David Cullinane (Waterford, Sinn Fein) | Oireachtas source

Sinn Féin will support this Bill, as we always do. It is an annual Bill to review the risk equalisation mechanism that supports the community-based health insurance market. It revises the stamp duty levy on policies and the risk equalisation credits payable to insurers for 2023. It is a self-funded system. Risk equalisation as a principle ensures that costs are constant across the life span of the individual. It seeks to ensure where possible that age, gender and health status do not influence the cost of an insurance product.

In 2021, 47% of the population was covered by private health insurance. That is not always because they want to, but because they feel that they have to. Many of the people I meet are not inclined to private market solutions to healthcare but such are the challenges in the public system that they feel they have no other choice. This is relatively constant across age cohorts but significantly lower among adults under 30 years and among people aged over 85 years. Even in the depths of the recession, 44% of the population retained their private health insurance and with more than 1.3 million people on some form of health waiting list, it is no wonder that half of the population hold onto their private health insurance. There are 897,000 people on hospital waiting lists. That is up 18,000 since September last year. More than 200,000 people have been waiting over a year and while I recognise that figure is down from last year, it is still nowhere near what needs to be done. There are also more than 200,000 people waiting for a diagnostic scan. More than 97,000 children are on hospital waiting lists and more than 100,000 children on community waiting lists and 18,000 on children's disability network team waiting lists. Behind every one of those numbers are real people with families who, in many cases, are waiting for access to care which should be provided much more quickly and better.

Because we are discussing health, I must point out that the Minister's waiting list strategy is failing. The targets that were set have not been met. They have been missed and they were too low in the first place. It was never going to succeed without a multi-annual plan. We are now reaching the mid point of this Government. There is a lot of talk about whether there will be a switch in different Departments. The switch in Taoiseach is certain; to me it is inconceivable that we would keep in place a Minister for Health who has served up waiting lists of 1.3 million people; where we have the challenges in the children's disability network teams and those in accessing home care for people because of the recruitment and retention issues and the myriad problems in the health service that simply have not been addressed. There is no multi-annual capital funding. That is necessary to deliver quicker delivery of hospital expansions. There is no strategic workforce plan. It is accepted by the Minster and the Government that the targets that we set ourselves in recruitment and training of healthcare professionals are too low. There is still no plan to deliver universal GP care or to expand primary and community care, other than the Minister throwing out big figures on budget day. There is no real plan behind any of it. There is no plan to address the shortage of home care supports, as I said earlier, or transitional step-down beds which is partly causing the problems in our hospitals. There is no roadmap to remove out-of-pocket charges and make all health and social care free at the point of use. That is certainly true at least of the charges that are non-hospital related.

What we need is a much different plan for the healthcare system. Here today, we are dealing with the private health insurance market. If I get the chance of being Minister for Health, maybe that will happen and maybe it will not, I would want to do more to dismantle and disentangle private health insurance and the private health sector from the public system. That would be basic public service, whereby we would not have this deeply unfair but also very messy set-up we have in this State in which public and private healthcare are joined at the hip. Even in public hospitals we have huge amounts of private sector activity. There are consultants on contracts who do a mix of public here and private there. Recently, I had a case involving a chap I know who needs serious surgery. He went into the outpatient appointment and saw the consultant who told him he needed a certain procedure and that he could be waiting between 14 and 18 months. He had a follow-up appointment some weeks later and having thought about it, he said he would go to a private clinic in Waterford. He asked if he should get his GP to refer him to the private clinic only to be told by the consultant that he would make the referral because he would be the consultant carrying on the procedure in the private hospital. That is what is happening. That is the unfairness in the system. It makes no sense whatever for the patient. It might make sense for those who are profiting from our healthcare system but from a fairness and equity point of view, that is one of thousands of examples of people who are not getting the care that they need. Even those who have private health insurance do not always get full value for what they put in. They still have to pay. There are all sorts of surcharges when they go to hospital and they still have to pay for GP visits and lots of other out-of-pocket expenses for their healthcare.

In some cases, those who pay for private health insurance to cover them if they become seriously sick, which is why people get private health insurance, pay not only a second time but also a third or fourth. During a cost-of-living crisis, that is not what we should be allowing. Once and for all, we must ask ourselves the fundamental question as to when we will get the break and seriously move towards decoupling private healthcare from the public system. I am in favour of public-only hospitals delivering public-only care. We need the new public-only contract in place. There should be a full-time contract for whatever number of hours a consultant must work in the public system. What consultants do outside that is a matter for them. I do not have a difficulty with that as I am pragmatic in that sense. The contract has to be for the public system, and the consultant has to do public work. That is the only way we are going to have truly public hospitals. We also have to substitute the private income that hospitals are getting with State funding to wean them off giving preferential treatment to private patients or those who might have private health insurance. Once and for all, we must grapple with the big dilemma in the healthcare system, acknowledging it is unfair, inequitable and not working.

There is an awful lot to do and a long road to go before we realise the big promises of Sláintecare. I understand from the INMO that the number of patients on trolleys today was possibly the highest in the history of the State, or certainly close to it. This winter, we are going to have several pandemics or epidemics at the same time. We will have Covid on the one hand and the flu on the other. We have had a very mild winter to date but it will become much more difficult in the months ahead, yet I do not see any plan from the Minister for Health to invest in the public system other than to provide more outsourcing and money for private healthcare and medicine, which drives many to obtain private health insurance. I do not see the necessary investment being made in the public system to ensure we can deal with the challenges. We do not have the step-down beds to allow people to be transferred from hospitals. We do not have the beds we need in the first place. There are patients going to the wrong place at the wrong time for the wrong care rather than what Sláintecare promised, which was the right care in the right place at the right time. There are people going to emergency departments because they cannot gain access to out-of-hours pharmacy or GP services. They have no choice. Once and for all, we must deal with all these issues.

The Bill is welcome insofar as it goes because it provides equalisation. Of course I support that but there are many things that need to be done in healthcare and far too many challenges for me to say any more than that. I contend, without wishing to create fear, that we could be heading into one of the most difficult winters ever faced by the Irish healthcare system. We are asking healthcare professionals, who are already burnt out, to step up to the plate again, to provide a line of defence and mask over all the failures of politicians and the Government. That will result in a bad outcome for patients and healthcare professionals. Much more should have been done.

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