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

I welcome this Bill and it is good the Government is abolishing the inpatient charge for children under 16 and that parents will no longer have that as an additional worry when their child gets sick and has to be admitted to the hospital. The Minister made the point that it will ease the financial burden on parents and ensure that cost is not a significant consideration for families when children have to go into hospital, which is good.

However, it begs the question of why anyone should have a financial burden when they have to go into hospital. The bar is set pretty high to be admitted to hospital. You are seriously ill if you are admitted to hospital and you need some kind of procedure. To stay there one night is not something you have any control over or that you can do anything about in terms of going anywhere else or getting it done on the cheap; there is no alternative to that. When somebody is admitted to hospital for one night they are charged €80, and many people would be in for ten nights so that is a charge of €800. This is a problem that applies to all families that do not have private health insurance. What exactly is the rationale for that? I cannot see how there could be any rationale for it. If somebody has to go into hospital they have to get treatment and they are seriously ill and we charge them for getting that treatment. Why do we do that? In the case of most families, particularly in the present climate, where do we expect that people will get €800 to pay a hospital bill? It is not as if we are talking about people who have money in the bank or who have savings. Why are we continuing to charge people for going into hospital for a procedure? It makes no sense whatsoever and in most other European countries this is unheard of. It is grand to finally be moving on children under 16 but there is no justification for charging people for being admitted to hospital. That was one of the key things that was looked at in Sláintecare.

There are many elements of Sláintecare which were all phased in detail over the ten-year period in the report. Under the heading of reducing and removing charges the first action mentioned is to remove inpatient charges. The proposal is that all of the charges should be removed in the first year of Sláintecare because there is no justification for them. They only cause hardship to people and the Government needs to make much more progress on this. I accept that the past two years have been difficult and have cut across the implementation of Sláintecare. We have lost the implementation people and all of that and it is regrettable that this was allowed to happen but things are getting back on track somewhat and I expressed the view at the most recent meeting of the Joint Committee on Health, when we had Mr. Watt and Mr. Reid in talking about regionalisation, that for the first time I got a sense that this is taking shape. In particular, the appointment of Liam Woods to head up the regionalisation is a positive development and it is a statement of intent on behalf of the Minister and other senior people in the health service, which is welcome.

The progress is painfully slow, however. There is all the structural and legal stuff, which is complex, but the fundamental problem with our health service is that it is inequitable because it denies care. It often denies lifesaving care to people because they cannot afford private health insurance and that is the only reason the care is denied. We are a complete outlier when it comes to the rest of Europe. The idea of paying to see a GP or because you have to be admitted to hospital is unheard of elsewhere and the idea of paying for medicines is unheard of in many countries. We are completely out of line with everywhere else in that. This measure is fine and grand but it is only a drop in the ocean in what needs to be done to remove that barrier to healthcare and cost is a massive barrier to people accessing healthcare.

Given the way things operate at the moment, I have a concern that while we are talking about Sláintecare and slow moves are being made to go down the road towards implementation, there is at the same time creeping privatisation in the health service. The worse the public health service is, the more demand there will be for private healthcare and the more money to be made from it. The reverse is the case too. If there is a really good public health service, there is not a demand for private health service and people are precluded from coining it. They are the vested interests, the people who will knock on the Minister's door and are continually, I am sure, trying to prevent the implementation of Sláintecare because it interferes with their business and profit-making. That should not be the concern of the Minister or Government because the number one responsibility in healthcare is to make sure people have access to it. Affordability is critical, as is adequate supply. At the moment, large numbers of people find their care delayed, deferred and, in many cases, denied. That is because they do not have the money in their pocket. That is completely wrong and inequitable, and that is one of the key principles behind Sláintecare. At this stage, cost should not be a barrier for people accessing care.

With regard to that creeping privatisation, we are seeing more and more that GPs and consultants are gatekeepers to care, particularly in respect of diagnostics. Because there are such long delays and waiting lists for diagnostics of all kinds, we have a practice whereby people are advised to go off and raise the money. They beg, borrow and steal to raise the money if somebody is seriously ill in the family. They are advised to get the money to go privately for an MRI scan, CAT scan or whatever it is. By doing that, they can skip the queue because they then get quicker access to public healthcare. That is wrong. It should not be like that and it is putting enormous pressure on people. One can understand it very well. For any of us, if a family member is sick, we will do anything to get them treatment. People are being forced into debt and all kinds of difficult circumstances to get that initial diagnosis so their family member can access the care they need. It is unfair and wrong and we should not allow this situation to happen.

I was at a meeting of the Joint Committee on Disability Matters a few weeks ago and listened to parents talking about the fact they could not get an assessment of need for their kids with a disability. They had to go off and borrow money if they could, get it from their family, credit union or whatever to get the assessment of need. By allowing a situation like that to continue with the health service, it drives behaviour for people, not only for trying to access it but for staff in the health service. The health service is becoming more and more difficult to work in but there is a perverse incentive for people to go into private practice. The people who do assessments of need, rather than dealing with a massive waiting list, can go out privately, do private assessments of need and get paid better on the basis that they get a payment for each assessment they do. It is much more lucrative and less stressful. People are incentivised to set up in private practice because the services are so dysfunctional. Families with children with disabilities may borrow that money and get a private assessment of need but then the therapies are not available because there are so many vacancies among therapists.

