Health (Miscellaneous Provisions) Bill 2007: Second Stage.

Minister for Health and Children (Deputy Mary Harney)

I move: "That the Bill be now read a Second Time."

I will begin by thanking the Ceann Comhairle and the House for facilitating the reading of this Bill and its passage through Dáil Éireann. I appreciate the time Deputies are giving to the Bill and will endeavour to ensure that we use our time well.

The Health (Miscellaneous Provisions) Bill 2007 is urgent because of the need to address, without delay, matters concerning bodies established under the Health Corporate Bodies Act 1961 and technical drafting issues identified regarding the Medical Practitioners Act 2007.

I have endeavoured since last Thursday to be fully open with Deputies about every aspect of the Bill and I welcome the opportunity now to set out its provisions and to make clear the purpose and value of each section. The Bill is straightforward in its purpose in all respects. It involves no policy change and no additional charge on the Exchequer.

In brief — I will go into detail later — the provisions in the Bill in regard to the health corporate bodies are required on foot of legal advice from the Attorney General that the constitutionality of the 1961 Act could possibly be open to challenge. The standards of legal engineering are different now from 46 years ago when the Health (Corporate Bodies) Act was enacted. When the need for structural reinforcements of a building or a bridge to modern standards is advised by engineers, this should be acted upon.

It is not a question of any of these bodies having "no legal basis" as some have described it. Rather, Deputies will fully appreciate that given the importance of bodies established under the 1961 Act to the health service, we could not allow any shadow of doubt to exist in this matter. Therefore, urgent action is needed to confirm these bodes in primary legislation.

Similarly, other provisions are being put in place for the avoidance of doubt. The Bill includes provisions amending the Establishment Orders for St James's Hospital and Beaumont Hospital to put beyond doubt the capacity of those hospitals to enter into co-location arrangements.

The technical amendments to the Medical Practitioners Act 2007 will facilitate the phased commencement of significant provisions in that Act and the moving from the old regulatory system to a new and better regulatory system.

Deputies will know that the Health (Corporate Bodies) Act 1961 has proved critical in the development of health services during the past 46 years. This Act allowed the Minister for Health and Children to establish by order bodies to perform functions in the provision of health services which could not be readily and conveniently operated by existing statutory bodies.

Prior to the 1961 Act, the Minister for Health met the need to establish a health body by arranging for the establishment of companies under the Companies Act. The use of the Companies Act in this way was an expedient solution to a problem at that time and allowed the Minister to act with speed where necessary. However, by 1961 it was considered that the use of the Companies Act in this way was not an appropriate device for the establishment of a body to administer a health service financed from public funds. The view was also taken that the establishment of companies in this way was not consistent with the responsibility which the Minister has towards the Oireachtas.

This presented a problem for our predecessors. On the one hand, it was not appropriate for the Minister to use funds under his or her control to establish health agencies without recourse to the Oireachtas. On the other hand, health services were expanding rapidly with a consequent need for health organisations operating outside the then statutory health authorities and it was necessary to have in place a mechanism that would allow the Minister to establish bodies quickly when the need arose. The solution at the time lay in the Health (Corporate Bodies) Act 1961, which allowed the establishment of bodies by ministerial order. This included the requirement that a copy of an order be sent to each Member of the Oireachtas after it is made.

The Act has worked well over the years with more than 40 bodies established under this legislation, 19 of which are in existence. These include St James's Hospital, Beaumont Hospital, St Luke's Hospital, the Drug Treatment Centre, the Dublin Dental Hospital, the Irish Blood Transfusion Service, the National Cancer Registry and the National Cancer Screening Service and other important health bodies.

Arising from consideration of the adequacy of the powers of the Health Service Executive under existing primary legislation to fund the new National Paediatric Hospital Development Board, a body established under the 1961 Act, the Attorney General decided in mid-October that a more fundamental review of the constitutional status of the Health (Corporate Bodies) Act was required. He wrote to me with his considered advice on 26 October to the effect that the breadth of powers conferred on the Minister under the Act could possibly breach Article 15.2 of the Constitution which vests power for making laws for the State in the Oireachtas. The legal advice also has implications for bodies set up under the Local Government Services (Corporate Bodies) Act 1971 and that matter is under active consideration.

It is important to emphasise that all these bodies were properly and transparently constituted under the 1961 Act by way of statutory instrument. However, given the advice and recommendations from the Attorney General, it is clear that urgent primary legislation is required to confirm the orders for existing bodies. This is the first and most immediate issue in regard to the 1961 Act.

Legal advice also indicated that further legislation be drafted to address a wide range of issues identified in regard to the Act, including the retention of the power of the Minister to establish bodies under the Act, the circumstances in which that power should be exercised, the nature and limits of the functions which may be conferred on such bodies, the relationship of such bodies to the Minister, the Health Service Executive and other statutory agencies in the health area, and the funding of such bodies. These are complex issues which clearly require further time and thought. The Government intends to introduce another Bill dealing with these matters in 2008.

However, given the immediate need for certainty as to the status and powers of bodies established under the Act, the wide range of crucial and fundamental health services provided by the bodies and the substantial public expenditure involved in their operation, it was decided to prioritise matters for the Bill before us. For this reason, the Bill confirms the orders made for existing bodies and related matters, acts carried out by former bodies and provides for related matters.

As I stated, provisions are also being included in the Bill to put beyond doubt the legal capacity of St. James's Hospital and Beaumont Hospital to enter into co-location arrangements. As these provisions have attracted some attention, it would be useful to put in context the co-location policy and the provisions.

It was clear in 2004 that there was a need for a comprehensive and consistent approach to the assessment of a variety of proposals for private developments on public hospital sites, including, for example, at Waterford and Limerick. Prospectus Management Consultants were engaged by the Department of Health and Children in autumn 2004 to advise on an appraisal framework which would both encourage private investment in the acute hospital sector and promote and protect the public interest. Moreover, I and colleagues had increasing concern regarding the extent to which the level of private practice in public hospitals was exceeding the ratio of 80:20 agreed with the medical organisations.

Approximately 2,500 beds in public hospitals — 20% of the total — are designated for use by private patients. However, the level of private elective admissions to public hospitals was running at about 35% of the total. This was affecting the ability of public patients to access public hospitals and contributing to longer waiting times for public patients. I was not and am not prepared to allow these and other factors lead to a position where private patients received priority access to public hospitals at the expense of public patients. This circumstance called for innovative thinking and out of this the co-location initiative emerged.

The essential idea underlying the co-location initiative is to free up capacity for public patients and deliver new public acute beds in the quickest and most efficient manner. The initiative was founded on the principle that all patients ordinarily resident in the State should have access to public hospitals based on medical need and the possession of private health insurance should not influence timeliness of access or treatment.

A diversity of providers of hospital care is commonplace in many countries and is entirely appropriate. We will also be capable of using the new privately managed facilities for public patients to supplement rather than supplant public service provision, just as we do via the National Treatment Purchase Fund. In principle, all hospital capacity that meets standards and offers value for money should be capable of being used for all patients.

The Government endorsed the initiative in July 2005. The policy directive I subsequently issued to the HSE required the executive to undertake a rigorous value for money assessment of co-location proposals which would take account of the value of the public site and the cost of the tax forgone. The HSE had to satisfy itself that proposals represented better value for money than building, commissioning and operating beds in the traditional manner. The HSE and National Development Finance Agency have confirmed that the tenders received for six sites provide value for money and the projects are in a position to move to the financial close.

Detailed and innovative features will promote the public interest. Each site will have one accident and emergency department. The private hospitals will facilitate medical training and research and development; accept direct admissions to medical and surgical admission units from primary care centres and general practitioners on a 24-7 basis; comply with physical design requirements to fit with the public hospital; have joint clinical governance, shared information and records management, performance management and documented service level agreements, where these are undertaken; and participate in the public HIPE and case mix information systems.

