John McGuinness (Carlow-Kilkenny, Fianna Fail)

While this Bill comes every year and so on, it relates to the implementation of the scheme already there and the costs involved and reflects the current cost of insurance. However, I want to raise the issue of the cost of private healthcare and ask the Minister of State to reflect on the increases that have taken place over the years in that cost.

We need to ensure that the private health insurers are diligent in how they pay out and investigate the payments being sought. We need to ensure they are paying hospitals on time for what was done, not for any extras that may have been inadvertently put into the invoice. I believe that is an issue that needs to be addressed because any type of increase in the cost of the care of a person in a hospital that does not fully reflect the type or extent of care they receive will simply increase further the cost of premiums to cover the profitability, if you like, of the private health insurers offering that cover.

It is significant money that people are paying. There is also a significant number of people who believe they have to pay that money. That should cause us to reflect on the system we have. Many speakers before me have highlighted the failures of the system itself. We are not criticising - or I am not - the staff who administer that system or, indeed, those at the coal face of the delivery of health services because they are pushed from pillar to post to deliver that service in a working environment that is not necessarily supportive of the task they are being asked to complete.

One of the issues this and previous Governments have had to deal with is the lack of value for money in our healthcare system and the amount of money going into healthcare that is being wasted. That is something we need to get a handle on because that figure is increasing every year. We just have to look at the 100 years of the PAC, which is being celebrated today, to see the amount of inquiries relative to healthcare is increasing by the year. The amount of moneys the courts are settling cases for is increasing every year. We are looking at millions of euro being paid out because of negligence of one kind or another in the hospital system. There is no business that could tolerate the payments being asked by the courts except for government because it can reach into the taxpayer's pocket and provide the payment the courts decide on. We should be looking beyond that and wondering why these things happen. What are the failings in our own systems - in the systems of public administration - that have caused the person to go to court?

I have a lady in Kilkenny whose father was cared for in hospital and who later died. The HSE has recognised the lapses of care in that hospital, yet it still continues to fight with the family in respect of a promise of apology. The HSE acknowledged its wrongs and said it would apologise but that has not been a fulsome apology. I find that shocking. If you have a customer in business and something goes wrong, own up to it. Take ownership of it and deal with it without having to spend a fortune going to the courts. In that game, it is only the legal profession and others who will win. The State Claims Agency and the HSE need to look at best practice. They are wrong in what they are doing. The individuals who go to court are not wrong because, obviously, they have a case and they went to court. The HSE or the Department of children is now standing over the payment of a hotel room, going back over the past 12 weeks or more, for a child who is kept there because it cannot get a proper, bespoke place for that child. The HSE and the Department are in the business of health and children long enough to know where they can get that care without squandering a fortune on a private hotel bedroom and without putting pressure on the parents to do a roster over the 24 hours to visit and look after that child. What in the name of God have we come to in Ireland that this would happen, given the billions of euro currently being pushed into the health services?

I look at the delivery of health for older people and what I see in our public hospitals is people who are going in for one health issue or another, experiencing lack of care, falling in the hospital ward and ending up being in even more difficulty coming out of the hospital than they were going in. The families are then promised home care hours and support, only in the attempt to have the patient removed from hospital and taken home. Once home, the hours are often not delivered at all and the family is pushed to a point where some have to give up work, the person is often left alone but should not be left alone, and the health of the individual then takes a nosedive. That is not acceptable in a country that is spending the type of money that we are on healthcare. It is not acceptable that the hours would be allocated and then, when they are not sufficient, they would not be topped up by the HSE.

I see it every day of the week. The Minister of State should look at the parliamentary questions being asked and ask himself why they are being asked. Why are so many questions about delivery of services turning up on the Question Paper every single day? The answer is the administration is wrong, it is not efficient, it is not delivering in the way that it should and it is not getting value for money. Families often then turn to private healthcare. What I am encountering now is a wait for hip operations, knee operations and so on even within private healthcare. Something is wrong with the output for the money being spent.

There is a new hospital in Thomastown in County Kilkenny, which is state of the art and a wonderful location. However, I have yet to determine when that hospital will be fully staffed and open so that the patients on waiting lists and in the hospital can be put into a better facility.

I ask that someone at least explore that question, find out and let us know. There is a wonderful hospital in Castlecomer, County Kilkenny. People use it for respite and it is used for the care of older people. That is a hospital model that should be developed. The community hospitals, those that are in the community supporting the care of older people, are not being funded in the way they should be. They are providing a brilliant service. It is an incredible service. For some reason or other, there is a high number of those hospitals in Carlow-Kilkenny. Every single year, they are being pushed by HIQA, or for some other reason, to spend money that they do not have. When they appeal to the Government, they receive a snail's pace response. When we have something that works, we should fund and develop it and, if possible, roll it out to the rest of the country.

In the past, in healthcare, religious orders sometimes looked after the hospitals and they set up new hospitals and community hospitals. They are still going and they are a proven model. Why are we in trouble with our healthcare given the billions available now that were not available previously? I support the hospitals in Castlecomer, Thomastown, Kilmoganny and all the others getting money to continue their development because they are doing a community service. They are not just hospitals. I ask that the care of our elderly in our public hospitals be looked at. There are times when they are admitted to hospitals where it is not the right place for them. Some are ending up on beds in accident and emergency departments and not being properly cared for.

I have respect for people in their senior years who are looking for the types of operations that would give them more years in life. I can never understand why the same ethos is not in place in hospitals to ensure that a hip or knee is replaced or cataracts are done. What have we come to?

I listened to other speakers. I ask the Minister of State to listen carefully to what is being said. Everyone has a contribution to make in terms of their own locality. They are not talking out of the top of their hat. They are giving facts about projects that are working. They should be supported.

See this speech in context