Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

The point we make is that this legislation will not add anything to patient safety and the delivery of health care.

There were a few planks in the Minister's manifesto. The key one was the development of primary care and the other one was to move to universal health insurance. We are certainly putting the cart before the horse in this legislation in respect of the abolition of the HSE, the establishment of hospital groupings and then trusts and the roll-out of universal health insurance. One thing is certain. We know that the funding model the Minister wants to bring forward is along the lines of private health insurers providing health cover to those who can afford it and a subvention from the State to those who cannot afford private health cover or a purchase by the State of private health cover for those people. I assume that this is the basic principle, that there was a suite of services that health insurers will be obliged to provide at certain rates and that competition between health insurers will find the level in terms of the market itself. Of course, there are a few major flaws in that. The first is that we do not have a very vibrant health insurance market in this country. There will be a massive subvention from the State to the private health insurance market because the numbers of people covered by private health insurance are tumbling. This is evidenced week in and week out by the massive numbers of people who have dropped out of private health insurance further burdening the public hospital system. While we continue down the road of speaking about universal health insurance, we are forgetting that the central plank that underpins it - the foundations on which it will be built - is a vibrant private health insurance market. Every policy that is being pursued by the Minister, the Minister for Finance and the Government collectively undermines the foundations on which the Minister wants to build the funding model of health.

The Minister absolves himself of it because he says it is a taxation matter and I agree it is a taxation matter but surely the Minister for Finance would be conscious of the fact that a policy is being developed by the Minister for Health that aims to promote a vibrant private health insurance market. What did he do? He waltzed into the Dáil last October and with one swoop of his pen decided to inflate the cost of private health insurance for ordinary families throughout the country. Reference was made at the time that the change only related to gold-plated policies. If every private health insurance premium taken out by ordinary families throughout the country is gold-plated, let the Minister say that. The bottom line is that it was an intentional sleight of hand or word to insinuate that somehow it would only affect a few premiums. It affected the average family plan offered by health insurance companies in this country. That is a fact and is happening as we speak when families get their renewal notice and bill from the private health insurance companies telling them that the policy has now gone up by "X" amount. It has gone up multiples of health inflation. The key reasons result from policies pursued by the Ministers for Health and Finance.

Full cost recoup for private patients in public beds is another area that will have an impact on the cost of health insurance. If the Minister or Government was serious about trying to provide a sustainable model of private health insurance, they would pursue policies that would attract and encourage as many people as possible into private health insurance to underpin the entire concept of inter-generational solidarity where the youngest and healthiest support those who are older and require more treatments. The basic principle of insurance is that one spreads the load and burden across as many people as possible but the Government's policies are doing the exact opposite. There is now an almost obsessive attempt to drive younger people out of private health cover. I cannot understand the rationale behind it and I think, deep down, the Minister for Health probably does not support that policy either but has been hung out in Cabinet and is now scratching around everywhere for funding to support the health services and the funding of same. It certainly does not make sense to charge full cost for private patients in public beds when facilities are not available through the private hospital system. These patients are already taxpayers, are making an effort through their own means to fund their own health care and are already entitled to that care anyway under the 1970 Act.

We need the White Paper soon. If it is delayed further, it will just be fanciful. A vibrant, private health insurance market that provides cover for 4.3 million people who either purchase it directly or on whose behalf it is purchased by the State will not happen. That system will not be sustainable if something is not done quickly. This is another key area in respect of which we need a full debate.

The Minister stated that he would welcome our input into the universal health insurance White Paper. We will have views on it, but my instinct is that this process is going down a poorly thought out route. The Minister claims that he achieved a mandate for the implementation of universal health insurance. It was undoubtedly a central plank in Fine Gael's policies, but its lines have become unclear. We must elucidate the policy dramatically.

The provision of care that is both safe and costs the State the least amount is often discussed. This will be done through primary care centres, general practitioner, GP, practices, public health nurses, community and home care packages and home helps. The aim is to keep people out of acute hospital settings. Given the budget and its individual elements, however, primary care is being underfunded considerably. Chronic illnesses are to be moved from the acute hospital setting into primary care where GPs will be expected to take it on. They have the expertise and the willingness, but there must be quid pro quoin terms of resourcing and support. The Government cannot keep stripping away supports while expecting to maintain the traditionally strong relationship between GPs and patients, customers or whatever one wants to call them. It will erode the services provided by GPs. As the Minister stated, they are doing work that nurse specialists could do and nurse specialists are doing work that care assistants could do. Would it not be a good idea to provide resources in order to address this deficiency and ensure that patients are treated by the most appropriately qualified clinicians? Clearly, this should be done, but the Minister has done the exact opposite. He has undermined primary care and eroded the ability of GPs, nurse practitioners and others to provide care in the community setting. This will create significant difficulties in the short and medium terms.

