Dáil debates

Wednesday, 19 January 2011

The following motion was moved by Deputy James Reilly on Tuesday, 18 January 2011:

That Dáil Éireann:

is concerned that:

— a national emergency has again emerged in Ireland's hospitals with an unprecedented 569 patients on trolleys in January 2011;

— the Government will not publish legislation to introduce risk equalisation until 2013, despite having promised to do so within three years when it was struck out by the Supreme Court in 2008;

— the public hospital system is under increased strain due to rising unemployment at 444,000, businesses unable to access finance and many people in negative equity; and

— the VHI's 1.35 million customers cannot afford increases of up to 45% in their private health insurance premiums because of the failure of the Minister for Health and Children to introduce risk equalisation; and

calls on the Government to:

— instruct the VHI to postpone premium increases until the Milliman Report is published and debated; and

— expedite the introduction of risk equalisation.

Debate resumed on amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"— welcomes the action by Government to reduce unacceptable waiting times for patients in emergency departments and to pursue the target of ensuring that all patients are assessed, treated and discharged or admitted within six hours of registration at an emergency department;

— welcomes the roll-out of the acute medicine programme which will provide that every medical patient presenting to hospital will be seen by a senior medical doctor within one hour and will provide access to same day diagnostics;

— endorses the Government's strategy that the best way of achieving a stable health insurance market, where policies are relatively affordable for older and sicker people as well as younger and healthier people and where health insurance can evolve in a way which supports overall health policy objectives, is a situation where:

— the core policy of community rating is supported by an effective, transparent risk equalisation scheme;

— the State does not act as both regulator of the market and owner of a company in the market, particularly one with a large or dominant market share; and

— there is a more even balance of older customers between companies in the market;

— notes that, following the Supreme Court decision in July 2008, the Government introduced interim loss compensation arrangements through the taxation system with effect from 1 January 2009 which to date has provided for the transfer of €89 million and is estimated to allow for the transfer of a further €70 million in 2011;

— underlines the Minister's intention to publish legislation this year which will provide for the development of a full, robust risk equalisation scheme which will protect the fundamental objective of community rated premiums, with transitional measures in place pending the introduction of the full scheme; and

— welcomes additional comprehensive actions being taken on private health insurance which include:

— arranging the sale of the VHI, with appropriate capitalisation and authorisation in advance of this; and

— pursuing measures to achieve a more even balance of customers among companies in the market."

- (Minister for Health and Children).

6:00 pm

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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We will resume with Deputy Jan O'Sullivan. There are 19 minutes remaining in this slot.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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I wish to share time with Deputy Costello. I will use nine minutes and Deputy Costello will have ten.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Very good. That is agreed.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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There has been a development since our debate on this matter commenced last night in that the VHI has issued a statement in respect of the comments made by the Minister in the House. The Minister took the opportunity to reveal some of the contents of the Milliman report, which has been available to her and the VHI but to which Members are not privy because it has not been published. The Minister indicated that she would publish the report in redacted form, leaving out market-sensitive information.

The statement issued by the VHI earlier today suggests that the Minister was disingenuous, to say the least, in the context of what she said about the company. She indicated that it should be able to make significant savings if it changes its system. In response, the VHI has stated that, in effective, it is being asked to become a US-style health utilisation company and that this would require it to invest in and establish significant pre-authorisation processes, concurrent review processes, post-care processes, etc. I do not know what is the truth of the matter because I have not seen the report. If we are going to engage in a debate on this matter, it should be an honest debate. In that context, we should all be given the information that is available to the Minister.

It was not fair to the VHI for the Minister to disclose some of the information she placed on the record last evening without making the full report available in order that commentators and public representatives might provide an honest appraisal of its contents. However, there are areas in respect of which the VHI must provide answers. One of these - the Minister must also provide an answer in respect of this matter - is whether the company acted legally when it increased the costs relating to the plans preferred by elderly customers by more than those which obtain in respect of the other plans it offers. That would appear to be in contravention of the spirit behind, if not the law on, community rating. When the Minister of State, Deputy Moloney, makes his contribution, I would like him to indicate the legal advice, if any, the Government has obtained in respect of this issue.

Plan B and Plan B Excess are used more by elderly people, who have suffered greatly as a result of the recently announced increases. Many elderly individuals have informed me of their concerns to the effect that they will be obliged to discontinue paying their health insurance. They are very scared about doing so because they have reached a point in their lives when they will need health care to a greater extent than would have been the case when they were younger. Most of those to whom I refer have been paying health insurance for most of their adult lives and have not been obliged to claim before now. It is important that we should discover whether a legal issue arises in respect of this matter.

A number of people have indicated that the VHI has paid out on their behalf in circumstances where it should not have done so. I refer, for example, to individuals with haemochromatosis who have stated that the VHI was charged in respect of situations where they did not receive consultant care. I understand that it is frequently the case that people with private health insurance who are treated in hospital settings never see a consultant. However, in addition to a hospital bill these individuals also receive a consultant's bill in circumstances where they were actually treated by a non-consultant hospital doctor who is paid a salary out of the public purse. I am of the view that questions must be asked with regard to what is happening in this area.

I would certainly not state that the VHI is without fault in all of this. As already stated, however, the Minister's comments were not fair because she made claims regarding what the VHI could do on the basis of a report which Members have not seen and the contents of which we are consequently unable to challenge.

The Minister also stated that because she is preparing the VHI for privatisation, she has basically surrendered the power which used to be at her disposal in the context of telling it not to raise its prices. I would be interested in hearing the Minister of State's comments on the first part of Fine Gael's amendment, which calls on the Government to "instruct the VHI to postpone premium increases until the Milliman Report is published and debated". I would question whether the Minister is in a position to do this now. She would certainly have been able to do it before she surrendered the power to which I refer. In effect, the Minister has left subscribers exposed to the vagaries of the market because she has not retained the power to protect them.

Is it really intended, in current circumstances, to privatise the VHI? Significant public money would have to be invested in the company to fatten it up for privatisation. There are many better uses to which such money could be put in the health service at present. Honesty is required from the Government in this regard. Is it intended to proceed with privatisation and, if so, from where will the money come? The VHI is currently not in a position to be privatised.

The Labour Party has a completely fair approach to this matter. We want to ensure that all patients will have access to services on an equal basis. The basis of our universal health policy is that, in effect, all patients will be insured. This would ensure that when people find themselves in a difficult position as a result, for example, of losing their jobs or whatever, they will not lose their health cover. Part of the major concern for people at present is that if they lose their jobs and cannot afford to pay their cover, they must give it up. That is unfair. It is also unfair that people who have health insurance can, in a sense, buy their care quicker than someone who does not possess such insurance. That is the ultimate injustice and the Labour Party is of the view that it should have no place in any health service. That is why we intend to introduce the change to which I refer.

Until such time as that change is implemented, there is a need for a fair system for those with private health insurance. The only way to establish such a system is by legislating in respect of risk equalisation and replacing the current interim solution. The latter has been in place since the court decision of July 2008. Despite what the Minister stated in respect of the complications involved, I cannot understand why it is taking so long to introduce the necessary legislation. I accept it may be complicated but it must be remembered that risk equalisation was previously in place. In addition, there are risk equalisation models in use in other jurisdictions so it is not as if we are seeking to invent the wheel. While the legislation is awaited, it is obvious that there will be unfair systems in place in the area of health insurance provision. Those who bear the brunt of the inequality created by such systems are the elderly, the sick and people who cannot compete. The costs relating to these individuals' plans are being increased by 40% or 45%, which is unfair. I am of the view that the market cannot be left to operate in this way for the period envisaged by the Minister.

I again welcome the opportunity to discuss these complex issues. Ultimately, we must move to a new and fair system which will use the public and private money spent on health in an efficient and effective way that will be to the benefit of patients.

Photo of Joe CostelloJoe Costello (Dublin Central, Labour)
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I compliment the Fine Gael Party on bringing forward this motion, which relates to the most recent crisis to affect our health system. We have witnessed many such crises during the past decade. There is an obvious solution to the crisis in the health service, namely, to get rid of the present Government and introduce a new system. The Labour Party has that policy prepared, and it is the way we should proceed. We need a new policy, a new Government and a new Minister, and we need to begin the work immediately. As soon as the election comes and we can begin that, the better.

It is incredible that the Government should have presided over the closure of so many hospitals, such as in my own constituency, as well as the closure of many wards and beds at a time when the population was increasing. It is incredible it should have imposed a whole new tier of administration on top of the existing one without first removing that existing tier, resulting in a non-functioning administration and management system. It is incredible that the Minister for Health and Children should have declared a national emergency in regard to the numbers of people waiting in accident and emergency units throughout the country in 2006 yet, four years later, we have a record number in the same units. She promised that within six months of her ten-point plan she would have dealt with the problem but the situation has reached an unprecedented level four years on.

