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

Everybody is busy, but this is health legislation and somebody from the Department of Health should be here to take it. I will cut my comments short because this seems to be a bit of a waste of time. I spoke yesterday evening about what is happening with the health area and the fact there is a symbiotic relationship between the public and private services of the health area. The public service is being run down. The more the public service is run down, the more potential there is for profiteering and making money generally in the private sector.

The official policy is supposed to be about developing a properly functioning public health service. As the Minister of State is a member of the Green Party, he might just take this on board, because it affects all of Government. What seems to be happening is, officially, the Government is in favour of Sláintecare but, while it is talking the talk, more aspects of our public health service are either being run down or privatised and hived off. We are seeing various sections of our public health and social care services taken over by private sector organisations. The aim is to extract wealth from the public health service and that is what is being done. Whether it is home care, disability services or nursing homes, commercial interests see an opportunity to extract wealth from the public services and they are taking that wealth. That, in turn, runs down basic public health and social care services and we have a considerably weakened public health service as a result.

While Ministers talk the talk, they do not walk the walk with healthcare. More and more people feel that if they want to get basic access to healthcare in a timely way, they have no choice but to take out private health insurance. That is especially the case for people who might be regarded as vulnerable, have underlying conditions, older people, or people with a family member who has a disability. It is a shocking way to treat people. They are forced into a situation where they have to fork out for private health insurance in order to have some chance. Nearly half the population feel they have to do that even though large numbers of those people cannot afford to pay for private health insurance, nor should they be made to feel they have no choice but to do that.

On the other side are people who do not have private health insurance, cannot afford it, or are opposed to the very notion of it. Some people feel there should be a social contract. If they are paying their taxes, then in return, they should have access to timely healthcare. Many people believe that and it should be the case, in a properly functioning, modern republic, that if people pay their taxes, they should have access to public services, with healthcare being a fundamental service. This is not working. People are not getting what they deserve.

It is a basic human right to have access to health and social care services when needed. As a result of the failure of successive Governments to honour that commitment to the public, many people in this country lose their lives every year because of the failure of the health system to meet their needs. People die on trolleys, isolated at home, waiting to see a consultant, or waiting to access services. Other people find themselves in a situation where they have an underlying condition that is worsening all the time because they do not have access to services. When people in those circumstances can eventually access healthcare, they often end up finding that their condition has deteriorated significantly. They may have had to give up work, for example, if they have bad arthritis in their hips or knees, meaning they are not mobile any longer. People are often forced into situations where they have to give up work. The family income drops significantly, which has an impact on the entire family. They end up waiting for years to get necessary, basic knee or hip operations or to have cataract surgery. They are immobilised and lose their ability to live life fully and participate fully. That happens on thousands of occasions every year. This huge impact on people's quality of life and their ability to live independently and earn an income for themselves and their families is a significant issue.

The other scandal is the thousands and thousands of children whose childhoods are being marred and held back by the failure of successive Governments to provide access to necessary therapeutic services. There is supposedly a legal right to assessments of need. There are long waiting lists. Children with special needs are supposed to be seen by early intervention teams in those vital early years. How many examples do we have of children ageing out of early intervention? Once they get to the age of five, they are moved to another waiting list, which is a scandal. Years are wasted for children and there is a negative impact on their childhood due to the failure of Government to provide basic services, including an assessment of need and recommended therapeutic or specialist services. This happens all over the country. Parents are at their wits' end because of the failure to provide that basic service.

Due to the lack of timely access to therapeutic services, when people finally get to see a consultant or even when they have been attending a general practitioner over and over again with the same problem, because they need access to specialist care, they are asked if they would consider going to a private service. They are told they will have to wait for two or three years on the public list. People are made to feel they have no choice but to pay to access basic public healthcare. If someone in the family comes up with the €250 it costs to see a consultant, after people have been forced into seeing a private consultant, they may be put on the waiting list for a procedure more quickly. That is exactly what is happening in this country. People are forced into a situation where they feel they have no choice but to borrow, beg or get money however else to pay to access the private service because the situation is so poor and public waiting lists are so long. They are forced into a situation, if they can afford it, where they make other sacrifices so they can pay for private health insurance.

