David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I am sharing time with a number of colleagues. Sinn Féin will support this Bill, as we always do. It is an annual Bill to renew the risk equalisation mechanism that supports the community-rated health insurance market. The Bill revises the stamp duty levy on policies and the risk equalisation credits payable to insurers for 2022. It is a self-funded system. The Bill also provides this year for high-cost claims credits, which will provide an additional layer to smooth the costs of credit allocation by directly subsidising very high-cost outliers, subject to European Commission approval. Risk equalisation ensures costs are constant across the lifespan of the individual. It seeks to ensure, where possible, that age, gender and health status do not influence the cost of an insurance product. Recognising the reliance of many people on health insurance, we will support the Bill, as we have done in previous years.

I take this opportunity to reiterate our critique of the current insurance market and the two-tier healthcare system in this State. The Minister of State restated in her opening remarks the Government's commitment to the implementation of Sláintecare and the commitments contained within it. The people who resigned their positions and walked away from the implementation of the programme would disagree that the level of urgency and commitment that should have been given has, in fact, been given. I do not doubt at all that additional funding was made available in last year's healthcare budget, but it followed a decade of underinvestment. Moreover, as we know, most of that money was not spent and was rolled over to this year. Even still, many of the staff and beds that were promised were not delivered and potentially will not be delivered.

A total of 45% of people in this State rely on the health insurance market, not because they want to take out private insurance but because they feel they have no choice in the matter. How can we blame then when we look at the waiting lists in the public system? There are 900,000 people on some form of health waiting lists, despite all the promises we had from the Minister, Deputy Stephen Donnelly, and his predecessors that we would see waiting list strategies. In fact, the head of the Sláintecare implementation body, who has resigned her position, is on the public record as saying there was a waiting list strategy already there and ready to go but it simply was not published and advanced by the Minister. Why is that? All we are seeing is waiting lists going in the wrong direction. It is bad enough that 900,000 people are on some form of public health waiting list but 200,000 of those patients, many of them children, are waiting more than 18 months. That is the reality for many people.

I do not have time to go into all the promises made as part of the delivery of Sláintecare. Commitments were given to enhance community care, which would involve more investment in community and primary care and ensuring people are treated, as far as possible, in their own home in the first instance and, for people with chronic pain and cardiac and respiratory illnesses, that their care would be managed in the community. This is not possible for many people because the community infrastructure simply is not there. Anyone to whom I have spoken who knows what he or she is talking about when it comes to healthcare says the HSE simply does not understand the community sector. It has outsourced huge amounts of public money, as we know, to section 38 and section 39 organisations and, indeed, to a large number of private organisations, when it comes to the delivery of home help and home care packages. That is the reality of what is happening.

One of the representatives of HIQA who came before the Oireachtas health committee a number of months ago when we were discussing the private nursing home sector and the subsidies the State pays for the sector, said: "The HSE does not understand the private sector that it spends so much of taxpayers' money on." I would say the executive also does not understand the community sector. I have put in parliamentary questions, as other Deputies do all the time, trying to establish where all the money goes, how many community beds are funded and how many staff there are in all these organisations and across all the different layers of community care. We get different responses or, on some occasions, no response because the data are not available. That is crazy when one considers the billions of euro of taxpayers' money that goes into community care. Much of that care is not driven by the HSE and is not publicly owned, managed and controlled. We then have all the issues that flow from that, with section 38 and section 39 organisations paying wages below HSE rates and not being able to attract staff at the same level as the HSE does because of the terms and conditions of employment they offer. We know there is a need to overhaul this sector. Community care is an area in which there has not been investment and where the step change that was needed, which Sláintecare promised, has not been delivered.

The two major areas in which very little progress has been made and that are relevant to this Bill are, first, removing healthcare from public hospitals and, second, expanding universal GP access and free GP care. On removing healthcare from public hospitals, we had the Sláintecare report in the first instance, which set out a strategy for how that would be delivered. It was followed up by the de Buitléir report, which again set out a clear strategy for delivering this objective in terms of public-only consulting contracts and grandfathering out those consultants who remain on the types A and B contracts, with some form of enticement, if possible, for the latter to move onto the public-only contracts. Very few advances were made in this regard. Despite there being the Sláintecare report and the de Buitléir report, we still have not made any inroads in this area at all. That will continue to be the case until the political will is there to do it. The lack of action is driving much of the private sector activity in healthcare, which is embedded in our public hospitals. We need, once and for all, not just to agree but to deliver on the commitment to disentangle private healthcare from public hospitals.

The cost of that, according to the de Buitléir report, was €700 million. Juxtapose that with the €200 million private sector funding that was made available as part of the winter plan, the access to care fund. That is in addition to what has already been paid in respect of the National Treatment Purchase Fund. That is an additional €200 million, the vast majority which will go into the private sector and into private hospitals. Yet, the cost of removing private healthcare from public hospitals would be €700 million. In the general scheme of healthcare funding, that is not a huge cost. It strikes me that cost is not the problem here but it is the political will to make it happen. It is not happening. It was a big promise that was made but it simply is not being implemented.

The expansion of free GP care will be important if we want to ensure people come off private health insurance and that we wean the State away from subsidising private healthcare through the National Treatment Purchase Fund and all of the short-term measures the Government comes up with at the last minute as we go into winter to give a veneer that it is doing something to deal with waiting lists and the crisis in hospitals. All it is doing is outsourcing more funding and giving more funding to the private sector. We need to grapple and deal with those two big issues that I have outlined.

Look at what happened in budget 2022 in relation to expanding free GP care. It was meant to be done by 2023, as I understand it. We are nowhere near that. What was funded in the budget was for seven- to eight-year-olds, I think, to receive universal GP access. That is still being negotiated. There are still ongoing talks with the Irish Medical Organisation, IMO. Even though it was funded, it still has not been implemented. In fact, many people who are medical card holders have problems getting access to some services already. Bloods, for example, is one of these services. There are huge challenges in that area. Despite the commitment to move to universal GP access for everybody within a five-year period of Sláintecare being committed to and delivered, it has not happened.

I am afraid that when the Minister of State and the Government give themselves a pat on the back for what they have done in healthcare reform, they only have to look at the people who are tasked with responsibility for doing that. The chair of the Sláintecare implementation advisory council, SIAC, walked away. The person who was the lead in the HSE for delivering Sláintecare walked away. The vast majority of people, or many of them, on the advisory committee walked away. That is being restructured. The Minister has given responsibility to the Secretary General in the Department and the head of the HSE. However, there has been no sense of urgency from those two individuals in regard to those two big issues. As long as that continues, we are going to be back here every year. Yes, this is technical legislation but I am not prepared to continue to support a two-tier system, which is broken and which does not work for the vast majority of patients. I want to see urgent delivery on the commitments that all parties signed up to in Sláintecare. It strikes me that some people and some political parties who signed up to Sláintecare did not believe in the principle of it. If they did, they would have moved much quicker.

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