I am conscious that this is the Taoiseach's last time, perhaps ever, to answer Leaders' Questions.

I promise the Deputy that is wishful thinking.

I know how important the meeting with Dr. Paisley and Mr. Adams is in the morning, although it is regrettable it was not possible to schedule it around Leaders' Questions. I will make one last attempt to ask the Taoiseach, as Head of Government, whether he will cause these contracts to be signed to build super, private clinics on the campuses of public hospitals. I have been getting a volume of letters and e-mails on this issue. I suspect the Taoiseach has also been receiving such correspondence, as have his backbenchers, given that they are so disquieted about this. It shows the depth of concern among health professionals and the public about the new drift of Government policy. I will read a paragraph from one consultant, which fairly much reflects feelings on this matter. Talking about the private capacity, he states:

They have a real potential to run down the public system and can reduce it to providing core services such as complex medical problems and providing care to acutely ill patients who cannot be catered for in any private system. So the profitable areas will be creamed off to be done in the private system. In addition to that, they have a disastrous effect on medical training. In short, I agree they will not solve any of the current problems. At present, what is happening in our acute hospitals is nothing short of a national crisis. The A&E departments are not able to cope and figures that are trotted out by the HSE are very dubious.

The Deputy's time has concluded.

I am glad I had finished the quote then. That quotation is fairly representative of the view of health professionals in nursing and other white collar professional grades, consultants and doctors. Last week I quoted for the Taoiseach the statement on behalf of accident and emergency consultants who said that not only would we have a two-tier health system but we would also have a two-tier casualty system. The Taoiseach tore up his own health strategy to provide 3,000 beds in favour of this new shift towards for-profit medicine. The Irish people do not want an American for-profit health model. They know that we badly need the land concerned to provide community care and step-down beds to take people who are inappropriately occupying beds in acute hospitals out of the hospitals, thus putting them into that kind of care and freeing up beds in the acute hospitals. The Taoiseach is going in the opposite direction, however. Everybody is counselling him against it, including his backbenchers who are excessively glum about this, and properly so. As this is likely to be the Taoiseach's last time on Leaders' Questions, will he permit that, as Head of Government, to satisfy a crazy Progressive Democrats ideology?

On the Deputy's first question, I understand that 90% of the documentation to enable bidders to tender has gone out to the individuals. The formal quest for tender is on the HSE board's agenda for Friday week, 13 April. The formal bid for tender would not issue until after that meeting, so that is the formal position.

I agree with the Deputy that acute hospitals have their difficulties, in spite of the enormous amount of resources, staff, equipment and capital they have received. Part of the solution is to contract nursing home beds in the private and public sectors, and building step-down facilities, which is happening in parts of the country. In other areas, such facilities are required. I do not believe this initiative cuts across that. The aim of the initiative is to transfer private activity from within the public hospital system to new privately-financed and managed hospitals, thereby freeing up 1,000 additional beds for public patients. The new facilities will have to meet specific requirements, for example, the ability to admit private patients 24 hours a day, seven days a week from public hospitals, accident and emergency departments and GPs, with the capacity to treat all patients currently catered for in the public hospital system through joint clinical governance. I accept the Deputy's point that people have written to him about that, but they are not talking about what the HSE is proposing. The HSE has made its position absolutely clear on the accident and emergency departments, GP and 24-hour issues. People may have a point, but it is not what the HSE has said.

Obviously, the HSE will make its own decision at that board meeting but my understanding is that it has reduced the number. The executive is looking at the following hospitals: Limerick, Waterford, Cork, St. James's, Beaumont, Connolly — which is Blanchardstown — Tallaght and Sligo. There will be a rigorous financial assessment of the proposals, which are subject to planning, including the value of the public site and the cost of any tax expenditure foregone. As I said previously, the lease of public land will be on a commercial basis, it will fully protect the public interest and there will be full adherence to public procurement law and best practice. That is where the negotiations currently are and the next move will be on Friday week at the HSE board meeting.

