Dáil debates

Friday, 1 July 2022

Health (Miscellaneous Provisions) (No. 2) Bill 2022: Second Stage


1:50 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I move: "That the Bill be now read a Second Time."

I am pleased to introduce the Health (Miscellaneous Provisions) (No. 2) Bill 2022 to the Dáil. First, I acknowledge that the Title has changed in recent days. This is reflective of the core purpose of the Bill being expanded from solely abolishing inpatient charges for children. Subject to my bringing a Committee Stage amendment next week, it will also encompass provisions relating to the introduction of a free contraception scheme, which will have a very real impact on sexual and reproductive health and rights in Ireland. I acknowledge and thank the Joint Committee on Health for agreeing to waive pre-legislative scrutiny of the Bill.

The programme for Government sets out the pathway for expanded access to healthcare in keeping with the vision of universal healthcare. We promised to expand universal access to healthcare in a manner that is fair and affordable. We have delivered and are continuing to deliver on that commitment. The measures being introduced as part of this legislation are very much intended to support access to care for those who need it. I am very conscious of the current financial pressures on families and it is something I am working to address. In budget 2022, the Government announced the introduction of a range of affordability measures in health that are intended to help ease the financial burden already being experienced by many families. These measures include increased funding for new medicines, a reduction in the amount people pay for their medicines through the drugs payment scheme, sustainable funding of the dental treatment services scheme, DTSS, and abolition of the inpatient hospital charges incurred for children accessing care in our public hospitals. This range of measures is intended to enable more people to access affordable healthcare. I will provide further detail in a moment on progress made in advancing these individual objectives.

I will focus first on the immediate objective of abolishing public hospital inpatient charges for children. Better access, together with affordability and improved quality, are among my top priorities in healthcare. This legislation, when enacted, will ease the financial burden on parents or guardians when bringing their child to hospital for inpatient care, helping to ensure that cost is not a significant consideration for families when children require access to inpatient treatment. Public patients, including children, are currently subject to a statutory acute public inpatient charge of €80 per day up to a maximum of ten days - or €800 - in a year. Medical card holders and other certain specific classes of persons are already exempt from these charges but I think colleagues will agree that parents or guardians bringing their child to hospital are already dealing with a very stressful situation for their child, themselves and their family and the idea that coming out of hospital, they could be landed with a bill of €800 for the child's stay in hospital is something we can consign to the dustbin of history. This is exactly what this Bill will do.

I will now provide a brief explanation of the sections. Section 1 contains standard provisions setting out the Short Title, citation and provides that the Bill shall be subject to a commencement order. Section 2 amends section 53C of the Health Act 1970. Section 53C provides that charges shall be made for acute inpatient services provided by or on behalf of the HSE. Subsection 9(aa) confirms that the €80 public charge is not applicable to persons who have chosen to avail of private acute inpatient services under section 55 of the Health Act, in which circumstances the more significant charges set out in the Fourth Schedule appropriately apply. In other words, there are circumstances in which hospitals will offer private facilities or provide the same healthcare to the child as a private patient. Those charges can range from over €800 to over €1,000. We will abolish the public charge for public patients. If parents opted to avail of private facilities or care, we would not also pay €800 or €1,000 per night for that. I look forward to hearing the contributions of Members but that is a matter on which Members will agree.

Subsection 9(bb) provides for the exemption of children up to the age of 16 years of age from the charge arising for acute inpatient services. The Bill also provides that under section 2(c) and (d), the existing inpatient charging exemption provisions for children will not be impacted. The key effect of these amendments is to remove the acute public inpatient charge of €80 per day for children below 16 years of age in all public hospitals.

I will update the House regarding a Committee Stage amendment that I will propose. Following Government approval earlier this week, I propose to amend the Bill to introduce the legislative framework to support the introduction of free contraception starting with women aged 17 to 25, as laid out in the programme for Government. Obviously, we want to roll this out further. It makes sense from a practical perspective to introduce the contraception provisions in this Bill as both policy objectives relate to reducing the cost burden when accessing healthcare. The proposed Committee Stage amendment I will bring forward will provide that the contraception scheme will be introduced at as early a time as possible to ensure access for women aged 17 to 25. The scheme is due to be launched in late August or early September. It will be open to all women aged between 17 and 25 ordinarily resident in Ireland and will cover the cost of medical appointments to discuss and prescribe suitable contraception; the cost of fitting and removal of long-acting reversible contraception, for example, implants and coils, as well any necessary checks; and the cost of the wide range of prescription contraceptives currently on the reimbursement list and available to medical card holders, including contraceptive injections, implants, intrauterine systems and devices or coils, the contraceptive patch and ring and various forms of the contraceptive pill, including emergency contraception.

