Dáil debates

Friday, 1 July 2022

Health (Miscellaneous Provisions) (No. 2) Bill 2022: Second Stage


2:20 pm

Photo of Duncan SmithDuncan Smith (Dublin Fingal, Labour) | Oireachtas source

The Labour Party welcomes the provisions in this Bill both in the area of inpatient charges for children under 16 years of age and in the measure the Minister will introduce in an amendment with regard to contraception services. That is an especially progressive measure and will make a real difference. It is an early step in what will be, should the action plan on women's health be delivered, a further, more comprehensive suite of measures in respect of contraception and women's health in general. That is to be broadly welcomed. It is something that will be delivered and is deliverable, which is the proof of the pudding in anything the Government or we in politics do.

The measure on inpatient charges is also very welcome. We would like to see a commitment in the upcoming budget to its extension and the removal of all inpatient charges. The cost of the removal of all such charges, based on the Department's own costings for 2018 to 2020, would be approximately €30 million. That is a significant figure and not something that can be found at the back of the Department's couch, but in the overall context of the health budget it is not a major amount. Given the cost-of-living crisis we face, and the desire for free health access at the point of delivery, it would be great to see this measure extended in the upcoming budget. As I am sure the Minister will be aware, it is a key part of the Irish Cancer Society's pre-budget submission. We had a debate recently in the House on that and the Irish Cancer Society held a drop-in session in Buswells Hotel earlier this week. It was a fantastic and very well costed pre-budget submission that asked for the abolition of all inpatient charges and an end to the practice of debt collections in the health service.

This is a matter I will bring up again because it is something that is linked to inpatient charges and the fact people cannot afford to pay them as they exist at present. They can be capped at €800 but inpatient charges can go to debt collection within a month. I mentioned the cost-of-living crisis and how difficult things are for people. No one plans or wants to be in hospital. At almost all times, it is a surprise charge that can be imposed on an individual or household. It is something that hospitals, hospital groups and our publicly-funded health service are outsourcing. Whether someone is suffering from, recovering from or living with cancer or any other illness, or is in recovery from an illness after a stay in hospital, an automated phone call from a debt collection service is highly distressing. It is something we as a nation and the State and public health service should not tolerate. I ask the Minister to re-examine that matter. It is an ask that will not go away and has broad support across the Opposition. I am sure the Minister, many in his party and many in the Government parties do not want to see this, and do want to stand over a private debt collection service operating in our public health system. If that is something that could be looked at, it would be most welcome.

I was not going to mention the other issues. I was going to stick to the Bill, but as the Minister referenced them in his contribution I will speak to them. On contraception, I tabled a number of parliamentary questions regarding the provision of community-based vasectomy services. We have a real problem in Dublin as regards GP practices that have either been retired or passed on. Apparently, there is only one practice left that is providing this service. Recommendations were made by a working group in 2018, which the HSE and the Department were all for. When the pandemic happened, they were not implemented. I ask the Minister, through the parliamentary questions that will come across his desk in a couple of weeks, to have a look at that. It is an important public health and contraception measure that everyone in his Department is in favour of delivering on. I ask him to give it some attention.

The delay in the continuation of the free GP care scheme is something we feel very deeply. The Labour Party brought this in when we were in the Government. We are very proud of it. Everyone likes it. Everyone remembers other stuff we did in Government but no one ever seems to remember we did that when they are in the Chamber crowing about it not being extended. The Irish Medical Organisation and GPs are dragging their heels on it. The Minister needs to call them out. We need to have this scheme continued. The scheme has now been in existence for seven years but this Government and the previous one have not been able to extend it to six- and seven-year-olds, which would be a modest increase. We should be well beyond that. We should now be at a stage where we are looking at it for all. If we are including the group aged 16 and under in the reduction of inpatient charges, we should at least be there for the extension of free GP care at this stage.