As I indicated, provisions are included in the Bill to put beyond doubt the legal capacity of St. James's Hospital and Beaumont Hospital to enter into co-location arrangements. It is arguable that these hospitals already have the necessary powers in their statutory instruments to enter into co-location arrangements as the HSE hospitals clearly do under the Health Act 2004. However, it is considered prudent to put the matter beyond any doubt and expressly amend the orders relating to the two hospitals.

Turning to the amendments to the Medical Practitioners Act 2007, the Bill addresses certain matters regarding the transitional provisions of the 2007 Act. The amendments being proposed in the Bill are essentially technical in character. The substantive provisions of the Medical Practitioners Act 2007 — enhanced lay membership of the Medical Council, registration processes, fitness to practise procedures and new provisions relating to medical education and training at basic and specialist level and regarding maintenance of professional competence — remain unchanged.

We are studying the implications of the judgment made by Mr. Justice Kelly last week concerning fitness to practise procedures in the Act and will bring forward amending legislation, if required. The Medical Practitioners Act 2007 was signed into law earlier this year. The main objective of the Act is to provide for a modern, efficient, transparent and accountable system for the regulation of the medical profession, which will satisfy members of the public and the profession that all medical practitioners are appropriately qualified and competent to practise in a safe manner on an ongoing basis. The advice from the Office of the Attorney General is that some technical amendments are required to strengthen the transitional provisions of the Act, which will allow for the nomination and election processes provided for in the Act regarding the new Medical Council to take place as early as possible in the new year. Thereafter, the other provisions in the Act will take effect on a phased basis. This is what is being done in the Bill.

I am anxious that there should be an orderly hand-over from the outgoing Medical Council to the new body and an orderly, phased implementation of the entire Act. Having carefully considered the advice of the Office of the Attorney General, I am proposing that immediate action is taken at this time by way of primary legislation because of the importance of the Act for both the medical profession and the protection of the general public. It is in the public interest that the necessary amendments are made as a matter of urgency.

My Department has been liaising closely with the Medical Council on the implementation of the Act, preparation of the election regulations and related matters. It is appreciated that the need to amend the Act has placed some additional responsibilities on the current council. I have already expressed my appreciation to the president of the Medical Council regarding the co-operation of the council in this process.

I will now set out the main provisions of the Bill. Part 1, sections 1 to 4, inclusive, are the preliminary and general sections. Part 2, sections 5 to 9, inclusive, deal with health corporate bodies. Part 3, sections 10 to 20, inclusive, amend the Medical Practitioners Act 2007. Part 4, section 21, amends section 38 of the Health Act 2004.

Sections 1 and 2 are standard technical provisions stating that the Act may be cited as the Health (Miscellaneous Provisions) Act 2007 and setting out the definitions used.

Section 3 is a standard provision on the payment of expenses incurred in the administration of the Bill out of moneys provided by the Oireachtas.

Section 4 repeals section 70 of the Health Act 2004. Section 70 allows the Minister to dissolve a health corporate body by order and transfer its functions to the Health Service Executive. However, once a body is confirmed under the current Bill, it cannot be dissolved by order but must be dissolved by primary legislation and, on this basis, section 70 is to be repealed.

Section 5 is a key element of Part 2 of the Bill in relation to health corporate bodies. It confirms establishment orders made under 1961 Act for current bodies and provides that these orders have statutory effect as if made in primary legislation. One of these existing bodies is the National Social Work Qualifications Board established under the 1961 Act to carry out a range of functions regarding the validation of qualifications of social workers. The Health and Social Care Professionals Act 2005 provides for the establishment of the Health and Social Care Professionals Council and registration boards to regulate and register members of designated health and social care professionals, including social workers. Section 83 of that Act provides for the dissolution of the National Social Work Qualifications Board as its functions will be carried out by the council and the relevant registration board when it is established. Subsection (4) is therefore designed to enable the Minister to dissolve the board in line with the provisions of the 2005 Act despite the fact that the board is one of the bodies that will be confirmed under this legislation.

Subsection (5) takes account of the provisions of the Public Service Superannuation (Miscellaneous Provisions) Act 2004 which provides for certain staff to continue in employment after the age of 65. Section 6 confirms that validity of acts carried out by former bodies in accordance with their establishment orders.

Section 7 and the associated Schedule — Schedule 1 — amend the establishment orders for existing bodies which are currently funded by the Health Service Executive to reflect the actual role of the Executive in its capacity under the Health Act 2004 and the health reform programme. Some ministerial functions are, therefore, transferred to the executive while the executive's current role is given effect in other instances, subject to ministerial oversight. Establishment orders for St. James's and Beaumont Hospitals are also amended to put beyond doubt the legal capacity of these hospitals to enter into co-location arrangements.

Section 8 is a technical provision relating to funding of bodies by the Minister. The section does not apply to the National Haemophilia Council which is funded by the Health Service Executive and the National Paediatric Hospital Development Board, which is currently funded by the Minister but is to be funded by the executive.

Section 9 is a technical provision to take account of the provisions of the Comptroller and Auditor General (Amendment) Act 1993 whereby accounts of bodies are audited by the Comptroller and Auditor General who submits the audited accounts, with a report, to the Minister who in turn lays them before the Oireachtas.

The next ten sections — Part 3 — amend the Medical Practitioners Act 2007. Section 10 explicitly provides for a phased implementation of the repeal of the Acts specified in Part 1 of Schedule 1, and the revocation of the statutory instruments specified in Part 2 of Schedule 1, on different days. Section 11 clarifies the definitions of key terms relating to registered medical practitioners provided in the Act of 2007.

Section 12 provides for the clarification of the provisions in the Act of 2007 relating to the continuance in being of the Medical Council and for the continuation of any work commenced but not completed under the Act of 1978 including, in particular, fitness to practise inquiries.

Section 13 provides clarification in relation to specialist registration in the context of the first election process; provides explicitly for the termination of the membership of the current Medical Council by providing that a person who was a council member immediately before the first appointment of the new council will cease to be a member unless he or she is one of the persons so appointed; and allows for the council to perform any functions assigned to it by the Act of 1978.

Section 14 clarifies that the Medical Council may charge fees for the retention of a medical practitioner's registration. Section 15 is a transitional provision which clarifies which medical practitioners should be registered in which division of the new register, including those medical practitioners who, immediately before register establishment day, were already registered in the General Register of Medical Practitioners.

Section 16 provides that medical practitioners are deemed to be registered on the register if their names are entered on the General Register of Medical Practitioners immediately before the register establishment day. Section 17 provides that a medical practitioner who is subject to disciplinary proceedings under Part V of the Act of 1978 may not seek, during the transitional period, to evade sanction being imposed on him or her by the Medical Council by applying to have his or her registration removed under section 52 of the Act of 2007.

Section 18 provides for the clarification of the provisions in the Act of 2007 in relation to the consideration of complaints by the preliminary proceedings committee. Section 19 provides that a Medical Council member may not hold office for more than two consecutive terms and membership of the existing council will count towards reckoning the membership period. Section 20 refers to the consequential amendments set out in Schedule 2.

Section 21 is a technical amendment to section 38 of the Health Act 2004. Schedule 1 sets out the details of the amendments to the health corporate body establishment orders amended in accordance with section 7. Schedule 2 sets out consequential amendments referred to in section 20 of the Medical Practitioners Act relating to when each of the relevant sections becomes effective.

I again thank the House for giving its time to this urgent Bill. In the case of the provisions concerning bodies established under the Health (Corporate Bodies) Act 1961, I believe that it is better to be safe than sorry. It is necessary, for the avoidance of doubt, to make these bodies legally safe. The amendments to the Medical Practitioners Act will result in the smooth transition we are seeking to the new system under the Act by strengthening the transitional arrangements which will apply to the regulation of medical practitioners. I commend this Bill to the House.