Last year, the Government decided to proceed with providing free GP care for five year olds and under. It was a good idea on the face of it. It would also have been a good idea to provide adequate funding and resourcing, but this is seemingly only being done by removing resources and supports from vulnerable people. The budget arithmetic in the HSE service plan as announced last October leaves one in no doubt about the Government's decision to target discretionary medical cards on a consistent basis. In fact, they have been so well targeted by now that the Government has decided to remove the word "discretionary" from the HSE service plan. When I submitted a Dáil question to the Minister of State, Deputy White, he told me that there was no such entity as a discretionary medical card. At one stage, there were nearly 96,000 of them. How they disappeared overnight is a mystery.

What has happened has had a major impact on the lives of the many people who struggle daily with illness, disease and disability and have been doing their level best to continue with family supports, etc. Those supports have been stripped away by the callous decision to undermine the discretionary medical card system, which had been built up over many years. Although it contained geographical inconsistencies, its principles were humanity and fairness. The suggestion that medical cards can no longer be awarded on a discretionary basis - the Health Act 1970 says otherwise - is simply not right. It is within the gift of the HSE and the Minister to ensure the availability of discretionary medical cards to people with long-term and life-limiting illnesses and disabilities. Financial hardships arise because of their circumstances. Removing discretionary cards is an incredible decision by the Government and the Minister in particular.

Health funding has been vested in a Minister who can callously cut services from the most vulnerable. When the Department of Health, the HSE and the Minister's office panicked in recent years, home helps, home care packages, disability supports and discretionary medical cards were the first services to be cut. I am not confident about giving more control to a Minister who can make such decisions. This is another reason for our opposition to the Bill.

Myths have grown up about the establishment of the HSE. It brought the health boards and all areas of health under its umbrella. The Minister makes great play out of the fact that we retained all staff, but his predecessor as Fine Gael's health spokesperson, Deputy Twomey, insisted at the time that there be no forced redundancies, only voluntary ones, and that packages be put in place. He stated:

The view of workers must be respected. Although the Minister said there will be no forced redundancies, many of the employees of the health service are extremely concerned about what their roles will be.

Fine Gael asserted the need to retain all employees, but it has now decided to vilify that decision. Consistency is scarce around this place, particularly given the comments made then and those being made now because the Government wants to abolish the HSE. The Government will regret its decision to politicise the health services again. It will regret its decision to give the Minister more power over capital expenditure. More importantly, the people who depend on services will be the ones who see whether there is fairness and impartiality in the decisions on capital expenditure and resourcing. This legislation will bring decision making and accountability back under the Minister's umbrella.

For these reasons, we need a sincere debate. Yes, the HSE was cumbersome and posed difficulties, but are we now saying that we should revert to a system of competing rather than complementary trusts scattered throughout the country that try to undermine one another in the provision of health care? This decision has not been fully considered.

If it was fully thought out, the Minister would have published that White Paper already. Four years ago, he had an idea in his mind about the Dutch model, but now that model has been moved off the catwalk completely and we are somewhere completely different, still waiting for a funding model we can analyse in the context of the Irish market. We do not have a population of 18 or 19 million people, unlike the Netherlands. We do not have 18 or 19 health insurance providers. We have a population of 4.3 million and we have only four health insurance providers, with one very dominant player. We now see that the whole edifice of the health insurance industry is beginning to crack and crumble. That is primarily down to policies that are being pursued by the Minister. Consistency about how to go about rolling out the Government's health policy does not even exist in the first place. That is why I have little confidence that we are going to see a model that is sustainable and fair, because the decisions the Government has made to date to rein in spending have been mainly unfair. In fact, they were downright lousy in terms of the areas targeted.

However bad the Minister may say the HSE was, let us have an honest debate about what way we will fund the health services and how we will fund them. The Government should publish the White Paper, but I must question going down a road into a cul-de-sac where we end up with an unsustainable funding model for a health service that will not be fit for purpose and that will be torn apart into trusts. That is why we will not be supporting this Bill.

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