Róisín Shortall (Dublin North West, Labour)

I thank all of the Members who engaged in the debate. The provisions of this Bill are exclusively technical in nature, providing for a one-year extension of the interim scheme of age-related tax credits and the community rating levy for 2012. It includes several small modifications to the scheme to allow for a more precise level of support for community rating. That is the purpose of the Bill and it does not pretend to do anything more than that. It simply deals with a situation that must be dealt with for the coming year. The broader issues in regard to risk equalisation will be dealt with over the course of the coming year by the Minister for Health. The concept of risk equalisation will be more vital than ever in the context of a universal insurance health system, and the programme for Government includes a commitment in this regard.

Section 2 of the Bill amends section 6 of the Health Insurance Acts 1994 to 2009 by providing a revised definition for "age group" and a new definition of "type of cover". These definitions will facilitate the provision of information broken down by each year of age and also by specific health insurance contracts.

Section 3 amends section 7 of the Act to provide for more detailed information returns to be submitted by health insurers to the Health Insurance Authority. The information returns will be broken down further by each year of age, as required, and also by type of health insurance cover. That will provide very important data to which we do not currently have access. In addition, regulations made under section 7 may require separate returns in situations where the benefits payable under a type of cover have materially changed.

Section 4 amends section 7 of the Act to provide broader scope to the Health Insurance Authority in terms of using additional relevant information alongside the formal information returns submitted by the health insurers. This will assist the authority and the Minister in performing their respective functions under the Act.

Section 5 amends section 470B of the Taxes Consolidation Act 1997 to make the necessary changes required to extend to 2012 the age-related tax credit in respect of private health insurance premia paid by persons aged 50 years and over.

Section 6 amends section 125A of the Stamp Duties Consolidation Act 1999 to provide for the continuation in 2012 of the collection of an annual levy on health insurance companies based on the number of lives covered by policies underwritten by them.

I am in complete agreement with the many comments of Members in respect of the unfair nature of our health service. It is because both parties to this Government are so concerned about the unfair nature of the health service and the great difficulty which so many people encounter in accessing the service and the unacceptable delays involved in accessing vital services that this Government is committed to introducing fundamental reform to the health service. Both parties in Government had substantial policy documents on the health service prior to the election and in the context of the negotiations for the programme for Government, the health area was the area of most concern to both parties. A substantial element in the programme for Government deals with the kind of health reform programme to which the Government is committed. I wish to make it clear there is no argument in this regard. The current situation where many aspects of our health service are dysfunctional and where it operates in an entirely unfair manner, is completely unacceptable to this Government. This is the reason we are so determined to introduce the kind of fundamental reform that is required in order to introduce a fair system.

The aim of the reform is to deliver a single tier health service which will ensure equal access to care, based on a person's need and not on their income. The programme for Government provides for this in a universal health insurance context. We are realistic in stating that these reforms cannot be introduced overnight. They are major reforms. What is involved in turning around the big ship of the health service requires very detailed preparation and very intensive work over a period of time. It is for this reason we are setting as an objective the introduction of universal health insurance at an early stage in a second term of government. If we suggested it could be done this year or next year, it is quite clear we would not be able to deliver such a commitment because it is not possible to do so in such a short timescale. For this reason we are being ambitious but also realistic in setting a medium-term timescale in order to introduce full universal health insurance. This is the responsible attitude for the Government to take and it is realistic.

However, there are a number of important stepping stones along the way and each of these will play a critical role in improving our health service in advance of the introduction of universal health insurance. First, significant reform of the acute hospital system is planned. The special delivery unit was established in June 2011 to unblock access to acute services by improving the flow of patients through the system. It undertook its work to put in place a systematic approach as a priority to eliminate excessive waiting times in emergency departments. This is probably the one major complaint we hear from our constituents and it was identified as an absolute priority. The special delivery unit is establishing an infrastructure based on information collection and analysis, hospital by hospital, so we can know the situation in real time. It is quite incredible that this information is not available to us but new systems have had to be implemented in order to collect this important data. This will allow us to begin to embed performance management into the system in order to sustain shorter waiting times. If we have learned anything over the past decade, we should have learned that throwing money at problems in the health service will not solve those problems. We need to introduce fundamental reform to which the Government is committed but we need to have accurate data systems in place in order to be fully informed. It cannot be a question of money going into a black hole without knowing what that expenditure is achieving.

