Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I will be briefer then.

I am really pleased to introduce the Health (Amendment) Bill 2023 to the Dáil. The Bill means that adults will for the first time have free access to inpatient care in public hospitals. At the moment, people are charged €80 a night for a stay in a public hospital, up to a maximum of €800 a year.

That is a very large bill for people to face. Many have to face it when they may be very sick and unable to work, or only able to do so part time, and are finding it harder to make ends meet. Last year, we abolished this charge for children aged under 16 and this Bill now does the same for everyone else. It is an important measure in its own right but it is also important as a very clear symbol of our path towards universal healthcare - a public health service that is free or affordable for everyone in the country.

Colleagues will be aware that over the past three years we have radically cut the costs of healthcare for patients and their families. In 2021, we reduced prescription charges, increased medical card access for those aged 70 and over and extended to two years medical cards for patients with a terminal illness diagnosis. Last year, we abolished inpatient hospital charges for children, introduced free contraception for women aged 17 to 25 and reduced the maximum monthly amount families pay for medicines, in 2020 and last year, from €114 to €80. Already this year we increased the age at which free contraception can be accessed from 25 to 26 years in order that no woman is aged out of the scheme. The Bill abolishes inpatient charges for adults. In the coming months, we are providing GP cards to approximately half a million more men, women and children. This will mean that, for the first time ever, more than half the population will have access to fully State-funded GP care. Later this year, we are increasing the free contraception scheme age to those aged between 16 and 30 and we are introducing State-funded IVF for the first time.

All these measures are welcome but, combined, these cuts in costs for patients amount to a radical shift towards universal healthcare in our country. These measures are already making an important difference to many patients and families using our public health services throughout the country. They are being introduced in tandem with new services for patients, such as IVF and many other women’s healthcare measures, including, for example, specialist services in endometriosis, perinatal mental health and menopause. In tandem with better access to medicines, I was delighted to be able to share the news last night that Kaftrio will now be funded for the 35 children who were excluded by the company involved last year.

At the same time as rolling out new services and medicines, we saw last year an important fall in the number of people on waiting lists, particularly those waiting longer than the Sláintecare-agreed times of ten and 12 weeks. While I fully acknowledge there is a long way for us to go on waiting lists, this is the first fall since 2015 and is an important step. I am determined this year will be the second year in a row when the number of people on waiting lists falls again. We are focusing, in the first instance, on "long waiters" and those waiting longer than the agreed Sláintecare targets. This three-pronged approach of reducing costs for patients, providing new services for patients and speeding up access for patients is how we are pursuing universal healthcare, which is the simple idea, core to the values of our Republic, that people can get access to great quality affordable care when they need it.

Specifically on this Bill, I acknowledge the work done by officials in my Department and, importantly, by several patient advocacy groups, including the Irish Cancer Society, which advocated for this charge to be abolished for many years. I will now provide a brief explanation of the sections of this very short Bill. Section 1 repeals section 53C of the Health Act 1970. Section 53C provides that: "Charges shall be made for acute in-patient services provided by or on behalf of the Health Service Executive". Section 1 also revokes the Health (Acute In-Patient Charges) Regulations 2021, SI 213/2021. These regulations currently provide the legislative basis for the persons liable for the acute public inpatient charge and that the maximum number of days this daily charge may be imposed over a period of 12 consecutive months shall be ten days. Section 2 contains standard provisions setting out the Short Title citation and provides that the Bill shall be subject to a commencement order. The key effect of these amendments is to remove the acute public inpatient charge of €80 a day for people accessing care as a public patient in all public hospitals.

While we have the opportunity, I will give some details on other eligibility measures being introduced this year. As provided for in the budget, from April, eligibility for GP visit cards will be extended to people earning up to the median household income. This measure will remove the cost of accessing GPs from those for whom cost is most likely to prevent access, helping to reduce the cost of living for young adults and young families in particular. We believe between 400,000 and 500,000 individuals, who would otherwise have attended their GP on a private basis, will now be able to attend essentially on a public basis, funded by the State. We are also working with the Irish Medical Organisation, IMO, on expanding GP care, without charges, to all six- and seven-year-olds this year. Coinciding with the median income expansion, a significant funding package is being prepared to support GPs in hiring many more GP practice nurses, as well as other supports GPs will need to manage the additional demand this measure will inevitably bring into place.

As colleagues will be aware, we are expanding the free contraception scheme. We launched it last September and have had very positive feedback on it. It was an historic initiative providing free access, for the first time, to prescription contraception and directly supporting women and their partners in sexual and reproductive health. The scheme will be expanded further to women aged 30 and under in September. Some €32 million has been allocated to that and, as I promised in the House last year, this funding includes expansion of the scheme to 16-year-olds, subject to consultation, legal advice and legislative amendments, which are required for this.

We are also looking at assisted human reproduction, as colleagues will be aware. We have made a commitment to introduce publicly-funded care for fertility treatment. Phase 1 involved the establishment of five regional fertility hubs throughout the country. These five hubs are operational and it is anticipated a sixth will be operational later this year. Essentially, these hubs are for the management of a very large portion of patients presenting with fertility issues at this level of intervention, without the need to undergo invasive advanced assisted human reproduction, AHR, treatments. Phase 2, however, will see the introduction of tertiary fertility services, including IVF. The plan, ultimately, is that all these services will be provided by the public health service. We are expanding those services but we do not want to wait the several years it will take to wrap up those services in order to provide them for all women and couples who want to avail of them. In the shorter term, we will subsidise private care and will then ramp up public care so that, ultimately, it is fully publicly delivered.

We spoke about Kaftrio. It is obviously very important that we create better access to medicines. Since the formation of the Government, we have allocated approximately €100 million for new medicines. The full-year costing for that is significantly higher. That has meant 112 new medicines or new uses for existing medicines and, critically, 34 of those are for rare diseases. These are the so-called orphan drugs that usually cost significantly more than mainstream drugs. We are also committed to delivering faster access to new medicines for patients. I want to see improvements in the transparency of the process and I have asked the HSE to bring forward proposals to that effect. Colleagues will also be aware that we have allocated €15 million this year for new State-funded oral health services for children, from birth to the age of seven, which is a public health initiative that will make a big difference in the coming years.

The programme for Government is committed to universal healthcare and Sláintecare as a key enabler of that. One of the three pillars of universal healthcare is free or affordable care. Much progress has been made and more will be made. This Bill does two very important things: it removes a charge of up to €800 a year from patients and their families and, critically, for the first time, inpatient care in public hospitals will be free for all patients. It is a very important step on our way to fully free or affordable public healthcare provision in our country.

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