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

"Laya profits soar to €36.55 million". That was a headline in the newspapers earlier this year. Its profits were up by €14 million. For AXA, I do not have the figure for its profits, but it had €2 billion coming in from premiums. It has 30% of the Irish market, while Laya has 28%, and I think AXA is now underwriting Laya premiums. This is big business and big profits, and those profits are generated through the fear that about 50% of working people in this country have regarding what will happen to them if they get sick and have to rely on the public health service. They know that if they have to rely on the public service, the chances are they will be on a waiting list. The chances are they may have to wait for considerable periods, maybe dangerously long periods, for procedures to alleviate their illness or pain, with all the fear and anxiety that goes with waiting for diagnosis and treatment. It is not because people want to pay out €1,600 or a couple of thousand euro a year in insurance. It is out of fear of the inadequate resourcing, staffing, capacity and funding of the public health service that they are driven to private health insurance, and then the private health insurance companies clean up.

That is what all this is about. The risk equalisation that we carry out every year with this Bill is a measure to somewhat ameliorate the profit-grabbing in order that there will not be wild disparities in the premiums that might be charged by these mostly profit-driven companies based on the age a person happens to be or on his or her state of health, although let us remember the reason we have to do this is that if we did not, they would rip us off even more. They would take even more money off us. Of course, we know about the consequences of this in countries such as the United States, where there is a full-blown two-tier system, as opposed to our two-tier health system that has been slightly mitigated. They spend more on health than any other country in the world does, but vast numbers of people have no health cover at all, because if you do not have the money, you do not get the healthcare. It is as simple as that. We are on that trajectory. In the United States, people are in a sorry state if they do not have the money to pay these profit-driven companies to provide them with healthcare when they get sick, are vulnerable or old or have a disability.

To my mind, the whole operation is pretty disgusting and we need to move rapidly away from it. Of course, it is self-perpetuating. The Government says it is committed to a single-tier system and that it wants to get rid of this with Sláintecare. How long ago did we all commit to that, with not a bit of serious movement towards it? The private healthcare providers are fully entrenched. Briefly, during Covid, when we had to because some of us were screaming at the Government to do it and because of the scale of the emergency, for a brief moment the State took over the private healthcare capacity because we had to have a single-tier response to Covid. Instead of moving on from that to take that private capacity as part of a single-tier health system and use the capacity of the private system to alleviate the crisis that exists in our public system, we gave it back to the providers in order that they could make more profits and in order that Larry Goodman, who owns the Blackrock Clinic, and all the rest of them could make more money out of it. Good old Larry, who moves from animal meat to human meat and makes a lot of money out of it, as do many others.

I find it quite revolting, and I do not think there is any serious intent by the Government to address this or to provide healthcare to everybody, regardless, on the basis of their health needs. That is what a decent and humane system would do. It would adequately resource this. Of course, the members of the Government will shake their heads and say this is not true, but the Government’s failure to properly staff and resource the public health system is, whether consciously or unconsciously, part of creating the conditions that allow the private healthcare companies to make a profit. The Minister will, of course, deny this and say the Government is saying to recruit people. We had this debate earlier, when I brought it up during Leaders' Questions, and members of the Government shook their heads and said the Government is not gaslighting the public but is really trying to recruit people, that there is no embargo.

I asked for further figures for St. Michael's Hospital and got a reply only after that debate. I wish I had had it during the debate. I got another answer about St. Michael's, my local hospital. I had asked the Minister for Health to confirm the number of staff who were on maternity leave at St. Michael's Hospital and whether cover would be provided.

The answer was that there were six staff on maternity leave, two senior physiotherapists, three enhanced nurse grades and one management administration grade 6. It was said maternity leave could not be provided within the hospital's current financial and employment control limits. It was made absolutely clear. With the pay and numbers strategy, it was not getting the staff to cover the maternity leave, and if that meant it did not have the nurses on the wards or the physiotherapists for the people who needed them, then it was tough luck on the patients and on the rest of the staff who were left to pick up the pieces as a consequence. That is repeated in hospital after hospital on a far bigger scale than St. Michael's Hospital, which is a relatively small hospital in my area. Is it any wonder that in that situation people would say they have to go to the Blackrock Clinic.

An interesting point was made to me by one of the St. Michael's healthcare workers and by a guy who worked in recruitment for the agencies and was part of the private thing. He asked why it is, when the Government says it is trying to recruit people into the public health service, that it is able to recruit people from the agencies? The Government is trying so hard but it just cannot recruit people. We cannot get them for the permanent jobs in a hospital, which are decent, secure jobs, but we can get them from the agencies. The truth of it is that the Government is not trying to recruit them in many cases. In some cases, it is just policy not to cover people out on maternity leave. People who leave are not replaced because if the staff required to replace the person who leaves takes that hospital area over the quota, then it is just not getting them. That is it. As the radiation therapists explained to me, if people leave, they might get replaced but they might not if the ceiling has already been hit. Therefore, in their case, machines lie idle that would otherwise provide lifesaving treatment to people with cancer. What are you going to do? Very likely, you are going to go private if you are facing the prospect of a condition that might end your life. What choice have you got? This is if you have the resources, and if you do not, you are in a dark space.

I will provide another little example from St. Michael's, a small hospital in my area. I tabled a parliamentary question to ask the Minister if a CT scanner has been considered for installation in St. Michael's Hospital. The answer received was that a business case for a CT scanner had been submitted to the HSE in 2023 and an outcome was awaited. In 2023, a question was asked about a CT scanner.

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