated and dangerous criminal activity. Over the past ten years there has been a concentration on putting in place Garda oversight bodies. Many gardaí will say they are now under more scrutiny than the criminals. Members of the Garda are swamped with paperwork and uploading data. More and more, I encounter Garda members who are unhappy, unfulfilled and disillusioned. Gardaí are our front-line protectors. They stand between law-abiding citizens and the multitude of dangerous elements within our society. We need to acknowledge and appreciate their heroic efforts in a tangible way.

The pay, terms and conditions of rank and file Garda members should reflect their primary role in our society. Concerns are mounting about the increasing numbers of gardaí who have quit the force. Worryingly, these figures include some who are leaving before they have even completed their probationary period. When resignations are added to retirements, we have 400 fewer members of the Garda now than we had this time last year. At the other end of the scale, the scant number choosing the Garda as a career is a grave concern. The Government set a target of 800 new trainees for 2022. Currently, there are just 96 recruits in Templemore Garda Training College. Increased resignations and a significant lack of trainees screams of problems within the Garda force.

Decisions by Garda management to amalgamate large districts across the country are now proving impossible to effectively control. As a result, people in towns and villages in Tipperary and across the country are left feeling vulnerable. People are growing increasingly afraid for their security and safety. Fear like this cannot be ignored. We need a greater Garda presence in our communities. We need to return to old-style visibility. Confidence and respect for Garda authority has faded. It is imperative that we take initiatives to revive it.

The ongoing dispute over rostering is damaging morale. There is growing discontent amongst members.

They are united in their view that it is more efficient and effective to continue working their current 12-hour shift on a four days on, four days off roster. To date, their voices and concerns have gone unheard. The growing frustrations of members of the Garda and the escalating fears of the public are not things that can be put on the proverbial long finger. A full review of all Garda operations must be a priority for the incoming reconfigured Government.

The Tánaiste

I thank the Deputy for raising these important matters relating to the Garda. I look forward to an early meeting with the Garda Commissioner in order that I have a chance to tease through some of these issues with him. We are in the process of reforming oversight of the Garda to establish the new office of the police ombudsman and I hope that reformed office will complete investigations into complaints in a more timely way. It is absolutely right that Garda members should be held to account but the fact that complaints can take years to be investigated is unfair. Those investigations can be left hanging over people. We hope it will become a speedier operation.

We have negotiated pay increases for Garda members, as the Deputy will be aware. Those increases are kicking in at the moment. They were accepted by the relevant organisations by very large majorities.

Recruitment and training of Garda members was significantly and understandably disrupted during the Covid restrictions but despite those restrictions, gardaí continued to be trained and attested during the pandemic, albeit in smaller numbers than we had planned. While the Commissioner is operationally responsible, the Government is committed to delivering the necessary resources to the Garda Síochána and bringing the total number of Garda members up to 15,000 and beyond.

Budget 2023 provides for funding to enable 200 recruits to enter the Garda College every three months. I was pleased that 92 new trainees entered the college at the end of November. Some 369 gardaí attested in 2022, bringing the total number who have completed their training this year to nearly 500. Despite a competitive jobs market, I take great confidence from the significant levels of interest shown in the most recent Garda recruitment campaign and take confidence in knowing that a further recruitment campaign next year will ensure a pipeline of suitable candidates.

As of the end of October, there were 14,200 members of the Garda across the country. In 2015, there were 12,860. We have seen a meaningful increase in the number of gardaí in the past six or seven years. The Garda is also now supported by over 3,000 Garda staff, which is a 50% increase on the numbers five years ago. That has freed up more than 800 Garda members from back-office duties to front-line policing.

Deputy Michael Lowry

I thank the Tánaiste for that response. It is also fair to say that arising from a trend towards violent disorder and aggression, the need for mental health and psychological support among members of the Garda force is growing and is a big concern. Up to the end of October of this year, €780,000 was spent on providing such support to members. That figure exceeds the entire amount spent in 2021. The figures show that 480 members were referred for psychiatric or psychological assessment, or for some form of mental healthcare, in 2021. Overall, almost €2.3 million has been required to provide psychological support to members of the Garda and staff who have dealt with traumas of some kind since 2020.

The increased numbers of resignations, the relatively low intake in numbers, dissatisfied members who feel unheard and the growing need for mental health support all pose a significant problem. I am asking that a full review of Garda operations will be high on the Government's agenda in early 2023.

The Tánaiste

I again thank the Deputy. He is correct to raise the issues of the mental health and well-being of gardaí. Being a Garda member has always been a tough job but it has become harder in recent years with the changing complexity of demands, some violence, quite frankly, and an increase in disrespect being shown to the Garda. One of the things we want to progress very soon is the use of worn body cameras, which can be an important protection to Garda members. I know they are in favour of that and we are keen to get it done next year. That requires legislation.

Garda management has introduced measures in recent times to support members, including a new employee assistance service, which is open to all Garda members and retired gardaí and their families. There is a 24-7 telephone helpline, a counselling service provided by Inspire Wellbeing and a peer support network. Arising from the cultural audit conducted this year, the Garda Commissioner acknowledged that while there are many positives in the service, it is clear that the organisation has more to do to ensure that people are being supported in their very challenging work.

I am advised that the resignation rate stands at 0.7%.

