Damien English (Meath West, Fine Gael) | Oireachtas source

I thank Deputy Neville for sharing time. I welcome the opportunity to contribute to the debate on the Health Insurance (Amendment) Bill 2012, which is an important item of legislation and which I am happy to support. The Bill forms part of the bigger picture. Health insurance is still very expensive for some people, while others cannot afford it at all. However, at least the Bill will be of assistance in ensuring that the system will be somewhat fairer. It will also ensure that people who have been affected by ill health over the years or with whom age is catching up will not be hit with massive increases in their bills. The term "intergenerational solidarity" is very nice, particularly as in this instance it means that the costs involved will be shared by everyone. However, we must remember to ensure that it is used when we are debating legislation relating to other Departments. We do not always witness intergenerational solidarity. We may, however, remember to use the term more often in the future as a result of our debate on this Bill.

The Minister indicated that the legislation before the House is part of the reform agenda which is detailed in the programme for Government and which was also outlined in Fine Gael's and Labour's manifestos for the most recent general election. Prior to that election, both parties indicated that they wanted to reform the health service and introduce a fairer and more equitable system within which people's access to care would be based on need rather than on their ability to pay. Health care was not provided in this way in the past and the Bill is part of the process that is aimed at ensuring it will be in the future. There is a great deal more work to be done in this regard and we must ensure that we remain focused on that fact.

We are concerned here with creating a level playing field. I accept that Opposition parties are of the view that there are different ways to achieve the same result. Having carried out a great deal of research and done much work in respect of this matter while in opposition, Fine Gael and Labour are both of the view that what is outlined in the Bill represents the way to go in the context of introducing a level playing field and thereby ensuring that people's access to services will be based on their needs. Regardless of whether one has money, the waiting lists, etc., relating to children are generally dealt with on a fairly even basis and access to care is based on need. This ethos must be spread to every other part of the health service.

I accept that some people have been placed at a disadvantage in certain instances, particularly where other individuals had private insurance. We are trying to balance it out but it is not possible to do this in six months, a year or two years. The Minister for Health and his Ministers of State have been very careful to state that the reform agenda will take some time to implement. It was clearly flagged before the election that it would probably take seven years to fix the problem. The programme for Government is very ambitious in aiming to have much of the reform carried out during this Administration's five-year term of office. I get somewhat fed up when other Members of this House, those in the media and people in the street state that we have been in power for nearly two years and we have not yet fixed the health service. It would never have been possible to fix it in such a short period.

For once, politicians were honest in their election manifestos and stated that it would take a number of years to reform the health service. It is not often that politicians are willing to state that it might take two terms in government to achieve something. In the area of politics, there is often a demand for immediate results. As a result, everyone should recognise that in this instance it was clearly stated that reform will take some time to deliver. That reform will happen but it will take a number of years to achieve. I have no difficulty with people being critical in respect of particular matters. However, everyone should accept that it would not be possible to fix the health service - not to mention the economy - six months, a year or two years. All good projects take a number of years to complete. That is the case in this regard. I hope that three to four years from now our health services will be close to being fully reformed and that people will have access to health care when they require it and that this will be based on their needs and not just on their ability to pay.

Progress has been made in the context of the reform agenda. I have seen evidence of this in the area in which I live. We must take the opportunity thank all of the staff involved in bringing about the reform to which I refer. The Croke Park agreement is often sneered at and people sometimes criticise it. However, I have witnessed major reforms in the area of health which are due to the efforts of all of those in government with responsibility in the area and also those of the staff involved who are willing to accept changes. As a result of the Croke Park agreement and their own common sense, those to whom I refer know that these changes were the right ones to make. The concept of the money following the patient has worked very effectively in the orthopaedic unit at Navan Hospital. The work done by the special delivery unit is yielding great results throughout the country. This has not been the case everywhere but that is because it takes time to implement reform. We are getting there. In the majority of cases, the number of people on trolleys in hospitals throughout the country has been greatly reduced. The figures in this regard are independently assessed. I accept, however, that we have more work to do.

Hospital waiting lists have been dramatically reduced. It is not good enough that people are still being obliged to wait nine or 12 months for procedures but these periods have been reduced. The Minister has put in place a plan to ensure that the amount of time people are obliged to wait will be reduced even further next year. The outpatient waiting list was previously way out of control. When we entered Government, there were 250,000 people on it. However, the Minister and his colleagues have set a target in respect of reducing the numbers on this list next year. When we were in opposition, I always stated that in order to fix something one must first admit that a problem exists. It was not possible to fix the problem when the figures were being hidden. When a Government initially releases figures such as those to which I refer and admits that there is a massive waiting list, it is given a great deal of slack. When the problem is fixed, the Government involved should also be given credit. One must count the numbers involved before one can fix the problem and I hope we will do this.

Much of the discussion on the Bill has related to the cost of health insurance. This is a matter which must be addressed. The effect of the cost of health insurance on the cost structure and governance of health care delivery is of major concern to many of us. Just over 4.5 million people live in this country and we spend over €14 billion on health. In addition, more than 2 million people have health insurance. They are obliged to pay massive amounts for such insurance and it is amazing that they can meet the cost involved. Most people believe, rightly or wrongly, that they need private health insurance in order to ensure that they can obtain access to health care. We must, therefore, change the system. Universal health insurance will eventually become compulsory and this will hopefully lead to a decrease in costs. What it will certainly do is bring down the overall cost. Both the public and private spend and health service reform should bring down this cost and people should be in a position to enjoy the benefit of this.