Time and time again, people who do not have private health insurance are being hammered for the fact that they cannot afford health insurance. It should not be about that. People should not be forced into a situation where, if they can possibly afford it, they will take out private health insurance. Private health insurance is an additional health tax being forced on people. If people pay their taxes, the least they can expect is a functioning public health service. We do not have that and there is no great sense of urgency about implementing the programme that is there. This is a unique opportunity the Minister and the Government have to deliver something really substantial. They will not have opposition from other parties here. It is a great opportunity to do something of massive significance to huge numbers of people in this country. It would be a great legacy for the Government to leave behind. Healthcare and access to it is so fundamental to people's lives, welfare, quality of life and general well-being that it has to be prioritised.

Funding has not been a massive issue in recent years and money is being provided for services at budget time. It seems great and one hopes that will solve problems in that aspect of healthcare but invariably halfway through the year or at the end of the year we discover that the money was not spent because it was not possible to recruit staff. That is because we do not have staff. We have driven many healthcare workers out of this country because they cannot take the pressure, dysfunction and the fact they have to continuously apologise to their patients for poor service.

There also seems to be very little workforce planning going on, which is a huge issue. When we were doing the Sláintecare work, we had Stephen Kinsella in speaking to us and at that stage there was a plan to bring him in to look at the question of workforce planning. I do not think anything came of that. Is there any connection between the demands of the population in terms of healthcare workers and the places provided in third level colleges? I am not aware of any connection there. At this point, there are serious shortages almost cross the board in the health service. We are hearing more and more from Ministers that the issue is not money; it is availability of staff. It is fine in theory to provide funding for this, that and the other but the services do not follow because we cannot get staff.

There are many issues about workforce planning that need urgent attention but the primary thing in respect of staff is ensuring we keep staff here and that they are encouraged to be part of the reform programme and leading that reform in healthcare. If people are given confidence that we are serious about reform and Sláintecare will happen in a reasonable time, they will get involved because it is potentially a transformative plan and hugely exciting for the country. It could change people's lives but they have to have the confidence that people are serious about it and that it will happen. They have to be invited back to lead the reform programme.

That brings me to the question of consultants and GPs. There are shortages across the board but particularly in doctors. It is unforgivable that negotiations on the new consultant contract have been in abeyance for six months. Why is this the case? There is an attractive Sláintecare contract for consultants. Why are we not going out of our way to attract back consultants on the basis of those attractive contracts? We should be doing everything possible, not leaving it aside and ignoring it.

I have said frequently that most young GPs do not want to be businesspeople. The business model involved in the GP contract is massively outdated. Most young GPs want to be GPs and to practise medicine.

They do not want to buy premises and set up a business nor have they the capital behind them to do so. We should be employing GPs. We should have salaried GPs. There is a shortage of GPs generally and also a shortage of GPs who are in a position to provide their own premises. There are also shortages of GPs for disadvantaged urban areas and remote rural areas. There is a shortage of GPs to carry on out-of-hours services. Many qualified GPs would happily come back to do that work. There are also many GPs who want to work part time or to job-share but those options are not open to them. Why are we not availing of these opportunities to strengthen the health service? I just cannot understand it. The Minister would have the full support of people on this side of the House if he pressed ahead with the implementation of the Sláintecare contract and introduced salaried GPs or different arrangements in respect of the employment or contracting of GPs. Just because we do things a particular way with regard to the employment of consultants or GPs - and we know that both areas are problematic - and have done so since the beginning of time, it does not make it right nor does it mean that we have to continue to follow those problematic approaches. I strongly urge him to change that.

There is another thing I wish to say about this legislation, apart from that it should apply across the board to all of the population. Will the Minister at least prioritise one more very important group of patients, that is, cancer patients? As he will be aware, the Social Democrats moved a Private Member's motion on this issue a few months ago. It is unconscionable that people who are diagnosed with cancer and who have to go into hospital to get treatment, whether radiation therapy or chemotherapy, are faced with a bill of up to €800 for that treatment. People have told us that they were in the process of getting life-saving treatment and, before they got home from hospital, a bill had arrived for their inpatient care. What on earth is the justification for that? Within a matter of weeks, if they have not paid the bill, the hospital gets the debt collectors onto them. These debt collectors are ringing people up and calling to their homes. They are telling people that their credit rating will be affected and so on when those people should be concentrating on their recovery following their diagnosis and treatment rather than worrying about where they are going to get money to pay for that treatment. The amount involved here is not very big. I ask the Minister to give priority to this group of patients in October's budget because what is happening at the moment is just wrong.

My next point relates to the amendment he proposes to table on Committee Stage next week about something very worthwhile. The free contraception scheme is very good. With regard to this legislation, I am concerned that it is happening so late in the day. It is obviously outside the scope of the legislation, which is why the Title had to be changed. The Joint Committee on Health got a briefing on it yesterday. When I then went to submit amendments yesterday evening, I discovered that the deadline was yesterday morning, which was before we got the Bill, saw the amendment or anything like that. I thank the Ceann Comhairle, who acceded to a request to extend the deadline for amendments. I hope the Minister and his officials learn a lesson from that and that they now know it is not a good way to do business. It is also not very respectful to the House. Notice needs to be given. This was a commitment in the programme for Government and fair dues to the Minister because he is now delivering on it. It should have been handled differently, however. Although he mentioned the amendment in his contribution, we have not yet seen it. It will be sometime this evening before we do. It is a popular thing and a very worthwhile addition to the legislation. I very strongly welcome it and the removal of inpatient charges, to the extent that is being provided for, although it needs to go much further much more quickly.

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