A question has quite rightly been asked as to whether this scheme will cover only part of the costs of access to contraception or will cover the costs right the way through, from meeting the GP to the cost of the devices, medications and prescriptions and the cost of return GP visits for check-ups and so forth. It will cover all of the associated costs of contraception. Approximately €9 million was allocated in budget 2022 to support the roll-out of the scheme from August to December 2022, which represents a wonderful opportunity to increase access to contraception and better support sexual and reproductive healthcare and gender equality in Ireland.

There is a strong rationale for introducing the scheme commencing with 17- to 25-year-olds in line with the programme for Government. The scheme will reduce cost barriers to effective contraception and crisis pregnancy rates among this high-risk cohort, many of whom are still in full-time education and are least likely to have independent sources of income. Introducing the scheme for 17- to 25-year-olds will also allow for expanding health service capacity by training more medical professionals to fit and remove long-acting reversible contraception, such as the coil, and monitoring the operation and costs of what is a demand-led scheme.

Free contraception is enthusiastically supported by stakeholders, particularly clinicians and others working in the area of women's sexual and reproductive health. Given that the costs of prescription contraception are typically faced by women, the measure will have a significant positive impact on gender equity reducing costs for women but also benefiting their partners and families.

The scheme will reduce costs to this vulnerable age group who are not eligible for a medical or a GP visit card. We know that analysis in other jurisdictions has concluded that free contraception is a cost-effective measure. It is, as the Irish Family Planning Association, IFPA, pointed out, a landmark development. I hope to roll out this scheme in a way that it is accessible for all women in Ireland.

I was up on Parnell Street a few months back with IFPA and it was a wonderful visit because it was set up, I believe, in the 1970s in direct response to the impact on women's healthcare of the ban on contraception at that time. It was wonderful to be able to go up and have a meeting with them about the fact that not only, obviously, is it not banned but it is all now being made free. I want to acknowledge and thank everyone in that association for all of the work they have done, not just over the years, but over the decades to deal with some of the implications and restrictions we have had in Ireland on contraception, particularly as it relates to women's healthcare.

Women’s health, as we have discussed, is a top priority for me and for this Government. It is strongly supported in this budget with a €31 million additional fund. In fact, the full year cost of that €31 million is nearly €50 million and the main reason for that very significant increase is this free contraception scheme. We have put in approximately €9 million for this year but in fact the full year cost, from memory, is a little under €30 million and considerably upwards on €20 million. It is the completely right thing to do and we have had to allocate a very substantial amount of money to ensuring it is carried through.

We have also recently launched our Women’s Health Action Plan, which sets out an ambitious programme of work to bring about progress in critical areas of women’s health in the country. It takes a targeted approach to addressing health issues that affect women’s everyday lives and, critically, has been informed by what we called a radical listening exercise. In other words, this is a Women's Health Action Plan informed by women and by what they have said they need and want in this country.

Bearing in mind all the very positive impacts that will arise from the introduction of contraception for women aged 17 to 25 under the scheme, I will be seeking the support of the Oireachtas for this very significant improvement in women’s health affordability measure.

The funding allocated to health for this year in budget 2022 is the biggest ever investment package in Ireland’s health and social care services and demonstrates the Government’s commitment to deliver universal healthcare. The abolition of in-patient charges for children and the introduction of free contraception for women are two of several affordability measures that were announced. Taken together, these measures are intended to ease the financial burden being experienced by many families and to help more people access affordable health care.

We are also committed to increasing access to GP care without charge for more children. This is an important healthcare measure that will remove what can be a prohibitive cost barrier to accessing GP care for children and, indeed, for their parents and will help improve children’s health as we move through this.

The budget made resources available to introduce GP care without charge for six- and seven-year-old children. As of 1 June, approximately 2.1 milion people, just over 41% of the population, already have access to a GP care card or medical card without charges. It is estimated that approximately 80,000 children aged six and seven years of age will be, after this expansion of the scheme, eligible also now for a GP visit card. It is not everything, but is a very important step in the right direction.

Consultation with the Irish Medical Organisation, IMO, representing GPs is ongoing and the service will be introduced as soon as possible after the completion of these negotiations.

This Government is committed to reducing the cost of medicines and making essential healthcare more affordable and accessible. The drugs payment scheme, DPS, significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines. This year's budget provided €11.5 million to fund a further reduction in the DPS threshold, for an individual or household, where it has moved from €114 to €100 from 1 January, and from 1 March, we have dropped this further to €80. That means for many families around the country just over an extra €400 less in cash a year will be spent by them on drugs via the DPS. It is at least something where these awful inflationary costs which are causing so much pain for people will not be passed on because, through the DPS, there is only a certain amount a family will have to pay. The State may end up paying more but the citizen is essentially protected from those increases in costs for the medicines via the DPS which is very important.

While we are talking about new medicines, I am committed to funding access to new and innovative therapies, including those for rare diseases. It is clear from my own analysis of the trends over the past few years that the overriding factor in medicines making it through the process to reimbursement is the availability of funding. In other words, over a significant number of past years, when funding is available for new drugs, new drugs are approved. When that funding is not available, we tend not to see them approved in the same way.