Following a query raised this afternoon, I should say that it was not possible for me, because of the legal advice, to give advance notice, before last Thursday, to the Opposition or to put into the public domain in advance of the capacity to publish the legislation the fact that there was a legal doubt surrounding 19 bodies. I acted totally in accordance with the legal advice made available to me by the Attorney General on that matter. We were not in a position to draft the legislation because of the huge number of bodies involved any faster than the period from 26 October.

Deputy James Reilly

I wish to share time with Deputy Neville.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Deputy James Reilly

It would have been much easier for us on this side had the Minister made available to us the legal opinion. I read the Attorney General's note to the Minister which stated it was privileged and should not be released. That does not mean it could not have been released; it could have been released at the Minister's discretion. If the Minister was truly interested in a bipartisan approach to this matter, that is precisely what she would have done. In that case, she would not have had to defend herself across the Chamber at this time.

I am disappointed at the manner in which the Bill has come before the House and I am concerned about it. In the short time I have had to consider the Bill, I understand its main purpose is to put beyond doubt the vires of 19 bodies established under the Health (Corporate Bodies) Act 1961. If that were the pure purpose of this Bill we would not have a debate, it would go through unopposed and the Minister would have got co-operation, if the legal opinion had been made available to us and it stated that clearly.

What I do have reason to question are the other elements of the Bill and the other things that have been attempted. This is complex legislation. It is coming before the House in the dying hours of this Dáil session. It will be rushed through. In its remit it seeks to address issues caused by the rushing through of the Medical Practitioners Act 2007 and seeks to correct the Health Act 2004 and deficiencies therein.

I have a major concern that we are again rushing through legislation with which, down the road, we may have issues. Nonetheless, I have been advised by the Minister and her officials that the legislation is before us because of the Attorney General's advice and I have already asked why we were not informed until last week. I do not really believe the Minister's explanation that she wanted to have the legislation ready first.

According to the Minister, the Attorney General has concluded there is a serious risk, in the event of a constitutional challenge being brought, that the provisions of the 1961 Act would be held to be invalid, having regard to the provisions of Article 15.2 of the Constitution. Article 15.2 states:

The sole and exclusive power of making laws for the State is hereby vested in the Oireachtas: no other legislative authority has power to make laws for the State. . . . Provision may however be made by law for the creation or recognition of subordinate legislatures and for the powers and functions of these legislatures.

I understand the Attorney General recommended that as a matter of urgency primary legislation should be enacted to confirm the orders which have been made to date under the 1961 Act. Last Thursday, I asked the Minister to provide me with the legal advice which prompted this legislation. All I received from her was a copy of a letter from the Attorney General confirming that he has given "unequivocal advice. . . that it was legally and constitutionally necessary to introduce primary legislation to confirm the bodies". However, it did not confirm the co-location of hospitals to redress issues raised by the last legislation rushed through under the Minister's guidance earlier this year, it did not address the issues of the HSE and it certainly did not insert the term "HSE" for "Minister" in a host of circumstances which devolve responsibility for these institutions and bodies further from the Minister.

If the Minster is genuine about getting Opposition co-operation for the passage of emergency legislation over these two days, it is advisable that she would allow the Opposition adequate time to consider the legislation and that all information, including the legal opinion on the issue, which can be released at the Government's discretion, is made available for consideration within good time. The last-minute publication of this Bill, days before the Dáil recess, is further evidence that the Minister's governance of health is nothing more than reactive, disjointed and chaotic at best. It also makes one suspicious as to her true agenda.

If the scope of the statutory instruments establishing these various bodies is beyond that which is provided in the principal Act, it is understandable and appropriate that this is rectified so that all orders and acts under the Health (Corporate Bodies) Act 1961 are placed on a sound legal footing. We do not have an issue with this. Given that the Minister, and her departmental officials, are satisfied that there is no litigation pending or threatened, it is difficult to understand why the Minister deliberately withheld this important legislation from the House and why she feels it necessary to guillotine it days before the Dáil recess. Fine Gael is willing to co-operate with Government on underpinning these important boards and their functions. However, we do not support the guillotining of this important legislation without proper consideration and debate, or its use to facilitate the introduction of the unrelated, controversial co-location of hospitals.

As well as underpinning 19 agencies, the Bill also addresses the legal capacity of St. James's Hospital and Beaumont Hospital to sign deals with private developers to build private hospitals on their grounds. To date, I have been given no compelling reason that the provisions relating to co-location have to be included in this legislation. It is just handy, or a case of "we will do it while we are at it". That might be fine if we had sufficient time to debate the Bill in an orderly fashion but it is not acceptable when the Bill is rushed and brought in under the umbrella of the Attorney General's advice to underpin the vires of 19 important State bodies and institutions, which, as the Minister accepts, are responsible for €900 million of taxpayers’ money.

According to the departmental briefing note, this legislation is being introduced "to put beyond doubt the legal capacity of Beaumont and St James's Hospital to enter into co-location agreements". In Schedule 1, with regard to Beaumont and St. James's hospitals, it states "The Board may, with the consent of the Health Service Executive, enter into an agreement with one or more persons for the provision by any person on land vested in the Board, of the hospital services that are not paid for primarily out of public monies." It continues specifically to include provision for the construction of buildings and facilities by private undertakings, and allows the board to enter into such other agreements with private undertakings of such services it considers appropriate. It is obvious that this legislation goes much further than putting "beyond doubt the legal capacity" of Beaumont Hospital and St James's Hospital to enter into co-location agreements. It appears that this provision established the legal capacity for these hospitals to enter into co-location agreements, which is very different from what the Minister suggests.

The letter received from the Attorney General states that he has given unequivocal advice that it was legally and constitutionally necessary to introduce primary legislation to confirm the bodies. The Attorney General does not refer to co-location or the need to include co-location in this legislation. Can the Minister confirm whether the Attorney General's advice refers to co-location or any concerns he may have had regarding the legal capacity of Beaumont Hospital and St. James's Hospital to enter into co-location agreements? Considering that the Attorney General's advice is based on concerns regarding bodies established under the 1961 Act, why has the Minister decided to incorporate the unrelated issue of co-location on the hind legs of this legislation?

At the meeting with Opposition spokespersons last Thursday, the Minister and her departmental officials categorically stated that no litigation is pending or threatened so why is it necessary to guillotine this legislation in the final hours of the Dáil session? Given the Minister's assertion that the boards of Beaumont and St James's hospitals are quite happy about the soundness of their legal standing, I fail to see the need to rush this aspect of the legislation through the Dáil. If the Minister is genuine about getting Opposition co-operation in these two days, she must produce evidence to support the inclusion of the co-location aspect, which she has not done.

I am very concerned, without having sight of the legal opinion, that rushing legislation through again will lead to yet more problems down the line and further questions about the competence of the Minister. Furthermore, this legislation, in attempting retrospection, may be unconstitutional. Clearly, what is now required is a considered debate to ensure that the detail will be correct on this occasion. The Minister in her contribution stated "given the immediate need for certainty as to the status and powers of bodies established under the Act, the wide range of crucial and fundamental health services provided by the bodies and the very substantial public expenditure involved in their operation, it was decided to prioritise matters for the present Bill", but that further Bills would be required. While there is a need to underpin the vires of these 19 bodies, they are being used as a conduit through which to introduce all this other activity.

With regard to co-location, I refer the Minister to a question asked of her by her Cabinet colleague, the Minister, Deputy Gormley, on 27 September 2006. Deputy Gormley stated:

I thank the Minister for her reply. She has correctly identified the company in question as Triad, one of the bidders for six co-located hospitals and which is also managing the Beacon Hospital. This company is a subsidiary of an American corporation that pleaded guilty to criminal fraud. This hospital chain, Columbia/HCA, paid a total of €1.7 billion to settle US Government fraud charges. Triad is currently under contract to its parent company for services that include patient accounting, which was the nub of the fraud case taken by the US Government against it. Does this information set off alarm bells for the Minister?

