Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

In his concluding remarks, the Minister spoke of how the funding generated will be for the benefit of those in acute hospitals and nursing homes. He also referred to the Bill modernising the charging and contributions regimes and claimed it was for the benefit of those concerned. While I would warrant that few would buy that sales pitch, even if the Minister could convince some of his claim that it will be for the benefit of - I emphasise what the Minister said - those in acute hospitals and nursing homes, what of those who will be forced by some of the measures included in this Bill to put off seeking access to acute hospital settings and nursing homes because they simply cannot afford it given their other competing responsibilities? I do not believe this modernising approach, as the Minister claims it to be, would be of any comfort to them at all.

This Bill is gift-wrapped as health reform but it is no such thing. The bottom line is it is another shoddy item of legislation designed to facilitate cutbacks in the public health services. The Bill also contains a mixture of provisions that make some significant and totally unsignalled changes, which have received little public scrutiny and virtually no public debate. In this Bill, the Minister for Health, Deputy Reilly, seeks to impose higher charges for shrinking public health services and the Bill again exposes how the Fine Gael-Labour Party Government’s health policy is full of contradictions. The Bill increases the daily charge for public inpatient services in acute hospitals from €75 to €80 and increases the asset contribution under the so-called fair deal nursing home scheme from 5% to 7.5%. These increases, arising from budget 2013, received little attention when the Bill was published. I have no doubt but that was much to the satisfaction of the Minister. The Bill provides that the insurers of private patients should pay the full cost for the use of scarce public beds and on this, the Minister and I agree. This is right and proper and is something for which my party, Sinn Féin, and I have called consistently. However, this must be perceived as an interim measure towards a fully public system with equal access to hospital care for all, based on medical need alone.

Fianna Fáil, the main architects of the two-tier public-private health system, used to claim the public-private mix gave us the best of both worlds. I heard this claim several times in this Chamber and a former health Minister made much of it. Of course, what Fianna Fáil created and sustained for the many years its members were at the lead of government in this State was a grossly inequitable and inherently inefficient system, which the superficial prosperity of the so-called Celtic tiger years could not disguise. After five years of recession, we now have the worst, not the best of both worlds. Incomes have decreased or have been wiped out, the private health insurance market has consequently shrunk and the result is many more people are totally dependent on the public health system. Moreover, that system has been undermined, weakened and downgraded by five years of health spending cutbacks, as it struggles to provide care for a growing and aging population with more complex health care needs.

The so-called solution being put forward by Fine Gael is to convert the system to one based on competing private health insurers and there is no other word for it than privatisation, plain and simple. As to how exactly this will work, one still does not know as the details of the plan have yet to be seen. However, international comparisons tell one that despite the claims of the Minister and other voices, it simply does not work. The truth is the health policy of the Fine Gael-Labour Party Government is full of contradictions. It claims to be aiming for free GP care for all yet it has further restricted access to the medical card, including within the past six months. The promised initial extension of free GP care to long-term illness patients has not been delivered and, it claims, cannot be delivered but that another way will be found. As to what that other way might be, again Members do not know as they have been given no details and no prospect of an alternative that would deliver this promise any time soon has been presented. The Government claims to seek universal health care but yet the private health insurance model it favours would see everyone who already pays tax to fund public health services also being compelled to pay health insurance with a significant profit margin for the private insurers, that is, the private for-profit interests.

This Government, like its predecessors in Fianna Fáil, vehemently opposes proposals from Sinn Féin, other Opposition voices and many others, including the trade union movement. Our arguments are for higher taxes for the highest earners and for a wealth tax rather than the measures the Minister incorporates in this Bill. Yet, at the same time, the Minister proposes to introduce a system of compulsory private health insurance, the cost of which will be artificially inflated to ensure profits for the private insurers. That is why they exist.

We would have greatly improved public health services today if, in the decade from 1998 to 2008, we had introduced a truly fair taxation system, with the wealthy paying their fair share and the revenue being invested in vital infrastructure contingent on public health needs. Instead, what we have is a two-tier system and such waste as, for example, the consultants profiting from both public and private systems being reinforced.

From this Government we are getting not real reform but a tinkering with the fundamentally flawed system, the prospect of yet undefined change and, above all, more cutbacks and more charges for reduced services.

I do not intend to revisit the current perilous state of our public health services - the overcrowding, the trolley count, the waiting lists, and the services simply not available to those who need them. We have aired those on many occasions and will continue to do so in other opportunities that present here and at committee. However, I want to cite just one example. The Irish Nurses and Midwives Organisation has reported an average of 79 patients per day placed in overcrowded and inappropriate environments on inpatient wards, above the stated bed complement of those wards. That is in addition to the scores of people daily on trolleys and chairs in emergency departments. It is an outrageous situation for people to have to endure.

Looking at the detail of the Minister's proposals in the Bill, the €5 increase in the daily charge for public inpatient services is, for those who will be obliged to pay, a significant rise. It is a significant further demand and will, as I said at the outset, further dissuade people, including parents of children in need of inpatient care, from presenting for important and essential services with all the potential consequences involved for all concerned. Make no mistake about it. The argument the Minister made about the 50 cent, as already highlighted by Deputy Kelleher, most certainly applies in a €5 increase.

