While it must be acknowledged that there have been a lot of improvements, the overwhelming atmosphere in most public hospitals is of dowdy, overcrowded wards, long waiting lists for sparse diagnostic facilities, nursing staff too rushed to give the amount and quality of attention the sick and scared need, consultants divided between public and private practice and . . . an important factor though seemingly trivial . . . incredibly unappealing food.

As she goes ahead with plans for more private hospitals to be built in the grounds of 10 public hospitals, Mary Harney assures us that the Beacon hospital's 61-slice CT scanners, 183 comfortable beds and image-guided radiation therapy will be shared on a 50-50 basis between public and private patients.

The hospital itself insists it will not "cherrypick" easily treatable patients or patients wanting profitable cosmetic surgery. At the same time, its A&E department will be open only from 8am to 8pm, and while it will take in people with chest pains . . . unlike the new VHI emergency clinics which offer treatment for only relatively minor symptoms . . . it will not see people with serious injuries from car crashes.

Now the debate over private hospitals versus public healthcare and the relationship our legislators define for them is complex and one we certainly need to discuss fully, not just in the Dail but as a community. But it seems the health minister has taken an ideological decision about the future of our health service and decided to do a solo run with little or no discussion about the implications and certainly no wider mandate from the electorate.

The decision to allow the private sector to build on public-hospital land was never part of the 2001 health strategy, though the provision of 3,000 acute hospital beds and 200,000 medical cards was.

Harney argues that it costs less to encourage the private sector to build and run hospitals, which will free up about 1,000 beds currently used by private patients in public hospitals. If public patients need more beds and services, then the state can pay for them in private hospitals, but only as they are needed. You save money and get a better service.

Now all of this may be true, but nobody knows.

Nobody has done that current 'must-have' of the moment, a cost-benefit analysis; nobody knows if the electorate wants to hand over land, tax breaks and big fees to private hospital developers; nobody knows if we'd prefer to build community care beds for the elderly on that land;

nobody knows what the ultimate consequences of such a major policy decision will be for the health service itself.

The Labour Party is right to raise questions about this new policy. The health service, as Pat Rabbitte says, is not a commodity that can be bought and sold for profit, it is a community service. It also provides the training for the next generation of doctors. It provides the research and the back-up laboratories on which modern medicine is built .

The public sector is very often the point of entry through which most people are channelled and, while those with straightforward injuries or ailments may well be capable of treatment in smaller private clinics, those with difficult diseases or multiple ailments will need the full resources of the health system.

At the moment, the private and public sectors are inextricably intertwined because consultants are allowed to treat private patients in public facilities. This is far from satisfactory and the whole point of the new contracts being thrashed out is that consultants will be asked to give far greater input into public-hospital patients.

Is it right, therefore, that, with an already unfair two-tier system, we plunge into adding extra layers of privatisation?

Maybe we will decide that's what we want . . . the health service patently needs reform. But so far nobody is asking if this is the right way.