The manner in which this matter is being dealt with is unfortunate. I understand that the issue before us is not of major importance in itself, but is a matter of making sure that the legislation is clear and watertight. One cannot argue with that, and there is logic to what the Minister is proposing. However, this is about a central illogic in our health service. The proposal is to ensure that all charges to private patients are included in data returns from insurers. In terms of the risk equalisation scheme, that makes sense, but what is under discussion - which should be highlighted, now that we have the opportunity to do so - is charges levied on a patient who is in a public hospital bed. Under our legislation, such a patient has an entitlement to hospital care. It must be asked whether such a person is a public or a private patient. Such people have rights as public patients once they are in public beds, but under the change proposed it is clear that they are being treated as private patients. In the way they are dealt with by the hospitals, they are certainly treated as private patients, because the consultant is being paid twice for the care that he or she provides. Can the Minister say if that is legal? What is the legal position?
We all know the outcome of the central point. We know we have a two-tier system that is grossly unfair, which incentivises the use of public beds by private patients. We know that hospitals and consultants are rewarded for the care they give to private patients, whereas if they care for too many public patients, they are in effect penalised because the hospital goes over budget. We know from ESRI research that public facilities are over-used and that there is excessive use not just of beds, but also technology, for the care of private patients, because incentivisation is inherent in the current system. There is a danger too in prioritising private patients where there is minimal private capacity in a hospital. Paediatric hospitals provide the obvious example.
This gets to the heart of the problem of our two-tier hospital service. It is a problem from which the Government has run away. We just happen to have an example before us of where the evidence of this failure to deal with the core issue emerges, by way of a discussion on risk equalisation and making sure the legislation is clear-cut. It exposes the reality of a situation where a patient is in a public bed in a public hospital, paid for by the taxpayer, and is being charged for the care given, with the insurer covering the charge, because of the person being defined as a private patient. I have argued many times that the way to deal with this is to get rid of the differentiation between public and private when it comes to hospital care, by means of extending insurance. That would deal with this issue permanently.
We need to know whether the current practice is legal. A woman recently complained to me that she was charged as a private patient for occupancy of a day bed in a hospital. She never saw a bed when she was in hospital. She goes there on a regular basis. We all know of the case where a private hospital was charging the insurer for expensive drugs that the hospital was getting free from the company as part of a research project. The insurer was paying that charge. Collusion is a strong word, but the practice has been that, for example, the hospital consultant, the insurer and indeed the Minister have all maintained this grossly unfair system. In effect we are now clarifying that situation in this legislation. We must make the point that in effect, something that certainly has legal implications needs to be questioned. We are talking of a situation that should be disallowed, whereby somebody can become a public patient, while a private patient still occupies the same bed.