In light of this information, does the Minister believe that providing massive inducements in the form of giving public land to such American companies is the right way forward? Instead of cutting costs, could they increase inordinately if the same pattern occurs here? Hence, while I am aware the Minister believes us to be closer to Boston than Berlin, do we really wish to Americanise our health system so health becomes a commodity to be traded in the market place? The Minister must realise that health is much more than that. It concerns people's well-being and using the market model may be ill-advised.

That was the position of the Minister, Deputy Gormley, just over one year ago. How things have changed. I see the Minister is wearing green, although the Minister, Deputy Gormley, is not in the House.

Deputy Mary Harney

It is a coincidence.

Deputy James Reilly

The Minister looks very well.

Deputy Mary Harney

I thank the Deputy.

Deputy James Reilly

We know that schools built under public private partnership which were supposed to save 6% ended up costing 10% more than if they had been built by traditional methods. The PPP model is far from proven and requires much more debate than what is allowed today.

Much like this Bill, it is fair to state that the entire co-location plan has been guillotined. It is supposed to release 1,000 beds. How will these beds be funded when the insurance stream of income has been lost to the public hospital? This plan has come from the Government without consultation. There was no Green Paper, no detailed cost-benefit analysis and no Dáil scrutiny. It was established in the recent general election that there is no mandate for the co-location policy. Handing over public land to private, for-profit hospitals does not have the support of the people — 56% of the people voted against it.

The guillotining of this Bill by Fianna Fáil and the Progressive Democrats, now supported by their allies in the Green Party, is to hive off public landbanks at knock-down rates to private developers at considerable cost to taxpayers in taxes foregone, removing the possibility for those same public hospitals to expand on the grounds they had very wisely kept beside them when they were first built.

Under the new system, two hospitals will co-exist on each site with two types of patient — one public, one private. New co-located private hospitals will pick and choose the procedures they offer and competition between patients for limited intensive care beds will apply. Key medical personnel will be lured from public to private hospitals and public hospital development will be sidelined while hospitals are roped into 60 and 70 year leases. The new model represents a nightmare scenario for our health care system and a Government that has washed its hands of the development of public hospitals.

If the Minister succeeds in causing a dislocation between those who fund the service — that is, the taxpayers — and those who use it most, the chronically ill and elderly, we will see a rapid acceleration in the demise of public hospitals in favour of private ones. We will be well on the road to what Deputy Gormley, before he was a Minister, referred to as the American system. Despite the fact that 16% of America's GNP is spent on health, it is the most inequitable system in the western world with 60 million people uninsured and facing financial ruin or even death should they fall ill. According to the recent docu-drama "Sicko", 18,000 people die annually in the good old USA because they have no health insurance.

The main source of revenue of the new co-location hospitals will be health insurance premiums. It is likely that insurance rates for co-location hospitals will be far in excess of the current rates paid. In addition, the new rates will undoubtedly drive the cost of health insurance up thus making private health insurance unaffordable.

The VHI's publicly stated policy has been that there is no need for any further private beds. In its 2006 annual report the VHI stated:

The single biggest challenge facing private healthcare in Ireland is the unprecedented increase in private hospital capacity which has been encouraged by generous tax relief for such investment. VHI Healthcare has questioned the wisdom of such tax incentives particularly since there does not appear to be any significant demand from the public sector to use these new facilities. The cost of financing the new capacity will place huge pressure on our objective to provide our members with quality healthcare at affordable prices.

The VHI has its own agenda but nonetheless it will be interesting to see how all these private hospitals are going to survive. Will the NTPF be their main source of income?

Throughout this process, the Taoiseach and the Minister have frequently stated that the co-location option is the best and quickest way to deliver more hospital beds. It is highly unlikely that they will complete this complex project when they have still not delivered the much heralded 3,000 public acute beds promised back in 2001. In five years, they managed just over 1,000 of the promised acute hospital beds.

As well as underpinning 19 agencies, this rushed legislation is also addressing deficiencies in the Medical Practitioners Act 2007 and in the Health Act 2004 which established the HSE. Both of these Acts were put through the House by the Minister for Health and Children, Deputy Harney. She claims that she is in the middle of a major reform programme of the health service and that she wants to finish the job. Reform is generally understood to mean changing things for the better but instead the last few months have seen the imposition of a staff recruitment ban and cuts to critical frontline and community health services.

The HSE is the Minister's creation. She shaped it, legislated for it, and established it quickly rather than taking the time to get it right. In setting up the HSE, the Minister promised it would deliver efficiencies and value for taxpayers' money but instead she has allowed bureaucracy to spiral out of control, so much so that the Minster for Finance now has to put a stop to it. We all saw the articles in The Sunday Tribune and yesterday’s Irish Independent about the Minister for Finance writing to the Minister, Deputy Harney, expressing concern about her ability to manage her Department’s budget in the more financially restricted times that now exist as the economy slows down under this Government.

On top of its bureaucracy, the HSE has superimposed a lack of accountability and an avoidance of responsibility while putting media spin before operational performance. It has lost the confidence of the public, most of its own staff and many Deputies, including some on the Government benches. While the Minister and others, including the HSE, blame the work practices of its staff, it is the action of the Minister herself and the senior management of the HSE which is now the problem. They put conformity to their systems ahead of patient safety and welfare. They treat patients as job lots. Their attempt to blame the former Midland Health Board for the fiasco in Portlaoise is now seen to have been nothing more than a pathetic smokescreen.

The HSE has given us cutbacks, cancelled operations, removed home-care packages for disabled children, removed home help for the elderly, closed wards and reduced transport capacity, yet the Minister wants us to devolve more power to this body. She wants to distance herself even more from her responsibilities.

The Medical Practitioners Act was rushed through the House earlier this year but why were these amendments not included in the original legislation some months ago? Maybe it is because the legislation was rushed though the House at such a pace. We are now repeating the same mistake. It is more than likely we will find ourselves standing here at some stage next year rectifying the deficencies of this rushed legislation.

Perhaps the Minister can provide clarification on the amendments proposed for the Medical Practitioners Act. What problems is she seeking to head off by these amendments and who wished to have them introduced?

Section 18 of the Bill amends section 59 of the Medical Practitioners Act by inserting the following section:

(1A) The Preliminary Proceedings Committee may, for the purposes of considering whether there is sufficient cause to warrant further action being taken in relation to a complaint, take account of such matters relating to the registered medical practitioner the subject of the complaint that arise from its investigation of the complaint as it considers appropriate.

Did everyone get that? This amendment suggests that if a separate issue, unrelated to the initial complaint, comes to the attention of the preliminary proceedings committee, it can be considered as part of the cause to warrant further action. It is not clear from the legislation, however, if doctors will be notified of this complaint or if they will be allowed the opportunity to respond to the complaint. Perhaps the Minster could clarify this point.

I ask the Minister to remove all mention of these other Acts from this Bill and focus on the Attorney General's advice, addressing it to the area he wished it to be addressed to, namely the 19 bodies. She should allow a more considered and ordered debate on other issues such as co-location, the Medical Practitioners Act 2007 and the HSE Act 2004. We could then wish the Minister a happy Christmas and offer her full co-operation. Otherwise, however, we will have to oppose the Bill.

Deputy Dan Neville

I welcome the chance to speak on this Bill. I am pleased the Minister is here as I will take the opportunity to raise an issue on which I sought a debate earlier today, namely mental health services. I offer my sincere sympathy to the family of Michael Hughes who was so tragically murdered. There are currently no dedicated beds available for severely disturbed and violent psychiatric patients. St. Brendan's Hospital deals with such matters for the State but the number of beds there has been reduced from 24 to 14 and those are occupied by long-stay patients. Therefore there are no beds for any disturbed person who becomes violent and is suffering from a psychiatric illness. It was reported today that a court decided a violent and disturbed person who was charged with a crime should go into a facility like St. Brendan's. However, because no such facility was available, that person got bail. The Minister knows the implications of that type of decision.