I would like to acknowledge that most if not all of the Deputies here have advocated for different drugs for children, for adults, for rare diseases and for common illnesses over the years. Last year, we allocated €50 million to new drugs. This funding enabled the sanctioning of 27 oncology medicines and 19 medicines for the treatment of rare diseases, including conditions like spinal muscular atrophy which we have discussed before here in the House. This is very important and I will be very happy to send a note around to colleagues on the long list. This is something that, as a State, of which we should be very proud. Obviously, there is an infinite amount that one would like to be able to do but there has been a very significant increase in the availability of new drugs. In talking to patients, to patient groups and to parents, some of these drugs are very much life-changing and it is fantastic. We have added an additional €30 million this year for new drugs. In the plast two years we have sanctioned €80 million just for new drugs and it is having a very big impact. So far this year the HSE has already approved 30 new drugs, which includes several drugs which are the so-called "orphan" drugs for rare diseases.

In December of last year the State signed a new four-year agreement with the Irish Pharmaceutical Healthcare Association, IPHA, and Medicines for Ireland, MFI, on the supply and pricing of medicines. This is a very good deal and I commend the officials involved on negotiating it. The agreements should contribute between €600 million and €700 million towards the cost of medicines over the next four years which means there will be more Exchequer funding available for new drugs and for new ways of tackling rare diseases and new therapies. It is very exciting.

Reform of dental services is something we are committed to also, to align it with the National Oral Health Policy. Work on that reform has commenced. The Government and I have been concerned that medical card patients in some, and indeed in increasing parts of the country, have been experiencing problems in accessing dental services and this is something that has to be addressed. In the past few years, a significant number of contracted dentists have chosen to opt out of the dental treatment services scheme. Essentially, that is the scheme where dentists, who are self- or privately employed, provide services to medical card holders. To address this problem, I secured an additional €10 million for this year to provide expanded dental health care for medical card holders, including importantly, the reintroduction of scale and polish. That is something that is now available under PRSI but had been withdrawn from medical card holders. It is important that we have parity there and I am delighted to see that back in.

As well as that €10 million, I am also allocating an additional €16 million of an underspend to this year’s Estimate allocation to increase the fees to the private dentists. If we look at the schedule, the fees have increased quite substantially because of this. The combined effect of these two interventions represents an additional investment of €26 million this year over and above what was spent on the scheme last year. I hope this significant additional investment will attract back more dentists into the scheme.

Regardless of the impact this will have, we have also committed to a root and branch reform or discussion with the representative body on oral health and a dental scheme that is fit for the future.

To conclude, there is a great deal of work underway within my Department to advance the objectives of affordable healthcare.

A range of very good policy measures have either been implemented or are being finalised and this Bill speaks to exactly that. This is the legislative basis for two of the affordability measures to which we have committed.

The provisions of the Bill, in conjunction with the other health affordability measures being developed or deployed, will help and enable more people to access affordable healthcare. The cumulative effect of the measures, which is what matters, will help mitigate the financial pressure people face and ensure that cost is not a significant consideration, and it should not be a consideration when people need to access healthcare. This includes access to hospitals for children in this Bill and access to contraception, which will be reflected in the Bill as a result of Committee Stage amendments.

I again thank the Joint Committee on Health for waiving pre-legislative scrutiny. I look forward to today's discussion.

2:10 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I welcome the Minister and commend the publication of the Bill. Any measure that reduces the cost of healthcare for any citizen is obviously to be welcomed. I also support and welcome the introduction of free contraception for women aged from 17 to 25 years. I commend the Minister on the very good work that has been done over the last year on women's healthcare, notwithstanding differences we had on the national maternity hospital. I accept that we have seen some significant changes in recent times in this area, on which much more needs to be done.

Three principles should underpin all of our approaches to healthcare, the first of which is accessibility. We all know the challenges patients face in accessing healthcare at every level, including long waiting lists, which are unacceptable in many different areas, long waiting times in emergency departments and people waiting longer to access a GP. All those access issues are very important, as are affordability and accountability.

Affordability and accountability are linked, as I will explain to the Minister. While the measures the Minister is introducing in this legislation are welcome, they are only baby steps towards achieving what is needed to move to a single-tier health service and universal healthcare system. We are a long way away from realising many of the big commitments that have been given, for example, universal GP care for all citizens. We have more to do even with regard to the inpatient hospital charges. The measure in the Bill relates to children only and should be abolished for all patients. We have the issue of car parking and prescription charges. The threshold for the drug payment scheme is still too high, although it was reduced in the previous budget. An awful lot more needs to be done to reduce the cost of healthcare. For me, however, the biggest issue is realising the objectives of Sláintecare and getting to a point where we truly have healthcare delivered free at the point of delivery, inasmuch as we can and certainly in primary care and acute care. We have a long road to travel.

