Billy Kelleher
Question:42. Deputy Billy Kelleher asked the Minister for Health the position regarding the provision of a new general practitioner services contract; and if he will make a statement on the matter. [29222/17]
Priority Questions
General Practitioner Contracts
My question is to ask the Minister for an update on the position regarding the provision of a new general practitioner, GP, services contract and if he will make a statement on the issue that I have raised. As we are well aware, there has been strong emphasis over many years on the provision of primary care, the enhancement of services in the primary care and community care setting, and the issue of a new general practitioner services contract is central to that evolution in health provision in primary and community care.
A core tenet of Government policy is the development of primary care, which is central to the Government's objective of delivering a high-quality, integrated and cost-effective health service. The aim is to develop a new modernised GP contract which will facilitate the shift within the health service away from hospital services towards an integrated primary care service in order to deliver better care close to home in communities across the country.
I want to see a new contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions. It should be flexible and be able to respond to the changing nature of the GP workforce. It should also include provisions for service quality and standards, performance, accountability and transparency. These are realities in today’s world which must be accommodated. I think this will be key in making general practice a more attractive career.
Since 2015, negotiations have resulted in a number of service developments, including the provision of free GP care to under sixes, over 70s, the introduction of a diabetes cycle of care for adult general medical services patients with type 2 diabetes, and enhanced supports for rural GPs. The next phase of engagement with GP representatives is under way. The discussions taking place are wide-ranging and ambitious in their scope. While there will be challenges for all parties involved, I am hopeful that with the goodwill and co-operation of all parties, significant progress can be made in these discussions in the months ahead. I made it clear around budget time, as did the GP organisations, that this body of work was always going to take the overwhelming bulk of 2017. It is a very substantive body of work. I hope that everyone will remain focused on our common goal of putting suitable new arrangements in place that will work for patients, for GPs and for other health care providers in primary care.
The problem with the Minister's answer is that we have been waiting for a long time for discussions to commence. That was a commitment made by the previous Government. We are now in a situation where we have the Sláinte report. It has identified key recommendations in the area of provision of primary community care, enhancing the services in disease prevention, chronic disease management, moving from a hospital-centric health service to a primary and community care setting and, of course, the key issue in all that is the issue of capacity within the primary care setting. That is fundamental to the delivery of the recommendations in that report, which are also in line and in tandem with Government policy about expanding the primary care setting. The Minister talks about under-sixes and over-70s, but the harsh reality is that until the Minister expands and enhances the capacity of GP services in the community, we will not be able to provide what has been identified both in Government policy and in the Sláinte report from the committee chaired by Deputy Shortall. I ask the Minister to give an outline as to whether or not the challenges are because of a lack of resources, funding, a lack of personnel to roll out the proposals or because there is prevarication, either by the representative bodies or by the Department of Health and the Government.
I welcome my new colleague in the Department of Health, the Minister of State, Deputy Jim Daly, whom I know will bring vigour and energy to his areas of responsibility.
I do not think there is anything wrong with my answer, because GPs and patients have been waiting for at least three decades for a new GP contract. Within weeks of coming into office, I began the process of engagement to put one in place. We have a situation whereby those negotiations are already under way. A process has been put in place for further engagement with GP representatives. Meetings with the Irish Medical Organisation, IMO, are held on a fortnightly basis, with some further meetings at an official level to discuss technical issues or, indeed, at a clinical level. There have also been consultative meetings with the National Association of General Practitioners, NAGP, and, as I have said, I expect a situation where we will see substantive progress made by the end of the year with regard to delivering a new, modern, fit for purpose GP contract. I am strongly of the view, as I think are GPs, that this should not be a static document. We should not do what all of us have done in the past, putting one static contract in place.
We should modernise the contract and then keep the engagement ongoing.
In relation to Sláintecare, a substantial body of work on which I am looking forward to having a debate in the House tomorrow, it is likely that legislatively changes will be necessary for any substantial extension of GP care without fees to further cohorts of the population. It is clear that GP capacity must be addressed as well. I look forward to expanding further on those matters in the conversations tomorrow and in the contractual negotiations.
