Generally speaking this section is acceptable. It identifies particular limits in eligibility. We have had a long drawn out debate and the Minister was about to allay our concerns about eligibility for people with medical cards. Rather than repeat on another section what has been said perhaps the Minister will give a once off reply, and I promise not to interrupt him. I have not done so up to now and I will not do so now.
Health (Amendment) Bill, 1991: Committee Stage (Resumed).
Question again proposed: "That section 3 stand part of the Bill."
I will be glad to clarify the matter once again for Deputy Ferris and other Deputies. In relation to charges for long stay patients, that is patients who are more than 30 days in a hospital, the regulations that allow for that are the Health Charges for In-Patient Services Regulations, 1976. The regulations have been in place and used by all health boards over the last 15 years. They have been used in respect of long stay hospitals for the elderly and psychiatric hospitals. The issue of acute hospitals arose this morning. During the sos I did a quick check around the health boards. As I understand it, in some health boards where a patient is no longer receiving acute treatment but is being maintained in an acute hospital for longer than 30 days, perhaps waiting for a long stay place, the charges are implemented in the same way as if that patient was more appropriately placed in a long stay institution.
The case to which Deputy Allen referred relates to a person who was in an acute psychiatric unit. I accept that such units are treated in the same way as in psychiatric hospitals, but it is only in recent years, with new developments in the service, that acute psychiatric units are being set up in general hospitals. As Deputy Allen recognises, it has always been the position that a patient in a psychiatric hospital for longer than 30 days pays the charge in the same way as anybody else. The measure really applies to long stay patients.
Mr. Ferris rose.
The Deputy asked that the Minister explain the matter and he has done so. I would remind the House that the question will be put at 5 p.m. We are now on section 3. There are amendments to other sections in the names of Deputies and I presume they are anxious to reach them. Every section is important.
I would like to clarify one point. These charges will be imposed even on people who have medical cards——
Yes.
——in spite of the fact that the Minister said this morning that people with medical cards are entitled to services in public hospitals. The normal procedure is that the chief executive officer of the health board notifies the person that they are withdrawing the medical card. The charges are now being imposed even when a person has a medical card, and that is bad news.
On a point of order, it is very important that the public are not misled in this case. What is in place is the same as what has been in place for the last 15 years. There is nothing new about it.
No charges have been imposed up to now.
Medical card holders who were in long stay residential care——
I am talking about acute hospitals.
Where a person is being maintained as a long stay patient in an acute hospital my understanding is that this charge is being introduced. This applies in a small number of cases only because it is not appropriate to keep a patient in long stay care in an acute hospital. Where a patient is undergoing acute hospital treatment it does not apply.
It does apply.
It applies to the same type of patient everywhere.
I am putting the question: "That section 3 stand part of the Bill".
Before the break——
I am putting the question, Deputy. This matter has been discussed for almost an hour and a half.
I raised points germane to the section but they were not answered.
I am now putting the question.
On a point of order, it is bad enough for the Government to introduce a guillotine on this Bill without the Leas-Cheann Comhairle doing so. As Deputies in the House, we have a right——
If Deputy Allen is expecting the Chair to get him publicity he is wrong.
I resent very much the allegation about publicity.
The Deputy can resent it if he likes. I am moving on.
Question put and declared carried.
SECTION 4.
Question proposed: "That section 4 stand part of the Bill."
With the greatest respect, I think we should try to conduct Committee Stage in a more orderly fashion. I recognise that we are now speaking on section 4, but before 1.30 p.m. I did raise points germane to the previous section that the Minister did not reply to. I feel that I have been hard done by in not receiving a reply to my questions about clinical decisions and common waiting lists.
I discussed common waiting lists.
Yes, I know. I went back to the Minister with a specific point and said that clinical decisions were essentially decisions about medical priority and that for the Minister to say that that debarred common waiting lists was inaccurate. Having said that, the Chair has ruled and I respect the ruling of the Chair.
The Deputy has raised the matter and if it is appropriate on Report Stage he can raise it again then.
In section 4 the Minister is taking powers to issue guidelines to the chief executive officers on who shall be deemed not to be ordinarily resident. I wish to have clarified a point I raised this morning about tourists from Third countries, countries not in the EC. The Minister's guidelines should be such that tourists from Third countries who have an accident while in Ireland should not be denied cover for medical services simply because they come from a Third country.
This matter was discussed at length this morning, and the regulations will set out to do what I said they would do. First, they will ensure that people do not come to use Ireland as a base for services. Certainly in theory they could do that under the existing legislation. Second, and most important, the regulations will ensure that service will be available to those for whom we would wish to provide it. I gave the examples of Irish people working on short term projects abroad and of young Irish emigrants who go to the United States, or another country outside the European Community, and come back. They would be provided for. The regulations will provide discretion for the chief executive officer of a health board to make decisions with regard to tourists. Nobody will be denied service because of inability to pay. That explanation should meet the Deputy's query.