The patients who come into the emergency sections of the hospitals are often elderly and fearful but the conditions they experience in their immediate interface with the hospital are appalling in many cases. In those circumstances, any senior Minister would have resigned long ago and handed over to somebody who would do something substantial with the service rather than allow it to collapse upon itself, as it has, and to remain in crisis over an entire decade. It is a disgrace that we should still be in this situation despite all the money that is spent annually on the system and all the promises that are made.

The Irish health system is a Third World system in a First World country. We had all the years of the Celtic tiger to get it right but the money was squandered. We now find we are faced with hikes of up to 45% in premium costs for VHI's Plan B and Plan B Options. These are the most popular plans which people would have embarked on perhaps decades ago, and of which those who are now elderly and more likely to be in need of care are in receipt. Such elderly people are the ones directly affected and they are being targeted - that is the sum total of all of this.

It is outrageous that the Minister should target the most elderly in our society, who have been loyal members of the VHI over the years, many for decades. They paid their premiums year after year yet what are they now told? The Minister for Health and Children tells them they can shop around. That is not what community rating is about. The situation is that VHI's customers are being thrown to the wolves. Many of them will either have to abandon their policies, reduce their premiums or take on and incur costs for which they cannot pay. This is what the Minister is doing with this unprecedented hike in VHI premia.

It is not good enough for the Minister to, on the one hand, tell people to shop around and, on the other, to justify it by saying she is preparing the VHI for privatisation and fattening it up for sale. Is that the way to treat patients, subscribers and customers? This is the sort of thing that was done with Eircom by the then Minister, Deputy Mary O'Rourke, when it was privatised some years ago. We can see what has happened. Whatever system we had then, we have a much poorer system now and we are lagging behind the rest of the world in terms of broadband procurement and provision.

There must be a major question mark about the actions of the Minister. It seems that, essentially, she does not care about the people with whom she is dealing. She cares only about putting in place an ideological policy position. It is the last dying kick of the now defunct PDs - privatisation at all costs and the marketplace rules. She is now preparing the VHI for privatisation. That it will damage the loyal customers and make them concerned and fearful is not taken into consideration. They are told to shop around and that they will get more or less the same somewhere else. Why were they in the VHI in the first place? What is the sense in a company operating unless it has some loyalty towards and protection for its customers, who have been loyal to it? For the Minister at this time, just as she is about to leave office, to unilaterally say costs are going to be hiked up so much that, effectively, people will not be able to pay is not acceptable.

It is not good enough that the Minister has delayed so long in providing risk equalisation legislation. While she states in her amendment that it will be produced some time in the coming 12 moths, she will not be around to deliver on it - we know that. She had three years to do it but she has done nothing. One cannot effectively talk about having community rating unless the statutory basis for risk equalisation is provided for. What needs to be done to protect and underpin a fair system has been neglected. The Minister has done the opposite in that she has put the cart before the horse and is now privatising the VHI when she should be providing a statutory system that would ensure equality within the health service. That has not been her priority, however, which is a reflection of the manner in which the entire health service has developed in the decade under her aegis.

It is time for a fresh start and the fresh start must have a fresh vision and a new policy. The Labour Party and Fine Gael have put forward two new policies which have many similarities, including a universal health insurance policy where the patient, equity and fairness are at the core, where the money follows the patient, where vested interests do not rule the system and where the system is not in control, whether that be a management system such as that of the HSE, which is dysfunctional in itself, or whether it is the main players - the GPs and the consultants - who have traditionally dictated the manner in which the health system operates in that it has been built around them rather than being built around the patients. It is time to put all of that to bed and put patient care at the core of a new health system.

Photo of Niall CollinsNiall Collins (Limerick West, Fianna Fail)
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I wish to share time with Deputies Charlie O'Connor, Michael P. Kitt, Timmy Dooley, Thomas Byrne and Margaret Conlon.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Is that agreed? Agreed.

Photo of Niall CollinsNiall Collins (Limerick West, Fianna Fail)
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I am grateful to have the opportunity to contribute and I hope to lift the mood somewhat given what we have listened to. While most discussions in the Chamber on the health service are tainted with a very negative tone, it is not all doom and gloom within the service. That negative tone impacts on the very many fine people who work within the health service, the HSE and the Department of Health and Children, who are committed to their jobs, take them seriously and do the best they can in the circumstances. My local hospital, the Mid-Western Regional Hospital in Limerick, treats more than 30,000 inpatients, caters for more than 120,000 outpatient attendances, 55,000 accident and emergency attendances and more than 4,000 deliveries in the regional maternity hospital on an annual basis. That is a significant throughout and there is a high level of service delivery by the medical, nursing and clerical staff and everybody else associated with the health services in the mid-western region. That acknowledgement is important because such points may not come through in debates like this. Likewise, it is not fair comment to say the Minister for Health and Children does not care. That was an unwarranted, personalised remark. It is not fair to say that anybody in this House does not care. We are all here as public representatives to do our best for the people from whom we receive our mandate.

The Fine Gael motion refers to the number of patients on trolleys in accident and emergency departments earlier this month, an issue which attracted a great deal of news reportage at the beginning of the year. This issue should be examined by the Health Information and Quality Authority, HIQA. It is not acceptable in this day and age that a trade union organisation should be able to dominate the news agenda for two or three days by doing a trolley count around the country. That is not its purpose and not what it is constituted to do. Trade unions are mandated to represent their members' views, and this particular union is not placed to carry out a trolley count. If we are going to have a debate on the numbers of people who are on trollys awaiting admission, the figures should be verified by an independent body such as HIQA. That is far preferable to the circus we have seen with the Irish Nurses and Midwives Organisation doing a whistle-stop tour around the country and being facilitated in that by news organisations. That is not right and proper in this day and age.

Clearly there are areas within the health sector where we would like to see an improved roll-out and delivery of services. For example, the provision of primary care teams must be advanced in a more speedy fashion. I understand 11 teams have been establish in Limerick city and county, with another five or six in the pipeline. If we can get the primary care teams up and running more quickly, that will take the pressure off the admission processes within accident and emergency departments. That is where the focus should be. The targets set by the Health Service Executive in this regard had been lagging behind slightly.

I would also like to see the progression of the co-location facility at the Mid-Western Regional Hospital in Limerick. It was interesting to note the observation by the chief executive officer of VHI in the debate on recent price increases that a private bed is cheaper in a private hospital than in a public hospital. That anomaly must be addressed.

Other parties have their own policies in regard to how they would like to see health services delivered. Ultimately, however, whether it is the policy of the Labour Party, Fine Gael or Fianna Fáil that is implemented, the provision of health care is costly. Those costs can be collected by direct charges or direct taxation, but services cannot be delivered for free. We must dispel the notion that a universal social health care system or some other policy initiative will deliver free health care for all. No such mechanism exists.

Photo of Charlie O'ConnorCharlie O'Connor (Dublin South West, Fianna Fail)
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I welcome the opportunity to contribute to this important debate. I am always pleased to compliment the colleagues who bring forward a motion, in this case, Deputy Reilly of Fine Gael. However, having listened to the Labour Party contributions tonight I wonder whether I am in the company of the next Minister for Health and Children. If that is the case I wish that person well.

Unlike Deputy Collins, I know very little about the condition of the health service in Limerick. However, I know a lot about Dublin, which is where I was born and live, and the area I represent. The increase in VHI charges have not gone down well in my city and county. Many of us on this side of the House have sympathy with the view - and I compliment the Minister of State, Deputy Moloney, on making that point - that these increases should at least have been postponed.

I have a particular interest in my local hospital in Tallaght. I live close to it, am a regular visitor, have been a patient there and have been involved in it in various ways for some years, including as a member of the management board. The Leas-Cheann Comhairle was kind enough to assist my involvement in that regard, which I will always appreciate, although I promise not to put it in a leaflet this time. It is important to have local representation. I recall that as Minister for Health and Children, the Leas-Cheann Comhairle appointed people to hospital boards who had an interest in and credibility among the local community. Unfortunately, that is no longer the case in some instances.

I visited Tallaght hospital some days ago to assess the situation in the accident and emergency department. Media reports in recent days have revealed a scandal at the hospital where the 46-bed Burkett ward was being used as a canteen. I have no problem with the provision of canteen facilities for staff but it should not be at the expense of patient facilities and resources. When I was in the hospital on Monday afternoon 46 people were on trolleys, some of them in very difficult circumstances. I understand that today, as of 20 minutes ago, 30 people are on trolleys in the accident and emergency unit and 22 are on trolleys in the former canteen. I compliment the Minister for Health and Children on her intervention in this regard. I brought the situation to her attention, as I am sure did other colleagues. Arising from that, as I understand, the Health Service Executive instructed the hospital this morning and, as we speak, the reversion of that facility to a working ward is under way.

Deputy Collins made a relevant point about the pressures on the health service. I will not politicise the issue other than to say I would love to be a fly on the wall at the negotiations between the Labour Party and Fine Gael after the election. I wish them well in that regard but they will have many problems in fusing their respective health policies. Although I do not know where I will be in a year, I will be the first to step up and congratulate them if they achieve that. I would love to be in this House in a year's time asking colleagues in those parties to account for what they have achieved.