I will not comment on the death of Michael Hughes because I do not know the full circumstances. A psychiatrist cannot be expected to anticipate that a patient he is trying to assess would go out and kill somebody. However, the position regarding disturbed patients is very serious. Throughout the State, disturbed people are put into long-term psychiatric hospitals and isolated but the staff are not trained to deal with disturbed and violent patients. It is an affront to the patient that the services are not equipped to treat him or her. That is an indication of the dearth of resources provided and attention paid by many Governments to psychiatric patients.

On 12 December, I was informed by the HSE that 3,298 children are on a waiting list for psychiatric services. Many have been waiting for more than 12 months with some waiting for several years. This is serious because early intervention to treat psychiatric conditions is absolutely vital to achieve a long-term cure. I do not understand why the Minister and the Government are not addressing this issue because early intervention is cost effective. If the child is dealt with early, he or she will have a great chance to be cured and will not need long-term care. However, delay in the treatment of a child or an adolescent compounds his or her position and his or her condition usually becomes chronic resulting in him or her entering long-term psychiatric services. Even from an expenditure point of view, it is in the Minister's interest to deal with these children. Many reports have been published and suggestions made on what should be done.

I am extremely concerned that the former Minister of State at the Department of Health and Children, Tim O'Malley, stated €25 million would be invested in developing psychiatric services in 2007 and implementing the recommendations in the report, A Vision for Change. However, the Irish Mental Health Coalition states, "Most of this money is not being spent and much of it has been used to pay for budget deficits in the primary and continuing care sector". Surely this is not the case. Has the miserly contribution of €25 million to develop psychiatric services been siphoned off to deal with other problems? This beggars belief. I have been involved in the Irish Mental Health Coalition since its foundation and its chairman, John Saunders, who is also director of Schizophrenia Ireland, has demanded from the HSE a clear financial account of where the money has gone. If a person with the status of John Saunders is asking that question, that rings many alarm bells in my mind about investment in the development of mental health services.

I refer to the report on the management of mental health services. The appalling absence of proper management in this service is unbelievable. Twenty local health managers have replaced the former health boards and they are responsible for all health services, including mental health services. Each region has a local health manager with strategic responsibility for adult mental health and disability services and child and adolescent mental health services. Mental health services occupy only a small fraction of the attention of the manager, according to the report. In most areas, mental health services are not represented within the management team. Mental health services are managed at catchment level by senior management teams, which comprise in most cases a clinical director, a director of nursing and a hospital manager. The absence of full multidisciplinary psychiatric teams, which were recommended 23 years ago in the report, Planning for the Future, is a scandal.

More senior management teams in the mental health service contain no representation from disciplines such as occupational therapy, social work or psychology. While the vast majority of services have signed up to the multidisciplinary teams, this is not reflected at management level. There is no logical reason this is the case but the apparent resistance to the widening of the senior management base is surprising. In view of this, when will service users be represented at management level? This is light years away. There is a also serious failure of management in communications and in the context of decision making. Managers of mental health services are not part of decision making and the majority of senior management teams do not feel they are part of the decision making process. There is little evidence of effective catchment teams. Senior management teams are rarely integral participants in the planning of the mental health services. I look forward to the Minister's response.

Deputy Jan O’Sullivan

I move amendment No. 1:

"To delete all words after "That" and substitute the following:

"Dáil Éireann,

Noting the reported legal advice of the Attorney General that it is legally and constitutionally necessary to introduce primary legislation to confirm certain bodies which were purportedly created under the Health (Corporate Bodies) Act 1961;

Accepting that this is an urgent matter requiring the urgent enactment of emergency legislation by the Oireachtas;

Believing it is unacceptable that such emergency legislation should be used to facilitate the introduction of other non-urgent, politically controversial matters, such as those relating to the proposed co-location of private clinics on the grounds of public hospitals;

Declines to give a second reading to the Bill, on the grounds that it bundles together urgent and uncontroversial matters with those that are in no way urgent and are intensely politically contentious."

I wish to share time with Deputy Caoimhghín Ó Caoláin.

In moving the amendment, the Labour Party does not wish to obstruct the passage of legislation to address the concerns of the Attorney General that certain bodies established under the Health (Corporate Bodies) Act 1961 may be legally and constitutionally suspect. However, we strongly object to the inclusion in this Bill of measures to facilitate the development of co-located private hospitals on the grounds of public hospitals. The Labour Party is fundamentally opposed to this measure, which seeks to take our health services further along the road of dividing public and private patients so that in the near future when sick people arrive on a hospital campus, they will be directed left or right depending on whether they are public or private patients, some of them to sparkling new facilities supported by tax breaks to wealthy developers and others to the older, public-only hospital.

The Minister has not convinced anyone that this separation of the sick into rich and poor hospitals is anything other than ideologically based, despite what she said which seemed to suggest this would bring patients closer together rather result in them being further apart in terms of whether they were public or private patients. Was she serious when she said the initiative was founded on the principle that all patients ordinarily resident in the State should have access to public hospitals based on medical need and that the possession of private health insurance should neither influence timeliness of access nor treatment? She suggested co-location would result in an equitable system, which I find incomprehensible.

An aspect of the Minister's political agenda should not form any part of an emergency Bill, especially one which is being rushed through the Oireachtas the week before Christmas, the debate on which will be guillotined and for which the time allocated is extremely restricted. This is dictatorial rather than democratic. Even though the Minister's party has only two votes, she has plenty of willing followers in Fianna Fáil and the Green Party who will ensure she will win the vote that will take place tonight. While we will do all in our power to remove the co-location element from the Bill, it is likely that we will not even reach that section of the Bill on Committee Stage. That is unsatisfactory and undemocratic. That is the reason we have moved an amendment on Second Stage to ensure the House will have an opportunity divide on this aspect, namely, the inclusion of the co-location element in the Bill which, otherwise, is emergency legislation.

The other anti-democratic aspect is that the Opposition and the public in general were not told about the Bill until the end of last week, even though the advice of the Attorney General was received in October and the Cabinet was told about the matter on 4 December. The Minister said her legal advice was that she was not to say anything about it until the end of last week. I do not understand the reason for this because she told us "The legal advice also has implications for bodies set up under the Local Government Services (Corporate Bodies) Act 1971 and that matter is under active consideration at present." That issue could be declared public when legislation on bodies set up under that Act was being prepared but not ready, yet nobody could be told about the legislation from the Minister's Department until it was ready to be published. If there was a concern about the public or the Opposition learning about it one month or so in advance of its publication, it appears there was no such concern in regard to legislation on bodies set up under the local government Act. I ask the Minister to respond to this matter, otherwise we can only conclude there is something undemocratic about her not telling us of the need for this legislation until last week.

This is a complicated Bill which involve considerable cross-references to various legislation. Clearly, for that reason it involved considerable drafting which must have taken some time to complete. It would have been helpful for the Opposition to have had sight of the legislation in advance to enable us to make the same cross-references and our legal advisers to examine it carefully to ensure there were no problems with it. Is the Minister satisfied that she has comprehensively covered the whole area incorporated in the legislation, given that it includes references to a raft of legislation? It covers 19 existing bodies and 40 bodies which initially were set up under the 1961 legislation. It is strange that in the intervening 46 years it did not come to light that there was a problem in this regard. The Opposition, anyone with an interest in these matters, particularly those interested in the drafting of legislation, and other members of the public should be given more information on the reason it was considered necessary to introduce this emergency legislation today and the specific legal advice received. I hope the Minister will give us that information.

On the technicalities of the Bill, I wish to raise an issue concerning one of the bodies established under 1961 Act but which no longer exists. I refer to the National Rehabilitation Board which was set up under the Health (Corporate Bodies) Act 1961 and dissolved in 2000. The Minister said on an RTE programme last Friday that her concern was focused on the 19 organisations still in place. I am sure she is aware of the legal difficulties concerning the National Rehabilitation Board, specifically the superannuation entitlements of its former staff. This matter went to court and it seems the former staff have a right to redundancy payments but no Minister has taken responsibility for ensuring their rights are fulfilled. The issues arises under this legislation. I ask the Minister to examine it and address the concerns expressed when the Employment Appeals Tribunal and the courts dealt with the rights of former employees of the National Rehabilitation Board. I hope she will be able to clarify the position and that we will be able to make progress for the former employees of the board.