By issuing guidelines the Minister is taking the decisions from the chief executive officers, so it seems to be a little strange for him to then say that at the end of the day the decisions will be made by chief executive officers rather than under the regulations. If the Minister issues guidelines then he has the opportunity to tell the chief executive officers that in principle he wants bona fide tourists to be treated with consideration.
One way that that could be dealt with would be to put down an amendment on Report Stage that would change the word "may" to the word "shall". The Minister would then have to notify the chief executive officers.
No, in all legislation pertaining to the health boards chief executive officers have discretion. There are many regulations covering the powers of chief executive officers. One example relates to medical terms. Chief executive officers have discretion under the law and they have flexibility. It is important that that flexibility is there to take account of the very point made by Deputy Bruton, that a tourist from outside the European Community who is not eligible for the service and is unable to pay for the service should have account taken of the circumstances and should have service provided. It is important to assure everyone that service will never be denied because of inability to pay. The issue of a wealthy person who is not eligible but who could pay afterwards could be examined.
Question put and agreed to.
SECTION 5.
Question proposed: "That section 5 stand part of the Bill."
I note that Deputy Ferris opposes the section.
I formally oppose the section. I oppose it in its entirely because it determines that those who have full eligibility or limited eligibility will be deemed not to have full eligibility if they avail of only part of the service. I cannot accept that provision. I know that the Minister wants people to decide at the beginning whether they are public or private patients. Perhaps built into the section is some way to ensure, as the Minister says, that there will be no queue jumping and that people shall not go into hospital as private patients and then decide to become public patients, or vice versa. However, I register my opposition to this section.
I seek clarification from the Minister. In principle I accept that people who opt for private care should not be offered public beds. Difficulty is created, however, and perhaps the Minister can clarify the matter or an amendment can be made on Report Stage. As Deputy Ferris said, it seems that people who go into hospital entirely as public patients but have an individual test or a small element of their care carried out on a private basis would have the rug pulled out from under them and would have the whole session of care deemed to be a private session for which payment would have to be made individually. That would not be a reasonable way to proceed. People who go into hospital as private patients accept responsibility for all of their consultants' fees and all of their private accommodation. However, it could not be seen to be just and fair to treat people as private patients if just a small element of their care was carried out privately, and that seems to be the way in which the section is drafted at present. It would be particularly unfair in that those same people would be asked to pay the full health levy on their whole income. They would feel rightly aggrieved if the Minister applied the kind of ruling that seems to be required under this section.
Under the new legislation patients will have the right to opt for public or private care. For the first time in the history of the State everybody will be entitled to opt for public care if that is what is wanted. At present, while everybody is entitled to a public bed in a public ward, people whose income is more than £16,700 a year have to pay their consultants' fees. Much of what was said during the Second Stage debate and again this morning identified areas of concern that Deputies had. For example, Deputies were worried about queue jumping and the use of half public care and half private care — in other words, people availing of their right to public maintenance and then paying a consultant. It has been suggested, and there is a small amount of evidence to back up those suggestions, that in some cases paying patients were finding their way into public beds ahead of patients who were on the public waiting lists.
I do accept that if patients go to a doctor's consultant rooms as private patients and then discover that it is necessary to be admitted to hospital, they should be able to then decide that it is too expensive for them to go to hospital as private patients. For example, they may not be in the VHI scheme or they might feel that their VHI did not cover them for their particular treatment. Patients will have the right to opt to be public patients. However, if people decide to go to hospital as in-patients to private beds they will then be private patients both of the hospital and of the consultants looking after them. The only exception is the discretion of a chief executive officer in the case of patients wanting to transfer back to being public patients if they discover that the treatment needed is too expensive. The whole basis of the legislation is to ensure that there is no unfair advantage to private patients over public patients. The Government want to ensure that public beds are maintained for public patients and that there is no back door way to the hospitals nor any queue jumping in the use of public beds. That is why the provision is defined clearly, but I do take the point made about people going to consultants on an out-patient basis and then discovering that they have to go to hospital. It is acceptable in those circumstances that patients should be able to make the choice.
I am not sure that the circumstances will be confined to out-patients visiting consultants privately as out-patients before hospitalisation begins. Unlike the Minister, I am not an expert in medical matters; but it would not be acceptable if a person undergoing public medical treatment decided to go privately for a second opinion and was therefore deemed eligible to pay for everything that went before. There may be some defects in the drafting where it refers to "some part". In other words any element of the whole episode of care, if taken privately, seems to make the person liable for the whole episode.