The GPs and the IMO are getting away with blue murder in dragging their heels on this. The Minister needs to be more vociferous in calling them out and demanding they sign up, at a minimum, to the inclusion in the scheme of those aged six and seven, and then start including eight-, nine- and ten-year-olds, and primary and secondary school students, as we move towards universality in free GP care. Children are more likely to visit their GP than to be inpatients in hospital, thank God. It is a more constant and regular cost-of-living issue. We now have accessibility issues tied into it, and trying to get more GPs on stream etc, but the fact this has now stagnated for seven years and has not progressed is not something the Minister will want to stand over. I think he would like to deliver, at least, what is now a very modest extension of the scheme to six- and seven-year-olds before the end of this year. It cannot just be another couple of lines in a budget without any delivery.

The work on new medicines is very positive. There will always be new medicines and therapies we will want to bring in. We will call for that when they happen, which will usually be in respect of young people or those with chronic diseases. We always need to strive to make sure we have the best new therapies available within our public system for people in Ireland who are sick no matter what their age. I can see the work that is being done, which will be ongoing.

There were two paragraphs in the Minister's speech regarding the dental treatment services scheme. I read the second paragraph as well. It states that the Minister hoped "this significant additional investment in the dental treatment services scheme will attract more dentists...". It will not. Dentists have turned their backs on the scheme. They believe it is totally outdated and archaic. It does not represent value for them and does not represent current dental services. I have raised this matter, as have Deputies Cullinane and Shortall, for the past year and more. It seems that when we have asked about the negotiations or engagements between the Department and the dentists' representative body, it is a case of the next quarter or the quarters thereafter, or there will be a meeting and then we will come back. There does not seem to be a sense of any real momentum and engagement. The Department may throw money at it, or allocate money to it, but if these dentists do not want to take part in the scheme and feel it is structurally unsound, they will remain outside it.

We are dealing with issues in our constituency clinics and offices every week relating to people who are unable to access dental services. The problem is chronic everywhere but very acute on the north side of Dublin. If I am out canvassing, after one hour at most, it will come up at least once on the door. It is always coming up now because it is impacting on so many people. Since people do not go to the dentist every week or every month, it may not have the momentum it should but it is impacting on them. They are forced to go private. They might get whatever emergency procedure they need done to get them over a particular dental issue. That individual may be sated for a while, but the issue continues. Dentists are no closer to re-engaging with the scheme. They will not re-engage with it as it currently exists. It has to be torn up and redone. That is just the reality of it. It will be expensive and uncomfortable but it has to be done. Otherwise, given the way it is structured now, we are consigning people on medical cards to be outside public access to dental treatment, which is a massively retrograde step.

The Department and the representatives of the Irish Dental Association need to get into real engagement on this. The Covid pandemic, which was the reason given for a couple of years that certain things could not progress, is now in a different space. Covid is not here in the way it was so there has to be the space for us to resolve this issue. While I appreciate the allocation of more money, and the PRSI cover for a scale and polish and all the rest, which is helping some people, the structural issues with the DTSS have not been addressed and seem no closer to being addressed.

I will finish by returning to the provisions of the Bill. It is important those aged 16 and under will not be charged for inpatient services in our public hospitals. That is a very positive and progressive step. It will help households and bill payers in families whose children have been in hospital.

That is to be welcomed.

I should have mentioned, when I spoke about the briefing by the Irish Cancer Society the other day, about how inpatient charges can accumulate. One of the patient advocates who has recovered from cancer had a two-year treatment through the private system. That person calculated they paid less than if they had have got the same treatment through the public system, and this is including the person's insurance premium and the €75 excess they had to pay in each of the two years. This was because of the inpatient charges the person would have incurred. It was €400 cheaper for the person to go private with their private health insurance than it was for them to go through the public system. I am doing up a note on that which I will send to the Minister. It is a kind of perverse example of how our health system is not functioning when it is more expensive to pay on the public system than on the private system.

I want the public system to be free at the point of use. I want it to be a world leader and for it to excel. I want private health insurance to diminish to such an extent that people do not want or need it because of how good the public health system is. That is the vision of Sláintecare, which is silent on private health insurance. The implication is that if Sláintecare is delivered, our health service will be good enough that no one will want private health insurance. That is where we need to get to. The above example is one to take note of because it certainly took me by surprise. The two main provisions of this Bill are a step forward. We look forward to supporting it before the Dáil recess.


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