I wish to address the issue of co-location and its inclusion in the Bill. I agree with my party leader and Deputy Reilly in asking the Minister if the reason the legislation is being rushed through today has much more to do with her urgent desire for co-location. She advised that further legislation would be required in regard to the 1961 Act and that she would introduce another Bill in 2008. Why then was it necessary and so urgent to put this Bill, to the debate on which a guillotine will be applied, through the Houses the week before Christmas, particularly when the legislation in regard to the Department of the Environment, Heritage and Local Government does not appear to have the same level of urgency attached? Some of us are suspicious that the real agenda is to introduce the elements that deal with co-location, specifically in regard to St. James's Hospital and Beaumont Hospital.

I am particularly concerned about the wording of the Schedule on page 11, which deals with St. James's Hospital, and page 13, which deals with Beaumont Hospital. It refers to "the disposal of land or an interest in land by the board of the Health Service Executive for the purposes of (i) the said construction, and (ii) the provision of those services by the private undertaking . . .". I understood it was not intended to dispose of lands and that the intention was to lease land for the purposes of co-location. I would be concerned if the legislation was being used to bring us to a position where we will dispose of publicly owned land to private operators who will get tax breaks to provide for private patients on the grounds of public hospitals. Up to now we have heard of the intention to lease land, but the Schedule clearly provides for the disposal of land. That would further add to my concern on behalf of the Labour Party that this element should not be included in the legislation. It is written in black and white that there is a provision for the disposal of land, among other matters. I am concerned about this.

I am also concerned about the issues that have not been teased out in regard to the relationship between private and public hospitals, particularly how public hospitals will be compensated in respect of the funds they currently receive for the accommodation of private patients. I found it incomprehensible that the Minister said this was going to mean that public patients would have access to health services on the same basis as private patients when we know perfectly well that this is not the case and is even less likely to be the case when we have co-located private hospitals.

Recently, a grandmother called to my clinic. She told me that her grandchild, who had an orthopaedic problem, had been told she would have to wait three years for an X-ray and treatment in the public system. The family has a medical card but decided to go to the private clinic of the consultant, which is held in the public hospital. The family subsequently brought the child for the X-ray but the child was not allowed into the X-ray department until €150 had been paid, because the X-ray was being carried out privately. The family's concern is that the child will have to stay in the private system, given that she started there.

Deputy Mary Harney

Did this take place in the public hospital?

Deputy Jan O’Sullivan

Yes, but it was the private clinic in the public hospital.

Deputy Mary Harney

That is exactly what I am trying to stop.

Deputy Jan O’Sullivan

I cannot see how what the Minister is trying to do will make this different. If this child presents in the co-located system, presumably she will have to go into the private clinic to get the X-ray——

Deputy Mary Harney

There will be 1,000 more public beds.

Deputy Jan O’Sullivan

——and it will be impossible to get her back into the public system. Another issue, which I raised previously, is where there is a medical expert in a rare specialty area. How will that person's clinical expertise be shared between the public and private system? That has not been clarified.

Another aspect to this issue came to light this morning, at the meeting of the health committee. The meeting was attended by Professor Tom Keane and discussed the plans for cancer services. It was a great opportunity to have him attend the meeting and we were given plenty of good information. One of the matters discussed was transport, and the difficulty for patients who had to travel to cancer centres — Professor Keane did not wish to call them centres of excellence. He told us that in British Columbia a patient's tests are scheduled to be carried out in a single day, so patients are not delayed there for too long.

There are also places adjacent to the hospital where patients can stay, if necessary. The cancer society in British Columbia is strongly involved in organising this accommodation for patients while they are undergoing tests and so forth. Would it not be great to have enough grounds surrounding the cancer centres to build places for people to stay, so they would not have to occupy expensive acute beds? While they are having tests carried out they could stay in these cheaper forms of accommodation which do not have the intensive support an acute hospital bed requires. I question the use of public hospital grounds for private hospitals and clinics. These grounds could be needed to provide facilities to accommodate patients who have travelled far for cancer tests or cancer treatment. A person who is attending the centre for radiotherapy, for example, could stay in this less expensive type of accommodation.

Similarly, last week we were told there are approximately 300 bed blockers — a term I dislike — in the Dublin area. These people do not need to be in acute hospitals and could be transferred into the community. The public land could be put to good use by using it to provide public beds for patients who are currently needlessly occupying acute beds. Another use for that land is in the area of maternity services. The capacity of maternity hospitals is under pressure due to increasing birth rates. In my constituency it is planned to move the maternity hospital to the grounds of the public mid-west regional hospital. However, it is planned to put a co-located hospital there, which will take up some of the valuable public land which could be used to accommodate the maternity hospital. The congestion in maternity hospitals is not confined to Dublin; it is a serious problem in other parts of the country. Growing demand on maternity services is a serious problem in my constituency.

I support Deputy Neville's comments on mental health services. Nobody wishes to comment on the case in the news yesterday but the policy document, A Vision for Change, made a number of recommendations on mental health services. One of these was that specific funding be allocated to those services each year. The allocation is €29 million for next year but that sum does not appear to be included in the health Estimates. There has been strong lobbying for a number of years to bring to public attention the needs of our mental health service, which has been the Cinderella of the health service for a long time.

Patients often present to hospital accident and emergency units with serious mental health problems. They live in the community and might have acute mental health issues that must be addressed. There should be liaison in the public accident and emergency services so a person who presents with a mental health problem is not sent away and advised to attend a clinic in the community a few weeks hence. All Members are aware of cases in their constituencies where somebody in acute mental distress has presented at an accident and emergency department but was left with nowhere to go. In some cases, the result has been suicide and in others, tragically, it has been violence. This is an urgent issue which must be addressed.

Another issue is child and adolescent psychological services, in particular the need for inpatient services. In my constituency there are no beds for child and adolescent psychological cases. An adolescent with a mental health problem must be accommodated in an adult ward.

There are appalling lapses and gaps in the public health service that must be addressed. I am concerned that funding has been so curtailed or tied to maintaining current services that we are not developing other services that are required. I appreciate that the HSE must watch its budget but I would prefer it to cutback its budget in certain areas where money is being wasted and ensure that money which was promised for other important areas is made available.

The Labour Party does not oppose most of the content of the Bill but it cannot support the elements relating to co-location. This is legislative sleight of hand on the part of the Government, which is demanding that the Dáil enact emergency legislation to close a loophole but is bundling urgent and non-controversial matters with those that are not urgent but intensely politically contentious. We propose the amendment for that reason.

Deputy Caoimhghín Ó Caoláin

I thank Deputy O'Sullivan for sharing time. I support the amendment tabled by the Labour Party. It is extraordinary that on the penultimate day of this session we have been presented with such emergency legislation. We are being asked to rush through all Stages of the Bill this evening. The Bill itself was only published last Friday, 14 December. The Minister informed the Opposition parties on Thursday, 13 December, of the Government's intentions with regard to this Bill and sought their co-operation.

As in all such cases, a great deal of trust is being asked of the Opposition parties. The Government is armed with authoritative legal advice, including that of the most senior law officer who sits at the Cabinet, the Attorney General. We are told that concerns were first raised about the powers of the Minister for Health and Children under the Health (Corporate Bodies) Act 1961 in the context of establishing the new national paediatric hospital during the past summer. It has also been stated, separately, that the Minister for Health and Children was provided with legal analysis on 22 June which suggested there might be complications related to the co-location of private hospitals in the grounds of St. James's and Beaumont Hospitals.

I asked the Taoiseach earlier but received nothing but a blank response, so I ask the Minister who provided this legal analysis. Was it sought by her and did she initiate an inquiry? Did it arise during the tendering process for the co-located private for profit hospitals or was it raised by one of the companies tendering for these lucrative contracts?