Section 52 of the original Act refers to health boards. The voluntary hospitals are not health board hospitals. If the Minister is legislating in this area we should get an opportunity to see what he is providing for in relation to voluntary hospitals. That will apply all the way through sections 5 and 6 which will apply with equal force to voluntary hospitals and health board hospitals. Indeed, in the eastern region there are not any Eastern Health Board hospitals to which this would refer. Perhaps the Minister could clarify that point.
I am a little confused by what the Minister has said. He is now saying that a person who goes to a consultant in his private rooms will be eligible to go into hospital and have public care if he requires medical treatment. To get an appointment with a consultant in a public hospital one must wait from one to six months. The Minister knows that. By allowing a person to see a consultant privately and then go into a public hospital for treatment, the Minister is creating a back door into hospital. The fact that one pays £40 in private rooms to a consultant means that one can immediately go on the waiting list whereas a person waiting for an appointment to see a consultant in a public hospital will have to wait for up to six months. Will the Minister explain how he can stand over that?
I do not have any problem with it, because I have taken the trouble to read the 1970 Health Act. Section 54 of that Act made that provision and this Bill is giving recognition to that fact. Even though a person has the right under the Act to public hospital care there is nothing to stop him from going private in some areas. That is clear under the Act.
Is not section 54 about approved services for health board subventions?
Under section 54 a person is entitled to avail of in-patient services——
We cannot have this sort of trade union negotiation over the table. I will call Deputy Bruton again.
A person with full eligibility has a right to opt for private treatment during the course of treatment. Section 52 (3) was referred to and I would like the Minister to comment briefly on that.
Subsection (3) is not referred to in the 1970 Act but we are inserting it in section 5 of this Bill.
In reply to Deputy Bruton, a patient will have a choice as to whether to be a public or a private patient. It is not practical to have a patient opting to be private in one case and public in another. When patients go into hospital there are many consultants involved, for instance the radiologist, the anaesthetist, the pathologist and so on. It is important that there be a clear demarcation between public and private patients.
In reply to Deputy Allen, the length of time for which a patient is on a waiting list is a clinical decision. The length of time for which a patient must wait to see a consultant in the first instance is a matter for the hospital, the consultant and the GP. Where somebody is concerned about the length of waiting time, the GP is the best person to contact the hospital or consultant to expedite an appointment. In relation to a patient going to see a consultant privately, a patient could do so expecting that to be the end of it, but the consultant might need to take a person into hospital for a number of days. In that case it is only right that the patient be given the right of choice. I take the point made by Deputy Allen. If any abuses creep into the system we will deal with them. I am trying to ensure that public beds are maintained for public patients. If the system lends itself to abuse we will deal with it. The House will agree at this stage that where persons go to a private consulting room rather than to a hospital's outpatient department believing the visit to be a once off one, it is only right that they should then be able to have their names placed on the public waiting list if they should then be able to have their names placed on the public waiting list if they have to go into hospital.
In relation to the question of the position of voluntary hospital and health boards, the health boards have always been responsible for eligibility. The voluntary hospitals only act as an agency on behalf of the health boards.
I am very concerned that if somebody who has opted to go public needs to have a further test carried out privately, and acts accordingly, he could bar himself from his full entitlement without necessarily being covered by VHI or any other insurance scheme. We must worry about how every comma and dot are interpreted by hospital administrators, executive officers and others. This specifically says "avail of some part of the service" which could be interpreted any way.
There is another problem involved in going to a private clinic for an opinion. This morning I said that there is a waiting list in the south east of 5,000 people for the outpatient's department. If any of those people went to a consultant privately and if, on clinical examination, the surgeon considered that the patient needed to be admitted to a public or private bed the surgeon would have to give his opinion to the channel through which the patient is admitted to hospital. We are dealing with public patients and their entitlements and they are entitled to be seen in a public hospital. However, they are still on a waiting list and cannot even cross the first hurdle. When a GP recommends people to outpatients they are put on a waiting list; the only way to overcome that is to go on a private waiting list and get a diagnosis quickly as to whether there is a need to go to hospital.
In my constituency a person was entitled to have her eyes tested with a view to surgery. She was waiting for the best part of two years although she had to be led around the house by her husband. They could not get to the designated eye clinic, there was a waiting list as the consultant was ill so they went privately to an opthalmic specialist who decided, when he saw the patient, that she needed to be operated on straight away. I can give all the details of that case to the Minister. I hope that unfortunate wife of an old age pensioner will not be asked to pay the private hospital charges. She had her eye operation about ten days ago and can now see perfectly but she had the operation as a result of being seen privately.