The least signalled part of this Bill is Part 2, which makes significant changes to the Nursing Homes Support Scheme Act 2009, the so-called fair deal scheme. Again, we are seeing increased charges. The Bill increases the asset contribution under the nursing homes support scheme and abolishes the requirement to backdate State support to the date of the scheme's commencement for those who were in nursing home care prior to that date. Section 7amends Schedule 1 of the Nursing Homes Support Scheme Act 2009 to increase the asset contribution from 5% to 7.5% for people who enter nursing home care after the enactment of this Bill.

Significantly also, the Bill, in section 4, provides for something not already highlighted, namely, the privatisation of the administration of the nursing homes support scheme. That is in line with the privatisation agenda of the Minister's party to which the Labour Party clearly has now completely surrendered. We know that the downgrading of the public service is in full flow, and nowhere has been more affected by the recruitment embargo than the health services, but where has the proposal to privatise the administration of the so-called fair deal scheme come from, and what is its motivation? What research or consultation has been carried out regarding the working of the nursing homes support scheme? This is a key State scheme requiring great care, sensitivity and scrupulous fairness in its implementation. It is a right of citizens who qualify under the scheme, and that right must be vindicated. Anyone who has gone through the process of application to the nursing homes support scheme will say it is one of the most complex, confusing and long drawn out processes. It is a bureaucratic and legal nightmare. It needs to be simplified, streamlined and better fitted to the needs of citizens who require this service.

I want to remind the Minister what he said when addressing the Nursing Homes Support Scheme Bill in the Dáil in 2008: He stated:

However, we do not wish to discover, as we so often have previously, that a perfectly good concept in principle turns into a mire and nightmare for people in practice. I do not wish to introduce an adversarial tone to the debate but we must be mindful of what happened with the HSE. We cannot allow that type of mess to be inflicted on people.

Hear, hear, twice over. A mire, a mess and a nightmare is exactly what we have now. In this context, I ask the Minister what the so-called outsourcing of the scheme as provided for in section 4 will actually achieve, and what it is meant to achieve.

I believe this is another example of cutting out the public service element, bringing in private contractors with staff on lower pay, to reduce the public service pay bill, with no regard to the effect of the changes on the citizens who use the service. I strongly oppose this section of the Bill and urge instead a reform of the administration of the scheme to make it more accessible, comprehensible and viable for service users. Any among our number could be among that number in our own turn and time.

I wish to reaffirm, as I did when the Nursing Homes Support Scheme Bill was debated in 2008, my strong objection in that I believe it effectively removed the universal eligibility for a place in a public nursing home as provided for under the Health Act 1970. This Bill reinforces that position. The statutory eligibility to a bed in a public nursing home as provided in the 1970 Act was never vindicated in terms of the provision of the resources to make those beds available. That led to a huge reliance on the private nursing home sector and a complex and inequitable system of State subsidy for nursing home care. Undoubtedly, that had to change but I believe the previous Government, in doing so, went in the wrong direction. The Minister also was somewhat of that view at the time.

If a person suffers a heart attack, and I have had the experience, he or she is entitled to a bed free of charge in a public hospital. However, under the Nursing Homes Support Scheme Act 2009, if a person becomes so dependent, say, from the effects of a stroke that he or she needs constant care in a nursing home, his or her entitlement to a public bed free of charge is effectively gone and he or she must pay. A fundamental shift took place with that Act and the implications for the entire health service were and continue to be profound. This Bill continues that trend.

I was not the only Deputy to raise these concerns at the time. I cite none other than the current Minister of State, Deputy Jan O'Sullivan, who, as its health spokesperson at the time, stated on behalf of the Labour Party:

Age Action Ireland put the argument well when it stated that the legislation sounds the death knell of the public bed for those who need a residential nursing home bed, and that it also means the introduction, for the first time in the Irish health service, of a charge beyond the grave for essential health care services. The organisation went on to state that if this legislation is passed, it will mean that those who have conditions such as dementia and stroke will be treated differently from those who have heart attacks and cancer. We must be concerned when legislation such as this is introduced because we are, in effect, treating different elderly people differently, depending on the condition from which they suffer. The Labour Party is committed to a universal system of health care whereby everybody is treated the same irrespective of income and age.

Again, I say "Hear, hear" but where stands that Labour Party commitment now? How do those fine words translate in the context of the Labour Party's involvement with Fine Gael in Government since February-March 2011?

We also need to place this matter in the context of the way in which we care for older people. The National Economic and Social Forum's Care for Older People report, which was published in 2006, stated that the then current official funding of services was not "consistent with the policy objective of encouraging community-based responses" and that "Considerable resources have been invested in nursing home care responses, some of which was unnecessary, not wanted and inappropriate". The NESF report identified the weakness of community care, the poor integration between systems and sectors, under-resourcing, the lack of responsiveness to the needs of older people, poor co-ordination and the fact that care is not embedded in local communities. That report is even more relevant today.

This Bill is another piece of patchwork legislation designed to do another patch-up job on our tattered health service. The Bill also facilitates cutbacks, privatisation and further and higher charges in respect of shrinking services. Where is the fundamental reform so long promised by this Fine Gael and Labour coalition? It is certainly not contained in this Bill and there is no sign of it on the horizon. The only thing we can see on the horizon is the onward march of the privateers under the Fine Gael banner, with Labour's tattered banner trailing behind. The Bill does not merit our support. We have consistently indicated our support in respect of the need to address a particular core matter. Regrettably, that matter is not being properly dealt with in this legislation and all the other issues which have been appended to it are being adversely impacted upon in the context of the broader public interest. We will be opposing the passage of the Bill.

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