The Opposition has sought access to the Minister's legal advice and she undertook at the briefing meeting on 13 December to ask the Attorney General if this was possible. The Attorney General responded on the same day in a letter to the Minister, copies of which were forwarded to the Opposition, that the advice is privileged and should not be released. There may be a good reason for that and it may be the case that the Government must act in this way to protect the State from potentially costly litigation. Again, however, the Opposition is being asked to take this on trust.

I ask the Minister to give us the information in response to the reasonable and fair questions I put to her rather than hide behind the smokescreen provided by the Attorney General. I acknowledge we must allow the Government some leeway. The Attorney General's advice is that primary legislation needs to be enacted as a matter of urgency to protect the 19 existing bodies established by statutory instruments under the 1961 Act. If that is the case, this legislation is necessary to ensure the continuation of the work of these bodies and to that extent should be supported. However, the questions I have raised need to be addressed.

The other major element of this Bill, namely, the extension of powers to the boards of St. James's and Beaumont hospitals in order to facilitate the Government's infamous private for profit hospital co-location plan, cannot and will not be supported by Sinn Féin. It is ironic that the first reference in legislation to co-location should come in a Bill which is designed to protect the State from a constitutional challenge on the grounds that an Act of the Oireachtas gives powers to a Minister that are too wide ranging. We have never had a thorough debate on the issue of co-location and no legislation has been brought in respect of it. This is a significant change in our health care and hospital system which will reinforce the two-tier nature of the system and swing State policy very definitely towards privatisation, yet no Oireachtas approval was sought for co-location and we are being presented this evening with a Bill that, in traditional style, is being rushed through the House to be guillotined in the last days before Christmas.

Surely the lesson to be learned from the situation that led to this Bill is about the danger that arises when the powers of Ministers and the Cabinet are taken too far. We have on many occasions raised concerns about Bills in which extensive powers are given to Ministers by means of ministerial orders. The role of the Oireachtas in democratic decision making and scrutiny of legislation has been weakened. When important bodies are established and funded to the tune of many millions of euro by the State they should be established by legislation, with all the checks and balances and the democratic accountability that entails, but the record of this Government and the Minister on accountability is lamentable. The Health Service Executive has been established as a buffer against accountability from two directions, Oireachtas Members and communities.

The Government has signalled its refusal to remove the sections it has inserted in this Bill to facilitate co-location. The Schedule to the Bill proposes to amend ministerial orders and give them legislative force. This will mean giving powers to the boards of St. James's and Beaumont hospitals to proceed with co-location. Therefore, Sinn Féin cannot support the Bill.

In June, a Protestant organisation, the Adelaide Hospital Society, joined forces with a Catholic one, the Jesuit Centre for Faith and Justice, to warn against the trend in health care policy represented by co-location, and in this festive week of Christian belief I want to repeat their warning. They stated co-location "sends out a powerful message about Government backing and support for the existing two-tier hospital system" and "represents a significant threat to the fundamental values of care and justice, which require that health provision is seen first and foremost as an essential service, which should be available on the basis of need". The Minister has heard that argument being made repeatedly in this House but she has ignored it. A Government which sponsors such a scheme can never be relied upon to deal with the underlying inequalities which contribute significantly to ill-health in society.

Authoritative opinion on the front line of hospital care states we need 3,000 additional hospital beds to replace those taken out of the system in the 1980s and to cater for the 25% population increase since then. However, beds have continued to be removed from hospitals until the present, including beds taken this year from the hospital in my community of Monaghan. This Government claims it will increase bed numbers by 1,500 but no less than 1,000 of these are supposed to come from the co-location scheme facilitated by this Bill. The Minister claims that 1,000 private beds will be transferred from public hospitals to the private co-located hospitals, thus freeing up that number of public beds but she has never answered parliamentary questions I and other Deputies put regarding the number of beds to be transferred at each hospital site. The reality is that co-location cannot provide the additional beds required. The Doctors Alliance for Better Public Healthcare has pointed out that most patients admitted as inpatients to public hospitals are not suitable for care in a private hospital, including most patients admitted through accident and emergency departments.

For the reasons I have articulated in the short time available to me, I cannot support this Bill as it stands. I regret that because I was prepared to support it on the basis of the arguments regarding the named bodies. If this is a means to facilitate the Minister's proposals on further privatising health care and deepening the apartheid-style divide in health services, I strongly oppose her.

Deputy Chris Andrews

I wish to share time with Deputy Finian McGrath.

I am delighted to have the opportunity to speak on this Bill. In recent years, the health system has been the subject of widespread debate. I have great sympathy for anybody who works in the health services because morale must be extremely low. We all know people who work in the health services but anybody who admits to doing so inevitably receives sympathy. Reform of the health system is the main priority for the Government and every Deputy.

It is important to highlight the hard work that is carried out by so many members of the Health Service Executive. It is easy to knock and to condemn. Everyone likes to be critical at times because it is the easy thing to do. However, being proactive, thoughtful and detailed in one's responses to problems does not appear to be as easy. Certainly, although the Opposition is very good at being negative, this does not do anything for their case or for the health system overall.

Deputies O'Sullivan and Ó Caoláin mentioned the issue of co-location because they believe it will reinforce the two-tier health system. People I meet in the street tell me they do not care if there are five tiers in the health system. They want proper care and to be able to access the services. If co-location brings this about, it should be rolled out quickly for them.

Deputy O'Sullivan also mentioned that she supports cutbacks in areas in which there is waste. The Deputy and the Opposition in general should point out where and by whom such resources in the health system are being wasted. Recently, I heard an Opposition spokesperson on a radio programme calling for firm, decisive management and for proper management of the health service. However, on the same radio programme, the same person then called for exceptions to be made in individual cases. One cannot have it both ways.

Although many good people work in the health service, they are becoming increasingly afraid to make good decisions. In a way, they are damned if they do and damned if they do not. While it may not be popular to make this point, a large number of good people work in the health system. We have good consultants, health care managers and pharmacists who need to be supported and encouraged. However, they are assaulted on a daily basis. While people always state that they are not criticising individuals within a particular section of the health service, this is not the case. Such individuals are being criticised and people's morale is being damaged. This is not because of criticism per se but inaccurate and unfair criticism affects people. The problem is that people are afraid to make decisions and this is due to the climate of discussion regarding the health service.

The HSE was founded in 2005 and is the State's biggest employer, with more than 120,000 employees. Many of them work at the coalface and treat patients on a daily basis. Amidst recent controversies, it is important not to forget the invaluable work being done by many of the HSE's staff. Its staff should become proud to state that they work in the HSE and in the health service. All families have experience of the hospital services. My personal experiences have been highly positive within both the private and public health care systems. The people who work in this sector are fantastic. In general, the consultants are excellent professionals who regularly work above and beyond the call of duty. Naturally they will argue for their own position, which is part of the process. The same is true of pharmacists, who are arguing the case in respect of the payments scheme. Although they are making arguments on this issue, pharmacists would be the first to acknowledge the existence of difficulties, which always will be present. This constitutes part of negotiating and negotiation is a good part of the process. While it sometimes can be somewhat torturous or slow, it has worked for years and continues to so do. It is important to embrace dialogue and consultation.

I read in today's edition of one of the newspapers an assertion on the part of a commentator that the health system is under-resourced. How often must Members listen to such complete nonsense? Almost everyone now accepts that the system is not under-resourced. While there are question marks over where resources are going and the manner in which they are being spent, there should not be a debate on this subject. However, one is obliged to listen to nonsense to the effect that the health system is under-resourced. Clearly, this is not the case. In the most recent budget, the Government provided almost €16.2 billion for health in 2008. This constitutes an increase of more than €1 billion on the 2006 allocation. Of this sum, more than €700 million is for the capital programme. Further budgetary provisions include increased allocations for cancer care, the elderly, people with disabilities and children, all of which are very welcome. Although it is clear there is not a problem regarding funding, commentators still trot out that old chestnut about the lack thereof.