Deputy Michael McNamara

Given that the Government Front Bench looks like a Christmas reunion of health Ministers, I am going to focus on that topic. Various people have held the position of Minister for Health and there have been various CEOs of the HSE. When the HSE was established and CEOs were drafted in, there were many promises that it would make a big difference. More recent appointees have been on a very significant salary scale. There was a promise that such a structure would bring a new order to our health service. The current Secretary General of the Department of Health has a special pay arrangement to bring his expertise to the matter. Notwithstanding all of that, our health system seems to be in a permanent state of crisis. We have learned that some people have waited 116 hours for a trolley. Others have waited for three hours and 15 minutes for triage, when that should be carried out within 15 minutes. Eighty people are on trolleys today in University Hospital Limerick, UHL. On the same day last year, there were also 80 people on trolleys in that facility. This year, we have been told that respiratory syncytial virus, RSV, is the issue. Last year, it was Covid-19. This year, there are only 15 people in intensive care units across the country because of Covid-19. Last year, we were told that the health service was facing existential collapse because of the threat posed by Covid. There were 105 people in intensive care units because of Covid last year. This year, the problem is RSV.

Essentially, the problem seems to be that people are getting sick. If people stopped getting sick, our health service would work perfectly. People pay taxes in the hope that when they become sick or need care, they will receive it. Our tax burden in Ireland is not very high by international standards but nor is it very low by international standards. Our health spend in Ireland is pretty average by OECD standards. However, I do not think that anybody in this Chamber or in the community thinks that our health system is adequate in return for that tax spend. When is our health system going to move beyond crisis into something that provides the service for which people pay their taxes? When is there going to be a value-for-money audit across the HSE and our health system? When is it going to move beyond crisis and towards something that resembles a First World healthcare system for which people pay First World taxes?

The Tánaiste

I thank the Deputy for his questions. At the outset, we should acknowledge that there are some very good things about our health service. Life expectancy continues to rise in Ireland. It is at 83 now and that is, in part, because of the improvements that have been made to our health service in recent years. Stroke survival rates are improving all the time. When I was working as a doctor, a stroke unit was very rare and there is now one in nearly every hospital. Cancer survival rates are improving every year and there has also been an improvement in the treatment for heart attacks. Many of the patient outcomes in Ireland are as good as, if not better than, our European peers and are better than those in the National Health Service, NHS, which is often used as an example that we should follow. We have also seen great improvements in chronic disease management. People with diabetes, for example, are managed at community level by their GPs in a way that was unthinkable only ten years ago. There is some evidence that waiting lists, having risen dramatically in part as a consequence of Covid and the cyberattack, are now starting to level off and, if anything, are perhaps going to fall a little. The word for that may not be "encouraging" because waiting lists should not be as long as they are, but levelling off is perhaps the first step before improvement.

I acknowledge that we face real barriers to access. Most people would acknowledge that when a patient gets into the health service, the treatment, generally speaking, is very good. That is what most people say when they are asked in patient experience surveys. However, we have a real problem with access. People are waiting far too long to see a consultant or to get an operation or investigation that they need. People are also experiencing unacceptable conditions in most of our emergency departments, including in UHL, which Deputy McNamara has mentioned many times.

We are pouring resources into the health service as the Deputy himself noted. In the past two years alone we have added over 1,000 beds to the system, 930 in the acute hospitals and 340 in the community. There are 15,000 extra staff now compared with two years ago including 4,500 extra nurses and midwives. There is a narrative to the contrary but the facts speak otherwise. We have 4,500 more nurses and midwives working in our health services than we had two years ago, 1,400 more doctors and dentists than was the case two years ago, and more than 2,000 additional health and social care professionals. That is happening against a backdrop of a rising population and an aging population with much more complex needs. That is the situation with which we are dealing. We will continue to strive to make further improvements in the years ahead and turn the tide on waiting lists which I think is achievable.

Deputy Michael McNamara

Can we have some detail on how that target is going to be met? We have a GP crisis which has been going on for a very long time. My predecessor from County Clare, Michael Harty, was elected to this House on the basis of the GP crisis and the fact that the number of rural GPs, in particular, was reducing. It would not be unfair to suggest that his experience here was somewhat frustrating and through no fault of his or no lack of effort on his part the situation was not any better when he left than it is now. We still regularly read in the newspapers of a GP crisis. We learn that one in three consultant positions is either unfilled or filled from an agency. There are 59,000 people waiting for healthcare across the mid-west. Resources are being poured into it but of course the population is aging due to a number of factors including dietary and health outcomes. I also learned that more than 200,000 PPS numbers were issued this year in Ireland. While we are pouring resources in, our population is also growing. I struggle to have confidence in how the Government is going to meet these targets it repeatedly issues.

The Tánaiste

I should add to my comments earlier that a waiting list initiative is under way and we are seeing substantial falls in the number of people who are waiting a long time to see a consultant or to have an operation. The number of people who are waiting more than six, 12 or 18 months is now falling. That is a result of the additional resources being put in. The target should really be 11 or 12 weeks, not six months or a year. We are at least seeing some progress in regard to the long waiters.

In regard to GPs there is a big shortage. On Friday I met some GPs in east Galway. They are offering positions in their practice at €120,000 for a four-day week with a practice nurse and with a manager yet cannot get any applicants. That shows the kind of challenge we face. In response to that we have doubled the number of trainees but we need to do much more work with them to encourage them to stay in Ireland because there is an exodus of GP trainees from the country and they are not coming back. In regard to consultants, ten years ago there were 2,500 consultants. There are now 4,200. There has been a very significant increase in the number of consultants in Ireland. However, we have vacancies and many positions filled by locums, as the Deputy mentioned. We think the new consultant contract is very attractive with a salary of over €250,000 a year. Anyone would agree that is a very good offer for a 37-hour week. However, we are asking in return that those consultants who take up that contract commit to public practice and work those 37 hours in a public hospital and only do private practice on their own time in a private hospital.