Dáil Éireann Debate, Tuesday - 22 June 2004
10 Mr. Neville asked the Minister for Health and Children his views on the increased number of private hospitals built around the country; if he intends to give direction and leadership to this development through formal public private partnerships; and if he will make a statement on the matter. [18495/04]
View answerOne of the key goals of the Government's health strategy is to improve access for public patients through a significant increase in acute hospital bed capacity. The Government indicated in the health strategy that it was committed to exploring fully the scope for the private sector to provide some of the additional capacity required in the acute hospital sector. Towards this end, my Department has developed close contacts with the Independent Hospitals Association of Ireland.
For its part, the national treatment purchase fund, NTPF, purchases procedures from private hospitals in Ireland. Where it is not possible to treat patients within a reasonable period in public hospitals arrangements are made to refer the public patients for treatment in private hospitals having regard to quality, availability and cost. The majority of procedures funded by the NTPF to date have been carried out in private hospitals in Ireland. To date the NTPF has arranged treatment for some 15,000 patients who have been waiting longest on waiting lists.
The Minister for Finance has moved to promote investment in the private hospital sector. Section 64 of the Finance Act 2001 as amended by section 32 of the Finance Act 2002 provides for significant tax allowances for the construction or refurbishment of buildings used as private hospital facilities under conditions which will also benefit public patients. I expect that the health services executive, when established on a statutory basis, will promote a strategic partnership with the private hospital sector with the objective of securing enhanced treatment options for public patients.
I accept the Minister's comments regarding the purchase of services in the private sector. However, I am worried about the emergence of a large number of private hospitals in an ad hoc, unplanned and unco-ordinated manner. That is not an optimum use of resources from anyone’s point of view. Does the Minister accept that those hospitals are emerging in response to market forces with people demanding services not available to them from the State in the quantity required or in any sort of timely manner? If the private sector can provide those services, why does the State not work in tandem with it, commissioning services from it so that there is some sort of co-ordination in the planning of hospitals around the country?
At a recent meeting of the Joint Committee on Health and Children, the Minister refused to give any kind of commitment to purchase radiotherapy services in Waterford, although there is a clear demand for them and a lack of capacity in the country as a whole. It defies understanding that we are not availing of the capacity provided by the private sector, given that incentives are being provided by the Department of Finance, as the Minister has said.
There is a one-minute time limit.
The direction in which we are going is leading to a duplication of resources. It is completely wasteful and we will end up with a far less equitable service. God knows the service lacks equity as it is. If we go down this route, the result will be that only those who can pay will have access to services.
Tax incentives and the treatment purchase fund have proved effective mechanisms to make use of additional private sector capacity in the system. They represent a complementary approach. For a whole range of procedures and specialties, there is no reason that some of the capacity demands should not be met by private sector hospitals being established, especially for day surgery, which has been the main driver for productivity increases in the acute hospital sector to date. There is a great deal of potential for increased capacity in day case procedures and surgical activities which may be funded through the treatment purchase fund. Some 50% of the population is now insured under private health insurance and the market can take a degree of additional capacity.
For the more major, supraregional specialties such as cardiac or neural surgery or radiotherapy, there is a need for synergy between the State and private sectors. However, the State sector has set out its stall. The Government has tried to build up capacity in radiotherapy, which we know was lacking historically. We had only one major centre at St. Luke's and two machines in Cork. That was the sum total of our radiotherapy infrastructure. Some years ago we gave a commitment to set up a radiotherapy unit in Galway. That was long before any private hospital facility was available and that is now almost ready. The building has been completed and the equipment is coming on stream. Staff are now being recruited.
What is the Minister's view on the fact that money is being lost to the Exchequer through the tax breaks the Minister for Finance, Deputy McCreevy, gave to encourage the provision of private day hospitals as a result of his being lobbied by a constituent? Had it been retained that money would have been more than enough to pay for the opening of almost €500 million worth of public facilities that had been closed or cannot be opened because money has not been forthcoming from the Cabinet. Does the Minister not think it bad value that we are losing money from our taxation system to build private day hospitals yet we cannot commission public facilities which are already built because not enough funding is being provided by the Minister for Finance? Such public facilities might be fully functioning if a relatively modest amount of money had been retained.
The Deputy is assuming the funding that went to hospitals through the tax relief scheme would not have gone elsewhere. We have a range of tax relief schemes of which people avail. Increasingly they are investing abroad in the global economy. Therefore, it is always important that one has mechanisms to attract and retain capital for domestic investment projects.
In Kildare.
