Clare Daly (Dublin Fingal, Independent) | Oireachtas source

I move amendment No. 1:

In page 8, line 39, after “Office” to insert “and, when it is created, the index prepared and published under section 51L(2)”.

As I was saying informally, this is incredibly important legislation. I am relieved we will not take Report Stage in advance of the recess because, in some ways, it is a little unusual that the pre-legislative scrutiny of this Bill was undertaken by the health committee and not this committee. We therefore find ourselves having to have a detailed discussion about a very important Bill on Committee Stage, so I ask for a little forbearance in dealing with some of these issues because they are important and we will, sadly, have to spend some time teasing them out on this Stage.

This group of amendments relates to the periodic payment order. We raised on Second Stage the fact that if we do not link the periodic payment orders, PPOs, to the actual cost of health care, we run the very real risk of people who have been catastrophically injured by our health service not receiving the funds they need for their care through their final days. The original recommendation regarding indexation of PPOs, which was unanimously endorsed by the judicial working group on medical negligence, was that an earnings and cost-related index would be introduced to act as a guide for the periodic payment orders. Sadly, the Bill before us does not do this. It gives us a harmonised index of consumer prices, as published by the Central Statistics Office, with no special provision for an index of care costs. Therefore, what we see in the Bill is the exact opposite of what was unanimously recommended by the judicial working group, which is unfortunate.

The working group also pointed out that the Department of Finance, in its paper on periodic payment orders indexation, noted that an index based purely on either the CPI or the harmonised index of consumer prices would not directly take account of wages, and that this was critical in dealing with situations where people's after care was going to be factored on. The paper noted that over the longer term, the index should give the best outcome for recipients. That is what we are arguing for here. With our amendment, we are trying to find a middle ground between the various recommendations. The CSO's quarterly earnings survey would not take into account changes in the cost of medical devices or assistive technologies, medical treatment and so on and would not be enough to properly index PPOs in our opinion. We are proposing that within a year of enactment of this section, the Minister would publish or cause to be published an index that tracks the following: earnings in the nursing and care sectors and such other sectors as appear to the Minister to be relevant to the indexation of PPOs; the cost of medical treatment in this jurisdiction; the cost of mechanical or other health aids and appliances in this jurisdiction; and such other costs as appear that Minister might think would be relevant. That index shall be used along with the HICP to calculate the rate of PPOs. The extra year has been provided for to allow things to bed in and give some idea of the types of fluctuation, if any, that might occur in the costs that are being measured.

I appreciate that the Bill does provide for a review of the use of the HICP after five years, and for the drawing up of a more relevant index at that time if the Minister so wishes. The Bill as it currently stands, however, is too wide open in that regard. There is no obligation for such a review to take place or for a change to take place following a review. It is too big a risk. Five years is way too long. After the five years, the review could take a year or two years. How long would it then take for the new index to be bedded in? What would happen to the people who are subject to these orders in the meantime? It is not an exaggeration to say we could be talking about eight years before a new index would be created. That is not acceptable for the people whose categories we are dealing with. In its current form, the Bill provides no guarantee that any new or better index would be created. There is no obligation to provide it and the Minister might not even bother to do so. It is too risky. Our amendments will bring certainty to the situation. Given the recommendations of the bodies that surveyed this already, that is particularly important.