The Minister's predecessor, now the Taoiseach, stated when he was Minister for Health that he hoped the negotiations would be concluded by April 2016. It is now June 2017. There has been a substantial amount of drift in terms of the negotiations. When does the Minister envisage these negotiations concluding? If we are to convince the public that the Sláintecare report, which is in line with broad Government policy in terms of the provision of primary care, expanding and enhancing those services, increasing capacity and trying to bring about universal access in primary and community care, these issues are critically important. They will require legislative changes. However, we need to see an end date in place. Could the Minister give us a rough estimate, at least more accurate than his predecessor's, of when those negotiations will conclude?
My predecessor, now the Taoiseach, is committed to cracking once and for all as a country the challenges that face the health service and he made that clear in one of his first speeches as Taoiseach in this House. I share that view and that commitment.
I expect to make substantial progress on a new GP contract this year, but I am also saying that should not be the end of the matter. This will be a multi-annual process. Let us try to have a number of wins for patients and indeed wins for GPs whom we need to be able to have a viable career pathway so we can have GPs in every community this year.
As well as expanding free GP care - in fairness the programme for Government commits to expanding free GP care to all children under the age of 18 subject to negotiations with GPs in the lifetime of a five-year programme - a priority for my Department and for me is to look at chronic disease management. We need to look at things that could be done today in the community, and in other countries are done in the community, that are currently being done in the acute hospital setting. I expect to make substantial progress within this calendar year.
Nursing Staff Recruitment
Louise O'Reilly
Question:43. Deputy Louise O'Reilly asked the Minister for Health the position regarding current nurse numbers; and the success to date in 2017 on reaching the target set under the most recent agreement between his Department and an organisation (details supplied). [27957/17]
I congratulate the Minister on his reappointment. Indeed, I congratulate the Minister of State, Deputy Jim Daly, on his appointment. I am sure if the Minister had been reassigned he would miss my repeated questions upon this exact subject.
My question is straightforward. It relates to staffing. I would like an update. I have received some updates but perhaps the Minister may be able to enlighten us as to where the nurses who are so vitally needed will come from.
Deputy O'Reilly and I get to hang out another bit longer anyway.
I thank the Deputy for her repeated question on what is an important issue in relation to nurse and midwifery numbers in this country.
As the Deputy will probably be aware, nursing and midwifery numbers at the end of April this year stood at 36,549 whole-time equivalents, having increased by 625 whole-time equivalents in the 12 months from the end of the previous April, and by 1,870 in the three years from April 2014 to April 2017.
The Deputy knows well that under an agreement reached with the INMO and SIPTU nursing, encompassing proposals put forward on 8 February and those in a related addendum on 4 March, health service management committed to increasing the nursing and midwifery workforce in 2017 to deliver 1,208 additional permanent posts. Delivery of these posts is possible through a combination of new development posts, for which additional funding is being provided in the current year, and the local conversion of agency employed staff into direct employees. Nursing and midwifery numbers increased by 126 from the end of February to the end of March and by a further 113 from the end of March to the end of April.
A broad range of measures is being implemented to give effect to the agreement. These include the conversion of agency employed staff into HSE direct employees, offering all graduating nurses and midwives full-time contracts, ongoing recruitment campaigns in Ireland and abroad - I welcome the one in Glasgow recently - and the implementation of a range of retention measures.
The recruitment measures include careers days, HSE attendance at national and international recruitment fairs and a communication from the national director for HR to all nursing and midwifery graduates telling them how to apply for a full-time permanent post in the Irish health service. A high-level group with an independent chair has been established for the oversight of the implementation of this agreement and the first meeting of that group was held on 24 May 2017.
Key retention measures include enhanced maternity leave cover, a career break scheme and offering nurses and midwives improved educational opportunities and career pathways. In addition, 130 additional undergraduate places are being provided in 2017, which means we will train this year more nurses than we have ever trained, in terms of undergraduate places, in the history of the State.