I am not a VHI customer and I hope my current good health, which means I hardly need health care, continues. However, I have spoken to many VHI customers who, when they are sent a copy of the bill for their treatment, are appalled at the costs involved. There is a role to be played by the Committee of Public Accounts, which does tremendous work, in this regard. I am sorry to hear that the Chairman, Deputy Allen, will not stand at the next election. The committee would have a good job of work to do in examining the issue of cost claims at VHI. I hope the Minister will give consideration to that proposal.

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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I welcome the opportunity to contribute to the debate on the Private Members' motion. I am disappointed at the announcement by VHI to raise the cost of its premia from 1 February. These are substantial increases, ranging from 15% in respect of plan A to as high as 45% for plan B Options. I hope the VHI can postpone the premium increases, which will be expensive for the old and infirm. It is easy to say that one can shop around but older people are very much attached to the VHI, which has a disproportionate share of older customers. Statistics indicate that while the VHI has 62% of market share, it also has 80% of claims.

I agree with Deputy Charlie O'Connor about costs and the Minister, Deputy Mary Harney, referred to savings. The Minister also referred to the Milliman report and the work that is being done in her Department. The report showed that potential savings of 5% to 10% could be made in this area, which could be achieved regardless of the risk profile of the insured population.

Some issues have been brought to my attention by constituents, including charges for procedures irrespective of the number of days a patient spends in hospital. One constituent told me of a charge of €12,000 for a minor procedure in one day in hospital. In fact, however, the same person had another minor procedure sometime later, which also cost €12,000 although they spent a few days in hospital. There seems to be a divergence of costs involved. The costs applied to operations should be investigated.

The Minister also raised the question of reduced costs for people in group schemes. The VHI teachers' plan, which has been mentioned, is certainly good value. It is not, as the title suggests, just available to teachers. The same cover in the VHI's plan B is also provided by Aviva's Smart Plan and the Quinn company's Health Plus scheme. One of the problems with the teachers' plan is that one must take these decisions quickly before 1 February, as the renewal date could be after that, and one must obviously get out of a group scheme before one does so.

The motion referred to patients on trolleys and such difficulties have arisen due to the outbreak of swine flu and other flu-like illnesses. The recent extreme weather conditions led to much pressure in hospital emergency departments. I commend the work that is done in our hospitals to deal with the increased number of patients. Some patients have to be isolated, which places an extra burden on hospital staff.

The reconfiguration of hospitals, such as the cluster proposed for Galway and Roscommon, is important in dealing with admission procedures and overcrowding. The idea that more procedures could be done in smaller hospitals such as Portiuncula Hospital in Ballinalsoe and at Roscommon Hospital, is a positive proposal. There is no reason that the majority of procedures, or in many cases the total, should be carried out in a major regional hospital. The proposal to allocate 35% of procedures to smaller hospitals is a good one. I hope we can work on that idea by providing resources to equip smaller hospitals and provide staff so that procedures can be carried out there.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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I welcome the opportunity to contribute to this debate. On many occasions, the House has discussed the health service and this is another opportunity to do so. The debate, however, seems to revolve continuously around the same old story, which is that the solution to the crisis in the health service is to get rid of the Government regardless of who is in power.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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It would be a good start.

Photo of Margaret ConlonMargaret Conlon (Cavan-Monaghan, Fianna Fail)
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That is a matter of opinion.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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I am sure it would be no different if there was another party on the Government benches.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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It will happen.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Do not worry, we will ensure that it will.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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They want to get rid of the Government, bring in a new policy and develop a new system. The notion of money following the patient, which Deputy Costello talked about, is not a bad system. I understand that has been proffered by both parties in the run up to the election. In tandem with that, however, Deputies from different constituencies want to retain the status quo, regardless of whether the local hospital is small or large. When the money starts to follow the patient, I wonder how many small hospitals will still exist. If one is serious about that policy, the small hospital will go.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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No, it will not. The Deputy is scare-mongering.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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They are hiding behind the notion that everything will be retained as it is because they do not want change. They are not prepared to change. They tell the unions what they want to hear when it suits. They tell the staff what they want to hear and say they will keep nurses where they are needed, and that units will also be maintained. Yet they will have a policy where money follows the patient. If the patient is not there, however, neither will the nurses. The policy espoused by the Opposition will create a requirement for considerable change. I am not suggesting that the system is bad but they should tell people the truth - that it will impact on small hospitals. The primary concern should not be about maintaining a building or structure; the policy should be all about the patient.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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Which the Deputy's one is not.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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It should be about the quality of care the patient receives and the safety of the service that is delivered. It should also be done to a particular, recognised international standard. It should not be about the grubbiness of appealing to the lowest common denominator in terms of the argument. We have had too much of that. It is facile to suggest that one Minister who is responsible for 110,000 people working in the health service is somehow the root cause of every idiosyncrasy that takes place within that service.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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She is not in charge. She gave over her responsibility to the HSE.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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It is wide of the mark but it appeals to the headline writers and the local media. It appeals to whatever angle one wants to use in order to protect the status quo. The Opposition argument is such that they are not looking for the status quo, they want to change it. They are talking about a serious policy, which is a good one, but costly. In addition, it will take a lot of time to implement. The current system certainly does not have all the answers. There are many problems, but when one is dealing with 110,000 individuals one needs a hell of a structure and a reporting system. One also needs the co-operation of everyone all the time to avoid mistakes and delays, as well as ensuring that accident and emergency units operate to the highest possible efficiency. All it takes is a small group of people for things to go wrong.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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Is Deputy Dooley going to speak to the motion?

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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Somebody may be out sick or somebody may swing the lead on occasions, which can cause problems. I want to reiterate what Deputy Collins said. Some of finest people in the public service work in our health services. Sadly, however, when people denigrate the Minister they believe that it does not affect the morale of those who work in the health service. I can say that it does. My mother is a retired nurse and I know that many nurses are appalled on a daily basis by such denigration. Cases may sometimes be advanced on behalf of a union agenda or initiative, but somehow they denigrate every individual who works in the health service. It is wrong and unfair because such people are doing their best pretty much all the time.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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The Deputy should speak to the motion.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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I thank Deputy Dooley for raising the issue of the Opposition's health policy. It is probably our fault but their policy has not been scrutinised, although I have tried to do so on local radio. Deputy Dooley mentioned small hospitals and he is dead right. Small county hospitals, such as Navan hospital, for which the Opposition does not have a policy, is gone under the Fine Gael system.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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The Deputy's party has no policy on it.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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They cannot defend themselves, so they attack the Opposition.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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When the money follows the patient everybody will want to go to the top specialists in Dublin the whole time. The current policy on Navan hospital is to provide some specialties which people can access at local level. That is what is important in health care. We see also the evidence that the costs of this universal health insurance will be far greater than anything the VHI has done, and Fine Gael needs to outline that to their voters.

The most crucial aspect, however, is that it criticises the Health Service Executive all the time, particularly HSE administrators-----

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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As does the Deputy.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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-----and those who make decisions within the HSE. They are very important people. Are we prepared as a nation to devolve those decisions to the VHI, Aviva, the Quinn Group and any other foreign company that comes here because it is explicit in the Fine Gael policy that decisions on whether somebody gets an operation or not will be made in the offices of a health insurance company? That is the reality. We are looking at films about this in America. The reality of Fine Gael's policy is that we will no longer have a public health service. We will have a fully private health service controlled from abroad. The HSE's problem, as a public health service and the guardians of the public, is that it has not explained that role properly to the people.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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It is no wonder the public will not listen to the Deputy.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Allow Deputy Byrne to address the House.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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It has not explained that it is the equivalent of the NHS, so beloved of the British, and that it is the protector of our public health service. That has not been explained because every time it makes a decision about protecting public health and public safety, the Members opposite show up at rallies protesting against it but they will not be able to go to rallies in Amsterdam, England or Abbey Street outside the VHI's offices because they are the people who will be making the decisions under Fine Gael's proposed health service if the people vote for it.

The health service Fine Gael is proposing will have to be scrutinised very carefully in this election because to according to Fine Gael policy, decisions in the health service will be devolved to insurance companies. That is what Fine Gael states and I would like its Members to explain that to the public.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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The Deputy need not worry. We will.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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The Fine Gael party intends to move the decision making from the public health service and from public staff, all of whom will be let go, to insurance companies who will do it for a much higher price. Do not tell me we will have some control over the pricing system of that because we will not. The VHI price increases were disgraceful but we will have no control over the system proposed by the Deputies opposite. Not only will the providers involved be deciding the prices, they will also decide who does and does not get treated. That is the reality of Fine Gael's system.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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It is flattering that Deputy Byrne has read all our policies.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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When people are making up their minds in this election health will be a very serious issue because the Deputies opposite have not thought out their policy properly.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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He does not have his own policies and he has to quote ours.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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They have stated they will devolve the decisions from a public service to foreign private companies.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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It is quite flattering.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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By and large we do not have a bad health service in this country when we examine the outcomes across the board in terms of cardiac treatment and cancer treatment. Of course, Fine Gael opposed the cancer strategy given to us by experts from all over the world.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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We established the cancer strategy, Deputy.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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You did not.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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Deputy Michael Noonan established it. I was here when he did it. The Deputy was not here.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Please allow Deputy Byrne to conclude.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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Deputy Michael Noonan set up the national cancer strategy. I was here.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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We had Deputies threatening-----

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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The Leas-Cheann Comhairle remembers it. Do you not remember that, a Leas-Cheann Comhairle?

