Michael Lowry (Tipperary, Independent) | Oireachtas source

Paying for health insurance is an expense that increasing numbers of Irish people now equate to the importance of paying their mortgage or rent. In excess of 2.3 million people now have some form of health insurance. Between April 2020 and March 2021 at the height of the pandemic, private health insurance companies gained almost 38,000 new customers. Ironically, also due to Covid-19, claims submitted by policyholders dropped by 27% in the same period as people avoided health settings. Despite this, when a semblance of normality returned, all three of the country's health insurers took the decision to increase the cost of premiums for customers. Very few people cancelled their policies. It is easy to understand why Irish people now place such importance on having health insurance. It is viewed as buying peace of mind. In fact the incentive to play on vulnerability when it comes to our health is a powerful sales pitch for insurance companies. They are pushing an open door in the Irish market. Irish people feel a huge sense of vulnerability when it comes to healthcare. Ongoing issues with accessing public healthcare at all levels have caused people to become more afraid of becoming suddenly or seriously ill. People feel reassured by the belief that they will wait less than three months for a medical appointment in the private system. They compare this to waiting indefinitely in the public one. The result is that health insurance is no longer considered a luxury but a necessity. The blame for this lies firmly on our failing public health service. People have lost confidence in a service that consistently fails to meet their needs.

Every day, in my constituency of Tipperary and every constituency, we hear stories of people on lengthy waiting lists for some form of treatment. Children are languishing on lists for all forms of healthcare for unacceptable periods of time. Out of hours GP services such as Shannondoc in north Tipperary provide all night coverage in Nenagh only. Ironically, Nenagh is the only town with a hospital. Meanwhile the services in the town of Thurles and Roscrea close at 11 p.m. Not every family in these towns has the transport readily available to get to Nenagh in the middle of the night yet if they cannot, they must wait until GP surgeries open the next morning. This is risky and obviously highly dangerous.

In recent years it has become impossible to replace retiring GPs in rural towns and villages. Large numbers of patients are without this core service. The centralised ambulance service results in Tipperary-based ambulances being despatched to other counties around the country. This leaves our own county without an emergency service and leaves patients who require urgent care waiting for an indefinite period. The nearest model 4 hospital to north Tipperary is University Hospital Limerick, UHL. Tales of overcrowding at the emergency department there have become almost legendary. In fact people have been quoted as saying they would rather risk suffering at home than laying endlessly on a trolley at UHL.

At the root of all these problems is a lack of staff. The common denominator is that we are unable to retain or entice people to work in healthcare in Ireland. The staff that have chosen to remain in our health service are doing a remarkable job. This is a fact that must always be acknowledged. We have dedicated and competent doctors, nurses and paramedics working at all grades throughout the country. However, we are continually driving them away. They are overworked, underpaid and undervalued. We tend to forget that they have options. More and more of them are taking alternative options. Those who are young enough are leaving the country. Those who are old enough are taking early retirement. Many between these two brackets are switching careers, yet we continue to do little or nothing to prevent this from happening. Many of our Irish-trained doctors and nurses have chosen to emigrate to countries where their skills are reflected in the wage they earn and where they have a proper work-life balance. Some do so shortly after they qualify. Some even choose to train in Ireland with the sole plan to emigrate as soon as they graduate. Irish-trained medical professionals are sought after and valued all over the world yet our own health service provides neither the incentive nor the encouragement to stay in Ireland. Instead we send private recruitment companies to far-flung places to recruit doctors and nurses to care for Irish patients, while our own medical professionals wave goodbye. It was recently revealed that the HSE cannot state how many healthcare staff have been successfully hired by these private companies. This is despite the fact that the HSE has paid these companies no less than €15.5 million since 2020 in their efforts to tour the globe and attract staff. When questioned by media recently, the HSE claimed that the figure is not centrally available. Has the Department this information? Can I get an answer to that question?

We are here today to debate amendments to the Health Insurance Act, particularly the issue of adjusting the risk equalisation scheme for 2023. When will we be here to reopen discussions on Sláintecare? The concept of providing a single-tier healthcare system was published in 2017. It was afforded a ten-year timeline for implementation. This Government is set to remain in power until 2025, just two years short of that timeline. Despite the problems encountered to date with Sláintecare, will the implementation of the single-tier health system be something on which this Government will focus in the next two years? If something is not done to address the crisis the exists in the provision of healthcare, the problems will continue to spiral out of control. This has the potential to surpass the enormity of the accommodation crisis that currently exists. The solution lies in the political will to take immediate and assertive action.

I ask the Minister of State for assistance. Earlier today I contacted the office of the Minister, Deputy Stephen Donnelly. Will the Minister of State take a personal interest in this and see whether he can get his Department and the HSE to move? I have a letter, and I will not read out the name or address of the child involved, but the parents wrote to me regarding the lack of provision of community-based paediatric palliative care in the south east. The Minister of State is familiar with the south east. They write on behalf of their seven-year-old son, which no parent should even have to contemplate in their situation. Their son has been battling stage-4 cancer for almost two and a half years. He has endured a gruelling treatment schedule. Unfortunately due to the aggressive nature of the condition, he has relapsed and the disease is progressive. He has been under the remit of the palliative care team in Crumlin since February this year. They were informed that due to where they live, community paediatric palliative care services will not be available. This has been the case for all terminally ill children in the area since the services were withdrawn in 2017. To date, they have done everything in their power to ensure that their son’s care is home based. They want and expect their son to be afforded the opportunity to die at home, to have the same access to community-based paediatric palliative care services that he would have if he was an adult in their area, or indeed was a child in most other community areas in the country. It is unacceptable that their son may have fewer choices with regard to end-of-life care due to geographical, political, financial or resource issues. Time is not on their side. As such they need a response to be actioned urgently.

Since diagnosis, their son has endured endless cycles of chemotherapy. He had his kidney removed, high doses of chemotherapy, a stem-cell transplant, and 39 sessions of radiation, as well as multiple bone marrow aspirates, innumerable blood transfusions and other medical procedures. They travelled with him to hospitals in Barcelona and Utrecht in the hope of accessing further treatment and clinical trials not currently available in Ireland. He has had the best medical care available in Ireland and has bravely fought every step of the way. He received excellent care from his oncologist and all the staff of St. John’s ward, Crumlin hospital whose help and support are greatly appreciated.

The point being made is that the child undoubtedly is in the last phase of his battle against this horrendous disease. The least he deserves is the chance to die at home with his family, in his own community, surrounded by those who know and love him. This should not be considered a privilege or something that parents should have to question when every moment they have left together as a family is so precious. They are not looking for special treatment, just equity of care that their beautiful seven-year-old boy would have the same access to end-of-life care as adults in his community would, and as most other terminally-ill children in the country have. These parents do shifts driving 14 runs to Dublin every week. They know the prognosis for their child. They are obviously emotionally distressed and have the physical burden of driving to and from Dublin for two hours each way. The mother does it by day and the father at night. To be told by officials in the Department and by the HSE that they cannot bring their son home to die in his own home because the palliative care services will not allow it is not acceptable.

I will give the details of this case to the Minister of State and ask him, if he does anything meaningful or positive this evening he will be doing this family a great service if he could knock some sense into the HSE services in this area, and find a resolution to allow this boy to come home and enjoy the support, comfort and companionship of his mother, father and brothers in his own home.

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