I also issued a written direction under section 10 of the Health Act 2004 - it has never been done before for nurse recruitment - to the Health Service Executive in order to emphasise the importance of the full implementation of this agreement.
I welcome all of that. Indeed, it is good news for Australia, America or wherever these bright young men and women will end up. The simple fact is they do not want to work in the health service as it is currently constituted. They are not only saying that to me. They are voting with their feet and they are leaving. For example, 22 nurses were trained as part of a co-operation between CUH and UCC. These were 22 highly specialised nurses trained in paediatrics and general nursing - absolutely top-quality, top-notch front-line professionals - and all 22 of them have left. That is a damning indictment of the efforts that have been made to date.
Deputy Kelleher mentioned the Sláintecare report. We all are hopeful of positive news from Government in that regard but we will not be able to do it without the staff. I am not convinced that enough is being done.
I did not think the Deputy would be. Thankfully, when the INMO members had an opportunity to be balloted on this, over 80% of them voted in favour of these proposals, seeing them for what they are, which is a genuine and sincere effort by nurse representatives in this country, by my Department, by myself and by the HSE to try to increase recruitment and retention of nurses.
I will give Deputy Louise O'Reilly another practical example. The Deputy talks of her 22 nurses. The HSE recently went to Glasgow to a nurse recruitment fair where it met 27 Irish nurses who had been working in Scotland now ready and willing, and wanting, to come home and talking to the HSE about how do they take up opportunities in this country. The message needs to go out from all of us in this House that there are now opportunities for those nurses to come home.
The Deputy and I have talked about the issue of pay previously. There are now pay proposals on the table through the Department of Public Expenditure and Reform and I am sure those issues will be debated by nursing unions in the coming weeks and months.
One cannot get away from the fact there were 625 more nurses working in the Irish health service at the end of April last than there were at the end of April 2016 and the numbers are growing. It is not all about pay. It is also about career pathways. That is why there are measures such as taking on 120 new people to study and train up as advance nurse practitioners this September. I genuinely believe those career pathways will encourage more people to stay in this country.
I would be interested to know how many of those are nurses whom we had to go abroad to recruit at significant expense when, in fact, our own graduates have no interest in staying in this country, as the Minister well knows. Brexit, in this regard, may be the Minister's friend. We understand that a lot of nurses who may have chosen to go to England may be forced to remain here.
When the Minister referred to the conversion of agency staff into directly employed staff, that does not add any extra bodies although it represents a saving to the taxpayer. With regard to the projected figures, I understand that 1,200 was the target by the end of the year. Is the Minister confident he will meet that target? I refer to the 1,200 additional nurses, not necessarily 1,200 recruits, because we must consider the retention as well.
To answer the Deputy's question directly, I am clear that the commitment in the agreement is to have 1,208 additional nurses, not just recruits, working in the Irish public health service.
Deputy Louise O'Reilly is correct in saying we need to do everything we can to keep our nurse graduates here. It is also right, though, and indeed moral, that as a country we would go to some of the destinations where many of our best and brightest left to go to during the economic recession, meet them, make it easier for them to come home and let them know about the opportunities. Certainly, we are getting a positive response in relation to that. I am also grateful that the INMO has offered to assist with that.
In terms of nurse numbers, on 30 April 2015 there were 35,080 whole-time equivalent nurses working in the Irish health service. Exactly one year later, there were 35,924. On 31 March this year, there were 36,436 and on 30 April this year, 36,549. I am the first to acknowledge we have a way to go to get back to the levels we were at but we are genuinely making significant progress.
Proposed Legislation
Margaret Murphy O'Mahony
Question:44. Deputy Margaret Murphy O'Mahony asked the Minister for Health when replacements for the mobility allowance and motorised transport grant scheme will be brought forward; and if he will make a statement on the matter. [29223/17]
First, I take this opportunity to congratulate the Minister on his reinstatement, and my constituency colleague, the Minister of State, Deputy Jim Daly, on his elevation. I will be expecting great things for Cork South-West now. I suppose, for me, it is a case of the devil you know is better than the devil you do not. I wish them luck.