This section is fatally flawed; we have been talking since the mid-eighties about the abuses under the common contract ageed between the Taoiseach and the consultants in 1979 which was up for review in 1985-86.
We had hoped the discussions the Minister had with the IHCA and the IMO in recent times would stamp out some of the terrible abuses in the health services. As I said yesterday, in the Minister's eyeball to eyeball confrontation with the IHCA — a very powerful group — in recent times he made a very expensive blink which will cost the taxpayers £36 million. God only knows what it will cost in the year ahead. There is a loophole as wide as a barn door in this legislation. I forecast that because of this section the private rooms of the consultants will be crowded because it will be the back door entrance for hospital treatment.
I have a letter in which a consultant wrote to a hospital administrator about a three year old child saying that there was a definite deficit in his right let function which warranted an orthopaedic consultant's opinion. I will not name the patient. That letter was sent from a consultant in Cork, Professor Cusson, to the administrator of the regional hospital. The reply to the letter from the hospital said that there was a very lengthy waiting list for an appointment to see Mr. McGuinness and that he could expect to be notified of an appointment in approximately 18 months time.
In that case all the parents have to do is to go to the consultant in his private rooms, the consultant will examine the child within a week of making the appointment and on medical grounds he will be admitted within a short time to the hospital for orthopaedic treatment. However, if the parents cannot afford to go to the consultant's private rooms the child will have to wait. The Minister is giving a licence to consultants to print money in their consulting rooms. They can see people privately, diagnose their medical need and put them into hospital; to see the same consultant in a public hospital there would be a wait of at least 18 months.
The letter to which I referred was dated 11 July 1990; I telephoned the Cork Regional Hospital an hour ago and the child is still waiting for an operation. It is a scandal for the Minister to tell us that he is creating a just and equitable system; he is trying to cod us. I will give evidence to the Minister although he received evidence before and nothing was done about it.
I put it to the House, as Deputy Ferris indicated earlier, that we should refrain as far as possible from having a public debate on a very private matter. If a Deputy indicates that, having brought the details of a very special case to the Minister and that the Minister was in default, I could see justification for it but we should accept that we do not identify even by inference——
I did not name——
I know you did not name the patient, I am merely giving the standard practice——
The Minister is trying to pretend that we will have an equitable and fair system. I did not mention the name of the patient.
The Chair did not say that you did.
Why are you talking about standards?
I am repeating the prevailing standards here and I am exhorting people to practice maximum discretion in the matter——
I used maximum discretion by not naming patients. It is an example of the codswallop we have here.
The Chair did not name the Deputy.
You were looking at me when you were talking.
I was looking at Deputy Ferris.
You were looking at me when you spoke about standards.
I suppose the cat can look at the King. May we proceed with the business?
I oppose the section.
Does the Deputy wish me to put the question?
There is a point that needs clarification, it goes back to the common principle that when we abandon the common waiting principle, in other words that the people will get in on the basis of medical needs, we are in very difficult waters in regard to trying to devise a system of separation of the public and private element.
Deputy Allen has put his finger on what seems to be a major weakness in the Minister's arguments. It is common knowledge that people who go privately to an out-patients will get attention well ahead of someone who joins the public queue. The Minister said that there can be barrages of letters to try to accelerate the process but any GP will tell him that it is a very frustrating experience which does not result in people who should be treated being seen urgently. We may be putting a system in place which will be riddled with anomalies and that goes back to the fundamental flaw of the common waiting list being abandoned. I would ask the Minister to explain the way the system will be policed to ensure that it is fair.
In reply to Deputy Ferris who raised the question of a public patient going private or vice versa and suggested that a test might be done privately, this is not the case. As Deputies are aware, all the necessary facilities are provided for public patients. I have pointed out that in some instances one can obtain an earlier appointment at a public clinic than a private clinic. I can assure Deputy Allen that there is no need for him to come into the House and attribute any motive to me. The Deputy tried yesterday and today to rubbish the public health services.
The Minister rubbished it.
Approximately 1.5 million people are seen at outpatient clinics each year——
The Minister should not preach to me.
—and the figure is increasing each year. In addition, 500,000 people out of a population of 3.5 million are treated in our public hospitals yet the Deputy tries to tell us day after day that some people have to wait 18 months for an operation; indeed, you tried to suggest that some people will have to wait eight years.
They have.
It is unacceptable that in certain disciplines——
I identified the specialties.
The Chair cherishes all its children equally. Would the Minister please address the Chair and not Deputy Allen?
I apologise. I accept that the waiting lists for certain disciplines are unacceptable for many of us in this House. However, this is not a new development, there have been waiting lists for years. As we pointed out, there was an increase of 12 per cent in the number of cataract operations performed last year, and an increase of 14 per cent in the number of hip replacement operations carried out while the waiting list for ear, nose and throat operations in the South Infirmary in the Deputy's home city, was reduced by 45 per cent. There will always be waiting lists.
