Finian McGrath (Dublin North Central, Independent) | Oireachtas source

I welcome the opportunity to speak on the Health (Amendment) Bill 2013. It is important in any debate on health that we speak up for the most vulnerable, senior citizens, the sick and the disabled.

Any health system that does not have equality and fairness at the heart of the service will not help to defend or respect our people and citizens. It is an important aspect of the debate. We must not hammer or exploit our elderly and senior citizens, who have made a major contribution to this country.

Last week I received a letter from a constituent on the matter and I will highlight exactly what was written. It states:

The Bill to increase the levy on the assets of nursing home residents by an appalling 50%, from 5% to 7.5%, is coming before the Dáil this week and maybe you would seek an explanation please as to why the financial penalty on the people concerned far exceeds that on any other category of citizens under the terms of the budget. The defence that the money must be saved will likely be trotted out but why are old and sick people kicked the hardest?

That comes from a constituent and it outlines the reality for many people I will try to defend today. I call on the Minister to support these people and act on the issue as a matter of urgency.

The Health (Amendment) Bill 2013 seeks to introduce or increase a number of charges across the health sector. It increases the financial contribution of people availing of the nursing home support scheme, and it also seeks to allow the HSE outsource the management of the scheme. It introduces charges for private patients in public beds in hospitals and it increases the charges for public inpatient stays. It also seeks to introduce a charge for those receiving residential support services, which will replace the current long-stay charge.

We must focus on the details of the legislation and the costs to our senior citizens, as a 50% increase is wrong and unjust. I would challenge anyone to say otherwise. Will the Minister confirm the impact of the Health (Amendment) Bill on the lives and economic resources of people with intellectual disabilities? What will the specific impact be for people with intellectual disabilities in State residential care? What effect will be felt by people with intellectual disabilities and their families when they avail of life-saving respite care? What, if any, consultation was undertaken by the Department in an attempt to explain the impact of this proposed legislation? Was there communication with those in the disability community, particularly those with an intellectual disability and who have seen an impact in residential arrangements and personal economic resources? I hope the Minister can answer those questions, and it is important that we put those hard questions to him.

We cannot have people with an intellectual disability and their families being persecuted. We saw a recent row about resource hours, and although they won that battle, a war is ongoing. The mobility allowance is on the agenda and many people are fearful of what will happen in that respect. I raise these issues as part of a constant battle. I thank the Ceann Comhairle as I received a letter this morning indicating that my Down's syndrome (equality of access) Bill will come before the House when the time is appropriate. That legislation is concerned with equality for young children with Down's syndrome and it is also about respect and the rights of citizens in this country.

The Independent Hospitals Association of Ireland is a representative body of the country's 21 independent hospitals. Its member hospitals play an essential role in the delivery of acute and mental health services, accounting for almost a third of acute hospitals in Ireland, employing 8,400 people, or close to 15% of staff in the sector. It provides almost 20% of the beds in the system and treats in the region of 400,000 patients every year, or one in every five patients. The Independent Hospitals Association of Ireland is very supportive of the plan to introduce a health system that promotes equitable access to high quality care, and that is a position I share. However, it firmly believes that the impact of this planned legislation will be entirely contrary to that objective, and it argues the components of the Bill related to the designation of all beds in public hospitals as chargeable should not proceed.

The proposed legislation would see patients having to waive their entitlements to public treatment in a hospital because they have purchased private health insurance, with a claim being made on a health insurance policy for service that has already been paid for through taxes. The likely 30% hike in health insurance premia and the subsequent exodus of more than 300,000 consumers from the health insurance market predicted by the Insurance Ireland Health Insurance Council will lead to an environment where independent hospitals will face closure. As a result, there will be a serious reduction in health services available to the people. The consequences for patients will be reduced capacity in the independent health care sector, reduced choice and growing reliance on already overly burdened public hospitals.

The association is advised that the proposed legislation is contrary to EU and competition law because it will have the effect of restricting competition and a consequential adverse effect on consumers by limiting choice and reducing quality of care. The Minister should answer that argument in this debate as ultimately the proposal will impair access, quality and affordability of health care for all consumers. It will also lead to the failure of some independent hospitals and increase the burden on the public system. There is also the potential to distort competition in the market for provision of new privately funded health care.

