Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the presentations. At the outset, I congratulate the people who have been appointed to the positions of directors, even though in my contribution during the debate on legislation I said it should have been an open competition. I am definite the successful candidates would have come through the process anyway. I wish them well in their positions, which will be quite challenging.

The following point struck me when Mr. Tony O'Brien was speaking about patient safety on 14 April. We know that seasonal factors cause pressures and pinches in accident and emergency units and admissions to hospitals. It is very alarming when another process must kick into gear because of patient safety to address difficulties in getting people to hospital. I refer to the change in the designation of beds under the Fair Deal scheme. There are major concerns that the Fair Deal system and the provision of beds for people in long-stay facilities is under major pressure and stress. It must be dealt with in the short term and the medium term. Looking at the demographic profile and the ageing population, it will be a major challenge in the years ahead. We are now in a delicate position in which accident and emergency units are dependent on another section giving up its bed designations, which are for vulnerable people, elderly people and those in the later stages of life. They are being shifted sideways for a period until the pressure is off the accident and emergency unit.

Comparing the profile of waiting lists by month and year makes the reduction seem successful. However, looking at December to April, it is clear that the pressure is significant in terms of admissions and treating patients in hospitals. It is a worrying development and the trends are not improving. From December 2012 to April 2013, in every single category, there was an increase in waiting lists. We can take account of seasonal factors such as influenza, but the bottom line is that the trend is beginning to go the wrong way. Major advances were made last year, which I am not disputing, but the alarm bells should be ringing in the HSE and the Department of Health in dealing with this worrying and continuing trend. I know €80 million extra has been put into the special delivery unit to try to deal with it but the fundamentals are very worrying. Perhaps this point can be discussed and elaborated on with regard to what can be done at this early stage of the year to address it.

With regard to the broader debate on the health service and funding, we have had the changes in the development of hospital groupings and the transition to trusts. We talk about free GP care, on which the Minister of State, Deputy White, will bring forward proposals in the next couple of weeks. We are still waiting to discuss how to fund this. While the universal health insurance model will be adopted, we are still waiting more than two years for the White Paper. There is increasing concern that the private health insurance market in the country is in a state of collapse. That will be an underpinning factor in any universal health insurance model. Mr. Colm McCarthy recently published a report on the pressures on private health insurance and we have also been raising the point consistently. There seems to be a view in the Department of Health that the VHI is dictating Government policy on private health insurance. The witnesses can correct me if I am wrong. The Health Insurance Authority, HIA, has made recommendations that have been either summarily dismissed or ignored and certainly not implemented. How long more can we sustain talking about hospital groups, hospital trusts, funding reform and governance structure changes when the basic fundamental that will underpin all of this is universal health insurance? The universal health insurance model proposed by the Minister is based on private health insurance companies providing a suite of care for citizens and competing with hospital trusts to do so. There is no point in beating around the bush; it is in crisis. We need the publication of the White Paper and a mature debate on the private health insurance market and how we will fund the system we are all talking about.

In the Dáil many other Members and I call for more medical cards, swifter action in accident and emergency departments and so forth. However, the one fundamental issue not being discussed, because we have no White Paper, is universal health insurance and how it will be funded. This issue is of particular concern because of the fact that the private health insurance market is in crisis and it is not only me who is saying this. It is a simple fact. The statistics and figures show this clearly in terms of the numbers reducing their premium payments and cover and the numbers who have left the private health insurance market entirely. That profile is increasing, as opposed to decreasing. We talk about stabilisation in the economy and the unemployment figures, but there is no stabilisation in the numbers leaving the private health insurance market. That will have an enormous impact in placing further pressure on the public hospital system prior to implementation of any universal health insurance model.

On the issue of VHI, a recent report states the more the cost of private health insurance cover increases, the bigger the hole in the company's balance sheet and because of the capital and solvency ratio requirements, that hole will have to be filled by the taxpayer at some stage in the near future. This issue must be addressed as soon as possible. As premiums go up, the balance sheet of VHI deteriorates and it will be up to the taxpayer to invest in the company, regardless of what model of universal health insurance is eventually adopted.