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

I thank the Minster for outlining the detail of the Bill. At this stage it is an annual event that we have to change the legislation before the end of the year to address the proposals outlined by the Minister. Fianna Fáil will be supporting the Bill which is in keeping with the ethos of the party and its view on lifetime community rating and risk equalisation, of which we have been in favour for many years, and there have been conversions along the road. The Government has converted to our view, which we welcome. If we can get to a situation where the vast majority of parties represented within the Parliament have a coherent vision for the health service, it will mean that we will be travelling in the same direction, no matter who is sitting in the Minster's seat. For too long, the health service has been without a clear and coherent plan from one Government to the next. This has done untold damage in the provision of health care services. That is not a political point but an observation. The Sláintecare report is the platform from which to make progress in that regard as there is broad political support for it and will be in the years ahead, regardless of where or even whether individual Members sit in the Chamber. I expect the same approach to be adopted by other political parties. That will give us a chance to invest in the public health system to ensure there will be access for all when needed.

There have been times in the private health insurance market when changing policies in the context of universal health insurance have undermined people's willingness to take out health insurance. They were unwilling to take it out in the years which it was believed would proceed the implementation of a policy which never actually happened. The downturn in the economy, the pressure on families, a reduction in incomes and the threat of compulsory health insurance meant people did not take out health insurance because they thought they would be forced to take it out at some stage in the context of universal health insurance system. There is no doubt that that undermined the health insurance market. However, there has been a recovery which we must acknowledge and welcome. The more people who take out private health insurance, the greater the extent to which the burden is lightened on the industry. That means that older people will not have to pay as much for health care.

Risk equalisation is to be welcomed and should be supported. Intergenerational solidarity transfers the burden from those who most need health care to a broader base of the population which in itself means that the health insurance market can survive and thrive. Lifetime community rating is critically important and something for which we have called for a number of years. It is welcome that it has been introduced and is having a very positive effect on the health insurance market. It encourages young people to take out health insurance or at least to take it out at an earlier stage in life than otherwise would be the case in the absence of incentives. They might not take it out while they are young and healthy; rather, they might wait for a number of years and take it out just before entering a certain age cohort, which undermines the concept of having an insurance fund because it means that they will take more from it than they will put into it.

When we talk about health insurance, we must also talk about Sláintecare, the policy direction in which we are travelling and, equally, what is happening at the heart of the public health system with reference to private practice in public hospitals. The "Prime Time" programme left a sour taste in the mouths of many. There are now a number of well paid professionals who are in breach of their contractual, ethical and moral obligations by spending more hours in private practice than they are entitled to do under their contracts. This is a matter which must be addressed very quickly, regardless of our direction of travel in the context of the Sláintecare report. The Minister referred to the matter when it was raised at the joint committee last week and agreed that we would ensure contracts were adhered to. I asked at the time - I hope the Minister can consider this - whether the issue was related to the Department of Health or the HSE or whether there was a need for an independent outside audit assessment of the contracts. There is a difficulty for hospital managers because of the incentives created by stretched budgets. While there is nothing in writing, there seems to be an incentive, a policy direction or an instruction from somewhere within the Department of Health or the HSE to engage in as much private practice as possible in the public health system.

When the redesignation legislation passed through the Houses to ensure all public beds would be available for patients with private health insurance, I said it would automatically incentivise hospitals to fill beds with private patients. That was completely obvious and it is what has happened. The question is whether it is happening because it is being driven by consultants who want to push as many of their private patients through the system as possible or if it is being done to address budgetary deficits by hospitals which want to undertake private work for which they can charge insurance companies. It is something at which we really have to look. That the public health system subsidises consultants to do additional work over and above what they are obliged to do, while public patients cannot access treatment or diagnostics, leaves a sour taste in the mouths of many. I urge the Minister to look at it in detail quickly. The perverse incentives created by the 2014 legislation were bound to encourage this activity.