I ask the Minister when the replacements for the mobility allowance and motorised transport grant scheme will be brought forward, and if he will make a statement on the matter.
I thank the Deputy for her question and good wishes. It is timely that the first question I get to answer in the House is for my constituency colleague.
Conscious of the reports of the Ombudsman in 2011 and 2012 on the legal status of the mobility allowance and motorised transport grants scheme in the context of the Equal Status Acts, the Government decided to close both schemes in February 2013. The Government is aware of the continuing needs of people with a disability who rely on individual payments that support choice and independence. In this regard, monthly payments of up to €208.50 have continued to be made by the Health Service Executive to 4,700 people who were in receipt of the mobility allowance.
The Government decided that the detailed preparatory work required on a new transport support scheme and associated statutory provisions should be progressed by the Minister for Health. A Programme for a Partnership Government acknowledges the ongoing drafting of primary legislation for a new transport support scheme. I can confirm that work on the policy proposals for the new scheme is at an advanced stage. The proposals seek to ensure there will be a firm statutory basis to the scheme's operation; that there will be transparency and equity in the eligibility criteria attaching to the scheme; that resources will be targeted at those with greatest needs; and that the scheme will be capable of being costed and affordable on its introduction and an ongoing basis. The next step is to seek Government approval for the drafting of a Bill for the new scheme.
On 26 February 2016 the Government decided to scrap the mobility allowance and the motorised transport grant. In June that year it decided that new statutory provisions would be established to provide individual payments for people with a severe disability who required additional income to address the costs associated with their mobility needs. An interdepartmental group chaired by the Department of the Taoiseach was asked to develop detailed proposals for the operation of the new scheme or schemes, including eligibility criteria and administration arrangements, and report back by October 2013. On 26 November 2013 the Government decided that the work to prepare for the scheme or schemes should be progressed by the Minister for Health. The Taoiseach who set up the interdepartmental group is gone and two Minsters have since left the Department of Health, yet we are still waiting. There is extraordinary annoyance and frustration at the lack of progress being made on the replacement schemes for the mobility allowance and motorised transport grant schemes.
I thank the Deputy for bringing my attention to this important matter. It is worth pointing out that the Government's legislative programme for 2017 includes the Health Transport Support Bill. As the Deputy is aware, the background to it did not involve the Government deciding to scrap the scheme. It was the result of the Ombudsman making a judgment on the operation of the scheme. I take on board the Deputy's concerns. It is a legislative priority for the Government and we intend to progress the Bill.
It is extraordinarily frustrating that there has been no movement on this issue. It is disheartening to see the same reply being given time and again. I have raised the issue many times, but the same reply keeps being given. It is even more frustrating for those who had qualified under the previous schemes. They have simply been left with nothing to help them in their day-to-day lives. More than 1,500 days later, we are still waiting. That is longer than the duration of the War of Independence and the Civil War combined. People with disabilities have waited for far too long for the supports they need and deserve. It is not good enough that they are left to put up with temporary measures. The absence of certainty on the future of these supports is causing immense distress for many. It is yet another example of maladministration and lack of planning. When will the wait be over?
As I said, those already participating in the scheme do not need to have any fear because the payments will continue. The HSE will continue to make monthly payments to all of them. I say as much, notwithstanding the concerns of the Deputy about new entrants to the scheme. It is a legislative priority for the Government. I will take up the matter with the Minister of State with responsibility for disability matters, Deputy Finian McGrath, to try to ensure progress. I will certainly convey to him the concerns expressed by the Deputy.
Health Care Policy
Michael Harty
Question:45. Deputy Michael Harty asked the Minister for Health to outline his views on the Sláintecare report of the Committee on the Future of Healthcare; and if he will recommend that the report form the basis of health reform to introduce a universal single tier health service delivered on need rather the ability to pay [28073/17]
I too wish to congratulate the Minister on his reappointment. Continuity in the Department of Health is important. I look forward to working with the Minister as closely as possible. I also congratulate the Minister of State, Deputy Jim Daly, on taking over responsibility for mental health affairs and care of the elderly, a major portfolio in which I wish him the best of luck.