The establishment of the special delivery unit necessitates alterations in the current role of the National Treatment Purchase Fund, whose resources have been refocused to align closely with the work of the special delivery unit and to allow for a progressive improvement in the performance of the country's hospitals. The National Treatment Purchase Fund is proactively working with the special delivery unit and the HSE to achieve the best possible results for patients. The National Treatment Purchase Fund is working to support hospitals in the delivery of a 12-month maximum waiting time for inpatient or day case surgery by 31 December 2011. The Minister for Health, Deputy Reilly, has stated on a number of occasions that he is committed to meeting that objective. We expect to be able to move forward to reduce further that waiting time, year by year.

A further critical aspect of reform of the acute hospital system is the implementation of a new, more efficient funding system for hospital care which will be a mechanism whereby money follows the patient. It will include a purchaser and provider split, whereby hospitals will be established as independent, not-for-profit trusts. Various initiatives to facilitate achievement of the money follows the patient funding system are already under way. These include a patient-level costing project to track resources actually used by individual patients in hospitals and a pilot project on prospective funding of certain elective orthopaedic procedures at selected sites.

We have to know that an amount of money being spent on particular procedures is providing value for money. For instance, if a block of funding is given to a hospital we will know how many hip operations this money will buy. It is not just a question of allocating a lump sum of money to a hospital and hoping it will carry out as many procedures as possible. The funding must be much more targeted in its allocation while ensuring that best value is achieved.

The reform agenda also involves enhancing and greatly expanding capacity in the primary care sector in order to deliver universal GP care with the removal of cost as a barrier to access for patients. This Government is absolutely committed to delivering on that element of the reform agenda in the short to medium term. The full universal health insurance is a medium-term project which is well underway but the reforms promised on opening universal access to GP care are reforms we intend to deliver within this term of Government. This commitment will be achieved on a phased basis to allow for the recruitment of additional doctors, nurses and other primary care professionals. Taking this step will allow us to move away from the old hospital-centred model where health care was episodic, reactive and fragmented. We aim to deliver a more proactive, joined-up approach to the management of our nation's health.

A total of 80% of health activity relates to chronic disease. It is the intention of this Government to move the vast bulk of chronic disease management away from hospitals to the local primary and community care setting. This is how real reform can be introduced to the health service. Unfortunately, as it works currently, fees act as a significant barrier for people in accessing care when a condition develops. In many cases, people cannot afford the fee of €45 to €55 for a GP visit. This problem is increasingly common and people are putting off having conditions seen to in the hope that the symptoms will go away. In many cases where people decide to neglect early symptoms, they inevitably end up with poorer outcomes and a more serious condition requiring more expensive care, frequently in an accident and emergency unit or through admission to hospital. The purpose of the reform provided for in the programme for Government is to have early intervention to encourage people to access care at an early stage and achieve better outcomes, earlier diagnosis and a much more user friendly health service. This also entails having a much more cost effective health service. This is what we intend to achieve in the term of this Government.

To respond to some of the points speakers made, given the complex nature of what is planned, the Government has approved the establishment of and terms of reference for an implementation group on universal health service. The details of the group are being finalised and it will commence work shortly. Its work will pave the way for the introduction of universal health insurance in the medium term.

I thank Deputies who contributed to the debate. This important legislation deals with a specific issue and should be considered in the context of the overall reform agenda to which the Government is fully committed. I am aware that Deputies opposite are also committed to introducing these types of reforms. As I stated, they should not expect us to have completed the task in the first nine months of the Government. Considerable work is under way and I hope Deputies will start to see the benefits of this work from next year onwards as we start to roll out the commitments contained in the programme for Government. I hope at that stage the Opposition will give us some credit for the work we are doing.

See this speech in context