The Minister and I have a difference of opinion on whether there is a need for an emergency budget. In the past few weeks, the Minister and the Government have introduced legislation to provide for commitments made in the previous budget. The Minister gave commitments in the budget last October that he would roll out contraception for women in this age group and that children aged six and seven would have access to GP care. We are still waiting for that. Other commitments were also made last October. In the most recent round of cost-of-living measures, provision was made to reduce the cost of inpatient charges. However, many of these measures take far too long to be brought in because of the contractual issues that must be negotiated to realise and deliver some of these issues.

Today, we heard that Electric Ireland is to increase its prices by at least 10%. Inflation will also hit 10%. Obviously, everything we can do to reduce the cost of living for families is very important, and healthcare is obviously part of that.

We are concentrating today on children and the abolition of hospital charges for children. A wider piece of work needs to be done regarding the cost of a child being sick. This is an issue the Minister raised when he was in opposition and it is one on which I would like to work with him. I have met many groups that represent parents of children who were in hospital for long periods. This gives rise to significant additional costs. The cost of overnight accommodation is sometimes provided for in hospitals and sometimes not. When parents have to take time off work they have no entitlements, which is very difficult for them. We need to look at the cost of a child being sick and do much more for the families of children who find themselves in that position. As parents, the Minister and I know that when a child is sick, parents want to do everything possible to support their child. They should not have to worry about all the costs that go with that, which, unfortunately, many parents do. A huge amount more needs to be done in that area.

The Minister mentioned the rolling out of free GP care for seven- and eight-year-olds, which is welcome. However, he added the important caveat that we do not know when that will be implemented. That is part of the problem. This measure has been announced and announced again. This House passed legislation that enabled all children aged under 12 to access free GP care. We have not even got past those aged eight years and under yet because the Minister is still stuck in negotiations with the Irish Medical Organisation.

As somebody who wants to be in his position one day and who will have to answer, I am sure, similar questions on how quickly we deliver all these objectives, I say to the Minister that we will never deliver or realise universal free GP care unless we increase capacity and have a plan to increase training places. While I know that has and is being done, we must do more. We must also put in place a new, modern contract for GPs that reflects a modern practice. If we do that and put in the architecture and foundations, we will be able to expand universal GP care more quickly. I would like to see a long-term plan negotiated with the IMO, one that provides a new contract and sets out what we are going to do and the direction of travel. The quid pro quowould be that the IMO must sign up to a realisable objective of getting to universal GP care for all, rather than having these piecemeal negotiations by month or by year in which we do not get anywhere. The caveat that has to be noted is that the Minister cannot tell us today when this measure will be delivered. It has been announced and announced again, which, unfortunately, is just part of it.

I also wish to deal with the issue the Minister raised about innovative medicines and the reimbursement process. I have engaged with many people who work in this area. We are very fortunate that we live in a country in which many of these high-tech drugs are made. Huge innovation has been achieved in the pharma sector and healthcare generally. I am blown away when I visit some of our hospitals and training colleges and see the innovation and talent we have right across our health services. We see it also in innovation in new technologies, drugs and medicines, in which Ireland is a leader. We are not always a leader in those drugs being made available for patients, however. The Minister is right that more medicines have been made available in recent times and that more funding has been made available. Funding is part of this.

The reimbursement process is very cumbersome and takes far too long. I know the Minister's staff and HSE staff tear their hair out when they see the number of parliamentary questions Deputies submit week in, week out. We do so because we want to get information and understand how processes work. I tabled many parliamentary questions recently on this issue to better understand the process. It is really cumbersome and needs to change. Funding is part of it but how we arrive at that decision is also part of it.

The Minister will be aware that Kaftrio, the drug for children with cystic fibrosis, is one issue on which parents are campaigning. I know we can come in here every week and talk about some drug. There will always be a drug that is contentious and that will be part of a hot political debate. We cannot do everything but this is obviously an issue that, again, has understandable traction because these children will benefit from it, yet it is still stuck in the process. We do not know when a decision will be made on that particular issue.

We have an awful lot more to do to reduce the cost of healthcare. I do not believe there is a roadmap in place for delivering a universal healthcare system.

In the replies to all the parliamentary questions I put to the Department asking how much it is going to cost to remove private healthcare from public hospitals, I am told the Department does not have the costs, it is too complicated and the Department does not have the formula to work it out, yet this is an objective of the Oireachtas as part of Sláintecare. When I ask how much it will cost to deliver universal GP care for all citizens, I am again told the Department cannot cost it and does not know how much it will cost. If the Minister says that information is available, he should provide it to me. I can send him at least 50 replies to parliamentary questions I have received in which I have been told the Department cannot provide a cost. I will send every one of them to the Minister so he can see I have tabled these questions time and again. I have asked the question in many different ways and I cannot get a costing. I am told we have to look at demographics and increased demand. That is all true, but that work should be done. What is more difficult for me is there is no timeframe when I ask what the timeframe is to realise this.

