Martin Kenny (Sligo-Leitrim, Sinn Fein)

I am glad to speak on the Health Insurance (Amendment) Bill 2025. As we know, many people in the country, almost 50% of the population, have health insurance. This is high when we consider that almost 77% of the cost of healthcare is provided by the State. You would wonder why the imbalance is there. Many people feel they have no option other than to have health insurance, particularly as they get on in life. There is always the fear of ending up on a waiting list, particularly for a diagnosis. I know many people who are waiting to get scans, scopes or other services. They go to their GP, who writes a letter to the hospital and says they will get an appointment at some stage. They wait months and months. It turns into years. Then they get very ill and end up having to go to accident and emergency.

In my constituency, Sligo University Hospital was recently described as one of the most overcrowded hospitals in the country. In fact, I was recently informed that the ambulance service at one stage got a notification not to bring patients to the hospital, such was the overcrowding in the accident and emergency department. It is the same all over the country. In one cases I had recently, a woman waited outside Sligo hospital in an ambulance for six hours because there was no space to bring her into the hospital. That ambulance came from south Leitrim. During the time the ambulance was waiting, there was no ambulance cover in the region. That is happening everywhere all over the place. It is small wonder, therefore, that people feel the service is so poor in the public system that they need to get insurance to be able to have a service provided. Yet, when they have that insurance, the level of service they get is often not up to the standard they would expect in those circumstances.

We have a two-tier health service and unfortunately it does not work for anyone. What we find is that people pay taxes all their lives in order to have a health service and then when they get ill, they have to take out their chequebook to pay for it. That should not be the case. There is a huge amount of work to be done to be able to provide the kind of service that people require. We recognise that the private system is withdrawing from the public system. That should happen as soon as possible. It has been my experience that the private system only wants to provide the easy parts. It wants to do the parts that are easily done, the clean-cut bits, such as the cataract that needs to be taken off, the hip or knee replacement and the stuff that is clean and easy. The harder part, the more complex cases, are put back into the public system again and the pressure is always on the public system to provide for it.

We have a health system which is run by professional and competent people. My daughter is a nurse who works in the health service. I know the level of commitment the staff have. She experiences it among the people she works with. We find, however, that the system is somehow or other under strain and stress, mainly because there are not enough people to provide the service. Many health workers will talk about the experience of working abroad being good. In general, when they go to other countries, they find that where there is meant to be three or four nurses and a number of care assistants in a ward, there is half that number in the Irish ward looking after patients. That creates huge strain because if a couple of people happen to need urgent care or are sick at the same time in those circumstances, they do not have the ability to look after them. They feel under pressure, stressed and unappreciated in the system, and the system fails. That is the experience of so many.

Having health insurance does not solve the problem for a lot of people. In fact, all it does is make them pay more and still get an inadequate service. There needs to be a full review of how our system works. I know Sláintecare was supposed to do that, but it has not delivered. There needs to be a re-examination of what we are going to do to get a proper health system in place that provides adequate services for all of our citizens.

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