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Please Deputy, you will have an opportunity shortly to say whatever you wish.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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He cannot get away with-----

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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No. Deputies are not shouted down in this House. Deputy Byrne.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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When health boards were making decisions for the betterment of the health of the people Fine Gael Deputies threatened court action in regard to it. That is the reality. The reality is that we brought in a cancer strategy that was supported, by and large, by the Irish Cancer Society charities such as Europa Donna but Fine Gael Members opposed that. They marched on the issue. They brought the marchers to Dáil Éireann but when I went to my local radio and explained it to people and said-----

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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You boys over there know how to march. Wait until you are in Opposition. You will be marching from the first day.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Please, Deputy.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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I remember you. You took over the-----

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Deputy McGinley, you will have a chance to speak shortly. Please do not shout down people.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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And let us not forget the people in Meath who will be coming to save their hospital tomorrow-----

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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They are great marchers on that side of the House.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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-----but I can assure them Navan hospital is safe under Fianna Fáil.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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Soldiers of the rear guard. They are great at marching.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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That guarantee cannot be given by the Opposition.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I call Deputy Margaret Conlon.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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The Deputy is talking out of both sides of his mouth.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Deputies, I ask you to control yourselves and allow Members to be heard in the House.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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We will allow ladies to speak.

Photo of Margaret ConlonMargaret Conlon (Cavan-Monaghan, Fianna Fail)
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I hope you will be able to protect me, a Leas-Cheann Comhairle, from the Members on the Opposition benches.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I will do my best.

Photo of Margaret ConlonMargaret Conlon (Cavan-Monaghan, Fianna Fail)
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I am pleased to have an opportunity to make a brief contribution. I want to focus on two aspects, the first of which is the increases the VHI announced over Christmas. Everybody was shocked, dismayed and disgusted by its decision to impose increases ranging from 15% to 45% from 1 February. That level of price increase is unacceptable and I believe it will prohibit many people from taking out private health insurance. I believe the VHI is penalising its good, loyal customers and it needs to examine this decision, rethink it and make a change to it.

One of the first things I did when I started work was take out private health insurance, and I have never regretted it. Many people do likewise. At that time there was no competition in the area but, thankfully, that is no longer the case. There is competition now and many companies are offering alternative plans to those of the VHI. That is to be welcomed because for some people their prices are much more competitive.

People talk about the difficulty elderly people or others might face in shopping around but if one wanted to buy a suite of furniture or a television one would not necessarily go into the first shop one comes across and buy it. One might have a look around first to get the best value. I would advise people to shop around to get the best value for money while getting the same level of cover.

We have benefited from competition and choice and I strongly encourage policyholders to investigate all options before renewing their policies and to feel secure in the knowledge that they can do so without incurring a penalty or waiting times for cover to apply. That is very important, and it is available for all regardless of their age or health profile.

The other aspect is that it is important that all insurers deal with their customers or potential customers in an open and transparent manner. Where that is not happening, the Health Insurance Authority must be appraised of it because it is not a nice practice and it is one I would not like to see developing in the country. It is not fair or acceptable that there would be any discrimination between old and young customers and between people who are sick or those who are not ill. Everybody deserves to be charged the same premium for the same level of cover.

I welcome the statement from the Minister that she plans to bring in new rules to encourage people to take out insurance at a younger age. When people start working they develop good habits, and those good habits remain with them throughout their working life. If one were to start looking for cover when one is older, it is much more expensive. I also welcome the fact that a break period would be permitted when people who find themselves out of work or in financial difficulty.

I refer to the emergency departments where challenges remain, and there will be challenges even into the future. We must continue to focus on the patients and ensure that we are treating the maximum number of patients in a timely manner and that they are channelled to the service they need very quickly. In my own constituency I see the benefits of the medical assessment unit in Cavan where people come in and are treated. For a large percentage of patients they can come in, be assessed, treated and discharged in a timely manner.

We have had changes and reconfiguration in Monaghan and following the next election, whenever it takes place, I do not believe those decisions will be reversed. We will be moving forward, not backward. We will not be rewriting history but I have been advocating for some time that we would have a medical assessment unit in Monaghan where patients who do not need acute care but who need good medical care could be assessed and treated in a timely manner and discharged rather than having them go to Our Lady of Lourdes Hospital or Cavan hospital and clogging up trolleys and beds when that is not necessary.

Some hospitals do very well while others do not. Why is there such a difference in that regard? If some hospitals are doing very well, all hospitals should be able to do that.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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I wish to share my time with Deputies Joe Carey, Pat Breen, Dinny McGinley, Tom Sheahan and Joe McHugh.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Agreed.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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The first words I want to say to the VHI are shame on it and shame on any organisation that will bring such misery to the oldest section of this country's population. What it did is outrageous, and it is all about politics. I was a member of the Joint Committee on Health and Children and we have been looking at risk equalisation for the past five or six years. The VHI found that we have no Government, or a Government that could not care less, and decided to put the shoe in when it got the chance. While what was done is the direct responsibility of the VHI, if we had an active, popular and efficient Government it would not have happened. Telling people they can shop around is baloney. We all know the whole thing will level up after a couple of years. Does anyone think Aviva and Quinn will stay at their level? They will do so for as long as the vast majority of their members are younger than VHI members.

Let no one tell me that any service, no matter where it is, could increase prices by up to 45% in the worst recession in the history of the State when people are losing 20% of their incomes. It is outrageous. People simply cannot understand why, in a democratic republic like Ireland, this would be allowed to happen.

If we can put manners on the VHI, we will have to ensure that people, as they get older, can wake up every morning and thank God they do not have to go to hospital or to a doctor, because when they do they have a huge issue from a health security point of view. From a psychological point of view, as people get older they get extraordinarily worried about their health. It will happen to us all. We never heard of a 45% increase in any product, service or utility. I never heard it in my 35 years in this House. I hope there will be an uprising over this.

What can people do, other than shop around as the Minister advised? They will never forget this increase and many of them will not be able to pay it. It will cause huge problems down the line.

While I always like to see the Minister of State, Deputy Moloney, in the House I am sorry the Minister is not here tonight. Everyone says keeping patients out of hospital is the way to keep costs down. The Minister for Health and Children was born in the parish of Ahascragh in County Galway. The parish's public health nurse retired the other day and, like many other public health nurses, will not be replaced. Public health nurses are hugely important to the health service. On top of this 45% increase in VHI fees, the very people who do their best to keep people out of hospital are not being replaced. I am sorry the Minister is not present to hear this tonight, because she knows every house in the parish I am talking about. What is happening there is an outrageous development.

When one puts the two together, one sees it is time to change the Government and introduce universal health care. No matter how it will work, it has to be better than what is there at present. I believe it will be better.

Photo of Joe CareyJoe Carey (Clare, Fine Gael)
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What we have seen in January - both in the accident and emergency departments of hospitals and in the boardroom of the VHI - is the result of a fundamentally flawed approach to the delivery of health services in this country.

The centre of excellence model has been put forward as the solution to our health problems. I do not reject the concept but I do reject and oppose the actual reality of what this model of health care has resulted in. The facts are that over the Christmas period scores of people were left on trolleys and chairs in Limerick Regional Hospital in our so-called centre of excellence. A sign was erected in the accident and emergency department informing patients of a 14 hour waiting period. The hope of a better service has not been backed up by the investment required and indeed the promises made to the people of Clare and the mid-west region. Empty words are of very little comfort to the 18 patients left on trolleys today in Limerick Regional Hospital and nine in Ennis General Hospital.

The mid-west has been at the coalface of this transformation with the closing of the 24 hour accident and emergency services at Ennis and Nenagh. It is a damning indictment of the Minister's policy that Limerick Regional Hospital featured prominently as one of the worst performing hospitals in the country in the recently leaked health statistics report in terms of accident and emergency waiting times and people on trolleys. The people at the front line - the nurses, doctors and other staff in our hospital system - are not able to cope.

Prior to Christmas I raised in an Adjournment debate fears about the removal of cardiac service from Ennis General Hospital. The four Clare Oireachtas Members had a subsequent meeting with staff members in Ennis. At that meeting it was agreed that the Minister, Deputy Harney, would be asked to facilitate a meeting to outline in detail her plans for future services in the hospital. I welcome the Minister's commitment today to Deputies Breen, Dooley and me that such a meeting will take place at the earliest opportunity. It is critical that the current services provided at Ennis General Hospital be retained and that a clear statement be issued confirming this position following our meeting.

