Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I move:

That Dáil Éireann: notes:

— that, on average, 45,753 cancers or related tumours were diagnosed each year during 2018-2020;

— that there are currently approximately 200,000 cancer patients or former cancer patients alive in Ireland;

— that inpatient charges are incurred by cancer patients without a medical card or private health insurance at a cost of €80 per visit, or up to €800 per year;

— that most courses of chemotherapy and radiotherapy require more than ten visits a year, meaning most patients will pay the maximum charge for inpatient treatment;

— that a significant proportion of cancer patients have neither a medical card nor private health insurance; and

— the lack of clear guidelines for hospitals for waiving inpatient fees in cases of excessive hardship;

acknowledges:

— the report entitled "The Real Cost of Cancer" published by the Irish Cancer Society in 2019;

— that the average cost to someone diagnosed with cancer is €756 a month; in some cases this can rise to over €1,000; with increased cost of living and energy expenditure this cost is rising; and at the same time, people are faced with an income loss of over €1,500 a month on average;

— the expenses around hospital visits - petrol, parking and eating at the hospital - come to an average of €291 a month, more than the average cost of medicines, which is an average of €261 a month;

— that, should patients not pay their charges within 47 days, many hospitals contract debt collection agencies to call upon patients to seek payment for basic cancer treatment; and

— that the Health Service Executive (HSE) spent more than €4.377 million on debt collection agencies in the period between 2013 and 2020; and

calls on the Government to:

— abolish the €80 inpatient charge for those who are receiving cancer treatment;

— direct the HSE to end the practice of using debt collectors to collect hospital charges from cancer patients; and

— honour its commitment in the Programme for Government: Our Shared Future to "introduce a cap on the maximum daily charge for car parking for patients and visitors at all public hospitals, where possible" and "introduce flexible passes in all public hospitals for patients and their families".

It is disappointing that the Minister for Health is not here to listen to this debate. Cancer care is a very significant element of the health service. It is really disappointing that the Minister is not present. He is not in the country. He is off at some business event. That is a pity. With the agreement of the House, I will share my time with Deputies Whitmore and Gannon.

Every three minutes in Ireland, someone receives a cancer diagnosis. Sitting in doctors' offices throughout the country, across every village, town and city, it is a largely indiscriminate disease. Many patients say the minute they hear the word "cancer" it feels like the whole world has been turned upside down - like they are losing control. Most of us at one point or another have thought about and worried about receiving this life-changing diagnosis, but most people have not thought about the cost associated with that diagnosis and the reason for that is that they should not need to.

However, a cancer diagnosis comes with a hefty bill with some patients facing financial crisis alongside their treatment. In a 2019 Irish Cancer Society survey into the experiences of cancer patients and survivors, one participant said, "It was like a bomb went off. It cost a lot of money and has left me weak and in need of financial assistance." Another said, "I am just 17 days into being diagnosed. It is complete turmoil. As it goes on the financial burden is sinking in." This survey is filled with harrowing testimonies which paint a shameful picture, leaving no doubt that the State is failing cancer patients in many ways.

The myriad of expenses, which are often unexpected, can at times feel endless - medication, GP visits, specialist dressings, travel, wigs and additional dental care to name but a few. For the patients who do not meet the strict medical card income limits or cannot afford private health insurance, the financial strain is even greater. They are essentially left adrift with no financial support at a time when their physical and psychological energy reserves are low. As a 2018 report into health inequality in Europe put it, these patients are stuck in the twilight zone of the Irish health service. They are at the sharp end of a two-tier system, incurring €80 inpatient charges per hospital visit. While this is capped at a maximum of €800 per year, it should be noted that a high proportion of patients end up paying the maximum rate as their course of chemotherapy or radiotherapy requires more than ten visits a year.

For many patients their first introduction to these inpatient charges is often upon receipt of an invoice. Understandably, some newly diagnosed patients are not even aware that these charges exist. They assume that their treatment is free, particularly the day services. Last year one woman told the Irish Cancer Society that she found out about the inpatient charge the morning of her first chemotherapy session. Imagine a patient learning about this unexpected cost just before their first chemotherapy session, as if they would not be frightened and stressed enough already.

However, for many people it is the speed with which bills, reminders and even debt collector letters are issued that really distresses them. Invoices often come through the door while patients are still recovering from the treatment they are being billed for. In one case a patient received 19 separate correspondences from the hospital and debt collection agency. It is quite remarkable how efficient the health service can be when it is owed money.

The practice of hiring debt collectors is especially disgraceful in my view. It is meant to intimidate patients who with everything else going on in their lives during treatment may just not have got around to paying, maybe they just do not have the money or maybe they are waiting for the outcome of their medical card application. Frankly, the reason does not really matter. What matters is the absolute lack of sensitivity and understanding being shown to cancer patients. One cancer patient described the debt collector's relentless pursuit as bullying. She was told that if she did not pay up, her name would be blacklisted with things like car loans, home loans or even mobile phone contracts. Instead of winding down this deplorable practice, it appears that the HSE has actually intensified its pursuit of patients and spent more than €4 million on debt-collection agencies.

On top of this, many HSE-run hospitals are still charging exorbitant fees for their car parks, with the average cost for car parking for cancer patients at around €62 per week. Despite a programme for Government commitment to introduce a cap on hospital car parking charges and to introduce flexible passes where possible, nothing has really changed. The Department of Health has failed to grasp this nettle after years of empty promises. Following a 2018 review of car parking charges, the HSE signed off on a plan to cap car parking charges at €10. The plan was signed off by the HSE directorate in January 2019 and yet many hospitals are still not complying.

For example, Our Lady of Lourdes Hospital in Drogheda charges up to €25 a day and there are many others doing likewise. In total this blatant moneymaking exercise amounts to around €12 million a year in income at HSE-run hospitals. These car parking charges are especially high in urban areas where our eight designated cancer centres for individual cancer types are located. The centres are in Dublin, Cork, Waterford, Galway and Limerick. Many of these hospitals, of course, are known as voluntary hospitals. They are public hospitals but they have the title of voluntary hospitals. They have commercial private car parks which they operate as substantial money spinners and which place a heavy financial burden on patients.

Of course, for those living outside these counties, the costs associated with their appointments are even more substantial. When travel, parking, food, accommodation and items such as tolls and car servicing are included, the average cost is €989 per year. For many people this is the final straw. Instead of focusing on their well-being, treatment and recovery, patients are worried about money; they should not be. These extra and unnecessary charges are taking a considerable toll on cancer patients and their families. We cannot stand by and allow them to continue any longer.

While this motion is not a silver bullet, it is an important start. We all know that abolishing inpatient charges for cancer patients and placing a cap on car parking charges is the very minimum that must be done. Of course, the only way to fundamentally tackle the considerable financial challenges faced by cancer patients and indeed all patients is a system of universal healthcare, based on need and not ability to pay. However, without real political leadership and a commitment to radically scaling up implementation of Sláintecare, we will need to continue to plaster over the cracks of our health service.

With the stroke of a pen, the Minister could change that, allowing cancer patients the opportunity to focus on their health and not on the mounting debts. It is time to accelerate reform of our health service, to view it as an essential public service and to remove the cost barriers for patients. The Social Democrats believe this motion would be a good place to start, to make our health service more conscious of and more sensitive to the difficult circumstances that patients are in and to make it more empathetic. Therefore, by removing inpatient charges for cancer patients, by ending the practice of hiring debt collectors and by capping car parking charges, cancer patients can be relieved of some of the financial worries and concentrate their energies on getting well. It is the least they deserve and the very least that the Government should do. I ask Government Members to support this motion.

See this speech in context