The planned new co-location hospitals will be permitted to establish their own minor injury units and urgent care centres, the Department of Health has confirmed, in a document provided to the current talks on a new contract for consultants.
The document says private patients will have access to these minor-injury units and urgent-care centres, but the operators of these facilities will have to find their own staff.
In a paper containing a series of answers to questions posed by medical organisations, the Department of Health maintains that no category of public hospital staff other than a consultant with the proposed type B contract or an existing category II contract would be allowed to work in a co-located centre.
The Department of Health says it is not envisaged that non-consultant hospital doctors from a public hospital would provide care in a co-located hospital.
The Department of Health, in its paper, appears to be drawing a distinction between minor injury units/urgent care centres and full-scale A&E departments.
In a speech on co-location in the Dáil on June 26th, Minister for Health Mary Harney ruled out the development of A&E units in the new private facilities.
"There will be only one accident and emergency department at each public-hospital campus in which every person will be seen in order of medical need. There will be no public and private distinctions and the new facilities will not be allowed to operate parallel [ to] accident and emergency departments," she said.
The Department of Health paper says the co-located hospitals will have their own "hot" laboratory for dealing with tests as well as "the full range of diagnostic modalities required in a high-tech hospital".
The document says the co-located hospital will be required to provide a full range of services, including critical care on a 24-hour, 365-day basis to all private patients who are currently in the public hospital.
"If, in an emergency, the patient requires the services of the public hospital, the public hospital will provide the necessary service and will recover the full costs involved from the private partner," the paper states.
The paper also says the lease on the State-owned land on which the co-located hospitals will be built will run for 65 years.
Under the controversial co-location policy, the Government argues that it can provide up to 1,000 additional public hospital beds in a more cost-efficient and speedier manner than through conventional means.
As part of the plan, existing beds in public hospitals which are designed for fee-paying patients would be transferred to the planned new co-located private hospitals, which are to be developed adjacent to a number of public facilities. This will free up the formerly private beds in the public hospital for public patients.
Initially, six co-located hospitals will be developed in Sligo, Limerick and Waterford as well as at St James's, Beaumont and Tallaght in Dublin. Developers can avail of tax allowances up to 47 per cent of the capital cost of building the co-located hospital.
The Minister told the Dáil in June that the value of the capital allowances used would represent the capital cost to the State of the new co-located hospitals.
Ms Harney said this would be less than half of the construction cost as relief would be claimed at the marginal rate.
"For every €1 million in allowable investment, the gross tax cost to the State would typically be €455,000 at current tax and PRSI rates, spread over seven years, without taking account of tax buoyancy from the activity generated," she added.
Ms Harney also said the current costs of the project would include about €80 million per year in income forgone from private bed charges raised by six public hospitals.
She said that to offset the loss of this money, the State would receive leasehold income from the land, a profit share from the operator of the new hospitals and a share of refinancing gains over the lifetime of the project.