The Minister has outlined the Bill in detail. I do not need to need to go through all of it again as we enact this legislation every year. However, I note that there are a few additions which we welcome.

For example, we welcome the ten-year cap.

There will be huge challenges in the provision of health care in the coming years. That fact is camouflaged at present because of the demographic of the population. We have a large number of young people but the balance will tip very quickly. The recent ESRI report should set off alarm bells for policymakers and we have to start addressing capacity issues very quickly. It will take time to build up capacity because it takes a lot of manpower, training programmes and advance planning. We do not seem to plan our health care provision. Instead, we react instead to one crisis or another. When the capacity review is published at the end of the year, using ESRI projections up to 2030, we will have a template for what is required. In addition, there is the Sláintecare report, which will set out the policy direction on which we have to travel.

We cannot pretend that we will get away without investing and we have to start the process now. Investment is required in the shape of bricks and mortar, in order to expand the public hospital system, and in health professionals. There is an expansion of GP training but we are light years behind what we will require in the years ahead in respect of secondary and allied health care professionals. If we are to shift the focus from the hospital-centric system we have to primary and community care, we need to enhance the capacity in terms of personnel and professionals in those settings. Moving chronic illness and disease to those settings will require a lot of nurse specialists and we will need increased training programmes to prepare for it. This is the right way to go and it has been confirmed by the Sláintecare report.

I urge all Deputies to read the Sláintecare report. A great deal of work was put into it and there were some exceptional presentations made to the committee. It is very positive that we were able to get consensus from all political parties represented on the committee to point our health services in a particular direction. It has to be accepted, however, by the Government and those which succeed it, that this will require investment.

At present, half the population have private health insurance and there are few waiting lists for those people. Of those who do not have health insurance, 687,000 are on some form of a waiting list. The 687,000 people on waiting lists come out of a population of 2.3 million, therefore, and not out of a population of 4.6 million. This shows that the health services are teetering on the edge of collapse in terms of their ability to deliver care in a timely manner. If it was not for the private health system being able to cater for those with insurance, the public health system would have collapsed long ago. Our public health system is dependent on a very active private health insurance market which encourages people to take out insurance or, indeed, forces them to do so out of fear that they will not be treated in the public health system. Many take out insurance for fear they will not get things such as diagnostics in the public health system. It is not because they want a nice room, menus or flat-screen televisions. Citizens want timely access to quality diagnostics and care but our public system cannot give that to them at present. People are leaving west Cork on buses heading for Belfast for cataract operations because ophthalmic services are very poor there and in certain other parts of the country. The situation would be far worse were it not for people feeling forced, out of fear, to take out private health insurance. A constituent of mine aged 90 was waiting for a cataract operation but he was told it could take three years. With some interventions and representations, the matter was subsequently addressed but a person aged 90 does not that have that much time. His wife also needed a cataract operation so they were dependent on each other. It was difficult to witness the hardship caused to that couple because they could no longer do the things they always did, such as walk the road, go to the shop or go to mass. They had to rely on neighbours and friends to take them places. We were hoping they would be able to get their operations within a year but were told it would take three.

If the Minister goes to the print room of these Houses, he would see that we are all sending leaflets out advising people how to get treatment abroad under the EU cross-border treatment directive or the treatment abroad scheme. That is an admission of failure on our part.

We welcome the contents of the Bill and the fact that there is now a vibrant health insurance market but we have to be conscious that people only have a certain amount of cover. We need to ensure that there is competition in the market place and that health insurance costs do not escalate again. There is health inflation and the cost of treatment is continually rising, while new technologies and advances in medicine, in implements and in devices such implants create additional costs that are borne by the people with private health insurance or those in the public health system who are on waiting lists. I welcome the Bill and hope it has a positive effect on attracting people into private health insurance. We should be under no illusions, however. Most people take out private health insurance not for the flat-screen television or the menu but because they fear the public system.

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