Give us the real figures.
There are waiting lists in every developed country. However, I want to assure Deputies that the purpose of the legislation is to ensure equity. If Deputies are of the opinion that public patients should not be allowed to attend a consultant privately as this would lead to anomalies in the system, this need not be the case and the two can be kept totally separate — public and private. What Deputy Bruton suggested is not practicable. Indeed, he is now objecting to what he himself suggested earlier, which was that a person while in hospital should be able to go from public to private. Patients will have to decide whether they want to be a public patient or a private patient but if for some reason a private patient discovers he is not able to meet the cost, he can change with the permission of the chief executive officer.
The Minister has not addressed the points raised and has not indicated ways in which we can prevent the system being abused.
I said that this need not be the case.
If people are told that they will have to wait between six to eight months to see a consultant in an out-patients clinic in a public hospital, they will decide to go private and be seen straightaway.
Question put and declared carried.
SECTION 6.
I move amendments No. 2:
In page 3, to delete lines 33 to 35 and substitute the following:
"(2) Except in the case of an emergency, nothing in this Act shall permit the Minister, or Health Boards, or others to redesignate public beds in public hospitals as private beds.".
This amendment will test the Minister's commitment to ensure that public beds will always be available for public patients in public hospitals and that the provisions of this Bill which will extend full eligibility to every person in the country will not interfere with the rights of those who are waiting for a bed. During my Second Stage contribution I suggested that one of the ways the money lost to consultants and hospitals from the VHI could be made up would be for the Minister, his officials or the health boards to redesignate public beds which may have been closed as private beds in public hospitals. If this were to happen the number of beds available for public patients would be reduced. I ask the Minister to state categorically if it is his intention to do this. If public beds are redesignated as private beds in public hospitals, then the people I represent will be placed at a disadvantage.
I have included the words "except in the case of an emergency" because in the event of a tragic accident, beds must be made available. The amendment reads:
Except in the case of an emergency, nothing in this Act shall permit the Minister, or health boards or others to redesignate public beds in public hospitals as private beds.
The Minister indicated on Second Stage that this probably will happen. I do not object to the idea that there should be some private beds in public hospitals. Indeed it is appropriate that there should always be two or three private beds in a public hospital — that is true in the case of St. Joseph's Hospital and Our Lady's Hospital in Cashel — because there are those who will wish to go private in their local hospital as they have a good relationship with their consultant. However, I do not want to see a large number of beds being redesignated as private beds because if this were to be done those entitled to a public bed would be placed at a disadvantage. Again, the Minister should be honest with the public.
The Minister has insisted throughout this debate that public patients will not lose out. At the same time he has not outlined the present complement of public beds and private beds. He has insisted that public beds will be available for public patients but he has not said at any stage that there are X number of public beds available and that he is going to insist that this number be preserved. He has mentioned that the total complement of beds will be preserved. In the interest of guaranteeing equity in the service, the public would like to see a certain number of beds being preserved and the Minister giving an assurance that this number will not be reduced. I fear that in the scramble public beds will go astray. The health boards may lose revenue and under that pressure, there may be an effort made to redesignate beds as private beds as a means of raising revenue in the face of tight budgets. There is a very serious issue at stake. People want to be reassured that the Minister knows exactly what he is talking about and that he can give a cast iron guarantee that the number of public beds will not be encroached upon. I hope he is in a position to do that because I feel there is a high degree of vagueness in the Department as to where the public beds are and who uses them. The Minister has always made great play of private patients coming in and using public beds, the Minister's point about queue jumping was that private patients were using public beds and this was the point he was trying to deal with. However, at the same time the Minister has never been able to answer questions on the extent of that practice. We are supposed to be making well thought out changes in health policy but we do not have the facts unpinning it. I hope we will get some worth while new information on the precise bed complement that will be guaranteed to public patients and that there will be a guarantee that there will be no erosion of that number under the pressures of budgets which might tempt hospital authorities to redesignate beds as private beds so that they could earn revenue from them.
Yesterday I was amazed when the Minister said he was not aware of the level of private practice in our public hospitals.
That is not what I said, Deputy.