There is no question that we have expanded the public service a great deal in the past five years. We have opened many new units and have several ready to open. Many were equipped but could not be opened until towards the end of the year. The Government is currently dealing with how to commission and open those units over the next two years, as they come on stream. There is an open question about the level of revenue. In theory, if one abolished the tax relief, some money should come back into the Exchequer but it could go elsewhere.
The Minister did not mention that some facilities have been waiting to be opened since last June which is a year ago. We are not talking about facilities that will come on stream by the end of this year. I am asking about facilities that are due to be opened or should have been opened many months ago but have not been opened.
That is the result of ongoing discussions regarding the opening and commissioning of those buildings, including the provision of equipment. The equipment is being provided in several of the units. There are issues with the other units to do with finance and the employment ceiling.
I am amazed that people have marched for a radiotherapy unit for the south-east. There were four massive marches and the Government was reduced to one Progressive Democrats and one Fianna Fáil member on Waterford City Council. Surely it will get the message. People are marching not to bring down the Government but for basic services. A radiotherapy unit in the grounds of Waterford Regional Hospital would provide the missing modality. As well as surgery and chemotherapy, it would provide radiotherapy. For less than the travel costs of transporting people where they do not wish to go, those facilities could be provided in Waterford. I ask the Minister how he can justify not providing that.
I also wonder about the money put into the treatment purchase fund. There is an old saying that if one gives a man a fish, one will feed him for a day, whereas, if one teaches him to fish, one will feed him for life. Where there are no consultants, there are massive waiting lists. For example, in Mayo General Hospital, 1,000 people are waiting for urology services and 1,500 for orthopaedics. What is the point in taking those people under the treatment purchase fund and paying people to carry out the work when one could open those facilities and have a local service without such long waiting lists? That quick-fix solution will not work. If one considers the numbers there and the treatment purchase fund itself, one sees that those people have been waiting on that urology list since 1996 which is eight and a half years. That is a long time to wait for the much talked about treatment purchase fund. What good is that to those 2,000 urology patients in Mayo General Hospital or the 1,500 orthopaedic patients who have been waiting for four years?
I do not know whether the Deputy is for or against the treatment purchase fund. Perhaps he should ask the 15,000 people who have had operations carried out under it for their views. We have done so and there is almost 96% approval.
I am amazed at the Minister.
One can do both and the waiting times have come down.
What about those still waiting?
I listed the hospitals in an earlier reply. In over ten hospitals, waiting lists are down to three months. In another ten, waiting lists are down to six months. Regarding specific issues, specialties and health boards, some issues might have to be resolved.
The Minister is using the wrong list.
No, I am using the treatment purchase fund list.
I call Deputy Crawford.
Some 15,000 procedures were carried out.
We have run over the time on this question.
How long will patients wait?
Is the Deputy for or against the fund?
They must wait eight years.
No one will ever have to wait for eight years under the treatment purchase fund. The wait is down to three months in some hospitals and six months in others.
Once they get on the list.
Allow Deputy Crawford to ask a brief question.
I will send them out to the Deputy's area next. He came in here one day and talked about 12 months. Rome was not built in a day.
The Minister forgets about one list.
I do not forget but let us get one list sorted out first.
Deputy Crawford has the floor. I ask Deputy Cowley to resume his seat.
A man will have to wait another eight years before he is treated under the treatment purchase fund.
Is the Minister aware that before Monaghan General Hospital was taken off call, it was serving patients from Northern Ireland under a similar fund? Is it good value for money to have a hospital such as Monaghan sitting less than fully utilised while buying treatment outside the country?
The treatment is good value for money. The figures have been done on that in terms of the costs of procedures and so forth.
The Minister refused to answer me before when I asked——
The Government invested in a new modular theatre for Monaghan Hospital. I said on countless occasions that, while I have no difficulty in increasing surgical activity there, it is not all one-way traffic. It is about time that the stakeholders in the area and the hospital got together and moved on. We have not moved on over the past two years as people found proposals unacceptable and refused even to meet on that basis. That is no way to progress the issue. I have given €2.7 million because I asked the heath board to advise me of the immediate requirement of Monaghan Hospital. I gave it on that basis having asked the health board to inform me what could be done.
While we will do more in the hospital, in terms of the organisation of the services, Cavan and Monaghan must work together. This notion that they are both operating in splendid isolation cannot be sustained. Deputy Crawford needs to tell people the truth about that. If we work in that way, we can make progress. If politics were to be taken out of the matter for about six months, something might be sorted out. I say that genuinely.
Did I not try to take it out of it?
The Deputy did and I give him credit for that.