The hikes proposed by the VHI are scandalous and in this environment are quite simply unaffordable. It is my understanding that the Milliman report, which was presented to the Minister in September, has identified massive inefficiencies at the VHI. It is natural that an institution in place for so long and without competition for much of its existence would evolve in this way. This evening, I am calling on the Minister to publish this report immediately, have it debated and not hide behind the cloak of commercial sensitivities. It beggars belief that, despite a 2008 court judgment, the Minister has yet to deal comprehensively with risk equalisation. It is a core issue which cannot be ignored while the VHI ploughs on with its intention to increase premiums by between 70% and 80%.

I commend Deputy Reilly on bringing this motion to the House and urge the Minister to act on its proposals.

8:00 pm

Photo of Pat BreenPat Breen (Clare, Fine Gael)
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I welcome the opportunity to contribute to tonight's debate. Paying VHI or any private health insurance is no longer a matter of luxury. The majority of people have private health insurance because they are afraid of their lives they will die waiting to be seen in our public health system. This is particularly true for elderly people, as many previous speakers have stated. My own constituency office has been inundated with calls relating to the VHI increases. Most people cannot afford an increase of 45%, given the effects of the 2011 budget.

On Wednesday night last, I raised this issue with the Minister for Health and Children on the Adjournment. She indicated that it would not be appropriate for her to intervene with the VHI in matters relating to pricing. The Minister appears to have had a change of heart. This morning, I read in The Irish Times that she has since spoken to the chairman and CEO of the VHI. It is not good enough for the Minister to say she is extremely disappointed. The Minister must take action and address the problem.

I was disappointed last week to hear the Minister say she has kicked the risk equalisation legislation to touch until 2013. In the absence of this legislation and without greater competition in the health insurance market, the cost of private health insurance will continue to rise. Moreover, this will push people into the public health system, which is already in crisis, as we have seen in Limerick Regional Hospital in the mid-west region.

The Minister for Health and Children replied to an Adjournment debate last December on the subject of cardiac services in Ennis General Hospital, as Deputy Joe Carey pointed out. Could the Minister clarify the situation regarding inpatient cardiology services at Ennis General Hospital? In her statement last night, the Minister said cardiac services would continue as usual and there would be no change in the situation at the hospital.

Nevertheless, staff have been informed that the consultant cardiologist and his team will be moving to Limerick on 1 March next. They have been given an additional stay of one month and it appears as though equipment may also be moving. This includes the high dependency unit, HDU, which will also transfer to Limerick. The staff at the high dependency unit provide an excellent service for the people of County Clare and are preventing the clogging up of the system at the Mid-Western Regional Hospital, Limerick. I have no difficulty with the concept of a centre of excellence or transferring the acute cardiac services to Limerick. However, this service is valuable for people who require monitoring, assessing and treatment, as well as for acute coronary assistance and heart attack patients. Like Deputy Joe Carey, I welcome the fact that the Minister will meet a deputation from Clare comprising the four Oireachtas Members and nurses from the high dependency unit. However, I seek clarity in this regard because there is utter confusion at present in County Clare. I commend the motion.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
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The announcement by the VHI last week of its intention to increase its premiums by such huge percentages undoubtedly came as a shock to everyone. While it came as a shock to each subscriber, it particularly affected those in a certain age cohort who avail of its Plan B+ and who now face an increase of 45%. This sent shockwaves throughout the country and through each subscriber to the VHI, at a time when such people were losing out on their pensions or whatever investments they may have had. They then received this hammer blow in respect of their VHI premiums at a time, as Deputy Breen has noted, when people are at an age when they are concerned about their health. This is absolutely unacceptable.

It is merely a symptom of what is happening in the health service. I have been a Member for many years and year after year, we have waiting lists, people on trolleys and so on. The service is no better today than was the case ten or 15 years ago. I happened to visit my local hospital in Letterkenny last Monday night to see a few neighbours and saw with my own eyes what was going on in the corridors at 8 p.m. or 9 p.m. People still were in wheelchairs and on trolleys while waiting to be admitted. I do not blame those who work in Letterkenny General Hospital or anyone who works at the coalface of the health service. I blame the system itself and until it is changed, we will face crisis after crisis, year after year. The Government used to pay €3 billion into the system, but this year the equivalent amount was €16 billion. I wonder whether any improvement for that money can be discerned. As matters stand, it cannot be improved and even were one to double the money, problems would still arise unless the system was changed. We must move to a system that has already been proven to be efficient in other countries. Fine Gael is not reinventing the wheel in this regard as it already has been invented for us.

I also wish to raise a local issue. Last week, the Minister for Health, Social Services and Public Safety in Northern Ireland, Mr. McGimpsey, cast doubts on the provision of radiotherapy services in Altnagelvin Area Hospital, Derry. He stated that while they might be able to build the facility, and there was a commitment to that effect, they would not have the requisite finances of £30 million to operate it. The people in the northern end of this country were depending on that facility being available and the Minister of State and his senior Minister should get in touch with the authorities in Northern Ireland to ensure there is no delay in the provision of this facility and that it will be provided by 2015, as previously indicated.

My final point is that I know of district hospitals in my native county in which half the beds are empty. However, the general hospital is bursting at the seams and is unable to move these patients from the general hospital to the step-down facilities because it lacks the staff as a result of the embargo. It is unforgivable that hospital beds are empty because they lack staff while the general hospital is unable to take in people. These are huge problems that must be addressed and hopefully this debate will help to get something done about it.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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I do not subscribe to the argument that the VHI is solely responsible for this problem. The VHI operates as a business and blame for this increase should be apportioned proportionately. In apportioning blame fairly, the consultants must take their fair share for their milking of the health insurance system. I will provide anecdotal evidence shortly. Other factors include the rates charged by hospitals and the Minister's failure to tackle consultants. Similarly, the VHI is to blame for not fighting the charges levied by hospitals and consultants and especially for pushing out its elder members.

I did not renew my health insurance 18 months ago on principle because of two experiences. I am the father of four young children and four years ago my wife went into hospital to undergo a minor procedure. She spent 15 minutes on the bed and was back in the car within 45 minutes. A bill came to our house for €970, some €880 of which was covered by the health insurer and we were obliged to pay €90. The issue was not the €90 we were obliged to pay but the €550 she was charged for the quarter of an hour that she was on that bed and that is what I do not agree with. Second, we have a little girl who is now two years of age. When my wife went for her first prenatal scan at 16 weeks, she returned with an appointment for another scan two weeks later. Personally, I was shattered by this news and every kind of thought went through my head. As my wife was being called back for another scan in two weeks I was left wondering what was wrong. When she returned to the hospital two weeks later, she was brought down to the consultant's private rooms. However, she stated that as our first three children had been born in the public service, which was excellent, this child would be born there also. She then was told that it would not cost anything, as she had health insurance. However, my wife stuck to her guns and went through the public service. How many more scans would she have been brought to had she used her health insurance to use the private service with the consultant?

This is the reason I apportion blame to consultants, who are absolutely milking the system. It is a disgrace that the Minister has not tackled in any meaningful way the hospital consultants. In recent years, wards are being closed and beds are being lost in each hospital in the country, while private rooms, which are moneymaking milking machines, are being put up. This is the reason beds are being lost in public hospitals and the Minister has failed to tackle this. As for the charges levied by hospitals, my wife spent 15 minutes on a bed and was charged €550 for so doing.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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While the Deputy's time is up, there are two minutes remaining in the slot as the final Deputy is not in the Chamber.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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However, the VHI's act of pushing out its elder customers is despicable and highly distressing.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I was indicating to the Deputy that Deputy McHugh was to take the final couple of minutes and that a couple of minutes remain, should the Deputy wish to use them.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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The Leas-Cheann Comhairle caught me out there.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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It is a reflection on the Deputy's naturally obedient nature.

Photo of Tom SheahanTom Sheahan (Kerry South, Fine Gael)
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MRI scans are another issue in this regard. The cost of such scans is being advertised at present in private hospitals at €200. Does the Minister of State or any Member present know how much an MRI scan costs through the VHI? It is a lot more than the €200 that is being advertised on the public airwaves by private hospitals and this must be tackled.

While one cannot blame the VHI for everything, I do not like the manner in which it is pushing out its elder customers who had been with it for years. As my colleagues have stated previously, everyone begins to worry about health later in life. Thankfully, my family does not have health issues and my decision to not renew my health insurance was more based on principle and the manner in which the system is being screwed by all sectors in the health service. While many people have told me this was a foolish thing to do, I hope that when Fine Gael is on the Government side of the House and introduces a new health system, the money will follow the patient. Hopefully, this will be the end of the days of giving block grants to hospitals and asking them to do the best they can with them, rather than having the money follow the patient. That will be a better day for the people and their health.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I propose sharing time with Deputies Maureen O'Sullivan and Finian McGrath.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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In that order?

