David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I am sharing time. I thank the Minister of State for her opening statement. This is an annual Bill to review the risk equalisation mechanism which supports the community-based health insurance market. It revises the stamp duty levy on policies and the risk equalisation credits payable to insurers for 2024.

As a principle, risk equalisation ensures that costs are constant across the lifespan of the individual. Where possible, it seeks to ensure that age, gender and health status do not influence the cost of an insurance product. Legislation is required each year to revise the system of credits and levies to ensure that the risk equalisation scheme operates in a consistent and fair manner, while also generating sufficient income to ensure that it is self financing. Recognising the reliance of so many people on health insurance, I will be supporting the Bill as our party has done in previous years.

I will be tabling an amendment on Committee Stage to limit the reasonable profit for providers to 4.4%. This was the rate of reasonable profit from 2016 to 2020 until this Government increased it to 6% for 2024. This is at a time when many families are facing significant cost pressures, when premiums are rising because of runaway health inflation and when 47% of the population rely on private health insurance. Because of this and previous Governments' failures to fix the problems in the public health service it is incumbent on private providers and insurers to do their bit to ensure affordability for ordinary workers and families.

At 47% of the population, this high level of private insurance is a damning indictment of the Government. The fact that so many people require private health insurance or feel they have to have it is testimony to the fact that far too many people simply cannot rely on the public system. They feel the only safeguard they can have to ensure they get safe care when they need it is to take out private health insurance.

In her opening statement, the Minister of State talked about the achievements of the Government in healthcare. Much has been done over the last five years. However, I want to unpick some of what the Minister of State said. She talked about the additional healthcare workers who have come into the system, and that is the case. However, right now we have a recruitment embargo which is having a significant impact on healthcare. In the last few weeks I have met many hospital managers in Mayo, Kilkenny and in other hospitals. They tell me that this will have an impact on their ability to safely fund the health services for the remainder of this year and into next year. There are many posts and vacancies which they cannot fill. There are many unfunded posts that they would have wanted to be funded and continued, which they now have to make hard choices about. Also, they cannot recruit nurses coming from countries which they might have left to come back into the public system. They can only recruit nurses who are fourth-year graduates. Yes, there are some exemptions, but these are few and far between in community services. The Minister of State is talking about "right care, right place, right time". The Minister of State also said in her opening statement that there has been an unprecedented shift in patient care from the hospital to the community sector. Chief officers in community services say the enhanced community care model is good and we have many good teams working in the community from ICP teams for older people to chronic disease management teams, community intervention teams, all of which are important. The vast majority of these teams are understaffed. They do not have the staff to deliver the necessary services. Because of the recruitment embargo they cannot recruit staff. This means home care services, chronic disease management, all of those critical areas where we need to have proper investment and resources to keep people out of hospital, will not now receive additional funding for next year. Worse than that, we now have a recruitment embargo.

The Minister of State also talked about an additional 1,000 hospital beds. In budget 2020, 1,047 additional beds were funded for 2021. It is now 2023, approaching 2024, and these beds have still not been delivered. In his wisdom, three times this year the Minister announced 1,500 rapid build beds. Half of them were going to be built next year and what has happened? They have fallen off the face of the cliff and because there was no new money in the budget I have not heard a whisper about those beds since. Yet, in every hospital I visit staff tell me that they do not have the bed capacity. Without this capacity hospitals cannot get patients into beds quickly enough, which is why emergency departments are clogged up and why people are waiting as long. It is not the only reason, but it is a big part of it.

The Minister of State went on to talk about national clinical strategies. Yes, in the last number of years some of those have received additional investment, but many of them have not. The reality is that because of the disgraceful way in which the health service was funded last year and going into next year, very few or none of those strategies are getting any additional funding. This was clarified for us at the Joint Oireachtas Health Committee session some weeks ago when it was made very clear that most, if not all, of the national strategies and the national clinical programmes have no new programme funding for next year. Perhaps some got small amounts, but nothing of substance. This means that all those programmes will stand still. All of those the Minister of State mentioned in her opening statement, cancer care, maternity care, trauma care, palliative care, critical care, dementia care, mental health services and older person services, will get no additional funding.

Regarding older person services, the Government promised a statutory home care scheme, which we are still waiting for. I do not know when it will be put in place but we are at the tail end of the Government's term in office and there is still no sign of it. Last week, I supported a motion from the Labour Party on home care services, an area where we are struggling to get staff. An expert group made recommendations on a living wage and on travel expenses. The Government did something on the living wage, but nothing on the travel expenses and nothing to try to achieve pay parity for those working in non-HSE settings. Now, as a consequence, we cannot deliver the home help that people need.

The Minister of State mentioned mental health services. Child and adolescent mental health services, CAMHS, is an absolute mess. That is not because the staff are not doing a good job. Everyone I have met who works in CAMHS does their very best. Consultants, psychologists, psychiatrists and support staff all do their absolute best, but very often with one hand tied behind their backs. Many reports, such as those from Mental Health Reform and the Ombudsman have criticised the lack of investments in our mental health services. We are simply not resourcing mental health to the extent that is needed.

If the Minister of State is going to outline a long list of achievements it is incumbent on me as the main Opposition health spokesperson to paint a different picture. Yes, there have been some improvements and of course there has been some additional funding and things have happened over the last number of years, which I welcome. One of those is the public only consultants contract, POCC. However, there is a lot this Government did not do. The only way we will get to a point where people do not feel the need to take out private health insurance is to deliver on the commitment of Sláintecare.

One of the core commitments in Sláintecare - for me, this was reform with a big "R" - is to establish elective-only hospitals, although I know there is some debate about what they should be. Elective-only hospitals are, essentially, about separating scheduled care from unscheduled care but the vast majority of private hospitals provide elective care. If there were four big elective centres that could cover a volume of elective procedures, that would reduce the need for more and more people to take out health insurance, given that is really where people benefit from private health insurance. Many people pay for private health insurance and do not get a benefit; it is more of a comfort blanket.

There will always be people who will take out private health insurance, as they are absolutely entitled to do, and if they want to access private healthcare and pay for it, that is a matter for them. Nevertheless, if we want to get to the point, as I do, of there being support every year for this Bill, we have to get to a point where the taxpayer is not funding it, where we separate private care from public hospitals and where there are truly public hospitals, but also where there is elective care such that people are not constantly having their planned procedures cancelled, which happens every time there is a surge in a hospital, with all the chaos that creates for waiting lists and patients.

While I support what the Bill will do, and I have signalled the amendments I will move, there is a lot more this Government and, I would contend, any future Government can do to reduce the dependency far too many people have on private health insurance, and to deliver a much better public service in which more people can have confidence and which can deliver both the scheduled and unscheduled care they deserve.

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