These are issues on which I would like to work with the Minister because regardless of who is in his office these are the big issues that have to be delivered. An accessible, affordable and accountable healthcare system is one we all would like to see.

2:20 pm

Photo of Patricia RyanPatricia Ryan (Kildare South, Sinn Fein)
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The Bill exempts children under 16 years old from hospital inpatient charges. Sinn Féin welcomes this, but the Bill does not go far enough. The Government should abolish hospital inpatient charges for all patients. This should start with abolishing inpatient charges for all children and dependants, not just those aged under 16 years. The Minister is looking for a quick win to mask the lack of progress on universal healthcare. Over the past two years I have dealt with many people who have had to endure long waiting periods for hospital procedures before finally getting an appointment.

This Bill is an important step to help families who are struggling, but the Government could do much more to help them. The Government is also too reactionary in some areas, with no vision or forward thinking. It must go further to reduce the burden on struggling workers and families, especially on older people. Measures such as phasing out car parking charges for hospital patients and phasing out prescription charges must be prioritised. There has been no progress on expanding free GP care, despite the Oireachtas passing legislation in 2020. There are people whose children have completely missed free GP care. It was announced when their children were young, but the slow progress meant their children have outgrown it. They simply could not get it.

The Government has not done enough to train more GPs and dentists and to expand public primary care. I asked a parliamentary question last week about the number of dentists in County Laois who had left the dental scheme that provides dental care for medical card holders. The answer was that 14 dentists have left the scheme in the past two years and there is just one dentist left in the scheme. There is one dentist who accepts medical cards for a county with a population in excess of 90,000 people. What is the Government doing to address this crisis? Nothing. It should be ashamed of itself. I asked the same question regarding County Kildare. The figures available relate to Kildare and west Wicklow. In April 2021, there were 46 dentists accepting medical cards. This has dropped to 38 this year, with just 28 dentists submitting claims for May. That suggests there are a further ten dentists who are not taking on new medical card patients or who have taken the decision to leave the scheme. This is a very serious crisis.

Anyone who has ever had a toothache knows there are few pains as bad. However, a medical card holder must wait in line with no prospect of an appointment. Otherwise, he or she will have to pay for private care, if that person can afford it. Obviously, the reason a person has a medical is that he or she cannot afford private healthcare. In the past month, patients of a dentist in County Laois have told me their dentist has written to them saying the dentist is leaving the scheme, and the patients of two dentists in south Kildare have told me the same. We are living in the sixth richest country in the world and have a health system that belongs in the Third World. That is despite spending €21 billion last year on our health service. I also asked the Minister for Health what options are available to medical card holders who are unable to find a dentist who is taking on new patients. The reply was:

Both I and the Government have been concerned for some time that medical card patients in some parts of the country have been experiencing problems in accessing dental services. The problem became particularly acute over the last couple of years as a significant number of contracted dentists chose to opt out of the D[ental] T[reatment] S[ervices] S[cheme].

I refer to what the Minister said earlier, "To address this problem, I secured an additional €10 million ... [in budget 2022] to provide expanded dental health care for medical card holders including ... the reintroduction of scale and polish." There are no dentists. The Minister might be providing the money, but there are no dentists available. It is ludicrous.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The Deputy should read the next paragraph.

Photo of Patricia RyanPatricia Ryan (Kildare South, Sinn Fein)
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The Minister need not panic because I am coming to the next part. It notes that there is €16 million of an underspend. I understand all that, but we still need to have dentists, so I do not know what the Minister is doing there. I will move on. The Minister and the Government are concerned, but not concerned enough to implement a comprehensive plan actually to address the crisis.

Last month in Kildare, President Higgins said that our greatest failure is housing. Surely healthcare is a very close second. The health system is broken. The Government does not even bother to pay lip service to Sláintecare anymore. My colleague, an Teachta Cullinane, has a plan that is fully costed and will address the health crisis. We know the issues and we have proposals to start to address them. They will not be an overnight fix, and we know that, but there will be an overnight indication that we are willing to take action. I am absolutely sick of the endless hand-wringing and whataboutery from this Government. We all see the problems and we need to act now.

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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This Bill is welcome insofar as it abolishes hospital inpatient charges for all patients under 16 years old, but it is emblematic of the snail's pace of the Government's progression to universal healthcare. It appears the provisions of the Bill are less about achieving universal healthcare than about keeping up the appearance of trying to achieve it. While it is an important step for the families who may regularly require hospital services, and there are many of them, much more could be done to help them. That is especially relevant in light of the current cost-of-living crisis and the pressure on families, not only to pay for fuel, food, back-to-school costs and all of the other essentials that must be paid for but also to access medical care. We heard the Tánaiste say yesterday the cost-of-living crisis could last for years. At the same time, he refused the proposal of an emergency budget and is prepared instead to wait until the autumn while the crisis gets worse and the pressure on families continues to mount.