I am seeking the Minister's views on the Sláintecare report of the Committee on the Future of Healthcare. Will he recommend the report as the basis for reform of the health service and introducing a universal single tier health service based on need, not on ability to pay?
I thank the Deputy for his kind wishes and important question. This is a preview of what I imagine will be a more substantive debate on the Sláintecare report in the House tomorrow.
Supporting the establishment of the cross-party Committee on the Future of Healthcare in June 2016 was one of the first actions I took on becoming Minister for Health. I commend genuinely the great work done by all members of the committee, including Deputies Michael Harty, Billy Kelleher, Róisín Shortall and Pat Buckley, as well as a number of others who worked extraordinarily hard on the committee. Everyone involved across the political divide worked extraordinarily hard. The committee's establishment was agreed to across the House, demonstrating a shared understanding of the scale of the challenges facing the health service, as well as recognition of the need for a fundamental reshaping of our vision and long-term strategy for health care. It should be based on cross-party consensus that does not change every time the Minister, the Government or electoral cycle changes. I have consistently supported this process, which I firmly believe can provide a once-in-a-generation opportunity to transform the health service.
The committee has lived up to its mandate and is to be commended for the significant achievement of developing a future vision, based on political consensus, for the health service. The report is the culmination of a year-long process of unprecedented cross-party collaboration, dialogue and engagement. It is testament to the desire across the political spectrum and the broader stakeholder community to work collaboratively to address the challenges in the health service.
I have been clear in my view since the committee commenced its work that, out of respect for its work, I would not advance major structural reforms until it had reported. It is vital that we now allow time to reflect and deliberate on the findings of the committee. I do not envisage it being a substantial period. I look forward to the Dáil debate on the report tomorrow. I will give full consideration to the recommendations made in the report when I have had the opportunity to hear views from across the Dáil.
The Taoiseach was very clear in his speech to the Chamber last week when he said delivering real improvements in the health service was a key priority for the Government. He has tasked me with preparing a detailed response to the report, including proposed measures and timelines, to bring to the Government. It is my intention to do so following the Dáil debate. I hope to bring a detailed analysis and proposals to the Government quickly.
I have no doubt that the report will be an essential document for all Governments and parties in the fundamental reform of the health service in the next decade. I look forward to talking with colleagues in more detail in the coming days about implementation and about how we can show the public that we intend to make quick progress in the areas where it is possible to do so, as well as how we intend to advance in the more challenging areas.
It is important that the Minister understand the need for health care reform. The public system is not fit for purpose. It is fragmented, disjointed and incoherent. Some areas work reasonably well, but all areas are under pressure and struggle to deliver quality care services. There are lengthening waiting lists in outpatient departments, as well as lengthening inpatient lists for urgent and planned care. Of course, there are also lengthening trolley queues. In addition, there is an increase in the population, with a corresponding increase in the number of patients with a chronic illness or who have complex needs within the community. We must reform the entire health service rather than only parts of it. This process cannot be delayed any longer. The Minister has a responsibility and a duty to deliver health service reform, starting in this Dáil. Delaying reform will only make it far more difficult and costly. There was a common thread in all of the submissions received - that there should be a shift from secondary to primary care services. The reform programme needs to include the entire health service. There is a need for a universal single-tier public health service to cover everyone based on need.
I thank the Deputy.
I think the clock is wrong. I think I had only one minute instead of two.
There was one minute for the first supplementary question.
This was my first, a Leas-Cheann Comhairle.
It is one minute. The Deputy has now almost two minutes gone. He inadvertently got two minutes.
