Mary Butler (Waterford, Fianna Fail)

We also have the Minister, Jim O'Callaghan, coming in, so there is someone in the Chamber to hear me.

It was great to finish on words of wisdom and lived experience from Deputy Daly. He is always there to give us all advice in relation to healthcare, and it is great to hear somebody speaking to the Bill.

I have been six years in the Department of Health. This is possibly my fifth or sixth time speaking on this Bill. I look forward to a stage when we will not have to speak on it, that we will get the legislation that means we will not have to come in every year and speak to it. However, it is important legislation, as we know. It is a technical Bill with eight sections focused on the specific area of health insurance.

A couple of points are worth mentioning. We know for a fact that a large proportion of people in Ireland have private health insurance, but it is important to put on the record of the House that 1.57 million people in Ireland have a medical card and over 700,000 people have a doctor-only card. I was struck by the point that some of the Deputies made, namely, that there was a cohort of people who could not afford private health insurance and who did not qualify for the medical card, but a lot of people qualify for doctor-only cards and have not applied for them. That is really important to say.

I also want to say, as somebody who has been in the Department of Health for six years now and having completed six budgets, that it is important to note what has been achieved to reduce the cost of healthcare for families over recent years, for example, free contraception up to the age of 35 and no more inpatient bed charges in our hospitals. You used to be charged up to ten days a year, and people found that quite hard. There is also the reduction in the drugs payment scheme for families, which is capped at €80 a month. All that has to be factored in as well. It is important to put such things on the record of the Dáil.

I thank all those who work in our health services all over the country, whether they are public, private or voluntary. They do a huge amount of work. I fervently believe that every person who goes to work in healthcare every day goes to do the best job they possibly can. However, I agree with our last speaker about the challenges we have in relation to productivity and, in some instances, culture. Those are areas where we have to see change.

As regards the Bill, I find every year that people do not always understand what we are trying to achieve. I refer to the risk equalisation scheme. To explain it in simple language, a community-rated market means that everyone pays the same price for the same policy regardless of age or health. That is really important. However, it costs more to insure older and sicker people, and without the support of the risk equalisation scheme, insurers with more high-risk customers would face higher costs and premiums could rise. This is why we have the risk equalisation scheme. It helps to resolve this.

I always see the glass as half full. I am very proud of the fact that we have one of the highest life expectancies in Europe. I am also very proud of the work that has been done over previous years on home care, day care and meals on wheels, that triangle of support that keeps people at home for as long as possible. The number of people who were under fair deal in a nursing home in 2019 is almost equal to the number of people in a nursing home in 2025 because people are living longer at home with the correct wraparound supports. I am not saying everything is perfect - far from it - but we have done a huge amount of work to support older people to remain in their communities. You only have to look at the number of home care hours that will be delivered this year. Yes, there are challenges in rural areas and at the weekend, but the fact that we have an ageing population who are living so much longer is something that should be cherished and that we should all acknowledge. That is because a lot of really good people are delivering really good services every day of the week.

I will leave it there. I believe we will have the Bill for Committee, Report and Final Stages tomorrow evening.

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