In the area of health, people are being faced with the consequences of decades of underinvestment by the Government. This has left Ireland in a situation where the system is vulnerable to any shock that may present itself. Healthcare workers are no longer attracted to what the HSE has become, so we are short of staff. That was only too apparent when the issue of needs assessments came to the fore. Home care is in short supply. Indeed I have fought for it on behalf of a number of Tipperary families for the past two years.

While the abolition of hospital inpatient charges for all patients under the age of 16 years is welcome, the Minister could do much more to reduce the cost of healthcare for workers and families. He could phase out hospital parking charges, especially for families who want to be near their children or other loved ones and have to cope with huge travel costs in travelling from County Tipperary to a hospital in Dublin each day. I could give the Minister several examples of families in that situation at present.

The Minister could also address the consistent loss of rural GPs in Tipperary by training more GPs and expanding primary care. Recently in Cashel we saw how difficult it is to replace the doctor at the minor injuries unit. The unit had to close for a time, and then it had to reduce from a five-day per week to a two-day per week basis for a time. This is where the Minister and the Government are failing. There has been no progress on modelling, costing or planning the roll-out of universal GP care, which would make a real difference in people’s lives. These problems are of the Minister's making. It is no wonder people have to go to emergency departments when they either cannot get a GP or the local injury unit is closed. If they cannot get a GP, they must pay to attend the emergency department. Then there are the HIQA reports such as the recent one on the emergency department in University Hospital Limerick.

Again, I welcome this Bill, but it goes nowhere near far enough.

Photo of Duncan SmithDuncan Smith (Dublin Fingal, Labour)
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The Labour Party welcomes the provisions in this Bill both in the area of inpatient charges for children under 16 years of age and in the measure the Minister will introduce in an amendment with regard to contraception services. That is an especially progressive measure and will make a real difference. It is an early step in what will be, should the action plan on women's health be delivered, a further, more comprehensive suite of measures in respect of contraception and women's health in general. That is to be broadly welcomed. It is something that will be delivered and is deliverable, which is the proof of the pudding in anything the Government or we in politics do.

The measure on inpatient charges is also very welcome. We would like to see a commitment in the upcoming budget to its extension and the removal of all inpatient charges. The cost of the removal of all such charges, based on the Department's own costings for 2018 to 2020, would be approximately €30 million. That is a significant figure and not something that can be found at the back of the Department's couch, but in the overall context of the health budget it is not a major amount. Given the cost-of-living crisis we face, and the desire for free health access at the point of delivery, it would be great to see this measure extended in the upcoming budget. As I am sure the Minister will be aware, it is a key part of the Irish Cancer Society's pre-budget submission. We had a debate recently in the House on that and the Irish Cancer Society held a drop-in session in Buswells Hotel earlier this week. It was a fantastic and very well costed pre-budget submission that asked for the abolition of all inpatient charges and an end to the practice of debt collections in the health service.

This is a matter I will bring up again because it is something that is linked to inpatient charges and the fact people cannot afford to pay them as they exist at present. They can be capped at €800 but inpatient charges can go to debt collection within a month. I mentioned the cost-of-living crisis and how difficult things are for people. No one plans or wants to be in hospital. At almost all times, it is a surprise charge that can be imposed on an individual or household. It is something that hospitals, hospital groups and our publicly-funded health service are outsourcing. Whether someone is suffering from, recovering from or living with cancer or any other illness, or is in recovery from an illness after a stay in hospital, an automated phone call from a debt collection service is highly distressing. It is something we as a nation and the State and public health service should not tolerate. I ask the Minister to re-examine that matter. It is an ask that will not go away and has broad support across the Opposition. I am sure the Minister, many in his party and many in the Government parties do not want to see this, and do want to stand over a private debt collection service operating in our public health system. If that is something that could be looked at, it would be most welcome.

I was not going to mention the other issues. I was going to stick to the Bill, but as the Minister referenced them in his contribution I will speak to them. On contraception, I tabled a number of parliamentary questions regarding the provision of community-based vasectomy services. We have a real problem in Dublin as regards GP practices that have either been retired or passed on. Apparently, there is only one practice left that is providing this service. Recommendations were made by a working group in 2018, which the HSE and the Department were all for. When the pandemic happened, they were not implemented. I ask the Minister, through the parliamentary questions that will come across his desk in a couple of weeks, to have a look at that. It is an important public health and contraception measure that everyone in his Department is in favour of delivering on. I ask him to give it some attention.