The Minister indicated that part of his work will be to reduce costs where possible. An example in this regard would be the VHI. The Minister expects the latter to undergo many changes in order that its costs will be brought down. In the event that anyone is of the view that such changes should not be made, I wish to read into the record a letter sent to me by a concerned constituent a number of months ago regarding the VHI and the issue of costs. The letter states:

Dear Deputy English,

I have expressed concern on several occasions regarding value for money in relation to VHI charges incurred by me. I wish to do so again, relating it to the example case below. Should you wish to use the actual case cited please feel free to do so. [I will forward a copy of this letter to the Minister].

As you know, following completion of treatment VHI provides each member with a detailed statement of the benefits it has processed in respect of a claim. They ask that if I have any concerns with the cost of care that I should contact them. So I did.

I rang the VHI to give them my experience of the cost of Healthcare I received.

My Treatment involved an injection (to the right eye), the charge being Euro 200.00 with which I have no problem. I also do not have a problem with the medical staff although there were a lot of them around and they obviously have to be paid. Where I do have a problem is the charge for a "side room and theatre and equipment etc." as explained by the VHI person I spoke to. The problem is that I was not in a side room - I commenced in a waiting room with c. 8-10 people present - I was then prepared in a corridor and in a smaller waiting room and eventually moved to a low tech "theatre" with a no bells and whistles table on which I had the injection administered, apparently by a hand held instrument. I then had a welcome but unnecessary cup of tea and toast prior to leaving.

The cost of this experience was Euro. 1,465.93.

My attempt to have this cost explained failed miserably and I was met with the mantra that this was the cost negotiated between the Mater Private Hospital and the VHI, full stop, end of story, pleasantly explained, just about.

My [bill] is for three of these treatments (at the time of writing one more to come) with a likely total cost of c. Euro 4,400, excluding the surgeon's fees. Obviously I am very happy to have benefited from it, however, if the VHI fees continue to increase even less dramatically than currently predicted I will have no option than to join the public patients' queues at a time of my life when I had hoped for better fortune.

I raise this matter as a specific, micro, example of where better accountability and value for money could probably be achieved. My three quick fix eye injections will exceed the previous cost of my hip replacement.

As a point of interest in discussion [with the hospital] on the day of my initial diagnosis, when costs were being discussed, it was mentioned by a person qualified to comment that in the USA such treatments were normally carried out in a GP's surgery.

I am of the view that this letter summarises the concerns which exist. In fairness, the Minister and others have long been critical of the way the VHI and other companies administer their affairs. I refer to the fact that they do not follow up on matters of this nature in order to discover why patients are charged so much for hospital procedures. In other words, they do not ask the questions. There is a need for people's hospital bills to be audited and also for health insurers to seek reforms in order to drive down costs. Having a procedure should not cost that much. The Government plans to have procedures carried out elsewhere in order to bring down the cost of health care in Ireland.

The combining of public and private moneys will result in a saving to the Exchequer and a better and more cost-effective system. We are not getting value for money for a range of reasons and this is the reason the system must be reformed. However, the many stakeholders will all need to be involved in the reform process, including VHI and the other health insurers. They will have to work with us to drive down costs. It is to be hoped the concepts of the money following the patient and universal health insurance will contribute to a changing of the health system.

There are significant plans for the reform of the health service. Some of the changes will involve a mixture of good and bad news for hospitals around the country. The range of services currently available in all hospitals will not continue to be available in all of them. The Minister will publish in the coming months a framework document on small hospitals which will set out the plans for many small hospitals. Many of us will disagree with the proposals to be mde and we will fight for the retention of hospitals or certain services in our individual areas. The Minister has given a commitment that we will all be consulted on the proposals to be made in the document when published. The medical experts on both sides of the argument will have an opportunity to air their concerns. Any reform of the health service must be accepted by the people, as well as by the professional staff. The people will have to believe the reform will benefit them as patients. I know this will be the case, but we need to inform and convince people. It is a case of building trust. People have lost trust in a range of organisations, including politics and the decision-making process. Any change which could affect the accident and emergency services in many hospitals will need to have the support of the people. This will take some time to achieve. We need to convince people that the change is good, that it is the right option for them and their families. That is the work that lies ahead of us. If we do not succeed in convincing them that it is the right thing to do, perhaps we are wrong and should review the proposed changes. However, any proposed change to any service needs to be teased out with all those involved in delivering the service. There will be a need for honesty in the debate, rather than just political argument and point-scoring. It will be difficult for some of us to accept some of the proposed changes because politically they will be difficult. However, if they are right for the health and well-being of the people, we will support them, even if it will be tough. It will mean that honest contributions will be required in the debate. When the framework document is published, I expect general practitioners, consultants and hospital staff who tell us one thing behind closed doors to tell us the same in public in order that we can tease out the arguments. As we might not be right in everything, it is important to listen to those who may be opposed to what we want to do. We will need to arrive at solutions acceptable to everyone. The reform agenda is not for the benefit of politicians or the Minister's trophy table; rather, it is for individuals and their families who want and deserve a better health service because of the amount of money expended on it.

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