Catherine Murphy (Kildare North, Independent) | Oireachtas source

The main media focus surrounding this legislation has been on the charges that will, if it is enacted, apply to private patients occupying public beds in public hospitals. This is a matter of concern to those who are facing the prospect of abandoning private health cover and moving to the overburdened public system. I will return to this matter later but there are other troubling aspects of the Bill which I wish to explore in the context of the charges relating to the nursing homes support scheme, formerly known as the fair deal scheme.

A number of fundamental questions arise with regard to the operation of the nursing homes support scheme and the way in which the nation treats those who require long-term care. The troika recently highlighted two areas, one of which is that which relates to health care, where further savings are to be sought. This obliges me to ask whether it was the latter which prompted the introduction of the Bill before the House at this time. We have been informed that the legislation will assist in increasing the funding available to the public health system. In fact, it will probably add nothing extra to that system. What the Bill more probably represents is an attempt on the Minister's part to remain within a certain budget. We are witnessing a decline in the overall level of service. I completely agree with Deputy Ó Caoláin who referred to the measure before us as a patchwork attempt at legislation which contains no vision, thought or general philosophy regarding the type of health system we should have and the kind of solidarity that should go with it. We had an expectation that such a system was going to be the objective of the current Government.

On numerous occasions I have been asked to indicate what it is we are paying for when we make pay-related social insurance, PRSI, contributions, which include an incorporated health levy, and the universal social charge. I find it impossible to provide answers to people's questions in this regard. Many individuals opt, if they can afford to do so, to join private health insurance schemes, primarily because they are concerned that their needs will not be met by the public system and not because they want to pay for private health care. I am in this position and I have private health cover. However, I prefer to rely on the public system. I can openly state that I would be prepared to pay more tax in order that we might end up with a good public system.

Health care must be paid for and it is a question of deciding how we should do that. This is a profoundly political issue. PAYE, PRSI and the universal social charge almost take the form of a solidarity tax but the problem is that there is no return for most of those who pay these. We are informed that 45% of private patients in public beds are treated in this way. How did these people end up in public beds? It seems that many of them are put in such beds because they were taken to accident and emergency departments in ambulances. Those to whom I refer are patients who ended up in public beds and who happen to have private cover. The explanatory memorandum to the Bill states that section 13(1) "provides that where a person waives his or her eligibility to services as a public patient, the HSE may make inpatient services available to him or her and impose the relevant charge set out in the Fourth Schedule." Such patients can be pursued by debt collectors or whomever in order to ensure that payments are made.

One must question the capacity of public hospitals, in which wards have been closed, to absorb the additional intake of those who will be obliged to opt out of the private system. I am no fan of the two-tier system but even if the political desire exists, it will take time to move to a single-tier model. It is my opinion that the public system is unable to absorb the extra intake to which I refer. I must query the savings which it is stated will be made. Too often the Government has put in place initiatives whereby it saves on one side only to pay out on the other. That makes no sense.

I supported the second referendum on the Lisbon treaty. I did so because the treaty makes provision for the application of the Charter of Fundamental Rights of the European Union. That was the only reason I could find to support the referendum. Article 35 of the charter states:

Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices. A high level of human health protection shall be ensured in the definition and implementation of all the Union's policies and activities.

I cannot identify how the Bill delivers in respect of that right. I am of the view that it does the opposite.

We have all received letters from the Independent Hospitals Association of Ireland which comprises 21 hospitals which account for approximately one third of the acute hospitals, employing 8,500 people and treating 400,000 patients. I realise the hospitals have two concerns, one of which is about their own viability. However, the public system does not have the ability to absorb the patients for whom they will be unable to cater if they close down. They have told us they support a plan to introduce a health system which promotes equitable access to high quality care, as promised under universal health insurance, but that they firmly believe the impact of the planned legislation is entirely contrary to that objective and, therefore, the components of the Bill relating to the designation of all beds in public hospitals as chargeable should not be proceeded with. They further state that the proposed legislation would see patients having to waive their entitlement to public treatment in a public hospital because they have purchased private health insurance, with a claim being made on their health insurance policy for a service for which they have already paid through their taxes. That is the point I made about PRSI and the universal social charge.

I spoke about the savings on one side and the cost on the other. Recently, I attended a presentation by the Irish Hospice Foundation, which was very interesting. It is looking for a broad end-of-life care strategy, which I thought made great sense. It is interesting to note that some of the providers in the private nursing home sector are looking for a framework for long-term residential care. That should be part of a broader strategy. I would like us to take a more strategic approach to this whole area.

The Irish Hospice Foundation told us that 30% of the whole of life health care cost occurs in the last year of life. It gave us some very useful information on the savings that could be made by the provision of home care from the hospice foundation. That needs to be looked at. If one is looking for the optimum, in terms of health care, one can find savings by doing the right thing as well as by looking at things as a crude means of raising funds for what is there already. That is what is happening here. A joined up approach is not being taken.

I received a reply to a parliamentary question the other day in which I was told that the latest information available to the Department indicated that there were 873 people on the national placement list for the nursing home support scheme at the end of April and that the average time spent awaiting funding was 49 days but that not all people were in acute hospitals. However, a significant number - approximately 43% - were in acute hospitals. The fact we do not have a strategy for moving people to more appropriate type care ends up causing terrible trauma and costing more money.

When dealing with people at our advice centres, we get a fuller understanding of how policy impacts on people. I dealt with a man whose father was over 90 years of age, had a whole host of ailments and was staying in a nursing home. However, the man was then classified as needing acute care and the nursing home was forced to ask him to leave, even though he had premium level insurance, due to a shortage of beds. The option for the family was to call an ambulance, with the possibility that the man, who was very ill, would end up in accident and emergency on a trolley. Instead, the family sourced another nursing home bed but had to wait weeks to be paid at considerable cost to themselves. They are the kind of choices people must make. Unfortunately, that gentleman has since passed away but the case was appalling. If one looks at the chaotic situation where someone who ends up in hospital after a stroke wants to return home, there is a lack of any kind of joined up system. Approval of the carer's allowance or a grant to adapt a home, where the need appears to be long term, can take months, if one gets either at all. The lack of a coherent approach is forcing people to make choices they would not otherwise make. Some of those choices are being made by people who would like to be cared for at home by their relatives but, unfortunately, they are in a position where the only option available to them is to look for a residential place in a nursing home, which their health profile permits them to do, even though it is not ideal. In fact, it is a more expensive approach than having people cared for at home.

There is a problem in terms of the lack of a joined up thinking, of a strategic approach and of any vision for the kind of health care system we should have. Instead, a piecemeal or patchwork approach is being taken and it is making matters worse rather than better.

There is a terrible language of dishonesty with this Government and this fits into that. Recently, we were told the money collected in motor tax this year - €150 million - would be used to pay the national debt. That was even stated in the legislation. The carbon tax is not used counteract the effects of smoky fuels and so on but it goes to the central Exchequer to pay off the national debt. There is nothing local about the local property tax, which is collected nationally. There is a dishonesty here.

We should call this what it is. Having assumed property prices would remain as in the boom years, we have found they have not, so there is an increase from 5% to 7.5% to cover that cost. Why does the Government not just say that? Couching it in something else is fundamentally dishonest. It is the kind of thing to which people react very negatively and it leads them to believe there is a second language around politics, which is not the kind of language they speak.

A broad strategy is required so I cannot support this legislation. Health care must be paid for but the way the Government is going about it is fundamentally wrong and it adds to the dishonesty of politics.

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