Is the Taoiseach saying that 90% of the bidding documents have issued and that they will be back by the time the HSE board meets on Friday week? Does he expect a decision to be made on Friday week? What is the process after that? What is the duration of the lease in question? How does it materially matter if a building is physically constructed for the next 99 years on this scarce public land? How can the Taoiseach say that professionals in the service do not know what the HSE has in mind? They include people who work at the coalface, consultants, those who have arguably money to gain from working in the private sector and who argue that the migration of personnel will make the public health service worse. They say it will damage the two-tier divide in our service, creating a new two-tier divide in accident and emergency units.

The Deputy's time has concluded.

How can it be argued that these people do not know what they are talking about? It is not a HSE initiative. As recently as 29 March this year, the Minister for Health and Children made a statement in the House and Government backbenchers should read up on it. They cannot go around the doorsteps whispering that this is a Harney-McDowell frolic. The Minister, Deputy Harney, stated, "In July 2005, following Government approval, I issued a policy direction to the Health Service Executive to develop co-located private hospitals on the sites of public hospitals".

The Deputy's time has concluded.

Those are the Minister's words. It was a ministerial instruction.

This is Government policy, not a HSE initiative. Will the Taoiseach tell us whether the investors are likely to get the go-ahead at the board meeting on Friday week?

What is the position on the consultants' contract? I understand that this relevant aspect of the public-private element of the common contract will emerge largely unaltered in which case this would be inoperable in any event.

Regarding the process, 90% of the documentation to enable bidders to tender has been sent and the formal request for tender is on the HSE board agenda for Friday week. Formal tender bids have not been issued and will not be issued until after that meeting.

I wish to reiterate two points I have made on many occasions. I have seen letters on the argument relating to accident and emergency services. The new facilities will have to meet specific requirements including the ability to admit private patients 24 hours a day, seven days a week from the public hospital, from the accident and emergency department and from general practitioners, and they will have to have the capacity to treat all patients currently catered for in the public hospital and through joint governance. There will be one entrance to the accident and emergency department on the campus so the idea that people will be refused, as the Deputy suggested last week and today, is false.

The accident and emergency consultants say that.

It is not true. There will be one entrance to the accident and emergency service on one campus and there will be joint clinical governance.

Private to the right, public to the left.

The accident and emergency consultants' point does not hold up in this regard. This is what currently happens in co-located hospitals and there are no accident and emergency services in these hospitals at present. This has worked in many hospitals, such as the Mater Hospital, St. Vincent's Hospital and in Cork, for many years. The aim of the initiative, to transfer private activity from the public hospital system to privately financed and managed hospitals and free up 1,000 beds, has not changed. As I said here recently when discussing infrastructural issues, the private sector will build this more quickly, by a matter of years, than the public sector, depending on the contract the HSE presents based on technical legal advice. The length of time involved in getting from A to B on building matters through public procurement contracts is too great.

The Taoiseach is in charge of such matters.

Speed it up.

We are speeding it up. We are allowing the private sector to build in these locations. Several other hospitals were cleared some years ago and jumping through all of the hoops creates much of the difficulty, alongside a rising population.

This is quite an admission of failure.

I have made this admission several times. There has been a substantial increase in the number of beds, it is in the region of 1,482, but it is not enough. This provides a quick way to build and to move private patients from public hospitals to private hospitals on co-located sites with joint clinical governance. If I thought this process would bring about a two tier health system or create difficulties I would not be so supportive of it.

What does the Taoiseach think will happen?

I will not argue with Deputy Rabbitte.

I ask that the Taoiseach argue with me.

I will not. I do not see how private patients in public beds help public hospitals.

They are entitled to public beds.

It is preferable that a private patient be treated in a private hospital on a co-located site. I do not see how this can damage the health service

There are those who are blind and those who will not see.

This system has existed for some 100 years on a number of sites of co-located hospitals in the country.

That is not the case.