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Yes, thank you.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Very good.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I support the motion in the name of the Fine Gael Deputies. That said, the motion is limited in scope and does not describe the full extent of the crisis in our public health services. The crisis includes the record number of patients on trolleys and chairs in accident and emergency departments during January 2011, as cited in the motion; the hundreds of beds closed in our acute hospitals due to cutbacks; the continuing recruitment embargo which means that there are not enough nurses, junior hospital doctors and other front-line care staff to cope with the care needs of inpatients and outpatients in our public hospitals; the rising tide of emigration of young trained health professionals; the continuing cuts to services in local hospitals and the drive to centralisation which is reducing the overall level of care to communities across the country; the shortage of GPs; the shortage of primary care centres; the exorbitant fees charged by many GPs; the increased burden on medical card holders through the prescription levy; the failure to more effectively address at source the spiralling cost of medicines, allowing profiteering by pharmaceutical manufacturers and distributors to continue; the cuts affecting care for the old, the young and the disabled; the unregulated home care sector; and the recent massive rise in VHI rates which imposes a further burden on thousands of families, especially those with children.

I challenged the Minister for Health and Children, Deputy Mary Harney, last week during Priority Questions on the accident and emergency situation. Her reply was mostly irrelevant to the issue at hand. There was no recognition of the extent of the crisis. She trotted out the usual guff about the system allegedly having been reformed and made more efficient. I have no doubt many efficiencies were introduced and that in many respects things have improved compared to five or ten years ago, but in other respects they have gotten worse.

The fact is that in 2006 the Minister said we had a national emergency because of the numbers on trolleys in accident and emergency departments. This month the numbers exceeded those in 2006 but there was no national emergency in the mind of the Minister on this occasion. For example, on 11 January there was the highest ever number of patients on trolleys in Our Lady of Lourdes Hospital in Drogheda. The equivalent of two full wards were waiting for admission in the emergency department.

Mr. Tony Fitzpatrick of the INMO described the situation as "extremely dangerous for patients and staff". The INMO called for an urgent meeting with HSE management, the same HSE management that gave clear and unequivocal commitments that measures would be put in place to alleviate over-crowding when they went ahead with the so-called re-configuration in the north east, including, of course, the axing of the accident and emergency departments at Monaghan and Dundalk.

The INMO and others, this Deputy included, correctly predicted that the levels of overcrowding would increase when beds were closed and hospitals downgraded across the north east. On 11 January, 66 patients were on trolleys in the north east while over 200 beds have been closed in that region.

What time did the Leas-Cheann Comhairle allocate to me?

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I gave you four minutes.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I have six minutes.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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There are ten minutes in the slot. Deputies O'Sullivan and McGrath have been allocated three minutes each.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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No, it is six minutes and four minutes.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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The Deputy has two more minutes.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I had timed it and the Leas-Cheann Comhairle has thrown me off.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I beg your pardon. I will give you injury time.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Do not give him an injury.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I asked the Minister, Deputy Harney, if had she assessed what impact her budget 2011 cuts will have on the accident and emergency situation and she told me she had not. I asked if her Department and the HSE had calculated how many public hospital beds will be closed as a result of the cuts in this subsequent years under the four-year plan which involves cuts to health of over €1.5 billion and she told me they had not.

Once again we are drifting towards further disasters in our health services. We have had three Ministers at the helm since 1997, including the current Taoiseach and his would-be successor as Fianna Fáil leader, Deputy Micheál Martin, and all have failed miserably. The VHI premium increases could not have come at a worse time for hard-pressed families, as was eloquently put on the record by another Deputy.

The health insurance market expanded during the so-called Celtic tiger years because many families with children who were aware of the perils of relying totally on the public hospital system took out personal health insurance. That market is now shrinking again as unemployment has increased and people's earning have decreased, resulting in many having to give up their health insurance. All of this points to the need for fundamental health reform.

Those who can afford to do so should be contributing to the provision of health care through fair taxation. In a new health care system there would no longer be a public-private divide and care would be available to all based on need alone and not on ability to pay. Sinn Féin has proposed the establishment of a health funding commission to plan the transition to such a fairer and more equitable system. I welcome a Fine Gael Deputy's earlier contribution which was eloquent and pertinent to all that is being considered.

Photo of Maureen O'SullivanMaureen O'Sullivan (Dublin Central, Independent)
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I want to acknowledge the positive things in our health system. We have excellent health care, which is provided by hard-working and highly trained staff, and it has a significant budget, once one is in the system. That is central and brings me to the issue of beds. It is ironic that people are left on trolleys, chairs and worse who need a bed while those in wards are left in beds, through no fault of their own, when they could and should be at home with support, nursing home or community care.

The first two points in the Government amendment are more aspirational than real. I support the call for the Government to instruct the VHI to postpone the increases because the time for increases, if at all, is during a time of plenty and not a recession. More will opt out of private health insurance because they need to spend their money elsewhere. This will lead to further pressure on the public health system.

Those paying for even the most expensive cover will need and use the public system if they are very ill, which brings me to a more fundamental question which has to be asked about our two-tier health system. There are gross injustices in such a system. It is not right or fair that two people with a medical issue can get a different initial response. A person with money or private health insurance can get an appointment with a consultant or an MRI scan within days or weeks while a public patient will wait for months if not longer.

New thinking on financing health care is needed. We need a new system based on the needs of the patients and not their ability to pay. There should be a system of equity of access to health care. As long as there is a two-tier health service with medical care readily available for those who can afford to pay and long waiting lists for the rest, the misery of trolleys in accident and emergency departments will continue.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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I thank the Leas-Cheann Comhairle for the opportunity to speak to the Private Member's motion on the crisis in the accident and emergency departments in our hospitals, the 45% increase in VHI premia and on the health service in general. It is a national scandal and a disgrace to have 569 patients on trolleys in our hospitals in January 2011. It is criminal to treat patients like this in this day and age. It is not acceptable and arises from gross incompetence.

After many years of growth and massive wealth and resources, I find it strange and unacceptable that there has been no real movement in the accident and emergency situation, which should be the major focus of this debate. The issue of beds is the bottom line and the Government has walked away from it. There is a shortage of beds. Let us quit the spin and face the reality that it is not acceptable to have elderly, sick or disabled people on trolleys in our hospitals. That is the reality for the 569 people to whom I referred, many of whom are senior citizens.

This crisis should have been dealt with many years ago and in any other country the Minister would have resigned. There was enough time in two years to resolve this priority health issue. The Government and Minister for Health and Children have been talking about this matter for ten years. How many more years does it need to resolve the issue?

Beaumont Hospital in my constituency is one of the largest hospitals which is directly affected and 80 to 100 bed would resolve the crisis there. To give any other response is to waste people's time talking about it. I demand that the extra beds are put in place immediately. People are sick and tired of waiting for a proper health service. It is now time to put up or shut up.

I believe in a universal health service, based on the equality for patients and medical need. It will have to be funded through taxation and I am prepared to support any party or body that believes in the principles of a good quality public health service. The current system needs to be changed and major reforms are needed for all of our patients.

Photo of John MoloneyJohn Moloney (Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Justice, Equality and Law Reform; Laois-Offaly, Fianna Fail)
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A number of specific questions were asked. Deputy Jan O'Sullivan asked if the VHI was acting legally its recent announcement. The answer is "Yes".

On the query regarding the cardiac services in Ennis hospital, I understand the Minister is meeting a delegation to discuss the issue next Monday. Deputy Costello referred to figures for the breakdown in services in emergency departments. It is worth noting that in 2010, some 1.2 million people went through our 33 emergency departments. The level of activity has increased. There has been an increase of over 30% in day cases, up 175,000 since 2006. There has also been a 28% increase in outpatient attendance, which is up by 800,000 since 2006. The number of inpatient discharges has remained relatively constant over the period and the average length of stay has reduced from 6.4 days to 6.16 days.

I welcome the opportunity to participate in this debate and to underline for the House the importance the Government has placed on the private health insurance market and its role in our wider health system. In her address to the House, the Minister outlined in detail the integrated package of measures the Government has brought together so that the private health insurance market can be strengthened and improved to support those who need it most, the older and sicker members of our society. Private health insurance has played an important and positive role in our health services, in bringing new innovations to medical practice, in encouraging competition and in serving the health needs of our community at the time of greatest need.

A number of Deputies have commented during this debate on the fears of older customers in particular regarding the recent large price rises announced by the VHI. The increases have undoubtedly come at a time when many customers are struggling with significant financial challenges. Some Deputies commented on the Minister's advice about shopping around and felt this was an inadequate response in the context of the increases. However, the Minister demonstrated the comparative rates in her speech last night. While the Minister cannot interfere with the pricing decisions of an insurer operating in a competitive market, she is anxious that private health insurance customers are aware of their rights to switch at any time they choose in order to get better value for money or to improve the benefits available on their policy. The Minister outlined at length last night the significant value for money which is available to all health insurance customers, young or old, healthy or sick. At the Minister's request, the Health Insurance Authority has increased its capacity to answer queries and questions from members of the public. The authority is handling thousands of inquiries and can offer advice and support to all customers on their rights and entitlements, either over the phone or via its website. I would also encourage customers to avail of the supports provided by the HIA in advising on what savings can be achieved.