I came across a case that the Minister of State, Deputy Noonan, might raise in Government circles sometime. An elderly woman, who was in her late 80s, was living in a nursing home. She needed intravenous antibiotics. Her GP referred her to an emergency department, so her daughter brought her to the emergency department. She was taken to an emergency department on the north side of Dublin. She waited for six hours. After six hours, her daughter felt that she could not possibly put her mother through that agony for any longer and took her back to the nursing home. The family came together that evening to chip in and come up with the €250 so that their mother could go to the emergency department, following the referral by the GP, the next morning, in the private wing of the same hospital. She was seen straight away. Two other older people in that private emergency department had the same experience the previous day. If that is not a perverse incentive, I do not know what is. In such circumstances the boundary between public and private healthcare and how they are funded is blurred in our supposedly public hospitals. There is an incentive for a hospital to whittle down its public services because it knows that if services are weak enough, patients will do everything they can to go to the private element of the same hospital. That is indefensible and immoral.

This is happening throughout our health service. There are issues with public and private systems, where the money goes and no sight of how much public funding that goes into hospitals is spent on public or private care. There is little or no supervision of where consultants are working. That is the quagmire that is our health service at the moment. We are spending €22 billion on it and about half the population feel they have to take out private health insurance.

It is important for those in Government to see the growing number of people who feel they have to have private health insurance. The number is growing by about 2.5% each year. It represents a political failure in the provision of health services. Health is critical because it impacts our lives so much.

Not to ensure an adequate public health service is a failure of Government. We are going in the opposite direction as more and people feel they have no choice but to take out private health insurance, whether they can afford it or not. As I said, nearly half the population has private health insurance, and it is very expensive private health insurance.

We might look at the spend on health in the country and where the money is coming from. Around 70% of the money for the entire health service comes from taxpayers, so it is State money. We then have what are called out-of-pocket expenses. That is where people, even if they have private health insurance, still have to pay €200 or €250 just to see a consultant. Then there is the expenditure on GPs. In the rest of Europe it is pretty well unheard of that a person who wants to go to a GP, who is the first point of contact when there is an issue, must pay €60. That just would not be tolerated in any other European country. It is another out-of-pocket expense. Then there is the amount people pay for drugs, as well as all the other therapeutic services people need, including speech and language therapy and physiotherapy. Such therapeutic services should be an integral part of our health service but we know they are not. You need to have a medical card, first of all, and if you do, you then go on a long waiting list, and it is so patchy all around the country. Those out-of-pocket expenses account for about 15% of the health spend. The nearly 50% of people who have private health insurance might wonder how much it contributes to the overall spend. It contributes about 14% or 15% to it, and we should bear in mind that, as I said, nearly 50% of the population has private health insurance. That is a very surprising figure. Half the people are paying for expensive private health insurance, yet it only contributes about 14% or 15% to the health spend. The only conclusion we can come to is the public sector is hugely subsidising private healthcare. That is the reality of how our health service is operating.

In the last few minutes available to me I will speak about Sláintecare. There is no excuse for this Minister or this Government not to reform the health service and bring us into line with every other European country that has universal public services which the vast majority of people are happy to use because they function properly. They uphold people's rights and provide that public service because people pay their taxes. We are a complete outlier in that context as our public health service does not function properly. The Government's official policy is Sláintecare, yet it is just not happening. There is massive resistance. Obviously, it is from the many people and organisations making a lot of money out of private healthcare. They are the vested interests that are holding this back. It is not only them but also the private hospitals, as well as certain consultants who want to see more and more private work. We have the drug companies and the insurance companies. I refer to all those organisations with muscle and significant skin in the game. They do not want their profits impacted by any Government decisions. They are the people who are holding this back but they are aided and abetted by a weak Government that does not have the courage or the foresight to drive through a reform programme. Along with housing, this is undoubtedly the biggest failure of Government. It is such a basic thing in life to have access to healthcare and, unfortunately, the majority of our population is being denied that.

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