If things go according to plan, by the end of this week one of the Republic's major hospitals, the Mater in Dublin, will have completed the closure of a fifth of its beds. It is just one of many public hospitals where drastic action is being taken to get back in the black. A service that was already inadequate to the point of daily crisis is shrinking, writes Fintan O'Toole.
Charlie McCreevy has an explanation for all of this. He sees the public health system as a black hole into which he is no longer prepared to pour money. "We have to get effective management and get value for money . . . We can't keep going like this. The Minister for Health and his officials are obliged to live within their allocation."
This is fair enough as far as it goes. The deficit the Mater it is trying to make up by closing beds is €18 million. It was built up, incidentally, by the appalling recklessness of actually treating public patients who needed operations, even though their needs could not be met within the allocated budget. But it is almost certainly true that €18 million could be saved in the public health system, most obviously by reforming the ridiculous health-board system.
But it would be even easier to find the €18 million the Mater needs by applying the same kind of scrutiny to the off-the-wall craze for private provision driven in large measure by the same Charlie McCreevy. Two examples of the insanity of the privatisation ideology in the health service will suffice.
Recently the Comptroller and Auditor General published a report on what seems like the most boring subject imaginable: the multi-storey car-park at Beaumont Hospital in Dublin, built in 1998. This facility created just 230 new parking spaces, at a cost of €8.6 million. The work was done by Howard Holdings plc, a British property company, which in return gets most of the revenue from parking fees until 2011. The developer also got, thanks to McCreevy, substantial tax breaks which allowed him to write off much his costs. According to the C&AG, this ended up costing the public between €9 million and €13 million more than if the car-park had simply been built as a public project. So, if we take a figure of €11 million as the middle of the range, we're already more than halfway to the Mater's €18 million.
Now let's take another McCreevy special. Just as the Finance Bill, which gives effect to the Budget, was being wrapped up in the Dáil, he introduced a sudden amendment giving new tax breaks to private hospital developers. As he explained, it was "devised as a result of a meeting I held last November with certain constituents". While McCreevy has been insisting that public health spending be subjected to the closest scrutiny, this measure got none at all.
The Minister read the amendment and very roughly outlined its origins, though without giving any indication of the cost to the Exchequer. The entire debate then went as follows:
Ms Burton: Who are the promoters?
Mr R. Bruton: I wish to speak . . .
Ms Burton: I indicated first. Who are the promoters and who did the Department meet on February 24th? Who were the representations from and to what kind of hospital facility is the Minister referring?
Mr R. Bruton: Why is the Minister including passive investors in this concession?
Mr McCreevy: I am not.
Mr R. Bruton: The Minister said he was.
Mr McCreevy: I am including the existing schemes, subject to the overall limit of €25,000.
Mr Rabbitte: Who is this doctor we heard about?
Mr McCreevy: He is a doctor in my constituency. He is an ordinary GP situated in the Naas area whose name was given to Deputy Stagg. He may even be a supporter of the deputy.
Mr Ó Caoláin: I object to the wording of the question that is being put, that the Bill is hereby passed. We oppose passage of the Bill and ask the Chair to correct the declaration that the Bill is now being passed. That is not the case.
Acting Chairman: As it is now 1.30 p.m. I am required to put the following question in accordance with an order of the Dáil of this day: "That the amendments set down by the Minister for Finance and not disposed of are hereby made to the Bill, Report Stage is hereby completed and the Bill is hereby passed."
And that was the full extent of the public scrutiny of the kind of health spending that Charlie McCreevy wishes to encourage. The cost to the public purse is at least €9 million, and could rise to €63 million depending on the number of private hospitals built. Put that €9 million with the €11 million wasted on the ideologically-driven folly of Beaumont's car-park, and there's more than enough money to keep the Mater's wards open. But then, they'd only waste it on operations for useless people who don't have the entrepreneurial spirit to avail of tax breaks.