Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

The Labour Party will be supporting this legislation. Every year we have this same debate, in which we amend the Health Insurance Act to modify the regulations governing the private health insurance sector. This is in the context of the goal of our health policy being the drive towards the delivery of Sláintecare, a universal, single-tier healthcare system that has the support, at least in theory, of all sides of this House. It would provide access for all and service free at the point of use. It causes me great concern that movement on Sláintecare seems to be slowing year on year, rather than increasing.

An area seldom discussed in the context of Sláintecare - it is silent on it - is health insurance. Until Sláintecare is delivered and we see it in operation, we cannot know what the long-term future of our private health insurance system will look like. As long as we have such as system and it remains as large as it is, with 2.44 million people or 47.6% of the total population having private insurance, we will be existing with a private healthcare system and the two-tiered system. That two-tiered system is not serving the wider interests of the country and certainly not those of the people who live here. Most people who understand and are engaged with the health service are 100% behind the delivery of Sláintecare. They see it as our opportunity to form a link with our health service, similar to that emotional link citizens of the UK have with the NHS. The Irish have an appetite to feel closer to their health service and we saw that during Covid, but if the health service continues to be mismanaged, underfunded and unfair due to the two-tier system, that link will never be delivered.

The people are losing faith this Government has the ability and indeed the power to deliver it. They do not see the required staffing numbers coming through or the level of student intake in our third-level institutions being sufficient to meet the need. They see a Government underfunding our HSE. We have seen a supplementary budget of €1 billion announced today just to meet the need for this year, but people see a recruitment freeze that is going to further cripple our front-line services. People see waiting lists, which many of them are on given the number waiting is nearly 900,000, only getting longer. People see a workforce that is burnt out and struggling to retain existing staff. The healthcare staff who are coming through cannot afford to live here. They cannot afford the housing and even some of the job and training opportunities in the healthcare service do not match what is on offer in other healthcare services such as those of our near neighbours or further afield in the Middle East, North America or Australia-New Zealand. We are not retaining enough people who are educated through FETAC or to degree level and the staff currently in the system are being forced out of it due to the uncertainty of our healthcare system, which is only exacerbating all these issues.

Private health insurance cannot become a synonym for good healthcare, though some on the right would have one believe that is the case. With waiting lists as bad as they are, there is a perception among people that they need private health insurance out of fear more than anything else. As we know, many people who pay sometimes thousands of euro per year so they and their families can have private health insurance are not getting any benefit from it. It is there, as Deputy Cullinane said, as a comfort blanket in case the worst happens. This is not the sign of a good healthcare system. Unfortunately, in some instances where people are let down by the public system and have private health insurance they still cannot get the care they need because the private system is also absolutely crippled. We are seeing this in a number of areas. We see this with assessment of needs waiting lists and especially in the area of mental healthcare. There is a huge issue in communities all over the country. People facing mental health issues and parents of children with mental health issues are being told to go private due to extensive waiting lists with the HSE. Whey they go through a private health insurer, if they have one, they realise either the condition is not covered or if it is, the service still is not there. It is an absolute mess. Mental health is an issue I do not feel this Government has taken seriously at all and we have seen that in the derisory mental health allocation in budget 2024. What it means in real terms is people are being let down and they are losing hope. Access to mental health services cannot be a choice between the year a person is lucky enough to get on a waiting list or whether their health insurance provider will cover those costs.

Moving forward, we need to see an end to the recruitment freeze, adequate funding for our health services year on year so we are not facing the circus that is supplementary health budgets totalling €1 billion being brought in at the end of the year. We need to see real actions on the true delivery of Sláintecare in order that it works for every citizen of the country. We also need to see the Government acknowledging the damage it has caused in this area. Budget 2024 will forever be known as the disastrous health budget, the budget that delivered nothing but a recruitment freeze, underfunding and uncertainty in the most important sector in our public service, which is our health sector.

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