On risk equalisation, the Minister outlined the significant amounts of money which are now transferring between insurers as a result of the interim scheme introduced by the Government for the period 2009 to 2011. It is important to emphasise that this is the first such transfer which has ever taken place and that the amounts involved are substantial. In spite of what some Deputies have said, the Government has not delayed in introducing a risk equalisation scheme. The interim scheme was always intended to be for this three-year period and is designed to be Exchequer-neutral over that timescale. Legislation will be brought forward this year to provide for a transitional risk equalisation scheme for 2012, while both insurers and the HIA put the systems and processes in place for a permanent risk equalisation scheme which it is planned will take effect from 2013.

The HSE is putting in place strengthened frameworks to manage and closely audit the implementation of the recommendations arising from its project aimed at improving the performance of certain hospitals which had experienced particular problems. The clear focus of the health service is, and must continue to be, on the number of patients we treat and how we treat them, not on the number of beds in the public system. The National Service Plan 2011 commits the HSE to treating people more effectively by reducing costs and reforming the way services are provided, without reducing access to appropriate services. We are treating more patients each year within the available resources and are measuring and improving patient outcomes. This will continue over the coming years.

Much has been made of the review commissioned by the Minister in 2010 on the VHI's claims costs. The purpose of the review, which was referred to by the Minister in the context of the announcement of the future strategy for private health insurance in May 2010, was to understand and examine the reasons VHI costs have increased significantly.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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I now call Deputy Ring. Time is tight because there are a number of people in the slot and the Deputy will have three minutes.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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Will the Chair tell me when my time is up as I would not like to hold anyone else back? It is easy to speak about how the Government has run down health services in this country. The Government has washed its hands of the middle class in Ireland. Last week people who receive child benefit had their benefits cut and then the universal social charge, which also targets the middle class, took effect and now the same people are hit by a rise in VHI charges.

I must speak out tonight on this and must point out that the Minister of Health, who is not here tonight, should not have been Minister for Health over the past three or four years, because she has no mandate from the people. She has lost control of the Department and of what is going on. The whole of the VHI board should resign. How dare that board think the people can afford an increase of 45% in charges when the board has mismanaged the company with the help of the Government. We need new people running the Department and the VHI. We have a man here who can and will be Minister for Health and who will reform our health services.

This morning I got a phone call about a woman with cancer who went to the regional hospital in Galway in November for a biopsy, but was told she could not have her biopsy. She got another appointment for this morning, but got a phone call this morning to say the procedure could not be done because of swine flu. There was no swine flu in November. This poor woman is frightened out of her life waiting for her biopsy. Is that kind of health service fair to the people, the sick and the poor? Is it fair to people worried about their condition? The Minister has lost control. The situation here and the number of people on trolleys all over the country is shameful. The Minister told us she was going to reform the health service, but she was only good at one thing. She was good at spinning and she was able to spin to the media, who fell for her spin. She talked a good game, but she was not much good at playing the game. The health service here is in disarray and people are upset and annoyed at that. The people are waiting in the long grass. All they want is fairness, but it is not available.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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The Deputy has half a minute left.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I will finish in a minute. All this Government has left is approximately ten minutes. The sooner it goes the better because the people are fed up with it. I say to the Ceann Comhairle, the Minister and the Government that they have let down the people. The VHI has let down the people who pay for that service. It is not right that a proper is not available to those people, particularly considering the amount of money taxpayers have provided. The Government lost control a long time ago. It is time for change and for a new Minister. We have the people who will do the job. I have the future Taoiseach and Minister for Health here beside me. Give us a chance and we will reform the health service and make it fair for everybody.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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I would like to make it clear that I have VHI insurance and was very glad to use it. Deputy Collins suggested that we should not complain and that everything is grand. Let him tell that to those who have paid VHI contributions all their working lives and who now in their latter years must pay an increase of 45% this year. Paying such an increase is a problem and thankfully some of the Deputy's colleagues on the Government side of the House admitted that.

I met a couple on Monday evening who are in their late 60s or early 70s. They have no other option but to cancel their health cover. The amendment to the motion put down by the Minister ignores the number of people on trolleys in Cavan, Cork and elsewhere. In his comments, Deputy Charlie O'Connor mentioned the problems in Tallaght. I welcome his constructive comments, which clearly showed his disappointment at the proposed VHI increases. While I will not be running in the next general election, I have no worries in regard to the ability of Fine Gael and the Labour Party, as questioned by Deputy O'Connor, to agree a health policy, which will be implemented by Deputy O'Reilly. Fine Gael will not roll over as did Fianna Fáil and the Green Party to a party of only two Members, one of whom, the Minister for Health and Children, Deputy Mary Harney, is now an Independent. The Minister will clearly welcome the VHI increases as the Department of Health and Children and Health Service Executive will benefit from increased bed and other charges. The VHI should negotiate reasonable prices and not introduce them ad libitum.

Deputy Dooley questioned Fine Gael's proposed new health policy. I have never questioned the front line staff in the health service. I can assure this House that under a health policy driven by Deputy Reilly there will not be a problem with front line staff. He will ensure that people will be given the wherewithal to ensure the patient counts. When I visited Cavan General Hospital last weekend, the patients said they were satisfied with the service but front line staff said they are under extreme pressure. Cavan General Hospital has the added benefit of having the highest number of beds and trolleys.

Is Deputy Conlon satisfied with the service being provided at Cavan General Hospital? Has she listened to the elderly and some of the families of the deceased in regard to the trauma they have suffered? We should be ashamed of our health service, which Deputy Reilly will rectify.

Photo of James BannonJames Bannon (Longford-Westmeath, Fine Gael)
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Our accident and emergency departments are in a disastrous and life threatening state. I would like to highlight the position of so-called emergency services at the Midland Regional Hospital Mullingar, which I monitored last week on a daily basis. On Thursday, there were 29 patients waiting on trolleys in the accident and emergency department at that hospital. What is it about the concept of emergency and safety that the Minister, Deputy Mary Harney, or Minister of State, Deputy John Moloney, do not understand? Perhaps the Minister of State will explain to me who will accept responsibility if this shameful disregard for patients' well-being leads to fatalities.

The Minister has given a stream of excuses which extends from the working time directive to swine flu. In the context of emergencies, none of these holds good. The Minister must face up to the fact that the closure of wards and beds as part of cost cutting measures is the cause of the log-jam. The bottom line is that the responsibility rests with the Minister. The closure of 1,500 acute hospital beds and not seasonal flu has led to increased waiting times.

On 5 January, 53 beds in the Midland Regional Hospital Mullingar were closed, 41 of which were inpatient beds and 12 of which were day beds.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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I must ask Deputy Bannon to conclude as we are on a tight schedule.

Photo of James BannonJames Bannon (Longford-Westmeath, Fine Gael)
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On the same day, 86 beds in the Midland Regional Hospital Tullamore were closed. While this lack of provision continues, the trolley wait will lengthen and more lives will be put at risk. I want the Minister to respond to the disturbing rumours that persist, despite denials by the HSE, that the accident and emergency department at Mullingar Regional Hospital is to be closed from 8 a.m. to 8 p.m. I want an answer to that question, not fudge.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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I call Deputy McHugh who has one minute unless Deputy Reilly is prepared to give up some of his time.

Photo of Joe McHughJoe McHugh (Donegal North East, Fine Gael)
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I would like to be associated with Deputy McGinley's calls for clarification on Altnagelvin radiotherapy services. We have a system and not a people problem. Paramedics are required to remain with their patients on the corridors of accident and emergency units. In one instance, a paramedic had to spend up to three hours with a patient on an accident and emergency corridor at Letterkenny General Hospital. Ambulances are not being moved from forecourts because paramedics have to stay with their patients. This happens because the infrastructure required is not in place, namely, the new accident and emergency medical assessment unit needs to be fast-tracked and we do not have resources. For example, there are nine vacant junior doctor positions at Letterkenny General Hospital which cannot be filled.

There are many assistant physicians in this country with the same expertise as general practitioners. Why are these not considered possible replacements or substitutes for junior doctors? This would help free up the gridlock. We have a system problem and not a people or staff problem. The only way to sort this out is to hold the general election.

Photo of Séamus KirkSéamus Kirk (Ceann Comhairle; Louth, Ceann Comhairle)
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I call Deputy Reilly who has four and a half minutes.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I should have six minutes. Deputy McHugh did not go two minutes over time.

The reason we have some information in regard to the Milliman report is Fine Gael's tabling of this motion. The Minister has had the Milliman report since September, yet she only told us about it in the House yesterday. She gave us a little snap-shot of it and stated she will release the remainder of it, with the commercial information redacted. We have little to be grateful for. Deputy Conlon spoke about the wonders of the medical assessment unit in Cavan General Hospital. While I welcome that unit, there were, according to the IMNO, 45 people lying on trolleys at that unit today. Some 32 people were lying on trolleys today in Tallaght hospital. A total of 444 people were lying on trolleys today in hospitals throughout the country. Many people are not on trolleys but are sitting on plastic chairs with drips hanging out of them while waiting for admission. This is relevant to the VHI. It is a fear of not being able to access the service which encourages people to take out insurance.