The delay in the continuation of the free GP care scheme is something we feel very deeply. The Labour Party brought this in when we were in the Government. We are very proud of it. Everyone likes it. Everyone remembers other stuff we did in Government but no one ever seems to remember we did that when they are in the Chamber crowing about it not being extended. The Irish Medical Organisation and GPs are dragging their heels on it. The Minister needs to call them out. We need to have this scheme continued. The scheme has now been in existence for seven years but this Government and the previous one have not been able to extend it to six- and seven-year-olds, which would be a modest increase. We should be well beyond that. We should now be at a stage where we are looking at it for all. If we are including the group aged 16 and under in the reduction of inpatient charges, we should at least be there for the extension of free GP care at this stage.

The GPs and the IMO are getting away with blue murder in dragging their heels on this. The Minister needs to be more vociferous in calling them out and demanding they sign up, at a minimum, to the inclusion in the scheme of those aged six and seven, and then start including eight-, nine- and ten-year-olds, and primary and secondary school students, as we move towards universality in free GP care. Children are more likely to visit their GP than to be inpatients in hospital, thank God. It is a more constant and regular cost-of-living issue. We now have accessibility issues tied into it, and trying to get more GPs on stream etc, but the fact this has now stagnated for seven years and has not progressed is not something the Minister will want to stand over. I think he would like to deliver, at least, what is now a very modest extension of the scheme to six- and seven-year-olds before the end of this year. It cannot just be another couple of lines in a budget without any delivery.

The work on new medicines is very positive. There will always be new medicines and therapies we will want to bring in. We will call for that when they happen, which will usually be in respect of young people or those with chronic diseases. We always need to strive to make sure we have the best new therapies available within our public system for people in Ireland who are sick no matter what their age. I can see the work that is being done, which will be ongoing.

There were two paragraphs in the Minister's speech regarding the dental treatment services scheme. I read the second paragraph as well. It states that the Minister hoped "this significant additional investment in the dental treatment services scheme will attract more dentists...". It will not. Dentists have turned their backs on the scheme. They believe it is totally outdated and archaic. It does not represent value for them and does not represent current dental services. I have raised this matter, as have Deputies Cullinane and Shortall, for the past year and more. It seems that when we have asked about the negotiations or engagements between the Department and the dentists' representative body, it is a case of the next quarter or the quarters thereafter, or there will be a meeting and then we will come back. There does not seem to be a sense of any real momentum and engagement. The Department may throw money at it, or allocate money to it, but if these dentists do not want to take part in the scheme and feel it is structurally unsound, they will remain outside it.

We are dealing with issues in our constituency clinics and offices every week relating to people who are unable to access dental services. The problem is chronic everywhere but very acute on the north side of Dublin. If I am out canvassing, after one hour at most, it will come up at least once on the door. It is always coming up now because it is impacting on so many people. Since people do not go to the dentist every week or every month, it may not have the momentum it should but it is impacting on them. They are forced to go private. They might get whatever emergency procedure they need done to get them over a particular dental issue. That individual may be sated for a while, but the issue continues. Dentists are no closer to re-engaging with the scheme. They will not re-engage with it as it currently exists. It has to be torn up and redone. That is just the reality of it. It will be expensive and uncomfortable but it has to be done. Otherwise, given the way it is structured now, we are consigning people on medical cards to be outside public access to dental treatment, which is a massively retrograde step.

The Department and the representatives of the Irish Dental Association need to get into real engagement on this. The Covid pandemic, which was the reason given for a couple of years that certain things could not progress, is now in a different space. Covid is not here in the way it was so there has to be the space for us to resolve this issue. While I appreciate the allocation of more money, and the PRSI cover for a scale and polish and all the rest, which is helping some people, the structural issues with the DTSS have not been addressed and seem no closer to being addressed.

I will finish by returning to the provisions of the Bill. It is important those aged 16 and under will not be charged for inpatient services in our public hospitals. That is a very positive and progressive step. It will help households and bill payers in families whose children have been in hospital.

That is to be welcomed.

I should have mentioned, when I spoke about the briefing by the Irish Cancer Society the other day, about how inpatient charges can accumulate. One of the patient advocates who has recovered from cancer had a two-year treatment through the private system. That person calculated they paid less than if they had have got the same treatment through the public system, and this is including the person's insurance premium and the €75 excess they had to pay in each of the two years. This was because of the inpatient charges the person would have incurred. It was €400 cheaper for the person to go private with their private health insurance than it was for them to go through the public system. I am doing up a note on that which I will send to the Minister. It is a kind of perverse example of how our health system is not functioning when it is more expensive to pay on the public system than on the private system.

I want the public system to be free at the point of use. I want it to be a world leader and for it to excel. I want private health insurance to diminish to such an extent that people do not want or need it because of how good the public health system is. That is the vision of Sláintecare, which is silent on private health insurance. The implication is that if Sláintecare is delivered, our health service will be good enough that no one will want private health insurance. That is where we need to get to. The above example is one to take note of because it certainly took me by surprise. The two main provisions of this Bill are a step forward. We look forward to supporting it before the Dáil recess.