I acknowledge there will always be problems and challenges within the system and that improvements can always be made. It is important to be cognisant of the hard work and commitment of people in the health service. I refer again to my personal experiences. All Members know people who work in the health service and know they work particularly hard. While Opposition Members like to claim there is waste, they are unwilling to point out its location in any detail. It is like listening to a pub conversation consisting entirely of broad brush stroke stuff and without any detail. The Opposition Members should come up with details on where and on what services they propose to make cutbacks.

The waiting times for accident and emergency services have been improved by 50%. Approximately 3,300 patients a day attend accident and emergency departments, of whom approximately one quarter require admission. Patients in the majority of the 32 accident and emergency departments do not wait long for admission but are admitted directly to beds. Obviously, a number of hospitals are causing some problems. That is more to do with a desire to be involved in politics instead of running the hospitals. The National Treatment Purchase Fund has been a great success. People from my constituency of Dublin South-East have availed of this scheme and have found it to be fantastic. This constitutes a success story.

In a recent survey conducted by UCD and Lansdowne Market Research, it was reported that waiting times for hospital admission now are less than three months for 91% of patients. A total of 76% of patients stated that they were admitted to hospital immediately on being informed they required admission. A further 11% were admitted within one month and a further 4% were admitted within three months.

I was particularly delighted to note the arrival in Ireland of Professor Tom Keane, who has brought great benefit to cancer services in British Columbia. He attended the meeting of the Oireachtas Joint Committee on Health and Children today and was highly positive and encouraging. He spoke of the enormous success in paediatric oncology. Clearly, the HSE, the health service and the people working within it have delivered a top-class service in paediatric oncology and should be applauded for it. This Bill is in the public interest and I will lend my support to it.

Deputy Finian McGrath

I thank the Leas-Cheann Comhairle for the opportunity to speak on the Health (Miscellaneous Provisions) Bill 2007, the purpose of which is to deal with the legal issues in respect of the Health (Corporate Bodies) Act 1961 and to amend the Medical Practitioners Act 2007.

This Bill directly affects Beaumont Hospital, which is located in my constituency. Following a detailed analysis, the Attorney General has concluded that the powers conferred on the Minister for Health and Children by section 3 of the Act are so broad that there is a serious risk, in the event of a constitutional challenge being brought, that the provisions of the Act will be held to be invalid having regard to the provisions of Article 15.2 of the Constitution. He has recommended that as a matter of urgency, primary legislation should be re-enacted to confirm the orders that have been made to date under the Act and to enable certain protective actions to be taken by some of the bodies.

The Bill directly concerns Beaumont Hospital in my constituency. I welcome the Minister for Health and Children, Deputy Harney, to the debate and also the announcement in the Budget Statement of an additional allocation of €2.5 million for cystic fibrosis services at the hospital. This is a major start in rolling out and developing services for the families of children and adults with cystic fibrosis. The extra €2.5 million is to be allocated in 2008, but there will also be other developments at the hospital.

During the last debate on health, I was subject to considerable criticism and was misrepresented by sections of the House and the media over why I had entered government to deliver services for Dublin North-Central, in addition to national services. In addition to the extra €2.5 million to be allocated for cystic fibrosis services at Beaumont Hospital, an extra €35 million will be allocated for the roll-out of national cancer services, as is occurring. Another €3 million will be delivered to develop cancer services at Beaumont Hospital. I welcome this step, as it is progressive and sensible for the city. I welcome the fact that the hospital has been nominated as one of the designated cancer care centres.

There is a considerable plan for an independent hospital on the site of Beaumont Hospital. It will work with the public hospital, provide extra funds and share the resources, services and consultants. This will free up over 170 beds and result in a major investment in the accident and emergency services. This will not take ten or 15 years but two. I entered politics to deliver on health and disability issues. Most objective commentators will now realise this is becoming a reality. In the next two years there is to be a major investment in Beaumont Hospital and I am confident it will happen.

In my area of Dublin North-Central, there has been a major improvement in education services in Marino. Furthermore, 117 new employees have been deployed to front-line health services on the north side since 5 December. Beaumont Hospital has had 110 new members of staff appointed to front-line services. Therefore, the work has already begun and will continue in the next two years. I welcome it and pushed for it very strongly in my agreement with the Taoiseach.

In the Dáil last week, I mentioned the additional allocations of €50 million for disability services and €25 million for the care of the elderly. These are welcome and important additional allocations and should be considered in this debate. I pushed the Government very strongly for them. I committed to securing them when elected and I intend to deliver on all my promises.

I prefer the phrase "independent hospitals" to "co-located hospitals". I would appreciate it if Members were straight in this debate and were less hypocritical. The reality is that 53% of citizens participate in private health schemes. My agenda is and always will be to protect the rights of all patients, particularly those from the poorer sections of society. There are already private beds in public hospitals — this is co-location. My broader vision for a universal health insurance scheme for all is based on need rather than money. However, the reality is that it will not happen in the next five years. Do Members want me to turn my back on major funding and investment for Beaumont Hospital? I have seen the plans and details and, having spoken regularly to staff at the hospital, know they are in favour of the proposal. Many Members support it privately, yet they use it to attack me in the House.

The plan for the independent hospital on the Beaumont Hospital site will contribute greatly to the development of the public hospital. This is a key consideration. The public hospital will also receive millions of euro from the lease of the land and this money will be pumped into its services. Many have ignored this. I have seen the exact figures but will not damage the integrity of the planning process for the proposed independent hospital by mentioning them. The millions of euro will represent a very important investment in the accident and emergency services at the hospital.

Some Deputies have asked the number of beds to be provided at Beaumont Hospital. The figure is in the region of 170. This is a major breakthrough for the hospital and its staff. I cannot walk away from a serious investment such as that proposed when I see no other viable option. It is a question of delivering services for people in my constituency of Dublin North-Central. It is also about creating new jobs.

I recently met the Minister for Health and Children to discuss services for people with disabilities and cystic fibrosis and thank her for meeting me. The meeting was very positive. On 3 December, I met Mr. Michael Cullen and his team from the Beacon Medical Group to debate co-location, including the issues raised by many Deputies in the House today. Afterwards I considered the facts pertaining to the Beaumont Hospital project in an objective way and when I did, I realised it was very impressive. It is a matter of pooling resources, investing in new services, doing up the entrance to the public hospital and obtaining millions of euro from the lease of land to the private hospital. The overall cost of the project is in the region of €254 million. It will include 170 inpatient beds, six high-tech theatre facilities that will employ 510 staff and complement the main hospital with extra support services on-site and millions of euro. It is hoped construction will commence in May 2008. If all goes well, as I believe it will, the project could be completed by 2010.

The reality is that 53% of people are talking along these lines. I would love a wider debate on the health service and accept that we need reform thereof and investment therein but we should note that the budget has provided for an increase in funding for the development of services. Certain services have been prioritised, which I welcome. I referred to cystic fibrosis services for Beaumont Hospital but there are also plans for the roll-out of such key services at St. Vincent's Hospital. Despite the downturn in the economy, we have managed to roll-out and develop the planned services.

The new facilities will increase the pool of health professionals working in the health system, which is necessary. The population is increasing; it is indicated in today's newspapers that it is now over 4 million. We, therefore, need to increase capacity and investment. The population will soon rise to 5 million. Consequently, we need to be sensible, radical and open to new ideas. The way forward is to ensure every patient who enters a hospital is treated with respect and dignity. This is a very important message. Society is about people; without people there is no society. I would like to redevelop respect, trust and community spirit by insisting on people-centred policies and actions.

Debate adjourned.

Dáil Éireann díospóireacht - Tuesday, 18 Dec 2007

Health (Miscellaneous Provisions) Bill 2007: Second Stage.

Dáil Éireann díospóireacht -
Tuesday, 18 Dec 2007