These concerns must be answered by the Minister and his Government. We are all in favour of equality and reform but we must ask the hard questions, to which I will return later. On Friday, 14 June, Ireland's four main insurers indicated that as a direct result of this proposed legislation, they will have to increase premiums by up to 30%, meaning up to 300,000 consumers will leave the private health insurance market. The Minister does not accept the 30% figure and on television recently he argued the actual figure would be in the region of 5% or 6%. Nevertheless, the economist Mr. Colm McCarthy recently indicated in a report on the future of private health insurance that the price of health insurance will rise by 25% as a direct result of this proposal. Once again the Minister has got his figures wrong and many people are concerned about that. We must closely examine this issue.

We have already seen an exodus of approximately 129,000 people from the private health insurance market in the past two years, with a further 500,000 having downgraded their plans because of austerity and other Government plans and economic policies. Further premium hikes in this quantum will undoubtedly result in many more thousands of consumers relying on the public system for their care.

The new risk equalisation levy has already burned a family of four who hold an "advanced" plan to the tune of €180, which is a 24% increase before any increase on the underlying premium. Government policy seems very strange as private health insurance is becoming increasingly unaffordable for thousands of citizens, particularly young people who are cancelling cover in great numbers while older citizens struggle to retain cover. Such issues should be addressed by the Minister.

Insured patients who are being billed for care in a public hospital may not receive the same elements of private treatment that they may if they present in an independent hospital. If the public hospital system sees significant increases in numbers seeking treatment, it may be unable to provide access to equivalent private or semi-private accommodation or a treating consultant. Over 2 million consumers in this State purchase a health insurance product with the expectation that when needed, it will entitle them to specific criteria of care, including access, accommodation and clinicians. In circumstances where they receive a standard of care that is the entitlement of all the citizens free of charge, the cost is none the less charged to health insurance companies. The insurance premia ends up defraying the cost of providing public health care. Will the Minister provide an answer on these hard issues?

When one looks at it from the perspective of the State and taxpayer, one can see that a significant consequence of this proposal will be a substantial increase in the volumes of patients presenting for care in the public hospital system, putting pressure on the existing capacity and adding to current waiting lists. That is something about which we all have concerns. The Insurance Ireland Health Insurance Council forecasts that the net effect of the legislation will cost the Exchequer in the region of €90 million. The Minister should wake up, smell the coffee and see what is going on. We hear much talk about reform and action so let us see the reality and let the Minister deal with the points I raised in the debate on this legislation today.

I am also aware that no regulatory impact assessment has been undertaken regarding the effect of the Bill on the Irish health care system. Where is the Minister going? Where is all the talk about regulation and planning? It has gone pie in the sky. No regulatory impact assessment has been undertaken regarding the effect of the Bill on the Irish health care system. Given the fundamental nature of the change proposed, it is vital that this key part of the legislative process is completed prior to the enactment of the Bill. The Minister should wake up and smell the coffee. He is not delivering and is waffling again. He is all hot air and is not dealing with the real issue.

Let us go back again to talk about our senior citizens and respect for them. A total of 5% of the population over 65 - over 22,000 people - live in nursing homes in the private and public sectors. The care is expensive and can range from €430 to €2,500 per week. The cost of care is prohibitive for most of these people and they are eligible to apply for State support for the nursing homes support scheme to assist them in meeting these costs. The nursing fees of those on the scheme are met by a combination of means-related contributions from them and the State. The 2013 budget for the scheme is in the region of €974 million. This Bill seeks to increase the amount that people must pay on their assets towards the cost of care.

The nursing homes support scheme, which is known informally as the fair deal scheme, is a system of financial support for residents in long-term nursing home care. It began on 27 October 2009 and replaced the nursing home subvention system and the practice of contract beds and long-stay charges in public nursing homes. Its aim was to ensure that nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate setting. Under this legislation, older people must pay more for their nursing home care. In the current economic climate, this is very difficult for a group of senior citizens and vulnerable people who have already paid taxes for many years and made their contribution to this country. I ask the Minister and Government to stand up for the people, the poor and senior citizens and look at the issues I raised in respect of disability. Let us build a proper health service, bring in reforms that are equitable and sensible and examine the costs. It is a national disgrace that these issues still exist. In spite of all the talk and waffle from the Minister, he has still not delivered and I urge the Minister and other Ministers to look seriously at the points I made in this debate.

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