The Minister said that I had made allegations which he hoped would I stand over. In reply I said I did not make any allegations but I that I was stating the facts as outlined in a report compiled over two years ago by the Southern Health Board which defined the level of private practice in public hospitals in that health board area. The first thing the Minister should have done before introducing this Bill was to define the level of private practice in our public hospitals throughout the country but by his own admission he did not do that. Second, and I can only speak from my experience as a member of the health board in my own area, at our last meeting neither the management nor any of the members could say definitely how we were going to designate the beds, as private or public beds. This scheme is due to take effect next Saturday but, despite being a health board member, I am totally in the dark as to how this is going to be managed. Even though the Minister is assuring us that the number of public beds will not be affected, the number of public beds is still being reduced and the most recent example — which I tried to raise on the Adjournment this evening — is the possibility that 40 beds will close in the Mercy Hospital, Cork for the summer months because of the inadequate allocation. This will take another 40 beds out of the system which is taxed to the point of over loading at present. Beds are still being taken out of the system.
I may not be suspicious by nature but in this case I am suspicious that some of the beds which were taken out of the system in recent months and years will be brought back into the system and designated as private beds. I believe the whole campaign of closing off wards was done so that the Minister could re-introduce them and designate them as private beds. I bet that is going to be done so that the wards that have been closed down will be re-opened and the beds will be designated as private beds. I would like the Minister to assure us that that will not happen. The beds which are presently being taken out of the system must not be redesignated as private beds. No matter what happens it is a simple algebraic problem, if you have X number of beds in the system and Y number of beds are designated as private beds you are left with X-Y. What is the third variable in the equation?
It is proposed to substitute section 6 for section 55 of the 1970 Act. This section refers to entitlements established under section 52. Am I right in saying that it is clearly defined in section 52 that a person may either have full eligibility or limited eligibility and provision is being made for persons who may appear on the scene from another European country who do not immediately appear to be able to establish that they are either in category 1 or category 2 and that this section makes provision for such cases. Section 55 of the 1970 Act states:
A health board may make available in-patient services for persons who do not establish entitlement to such services under section 52 and (in private or semi-private accommodation) for persons who establish such entitlement but do not avail themselves of the services under that section and the board shall charge for any services so provided charges approved of or directed by the Minister.
Such a provision exists already. I feel that perhaps that section gave more power to the health board or to the consultant to have private beds in public hospitals. I understand this will be limited and it will be very interesting to see how many of the 64 beds in my local hospital will be used for private practice. Let me tell you that I am aware of the fact that it is very hard to get the information as to how many are being used for private practice but I can see this being sorted out under this legislation unless, as Deputy Allen says, there is something we cannot see beneath the surface, and that we could find that the beds are designated as private beds in a subtle move to get more money for the health board. However, I do not see it that way. I see this as good legislation in so far as it will identify quite clearly and draw a distinction between public and private beds as it is impossible at present to make that distinction.
I would like to raise a few points on this section. Over the past number of years despite the closure of a number of beds there has never been a shortage of beds for private patients and I fear that in the climate of financial restraint and cutbacks for voluntary and health board hospitals there will be a likelihood that a designation of beds for private patients will be used as a revenue raising process to make up for the shortfall in finance from the Department. That trend is very evident in many of the voluntary hospitals. I think it is wrong of the Minister not to give some indication to the health boards as to the ratio of public to private beds. I know this will vary from health board area to health board area because of the potential patient profile, including the age profile, which varies greatly from area to area and the percentage of population who have health insurance as opposed to those who will be relying on public beds. There is an onus on the Minister to provide some indication and some baseline, which he thinks fit, beyond which the health boards and hospital management should not go in terms of identifying the number of beds for private and public patients. Otherwise this vehicle will be used by health boards in financial difficulties to make up for the shortfalls in the allocation of money from the Minister. I would like the Minister to give some indication this evening as to what he thinks the breakdown between public and private patients should be.
I also want some assistance from the Minister on the question of health boards carrying out a profile of patients in their respective areas because it varies greatly from one health board to another. One of the great difficulties of health boards planning any service for their area is that few, if any, of them have carried out or have any record of patient profile in their area. Attempting to provide a service to the public without having the basic information is impossible. The Minister must state today a base line beyond which health boards and voluntary hospitals cannot go in terms of demarcation between public and private beds.
I regret that this section seems to be the last we will discuss because I had hoped to raise the important matter of the abandonment by the Government of the plans——
I would advise Deputy Rabbitte that prior to his arrival we were discussing an amendment on Committee Stage. I will not tolerate any Deputy raising any matter that is not pertinent to the amendment we are discussing.
The Minister might avail of this opportunity to assure the people of Tallaght that they can expect that the hospital will be built.
The Minister is not allowed to avail of it. The Minister will not avail of any opportunity that is not appropriate under the section. We have had this before.
This is a major question for the entire region, not just Tallaght. Deputy Flood brought forward——
Deputy Rabbitte has been three times wrong.
Deputy Rabbitte, as a democrat you will appreciate that you cannot come in here and, within a minute of your arrival, attempt to disrupt Committee Stage. I ask you to accept that and not to press it any further. You are disruptive.
