Does the Taoiseach acknowledge that all expert opinion agrees that the greatest challenge in our health service is the two-tier system? Does the Government accept this is the cause of the fundamental inequality in our health service? Public patients are treated as second class citizens, languishing in the community, languishing in queues and waiting for access to hospitals. The Government's latter day response is the Harney plan to give tax incentives to private developers to build private hospitals on scarce public land. The two tier divide at the heart of inequality in the health service will be worsened by the plan to build super private clinics on scarce public land. Where did the Minister for Health and Children get the mandate for this gearshift towards medicine for profit? It was not included in the manifesto or in An Agreed Programme for Government. It is a reversal of the health strategy published by the two Government parties.

Have contracts been prepared and will they be signed on the eve of the election to hand over public sites to private developers and investors to make profit from health, which is a community service and not a commodity? Is it the intention of the Government to sign such contracts in advance of the general election?

One aspect of Government policy is to increase the number of beds, which is needed. There are 52 acute hospitals and there is a problem with seven or eight, and two or three at any one time, where we require more beds so that acute hospitals can refer patients who do not require intensive care to other locations. We must deal with the bed situation, the biggest problem in the health service. Arising from this, the co-location initiative was to invite private investment to free 1,000 beds now in public hospitals. This will add more quickly to the overall capacity. These services will be bought for public patients. If Deputy Rabbitte asked if I was in favour of co-location beds on the sites of public hospitals — he is right to say the sites are scarce — that would never be accessible to any public patients and would not stand down the 1,000 beds designated as private or semi-private in public hospitals, I would be against such a proposal. That is a clear statement. The Deputy asked if I was for or against a proposal that takes over 1,000 beds currently in designated public hospitals being taken up by private patients, creating at times a delay and difficulties for public patients coming in I am not against that. That is a sensible thing to do.

In regard to co-location I will cite the example I know best for obvious reasons. For over 120 years there has been co-location on the site of my former employment, the Mater Hospital, where the public hospital operated as such and the private hospital has worked since 1860. There is no difficulty there. The doctors on the campus move from one hospital to another.

That does not solve the problem.

Under the terms of their contracts they can do that. It works very effectively. I do not see a difficulty in that happening. In modern life to have co-location of senior staff is an enormous help.

It equates to inequality.

It creates equality for public patients not inequality.

There are no public beds in private hospitals.

I do not see an extension of that being anything other than helpful. In fact what has happened recently, whether with Whitfield in Waterford, the new private hospital in Galway, or private hospitals——-

That is gone now.

These hospitals are increasingly using their facilities for public patients too.

They are doing so at three times the price.

Allow the Taoiseach to speak without interruption.

The Ceann Comhairle is as bad as the Taoiseach.

When the Opposition Deputies do not like the argument they interrupt.

We do not believe the argument.

The consultants use the facilities in private hospitals for public patients. Last week I attended an event in the Mater Hospital for the arrival of new cancer equipment. This equipment is not available anywhere else on these islands, not in Scotland, England, Wales or Northern Ireland. It has come first to the Mater Hospital. One quarter of the patients using it will be public patients. I see no difficulty in that.

It is not a good idea to separate them totally with Chinese walls. I am very clear about that. A campus hospital, with private and public hospitals, with the proper facilities and co-location, is good for public patients. That is my view after seeing the argument from both sides, as an administrator, an accountant, a practising politician, and Joe Public, as well as being Taoiseach.

The Taoiseach of course did not answer the question I asked him about the contracts.

I will answer that question.

He has made clear that the modern Fianna Fáil is in favour of reinforcing inequality.

That is Deputy Rabbitte's spin.

That is essentially his point. I am not talking about private hospitals. We have always had them. That is not the issue. If one wants to pay for a private hospital one should go ahead and pay. I am talking about the inequality at the heart of our existing system whereby public patients are treated in an inferior way and must wait in never-ending queues.

Yes, absolutely.

The Taoiseach has given his blessing to the construction on public land of private hospital beds when he knows well that he cannot stop any private patient occupying a public bed. The Taoiseach knows that and he knows there is hypocrisy at the heart of the aspiration in the negotiation with consultants which reinforces the two-tier system. The Taoiseach will permit further cherrypicking of the simple procedures that are profitable and leave the complex medical specialisms and teaching obligations to the public service, facilitating a migration of personnel to the private sector. That is the nature of this plan. Fianna Fáil ought to hang its head in shame for going along with an idea clutched in desperation out of the ideological air by the Progressive Democrats.

Will the Taoiseach sign those contracts? If there is a change of Government, and I believe there will be, we will not proceed with those contracts. The Taoiseach should say clearly whether he is going to sign them before the election.

Hear, hear.

I apologise for not answering Deputy Rabbitte's first question. I am not aware of any contract. The Deputy can table a parliamentary question to the Minister for Health and Children. I am aware of no contract at any stage of negotiation.

I am not suffering an ideological problem, but Deputy Rabbitte is.

Exactly. It is Deputy Rabbitte's problem.

The Taoiseach has back up from the PDs anyway.

They might never see any other talks.

I listened carefully to Deputy Howlin's leader can he please just give me more than ten seconds without interrupting? We have a good medical service——

Have we?

——and a good health service for public patients.

Tell that to the people on trolleys.

There are 34 people on trolleys.

Yes, 400,000 plus. It is Deputy Cowley in Mayo.

The advantage in our system is——

——that some people get very rich from it. That is the advantage.

Deputy Burton should allow the Taoiseach to speak without interruption. She is not the leader of her party. Deputy Rabbitte is entitled to hear the reply to his question.

We wish there was a reply.

People die while waiting with us.

The advantage in the system is that medical consultants can work in private and public hospitals. It is my absolute conviction that the public patient gains most out of that system. A high-powered consultant who has worked anywhere in the world, comes back to this country and operates in public and private hospitals in our system.

The fact there is co-location on the site whereby some beds are designated as private, and there is a public hospital too, for out-patient clinics, ward rounds, surgery, pathology, radiology and a host of other services we get the benefit of top class consultants who can work on both sites. That is an excellent system. It means that Joe and Mary Bloggs who have little other than welfare, or Mr. X or Mr. Y, who are millionaires or billionaires, can be seen by the same consultant. It happens every day in our hospitals, very successfully.

That is a joke.

People wait five years to get an out-patient appointment.

Where does the Taoiseach live?

It is a pity the Labour Party does not even know how a public hospital works in this country.

Poorly.

The Deputies laugh because in their ignorance they do not understand the system.

We are laughing at the Taoiseach's ignorance.

Some of the most eminent consultants in this country, and it is not for me to argue their case because I am negotiating trying to change a contract with them but that is another point, give their service in public out-patient clinics looking after Joe and Mary Bloggs day in and day out. I would like them to do more of that and we are trying to negotiate a contract on it.

Deputy Rabbitte unfortunately does not understand the system.

He understands that it does not work.

He understands it all too well.

If Deputy Rabbitte has announced this morning, and I believe he has, that he is opposed to it and that if he is elected his position is the current——

Is the Taoiseach going to sign the contract?

I have said I have no contracts.

The Taoiseach has signed contracts for every community centre around the country.

There are no contracts. The position is that Deputy Rabbitte wants to stop the practice of medical consultants in this country working for public patients. Shame on him. That would create the greatest inequality we ever had.

Apartheid in the health service.