Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputies for their varied contributions on this issue and a range of interconnected health matters as well. I assure them I take their contributions seriously.

I reassure the House that I am a fully supportive advocate for an Irish public health service, as are all individuals in this House. We have a public health service that needs more support and further investment, in particular after the very difficult years we have come through. I genuinely look forward to the work of the Oireachtas Committee on the Future of Healthcare in devising a ten-year strategy. To take up the point Deputy Fitzmaurice made about vested interests, the only way we will deal with vested interests in the health service is by saying that it does not matter who sits here as Minister for Health, this House is unified, regardless of the outcome of elections or party politics, in a certain direction of travel and therefore the vested interests cannot just wait out a Minister or a Government, they have to wait out all of us and that makes it an awful lot more difficult. I genuinely look forward to the committee reporting.

The publication of the HIA report is a reasonable and fair request from Deputy Kelleher. That will happen in the coming days and I hope it will then help inform the debate. It is important that we share the report and we will make it available as quickly as we possibly can.

One issue that was raised related to a percentage-based levy. The suggestion is that the current monetary approach has a disproportionate impact on consumers with cheaper plans. That is a legitimate point to raise. The scheme is approved by the European Commission on the basis that the key rationale for a risk equalisation scheme is to support the achievement of the principle objective of the Health Insurance Act, namely, to remove or reduce the incentive for insurers to target younger, healthier consumers at the expense of the less healthy or the less young. That is something to which we can all subscribe. The purpose of the risk equalisation scheme is not to support competition for the most price sensitive but to equalise the risk and to ensure intergenerational solidarity. People with lower level products do benefit because they get a higher rate of tax relief as the rate of tax relief is restricted to the first €1,000.

In relation to the levy, we have four levies and there are lower levies for non-advanced plans, which accounts for approximately 10% of the market. A percentage-based levy could have the inadvertent consequence of penalising older or sicker people who buy higher cost policies to provide the services they require. However, I take the point Deputy Kelleher made and I will reflect on it. Perhaps we could discuss it further.

On the waiting times for children with scoliosis, the Deputy is right to raise the matter which is an extremely important one. I have had significant engagement with parents and advocacy groups of children and adolescents with scoliosis. That is why, as part of the €40 million winter initiative funding, I have allocated the specific sum of €2 million for scoliosis patients. That will ensure 39 adolescents and an additional 15 to 20 paediatric patients with scoliosis are treated by the end of the year. We have more to do in this area but I am pleased to have this ring-fenced, targeted investment in scoliosis to address those who are waiting the longest for treatment in order that we can begin to deal with the waiting list.

I heard one or two Deputies sneer but who did not stay to hear my response to their comments. I felt it was a very fair comment to tell private health insurance companies not to use legislation passed by this House to protect older and sicker customers as an excuse to hike up the price. Let us be honest, every single cent of this stamp duty is going into a fund to support the market. It is going into a fund which supports risk equalisation and recognises that some insurance companies have a disproportionate amount of older and sicker patients and that they should not be discriminated against. Therefore, when people talk about passing on the cost of higher stamp duty levies I hope some politicians in this House and their media advocates will also talk about passing on the benefits of the higher credits in which this legislation will result. As I noted in my opening speech, the VHI statement welcomed that measure. Deputy Kelleher made the point that the VHI has approximately 53% of the market but it has about 67% of the claims because it has, historically and to this day, an older and often therefore sicker customer base. Let us be clear: this is not a levy to go into some sort of black hole, this is a levy to provide credits to insurance companies so that they can continue to provide cover for and not discriminate against older and sicker customers. That is an important point to make and one that might have been lost in some of the debate and commentary.

Deputy Connolly asked what I have done in terms of supporting the public health system since coming to office. The first thing I did was provide €500 million of additional funding on behalf of the taxpayer to stabilise the funding for the public health service. The second thing I did was deliver the largest ever health budget of €14.6 billion for the public health service in the history of the State, including the boom years on a like-for-like basis. Let me be clear: that is not to suggest it is a panacea or that there are not significant challenges. We are coming through a period in which there has been huge pent-up demand for investment, in particular capital investment in infrastructure. I have visited 24 hospitals in the past six months and I see a need for capital investment to upgrade infrastructure and to provide more space to deal with more patients coming through the door and to provide better working conditions for front-line health care professionals. I know that is an acute issue in Galway. I will visit Galway and do exactly what Deputy Connolly asked here this evening.

We have a capital review across Government next year and that is an opportunity to look at how we can add additional capital projects, not just in health but in a range of areas, but obviously I am particularly interested in health, to our capital programme. I will look at Galway in that context. When I visit Galway in the coming weeks I hope to have an opportunity to engage further with the health care professionals, hospital management and clinical directors on the issues Deputy Connolly raised.

I am aware of the discussion about Merlin Park Hospital but I will not give false assurances that I cannot back up with funding.

A number of issues arise with regard to Galway, one of which is the emergency department situation in terms of the physical capacity. The second issue is the medium to longer term project in regard to Galway on which I look forward to further engaging with the Deputy. I would make the point that we have a number of initiatives aimed at increasing capacity in Galway. Earlier this year we saw 30 new beds opened. In addition, there is a 75 bed ward block and an acute adult mental health unit under construction, both of which are expected to be operational in 2017. Furthermore, a Programme for a Partnership Government contains a commitment on a new emergency department at Galway University Hospital.

Also in regard to Galway, which falls within the community area of CH02, that area has received €5.5 million for additional home care as part of the €40 million additional winter funding I have provided. In addition, that area is also receiving €1.8 million specifically for University Hospital Galway, which provides six additional home care packages each week starting last month and going forward to February 2017. That will provide 114 additional home care packages associated with University Hospital Galway during that winter period.

I heard Deputies talk about the public hospital subsidising the private system. People need to make those comments in the context of initiatives that have taken place in recent years because since 2004 we have seen the new charging regime for private patients in public hospitals. Our insurers must now pay for all private patients in public hospitals. To give some figures on that, we have seen payments increase from €454 million between July 2013 to July 2014 to €650 million from July 2015 to July 2016.

With regard to risk equalisation, I want to be clear. I do not hold any candle for private health insurance companies here. The reason we are doing this, and I thank the many Deputies who acknowledged this, is to benefit individual consumers, not to protect individual insurers. This is a key consideration in the European Commission analysis. If we did not do this, how exposed would we be leaving some of our sickest and some of our most elderly citizens who access private health insurance? They are not here now but some of the Deputies wished to have an ideological debate about private health insurance, and that is their right, but we cannot close our eyes, put our hands over our ears and pretend that almost 50% of our citizens do not have private health insurance. This is a real issue for almost half of our citizens and some of those, particularly the oldest and the sickest, need us to pass this legislation to make sure that the now long-standing policy of risk equalisation and a community rated scheme can be provided, which would protect them from much higher premiums were we in a risk-rated free market type approach to this.

There should not be scare-mongering, misinformation or partial information regarding this matter. This is not the Government saying that the cost of health insurance policies must be increased by 10%. It might suit some people to try to present it as that. This is the Government taking the expert actuarial analysis of the Health Insurance Authority, HIA, in making sure we apply adequate credits to the insurance market through stamp duty so that we can continue to carry out a community rated system, a risk equalisation system and a system that supports older and sicker patients in particular. I welcome the fact that the VHI has acknowledged that this supports it in protecting that consumer base.

I look forward to this legislation progressing, and to further discussion on Committee Stage. I will revert to Deputy Fitzmaurice directly on the important issues he raised. I know the air ambulance is of particular concern to the Deputy. I thank Members for the debate.

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