I am not seeking to disrupt the proceedings.
You are disrupting the proceedings and I ask you to resume your seat while I call on the Minister to reply to questions posed by other Deputies.
There is apparently no other procedure open to me to get the Minister to clarify what is an important question for 150,000 people. The Government said they would bring it forward to 1990.
The Deputy is trying to cancel it now.
It is 1991, and the hospital has disappeared.
Deputy Rabbitte, you are not adding to your reputation as a democrat or as an elected Member of this House——
I am merely asking the Minister to deal with the matter.
And I will not allow the Minister to answer the Deputy. Please resume your seat. I ask the Minister to respond to questions that were put before you arrived, Deputy.
Three times wrong; that is a bad record.
Minister of State, I am surprised at you too.
The issue of the number of public and private beds raised by Deputies is crucial to the Bill. I have assured the public here and outside the House that there will be no reduction in the number of public beds available to public patients, and I stand over that.
But the Minister does not know how many there are and how can he give that guarantee?
There is a reduction in Tallaght.
We have carried out our own census along with each of the agencies, the voluntary hospitals——
On a point of order, I understood the Minister to say earlier that he did not have available to him any mechanism for determining the number of private as opposed to public beds in the system at present. If he has that information now, can he give it to us?
As the Minister is on his feet and we have scarcely a minute, could we listen to him and then the Deputy may ask him a question arising out of that in an orderly fashion.
I want to speak to my amendment.
At no stage did I make the statement attributed to me by Deputy Creed.
The Minister indicated——
What I said was that we do not know the number of public beds to which private patients are admitted by consultants.
We certainly do not know the number in Tallaght.
I found Deputy Allen's analogy very helpful. If there are X number of public beds and Y private patients, and Y is taken out, that means there are more public beds. The Deputy's own equation answers the very issue he raised.
The Minister should answer the riddle and tell us how many there are.
The position is that we have carried out a detailed analysis with each of the agencies and I want to assure the House that there will be no reduction whatsoever in the number of public beds available to public patients. Indeed, public beds at present being used by private patients will no longer be available to private patients except for emergencies. We are talking about elective procedures now.
The Minister could go into the three card trick business.
This is the reality, and I want to make the position clear to the Deputies. This legislation was recommended by numerous bodies, including the Commission on Health Funding and the NESC. The Irish Congress of Trade Unions sought it and it was agreed by the social partners and the Government.
The Minister has emasculated what they recommended.
There is the greatest consensus we could have on anything, agreement between the Government and the social partners. Despite the fears of Deputies, real or apparent, I am satisfied that this legislation——
Unfortunately, in this debate being out of order has become infectious and even the Minister has not been immune from it. Could we confine ourselves——
Will the Minister reply? Can he take the opportunity to reply?
There will not be any opportunity.
Will there be a Tallaght hospital, and when?
The Deputy should read the legislation.
The Deputy knows well what he is at and I know well too. Let us hear the Minister without interruption.
The Deputy does not know where Tallaght is. Will he be running for the Tallaght district again?
The Minister of State should not worry; I will be there after him.
The Deputy will not.
As I stated there will be no diminution in the number of public beds available for public patients.
How many will there be?
As I stated, I could not imagine any greater consensus than having the agreement of the Government of the day and the social partners. They want this legislation and I agree fully with them. It will set out to do what the Government intended which is to ensure there will be——
How many public beds?
A detailed analysis is being carried out with each of the agencies.
The Minister does not know.
Deputy Ferris referred to the hospital in Cashel and Deputy Sherlock referred to what is happening in Mallow. He expressed a legitimate concern that, perhaps, a health board might designate all their beds as private to make money. That will not happen and I want to assure the Deputy of that. It will be the Minister who will——
But how many?
They do not know what is happening at present. The system is out of control.
There is only a site in Tallaght.
The Deputy is leaving Tallaght, going off to Dublin South. It is easier to work there.
Deputy Allen comes in here and makes wild and derogatory statements about consultants which I could not agree with. He talks about the number of patients who are in public beds in the hospital and I do not have the evidence at my fingertips that he has about wards in specific hospitals.
The Minister should be ashamed to admit that. It is in the Official Report.
The health board, and the voluntary agencies, give me the information. We have carried out a detailed census and I am satisfied the number of private beds will reflect the present position in those hospitals. Private patients will no longer be allowed into public beds except in emergencies. If a hospital wants to increase its complement of private beds it will have to be self supporting and it will be done, presumably in association with the Voluntary Health Insurance Board, but it will not be done out of public funds. I want to make that clear.
The Minister will open all the beds he closed?
I must put the question; it is now 5 o'clock.
Will I get a reply?