We will have a lengthier time to discuss this issue tomorrow. It deserves and requires more time. The Deputy is correct that I do have a duty to deliver health reform. Clearly I have to discharge that duty in terms of my membership of the Cabinet and the Government. I formally received the report, which I am happy to describe as an excellent piece of work unprecedented in terms of cross-party effort. There are many elements within it that reflect my own thinking, which I articulated when I had an opportunity to address the committee. While I am eager that we put in place health care reform as outlined in respect of Sláintecare, we need to discuss some elements of the report. The Government will have a duty to do its own analysis of the costings, and to put in place implementation structures that can get on with delivering the report. I am committed in that regard.
While a number of elements of the report are in line with long-standing Government policy, such as e-health, integrated workforce planning, and clinical governance, it also puts forward a number of key policy changes, which I welcome. The biggest is the clear indication of a desire to move towards the establishment of a universal single-tier system, where access to care is on the basis on need and not ability to pay. That is going to require the introduction of a universal entitlement to health care services underpinned in legislation, at no or low cost, and the removal of private activity from public hospitals. I am committed to doing this but it is a substantive body of work. That is why it is a ten-year plan.
This report needs to be implemented. It contains strong recommendations on implementation. To drive implementation forward, there needs to be political buy-in. The first requirement we ask from Government is that there be strong political buy-in for this reform. If that is not present, the reform programme and Sláintecare report are not going to get off the ground. Part of that is the provision of legislation to provide accountability, governance and responsibility in our health service, which is sadly lacking. No longer can we have a shrug of the shoulders style of management whereby things that go wrong are blamed on system failure. We must have strong governance underpinned by legislation.
We need to restructure the HSE so that it is decentralised and devolved down to regions. We need new contracts, as Deputy Kelleher said, not only for general practice but also for consultants. We need an implementation office developed very quickly to drive this reform programme forward.
I agree fully on the need for new contracts. It is very important, and not just in the area of general practice. There is political buy-in. Every political party and grouping in this House, bar one, decided to sign off on the report. There is a role for the Government as well. As the committee members have pointed out, while the committee has costed the proposals, it was not its role to decide how to fund those costs. There might be very different views in the different political groupings as to how we might go about doing that. The Government has to look at all of the resources available to it, the fiscal space and all these terms of which we are well aware.
As Minister for Health, I am determined to work with the Oireachtas to put in place an implementation structure to get on with progressing Sláintecare. One other point, which I will discuss further in tomorrow's debate, is the issue of capacity. As a general practitioner, Deputy Harty will know very well that even if we had the funding to provide free entitlement to all general practice services tomorrow, we might not have the capacity within general practice. The sequencing of change is very important if we are to make sure it is a sustainable model. Where there are entitlements, there must also be the capacity of health care professionals to deliver them. That view is shared by many health care professionals around the country.
National Maternity Hospital
Róisín Shortall
Question:46. Deputy Róisín Shortall asked the Minister for Health his plans regarding the ownership of the new National Maternity Hospital; and if he will make a statement on the matter. [27956/17]
It was mid-April when the controversy about the proposed new governance and ownership arrangements for the National Maternity Hospital broke, arising from the disclosure of the Mulvey report. There was widespread public controversy for a number of weeks and, at the end of April, the Minister asked for a month to consider this matter. That month came and went. While I appreciate that the Minister has been busy with other things, we are now three weeks over the deadline. I would like to know what developments have taken place.
I thank the Deputy for her question and her ongoing interest in this very important matter. I would strongly refute the suggestion that the month came and went. As the Deputy will be aware, during that month there was significant engagement between myself, the chairs of the National Maternity Hospital and St. Vincent's, and the CEOs and masters of both hospitals, as well as extensive engagement between the St Vincent's Healthcare Group and my officials.
On 29 May, the Sisters of Charity announced their decision to relinquish their ownership of and involvement with the St. Vincent's Healthcare Group. This decision is an extremely significant development for the health care sector and for the National Maternity Hospital project. It addresses not all but a number of the concerns that were articulated by many. My Department has been briefed on this development. The St. Vincent's Healthcare Group's constitution will no longer refer to the Sisters of Charity and will be amended to reflect compliance with national and international best practice guidelines on medical ethics and the laws of the Republic of Ireland. I know that despite the specific provisions in the Mulvey agreement, there was a concern on the part of some about the potential religious influence being brought to bear on the new maternity hospital, and the potential role of religious interests on its board. The decision of the Sisters of Charity is extremely helpful in dispelling any such concerns.
