Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance) | Oireachtas source

The only reason we need this legislation is because of the shameful fact that we have a two-tier health system. Consequently, huge numbers of people, nearly half the people in this country, are so frightened of what will happen to them when they get sick, given the state of the public health system, that they feel it necessary to pay out large sums of money every year in order to have insurance so they might access private healthcare in the event that they are sick. They do it out of fear. It is obviously not their fault that they are afraid. It is the fault of the Government that it presides over a public health service that is failing people so disastrously.

That is not in any way a criticism of the heroic healthcare staff and professionals we have in the public health service, who work under the most extraordinarily difficult circumstances. The nurses, midwives, doctors, porters, orderlies, cleaners and allied health professionals do their very best for people but they are crushed by the lack of adequate and, for the most part, safe staffing in our hospitals and health services. They are dealing with massive backlogs and record numbers of people. In the month of November in particular, we saw the highest number of people on trolleys on record. When people are faced with that sort of disastrous situation in our public health service, it is no wonder they are terrified into having to take out private health insurance. It is a source of shame that that is the situation, that people are encouraged to buy into the idea that if you have money, you can get a better standard and quality of healthcare than if you do not.

As Deputy Murnane O'Connor has pointed out, as the cost-of-living crisis impacts on huge numbers of working people, they are having to make very difficult choices. With the cost of heating their home, the cost of feeding their family and the cost of just about everything going up, the pressure will come on and they may decide they cannot really afford the private health insurance premiums and will let them drop, with all the associated fear that goes with that.

I was asked by somebody who recently suffered a tragedy to read something into the record. I will only do it because they have asked. It is pretty harrowing. You kind of understand the sense of despair and anger people feel when they go through situations like this. I will not have a chance to read it all but it is from Karen - I will not give her second name - who wrote the following:

This letter is mainly about the health service and what all the ministers of health and all past and present governments did, or [are] doing to help, which is basically nothing to change the system.

On the 6th of November 2022 my brother passed away, it took 55 minutes for an ambulance to arrive to my family home 55 minutes due to your cuts. My family lives 10 minutes away from St Vincent University hospital and it still took 55 minutes.

We couldn't get him down the stairs to get him out to a car, we needed help, we needed our health care providers, he needed them to save his life, that night was a complete nightmare for us. Being helpless, being told after ringing a few times it was on the way, watching out windows and doors waiting on help.

I live further away from my family home, his home, and I arrived before the ambulance did, he was still alive, when I arrived, he was in so much pain. He wasn't a drinker or on drugs, we will have to wait to find out how and why he passed.

I will not get into the political stuff but she goes on to absolutely castigate the parties of Government. She is very explicit in the letter that she is not blaming the ambulance workers, who she says were wonderful when they arrived, but places the blame for all of this squarely on the shoulders of the Government.

Why did that ambulance take 55 minutes to make a ten-minute journey from St. Vincent's Hospital? We probably know the answer, because the ambulance drivers have told us. They are sitting outside the emergency departments because those emergency departments are overrun. They cannot discharge people from ambulances, and so they sit in a queue in St. Vincent's Hospital and other hospitals and are therefore not able to go out as quickly as they should on calls, even ones ten minutes away from the hospital. Why is that happening? Another letter I got this week kind of explains it. It is to do with staffing and our inability to staff the public health service. This letter is from student nurses and midwives. It reads:

Dear Deputy,

Student nurses and midwives are working and training in unprecedented conditions in the health service. On top of this the Government has failed to implement an agreed report to address significant costs associated with travel, subsistence, accommodation, and uniform costs associated with our clinical placements.

We are affected by the same cost-of-living challenges as our qualified colleagues, with many of us struggling to meet the costs of transportation, fuel, heating, accommodation, and other necessities required for students to complete our training, including the additional burden of obtaining accommodation away from home during placements, and the costs of acquiring and laundering uniforms.

The McHugh report, originally published in August 2021, and accepted by Government, was aimed at bringing allowances for student nurses and midwives in line with the expenses incurred as part of their training, and recognizing the additional challenges placed on students while they made their extraordinary contribution to the frontline pandemic workforce. However, many recommendations of this report, which were due to be implemented by September 2022, have yet to be implemented, and student nurses and midwives continue to struggle to meet the costs of our training.

I do not have time to read it all but the writer goes on to talk about the enhanced reimbursement scheme for student nurses and midwives, travel costs, subsistence costs, the fact that even just going to work each day they are paying about €9 in parking charges and the cost of the uniforms they were promised they would be given. Another simple thing is the cost of laundering those uniforms. She also writes:

The COVID-19 pandemic proved that student nurses and midwives are an essential part of the healthcare workforce in Ireland, and that recognising our high level of skills and training was an important part of keeping those skills in the Irish health service. The long delay in implementing these measures undermines that recognition, shows complete disregard to us as student nurses and midwives, and will not encourage the current cohort of students to build their careers in the Irish health service where they are so badly needed. Furthermore, this delay has no regard for the very significant cost of living pressures we are experiencing.

She goes on to plead with the Minister to address that.

We can put the two things together. If this is how we treat our student nurses, is it any wonder that the vast majority of them say, as they have in survey after survey, that once they qualify they will leave the country? Consequently, we are massively understaffed in hospitals so when ambulances arrive at St. Vincent's or any other hospital, there are not enough staff to deal with the people there and to open the wards and beds. Often the beds are sitting there empty but we do not have the staff to open them. Then if you listen to the radio you will hear the ads for the private hospitals, saying "come to us". There are no queues there, if someone has private health insurance and can afford it. There is a sort of hierarchy, is there not? People can get a better package of health insurance depending how much money they have. That is abhorrent. It is obscene. It is obscene that we have the health capacity, or much of it, we actually need to have a decent and dignified health service but it is only available to those who can pay. In our public health service, we cannot retain and recruit the staff we need to prevent the sort of tragedy that woman and her family had to go through because we do not treat the staff properly.

We must have a national health service, with cradle-to-grave healthcare, not a two-tier system or a system where the healthcare people get is dependent on how much private health insurance they can get. The idea of a private health insurance market is frankly abhorrent, with people profiting from this health misery when so many people are suffering.

We need to do away with that two-tier system but in order for that to happen, we need to resource the health service and, crucially, treat the people who work in it properly so we can actually recruit and retain those nurses and allied professionals so they want to work in a health service that actually delivers decent healthcare for everybody regardless of the size of their pocket.

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