Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

I thank the Leas-Cheann Comhairle. We have the same debate annually in which we amend the Health Insurance Act to modify the regulations governing the private health insurance sector. The whole goal of health policy at this time is the delivery of Sláintecare, that is, the delivery of a universal, single-tier healthcare system, with access for all and service free at the point of use. Sláintecare is silent on health insurance because the gamble is that once it is delivered, people will be so impressed, looked after and cared for in the universal one-tier system that the need for private health insurance will diminish. That is a big gamble to make. Until Sláintecare is delivered and we see the proof of the pudding, we do not know what the long-term future is for our private health insurance system. As long as we have such a system and it remains as large as it is, with 2.2 million Irish people having private insurance, we will have private healthcare in this country. As long as there is private healthcare, we will have a two-tier system. It is an unvirtuous circle. Until Sláintecare is truly able to deliver in our communities across a whole range of primary and community services, we will be back here every year dealing with this legislation and with what we have now, which is a health service that is across two tiers and is not functioning as well as it should.

As a previous speaker stated, people who have private health insurance sometimes do not get the care they expect to get. In some instances, where people are let down by the public system and have private health insurance, they still cannot get the care they need. I refer specifically to speech and language therapy. There is a huge issue in communities all over the country whereby parents of young children who are facing speech and language challenges are told to go private. The first thing they do is call their private health insurer only to be told they are not covered for that service. They pay their taxes and are let down by the public system. They pay for private insurance and are let down by that system. They are in the private system off their own bat only to find the waiting lists are out the door. Even if they get an appointment and access to a service, they are paying on the triple for it. This is not good enough and it is another example of how our health system is fundamentally failing people at the point at which they need it. We are not getting the delivery of care right in the community.

Most people in the country who understand and are engaged with the health service are 100% behind Sláintecare. They want to see it delivered but they are losing faith that the Government will do so. They do not see the required staffing numbers coming through or the levels of student intake that are needed in our third level institutions. The public sector unions that represent nursing and midwifery staff, healthcare assistants, doctors, physiotherapists and occupational therapists say we are not educating and delivering enough staff into the workplace. The healthcare staff who are coming through cannot afford to live in this country, cannot afford housing and are going abroad. We are not retaining enough of the people we are educating to Further Education and Training Awards Council, FETAC, and degree level. The staff who are currently in the system are being forced out of it. If they are in the capital city, they have to move down the country or go abroad. We are fundamentally failing in the delivery of the core part of our health system, which is about providing a workforce that can deliver Sláintecare and everything else we need. The Sláintecare progress reports we receive every quarter from the Minister include lots of green, amber and red indicators. The green lights seem to refer to administrative issues. They are not indicative of the delivery of services in primary care centres, healthcare centres, emergency departments or speech and language therapy clinics across the country.

A version of this technical Bill comes around every year. I have a question on policy for the Minister of State, which I hope he will respond to at the end of the debate. Will community rating still be needed if Sláintecare is delivered? We do not know the answer to that. How much money is collected for risk equalisation under lifetime community rating due to loading penalties paid by people aged between 35 and 50 who do not take out health insurance before the age of 34? We recognise that this Bill must go through, but the fundamentals remain the same. We have more people on trolleys this month than we ever had before. December will likely be worse and January worse again. The perpetual crisis in healthcare, the lack of progress on Sláintecare and the fundamental continuation of our two-tier health system, underpinned by a massive private insurance system, are unsustainable because they are not delivering for the people of Ireland.

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