We need to resolve the issue of ownership. I have made my views clear on this. Discussions are continuing with the St. Vincent's Healthcare Group on the terms of the State's investment in the new hospital and, in particular, arrangements for the protection of this investment. The Mulvey agreement envisaged that further consideration was required of the legal mechanisms necessary to protect the State's considerable investment. My Department is actively engaged in devising suitable arrangements to ensure that these facilities are legally secured on an ongoing basis for the delivery of publicly funded maternity, gynaecology and neonatal services. I expect to be in a position to report significant progress on this shortly and will update the Government and the Oireachtas at that stage. I will also be bringing proposals to Government in the coming weeks for a broader discussion of ownership within the health service and the role of the religious and voluntary hospitals, as has already taken place in the education sector through the forum on pluralism and patronage.
I thank the Minister. He will be well aware, I am sure, of ongoing concerns on the part of the HSE and his own Department in respect of the very unorthodox corporate structure in St. Vincent's Healthcare Group, whereby it is not possible to identify where public money is actually going, or the extent to which there is intertwining of public and private in respect of consultants' use of facilities and spending of public money. Tony O'Brien referred to the private hospital as having a parasitic relationship with the public hospital.
This is a very real issue. The audit done by the HSE is still under consideration. Recently, the HSE announced that it was commencing the second part of that audit, covering the breach of contract arrangements by consultants. In the context of that issue alone, does the Minister accept that it would not be appropriate to add a further public hospital to a very unorthodox, mixed group? Does he agree that it would not be a good idea?
I thank the Deputy for her comments. The structure proposed in respect of the new National Maternity Hospital is envisaged as standing apart from the current St. Vincent's Healthcare Group. It retains the mastership structure. We have had a lot of public discourse and debate about this.
Although I always like to be forthcoming with information, I must be conscious of what I say as we are in the middle of ongoing discussions and negotiations between my Department, the Chief State Solicitor's office and the St. Vincent's Healthcare Group. This is a potential investment of €300 million by the taxpayer. I am absolutely clear in my view that the issue of ownership is of paramount importance. Absolute protection for the State's investment can be achieved in a number of ways.
The Deputy may have articulated a number of ways in which this can happen. A number of ways are being explored and I expect to be able to revert to the matter very shortly when I hope to be able to announce significant progress in that regard.
It was very clear that public concern was centred on two aspects, the first of which was ethos, while the second was ownership. Perhaps the issue of ethos has been addressed, but we do not know because we do not know the further details of the new entity proposed. On the issue of ownership, people were outraged that a publicly owned facility, valued at €300 million, could be handed over to private interests. This was rejected outright by the public and that message came across very clearly. On the use of public hospitals by public patients, does the Minister accept the principle that such a hospital must be retained in public ownership?
It is a broader question than that. I am not sure what the Deputy's view was or what the views of many Members of the House were when the State invested €266 million in the Mater hospital to provide new state-of-the-art facilities, a hospital that is not in the ownership of the State. There are approximately 17 hospitals in the State that are either voluntary or joint board hospitals. There is also the National Rehabilitation Hospital. There are a number of hospitals that have not been owned by the State and for which Governments of various political colours sanctioned projects. As I have described it previously, we have a rich tapestry when it comes to ownership. There are a number of religious and non-religious voluntary hospitals. The reason I want to have a broader discussion is that we need to identify the impact of the Deputy's statement, namely, that the State can only invest in what it owns. That may be desirable but it would not be without consequence. It would be quite significant and have an impact on the overall health budget. On the building of a new national maternity hospital, the position is somewhat different. I take the issue of ownership as being very important in that regard and have heard many people speak very clearly on the issue. The views of members of the public are quite clear. I hope to be able to report progress on it shortly.