Deputy Ferris, you have 30 seconds. I must put the question as ordered by the House.
On a point of order, may a person resubmit on Report Stage an amendment that has not been reached on Committee Stage?
The Deputy can indicate that that is his intention as long as it has not been withdrawn or defeated.
It is my intention to resubmit my amendment in regard to redesignation of private beds as public beds and vice versa.
Deputy Sherlock was referring to amendments not reached on Committee Stage. They can be resubmitted for Report Stage. Deputy Ferris, I must do what the House has ordered——
I will resubmit this amendment because we have not dealt with it.
The Deputy can so do but I must put the question.
Question put: "That the sections undisposed of and the Title are hereby agreed to, and that the Bill is hereby reported to the House without amendment."
The Dáil divided: Tá, 80; Níl, 52.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Aylward, Liam.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Mattie.
- Browne, John (Wexford).
- Burke, Raphael P.
- Byrne, Eric.
- Calleary, Seán.
- Callely, Ivor.
- Clohessy, Peadar.
- Coughlan, Mary Theresa.
- Cullimore, Séamus.
- Daly, Brendan.
- Davern, Noel.
- Dempsey, Noel.
- Dennehy, John.
- De Rossa, Proinsias.
- de Valera, Síle.
- Ellis, John.
- Fahey, Frank.
- Fahey, Jackie.
- Fitzgerald, Liam Joseph.
- Fitzpatrick, Dermot.
- Flood, Chris.
- Flynn, Pádraig.
- Foxe, Tom.
- Gallagher, Pat the Cope.
- Garland, Roger.
- Geoghegan-Quinn, Máire.
- Gilmore, Eamon.
- Harney, Mary.
- Haughey, Charles J.
- Hillery, Brian.
- Hilliard, Colm.
- Jacob, Joe.
- Kelly, Laurence.
- Kenneally, Brendan.
- Kirk, Séamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lawlor, Liam.
- Lenihan, Brian.
- Leonard, Jimmy.
- Lyons, Denis.
- Martin, Micheál.
- McCartan, Pat.
- McCreevy, Charlie.
- McDaid, Jim.
- Mac Giolla, Tomás.
- Molloy, Robert.
- Morley, P. J.
- Nolan, M. J.
- Noonan, Michael J.
- (Limerick West).
- O'Connell, John.
- O'Dea, Willie.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Leary, John.
- O'Malley, Desmond J.
- O'Rourke, Mary.
- O'Toole, Martin Joe.
- Power, Seán.
- Rabbitte, Pat.
- Reynolds, Albert.
- Roche, Dick.
- Sherlock, Joe.
- Smith, Michael.
- Stafford, John.
- Tunney, Jim.
- Wallace, Dan.
- Wallace, Mary.
- Walsh, Joe.
- Wilson, John P.
- Woods, Michael.
- Wyse, Pearse.
Níl
- Allen, Bernard.
- Barrett, Seán.
- Boylan, Andrew.
- Bruton, Richard.
- Connor, John.
- Cotter, Bill.
- Creed, Michael.
- Crowley, Frank.
- Currie, Austin.
- D'Arcy, Michael.
- Deenihan, Jimmy.
- Doyle, Joe.
- Dukes, Alan.
- Durkan, Bernard.
- Farrelly, John V.
- Fennell, Nuala.
- Ferris, Michael.
- Finucane, Michael.
- Flanagan, Charles.
- Gregory, Tony.
- Harte, Paddy.
- Higgins, Jim.
- Higgins, Michael D.
- Hogan, Philip.
- Howlin, Brendan.
- Kavanagh, Liam.
- Bradford, Paul.
- Browne, John (Carlow-Kilkenny).
- Bruton, John.
- Kemmy, Jim.
- Kenny, Enda.
- Lowry, Michael.
- McCormack, Pádraic.
- McGahon, Brendan.
- McGinley, Dinny.
- McGrath, Paul.
- Mitchell, Gay.
- Mitchell, Jim.
- Noonan, Michael.
- (Limerick East).
- O'Brien, Fergus.
- O'Shea, Brian.
- O'Sullivan, Gerry.
- O'Sullivan, Toddy.
- Owen, Nora.
- Quinn, Ruairí.
- Ryan, Seán.
- Sheehan, Patrick J.
- Spring, Dick.
- Stagg, Emmet.
- Taylor-Quinn, Madeleine.
- Timmins, Godfrey.
- Yates, Ivan.
Tellers: Tá, Deputies V. Brady and Clohessy; Níl, Deputies Flanagan and Boylan.
Question declared carried.
When is it proposed to take Report Stage of this Bill?
Tomorrow morning.
Is that satisfactory? Agreed.
Report Stage ordered for Thursday, 30 May 1991.