The Minister, Deputy Mary Harney, continually muddies the waters saying that the service is excellent. The service is excellent if one can access it. The quality of care in the country is also excellent if one can access it. However, there is a lack of access in both regards. My colleague, Deputy Ring, spoke of a lady with cancer who is waiting for an operation. A colleague informed me today that a public patient who had a scan in November, following which he was diagnosed with cancer and now requires a further scan, will not get that scan until February. That person and his family were left to worry about this all over Christmas, which is unacceptable and is no way to treat people in a modern society.

The proposed VHI increases are horrendous. They are a kick in the teeth to people. I believe it is the VHI telling the Government to get up off its rear end and bring in risk equalisation. A 45% increase on top of increases of 48% over the previous four years clearly makes VHI insurance unaffordable for people. The Minister's failure to introduce risk equalisation is a disgrace. She told us in 2008 that it would take her three years to do so and that in the meantime she would introduce a levy. That levy has resulted in an increase in the cost of insurance for younger people, pushing 70,000 of them out of the market. The VHI is now proposing to hit the very people it is supposed to be protecting, namely, older clients who have remained loyal to it for, in many cases, 40 years.

The VHI is now running a campaign in relation to its provision of free insurance for children. I am told this is costing in the region of €9 million. Consequently, older people will be subsidising younger people rather than the reverse, which was previously the policy. Furthermore, the Minister told us this was revenue neutral, that there was no gain to the Exchequer. The Exchequer got €13 million last year and stands to get another €23 million this year, which amounts to €36 million. So much for spin. This contravenes the Minister's policy on community rating.

I was told today that 50 beds are not open at St. Joseph's Hospital in Raheny, which is an overflow for Beaumont Hospital and could alleviate some of the problems there. There are 26 people lying on trolleys or sitting on chairs in the accident and emergency department at Beaumont Hospital, yet these beds in St. Joseph's Hospital remain unopen. Deputy Collins berated the IMNO for releasing daily figures on trolley-watch. Why would they not do so when they have to listen day-in and day-out to HSE spin that only half a particular number of people are trolleys, with many people as I stated earlier sitting on chairs and in distress?

Deputy Byrne stated that our universal health insurance is flawed. There may be some tweaking to be done in that regard but what is certain is the current system is deeply flawed. It is broken and is not delivering for people.

The VHI has not sought - the Minister has not sought to encourage it to do so - to provide chronic illness care in the community, which would allow people be treated in their communities, or to offer a great range of diagnostics to general practitioners so they can diagnose and treat in the community. Very little prevention takes place in the community and health insurance companies are doing little in that regard. They may have plans. The Minister stated last night there will be further plans on this, she would like to see a bit of that and she will do the other. This is more of her modus operandi - plans for tomorrow instead of action today - while the people suffer day in, day out.

Our economy is wrecked with 440,000 people out of work and young people haemorrhaging out of the country with more making the decision to emigrate. Even more of them will probably leave after yesterday's decision by Fianna Fáil to retain the Taoiseach as its leader. He should go to the country and give people hope. We should have an election. Apart from that, there should be control from Government. The Minister is the principal shareholder in the VHI and she can instruct the board not to implement the increases in charges until there has been a proper debate and an examination of the costs the organisation incurs. As other colleagues have pointed out, bills are paid in many instances without being questioned and no attempt is made to reduce the cost of medical care, despite the company operating as a monopoly for almost 50 years.

I ask the Minister again to consider those who are responsible for building the country and bringing us the Celtic tiger era. They are in the latter years of their lives and, despite their loyalty and all the pain they endured, they will find they cannot afford health insurance, which would give them comfort during years in which they know their medical need will increase. I commend the motion to the House.

Amendment put.

Amendment put:

The Dail Divided:

For the motion: 76 (Bertie Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Seán Ardagh, Bobby Aylward, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, John Browne, Thomas Byrne, Dara Calleary, Pat Carey, Niall Collins, Margaret Conlon, Seán Connick, Mary Coughlan, John Cregan, Ciarán Cuffe, John Curran, Jimmy Devins, Timmy Dooley, Frank Fahey, Michael Finneran, Michael Fitzpatrick, Seán Fleming, Beverley Flynn, Paul Gogarty, John Gormley, Mary Hanafin, Mary Harney, Seán Haughey, Jackie Healy-Rae, Máire Hoctor, Billy Kelleher, Peter Kelly, Brendan Kenneally, Michael Kennedy, Tony Killeen, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Conor Lenihan, Michael Lowry, Tom McEllistrim, Michael McGrath, John McGuinness, Martin Mansergh, Micheál Martin, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Éamon Ó Cuív, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, John O'Donoghue, Noel O'Flynn, Rory O'Hanlon, Batt O'Keeffe, Ned O'Keeffe, Christy O'Sullivan, Peter Power, Seán Power, Dick Roche, Eamon Ryan, Trevor Sargent, Eamon Scanlon, Brendan Smith, Mary Wallace, Mary White, Michael Woods)

Against the motion: 74 (Bernard Allen, James Bannon, Seán Barrett, Joe Behan, Pat Breen, Tommy Broughan, Richard Bruton, Ulick Burke, Joan Burton, Catherine Byrne, Joe Carey, Deirdre Clune, Paul Connaughton, Noel Coonan, Joe Costello, Simon Coveney, Seymour Crawford, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Pearse Doherty, Andrew Doyle, Bernard Durkan, Damien English, Frank Feighan, Martin Ferris, Charles Flanagan, Terence Flanagan, Eamon Gilmore, Brian Hayes, Tom Hayes, Michael D Higgins, Phil Hogan, Brendan Howlin, Enda Kenny, Paul Kehoe, Ciarán Lynch, Shane McEntee, Dinny McGinley, Finian McGrath, Joe McHugh, Liz McManus, Olivia Mitchell, Denis Naughten, Dan Neville, Michael Noonan, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Kieran O'Donnell, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, Maureen O'Sullivan, Willie Penrose, John Perry, Ruairi Quinn, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Tom Sheahan, P J Sheehan, Seán Sherlock, Róisín Shortall, Emmet Stagg, David Stanton, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar, Jack Wall)

Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dail Divided:

For the motion: 77 (Bertie Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Seán Ardagh, Bobby Aylward, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, John Browne, Thomas Byrne, Dara Calleary, Pat Carey, Niall Collins, Margaret Conlon, Seán Connick, Mary Coughlan, John Cregan, Ciarán Cuffe, John Curran, Noel Dempsey, Jimmy Devins, Timmy Dooley, Frank Fahey, Michael Finneran, Michael Fitzpatrick, Seán Fleming, Beverley Flynn, Paul Gogarty, John Gormley, Mary Hanafin, Mary Harney, Seán Haughey, Jackie Healy-Rae, Máire Hoctor, Billy Kelleher, Peter Kelly, Brendan Kenneally, Michael Kennedy, Tony Killeen, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Conor Lenihan, Michael Lowry, Tom McEllistrim, Michael McGrath, John McGuinness, Martin Mansergh, Micheál Martin, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Éamon Ó Cuív, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, John O'Donoghue, Noel O'Flynn, Rory O'Hanlon, Batt O'Keeffe, Ned O'Keeffe, Christy O'Sullivan, Peter Power, Seán Power, Dick Roche, Eamon Ryan, Trevor Sargent, Eamon Scanlon, Brendan Smith, Mary Wallace, Mary White, Michael Woods)

Against the motion: 75 (Bernard Allen, James Bannon, Seán Barrett, Joe Behan, Pat Breen, Tommy Broughan, Richard Bruton, Joan Burton, Catherine Byrne, Joe Carey, Deirdre Clune, Noel Coonan, Joe Costello, Simon Coveney, Seymour Crawford, Michael Creed, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Pearse Doherty, Andrew Doyle, Bernard Durkan, Damien English, Frank Feighan, Martin Ferris, Charles Flanagan, Terence Flanagan, Eamon Gilmore, Brian Hayes, Tom Hayes, Michael D Higgins, Phil Hogan, Brendan Howlin, Paul Kehoe, Enda Kenny, Ciarán Lynch, Pádraic McCormack, Shane McEntee, Dinny McGinley, Finian McGrath, Mattie McGrath, Joe McHugh, Liz McManus, Olivia Mitchell, Denis Naughten, Dan Neville, Michael Noonan, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Kieran O'Donnell, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, Maureen O'Sullivan, Willie Penrose, John Perry, Ruairi Quinn, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Tom Sheahan, P J Sheehan, Seán Sherlock, Róisín Shortall, Emmet Stagg, David Stanton, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar, Jack Wall)

Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe.

Question declared carried.