Billy Kelleher (Cork North Central, Fianna Fail)

There are concerns that closing these beds will create difficulties. I remind the Minister that he passionately held that view only this time last year, when he stated that bed closures would result in delays and cancellations in elective surgery. He was an advocate of more beds in the hospital system. He is not credible when he now claims the exact opposite is the case.

In regard to the idea that we can foist the beds onto community groups, many of these nursing homes need capital injections to meet the standards HIQA will be forcing on them and that will be difficult in straitened times. The plan states: "This is likely to require a combination of actions such as consolidation of services; changes in staffing, skill mix and work practices; consideration of the public and private capacity available within an area and ... other voluntary providers". The proposal to farm these community and public nursing homes out in the vain hope that voluntary organisations will keep them afloat is far-fetched to say the least. If we are serious about using the special delivery unit to achieve throughput, step down convalescence facilities involving quality beds will be required. That is what the Minister originally proposed but, unfortunately, taking as many as 1,000 beds out of the system will lead to a back log in the acute hospital system.

We need to debate the question of universal health insurance prior to the implementation of the Minister's proposals because we are not sure what guidelines were laid down. Has a cost analysis been conducted? Will the public be expected to pay an inordinate amount in mandatory health insurance? How will the means testing system be developed and how will entitlements to subvention to be decided? We accept the need to provide some form of guaranteed funding to ensure people get treatment when they need it as opposed to if they can afford it. Equally, however, it is a myth that universal health insurance will be free. It will cost a lot of money. People will have to pay considerable amounts for a mandatory health insurance system, either through general taxation or health insurance. Either way, it will not be free.

This time last year the Minister was almost falling over himself in apoplectic rage about the hike in the community rating levy of 11% or 12% yet he recently announced a 40% increase. I cannot take him seriously given that this time last year he said this would drive families away from private health insurance and cripple them in terms of being able to afford health insurance. However, two actions of his in the past six weeks have put enormous pressure on insurance companies and as sure as night follows day, even with the best will in the world on his part and his diktat, it will lead to increased premiums on hard-pressed families. The idea that all insurance companies will be charged the full amount even if the patient is treated in a public bed will inevitably lead to increased premiums.

His second decision was to apply a 40% increase on the community rating levy. If a smaller percentage last year caused him such distress, surely a 40% increase will cause him more distress this year. He blindly passed it off claiming it would not increase insurance premiums. However, it has already increased insurance premiums and it will continue to increase them. I am making the point that this is a serious issue.

Everybody wants a system that allows people to access medical services based on need as opposed to ability to pay. It is wrong to believe that those who have private health insurance are somehow an elite group with endless resources. Many people are making great sacrifices to continue to pay their private health insurance premiums and are making very difficult choices about putting heating oil in the tank or paying for private health insurance. Any increase puts enormous pressure on them. The number of people falling out of private health insurance is astonishing. Some 60,000 did so last year and it could be up to 100,000 this year. While the Minister is talking about universal health insurance on the one hand, a group of people who are trying to provide as best they can for themselves and their families are being hard-pressed and forced out of health insurance. The Minister's policies are not helping and are increasing the premiums health insurers will charge for cover.

The difficulty is that it creates concern and anxiety among people who are asking whether they can afford to pay €3,000 this year and whether it is a waste of time paying for it. If it is a waste of time paying for it and if the Minister has a grand plan for universal health insurance, he should publish it as quickly as he can and give people some comfort in knowing what will be ahead of them in the years to come. Waiting until 2016 or 2017 and claiming it is a ten-year project creates enormous uncertainty in the meantime.

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