2:40 pm

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I thank the Minister for bringing forward this legislation. I very much welcome it. I will reply to a comment made earlier which compared the Irish healthcare service to the Third World. It is totally inappropriate. I say this as someone who has visited a number of countries in the Third World. Life expectancy in this country is one of the highest in Europe. To compare our healthcare service to the Third World is totally inappropriate. It is also a criticism of the people working in our healthcare sector.

Staff in our healthcare sector has increased by 35,000 people. Since December 2014, it has gone up from 103,000 to more than 135,000 whole-time equivalents. We are really talking about 150,000 to 155,000 people working in the sector. There has been a substantial increase. Yes, there are challenges in many areas, which will continue to be there and to be dealt with in the best way possible. It is important that correction is made.

I welcome the Minister's proposal on the removal of the inpatient charters for children under 16. It is very welcome. I very much welcome the fact we are also talking about a scheme to increase the age limit for medical cards which will bring in an extra 80,000 children. With regard to the proposed introduction of pre-contraception, I raised this as a Topical Issue matter last Thursday week, and I flagged concerns on a number of issues. The first was on whether there was a need for legislative regulation. The reply was not as informative as the Minister has been today. The issue of legislation is now clarified, which is one of the issues on which I was looking for clarification last Thursday week.

The second issue about which I was concerned was the agreement with the Irish Medical Organisation, IMO. We need to get some clarification on that, because it is very important we have all parties on board with regard to dealing with and delivering this scheme. I was looking at a survey done on people in the healthcare sector. Some 41% of those interviewed were worried about cost recovery being in place with regard to the service provided. A concern was also raised about long-acting reversible contraception, LARC, in terms of whether we have sufficient training available for GPs. The other issue with the roll-out of this scheme is the geographical spread. Has enough work been done on that issue to make sure all areas of the country have access to the scheme? It is very important.

The third issue was the information campaign. We need to get clarification about the roll-out of an information campaign and, in particular, the issue with third level colleges. It was for that reason I tabled that Topical Issue matter last Thursday week. We are talking about having this up and running by the end of August. I am not sure whether we are dealing or have dealt adequately over recent years with the importance of our third level institutions and making sure we have adequate medical support for people who attend our third level colleges. However, I welcome that we are now covered by way of legislation. I know it is an amendment to this Bill. It is extremely important we make sure all the i's are dotted and t's are crossed with the introduction of the scheme and that it is available in the time planned, which is August of this year.

I will move on to the issue of new drugs. The former Belgian health minister did a short presentation at the Oireachtas Joint Committee on Health recently on the issue of the group of countries in the Benelux agreement. Despite the fact that six countries are involved in the Benelux agreement, there is still a problem with regard to the timescale. We were given information to the extent that it is taking approximately 212 days for a new drug to be made available in Denmark, whereas it is taking 440 days in Belgium and 477 days in Ireland. That is an average timeframe. It is great we are now putting more funding into this area and that is very welcome, but it is very hard to explain the timescale to a parent of a child who needs a particular drug and cannot access it when it is available in another country in the European Union and even one that is part of the Benelux agreement.

I was on the committee on health back in 2018 when it did a report on this. We made substantial proposals about how to expedite the issue of availability. It is interesting that when the European Medicines Agency approved a drug for Covid, it was suddenly made available to 450 million people within a very short timeframe, and rightly so, but when a very small group of people need access to a drug, the average time period, as given to us at that committee meeting, is 477 days. We need to look at bringing about the change required to make sure people can get a drug in a timely manner. We have been talking about it. The committee on health dealt with it back in 2018. We are four years on. The time period for getting access to medication has not decreased. It is a very important issue we need to prioritise.

There are challenges within the healthcare sector on which we all need to work, such as the roll-out concerning GPs. We are talking about GPs providing services but also about a major challenge coming down the road with the GP workforce in that quite a high number of GPs are over 60 years of age. Will we have an adequate number of people to replace those GPs, given that we have a considerable increase in population? We need to have more GPs available on the front line to deliver services. We need to look at how we expedite the increase and make sure we have GPs to replace those who are retiring and an adequate number of GPs to deal with our growing population. We have been very lucky in this country in that, over the past ten years, we have increased the number of people in employment by 650,000. It is a considerable increase. We have also increased the demand for services. One of the services for which the demand has increased is healthcare. We must respond accordingly, in particular on the front line. The more GPs we have, the more people we will keep out of hospital.

I thank the Minister for bringing forward this Bill and I look forward to working with him on passing it through both Houses and on its implementation.

2:50 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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We will go to Deputy Ó Murchú for a perspective from County Louth.

Photo of Ruairi Ó MurchúRuairi Ó Murchú (Louth, Sinn Fein)
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I agree that a lot of people use dramatic language about the health service. We all know how difficult the work in the health service can be. Sometimes that is down to the weaknesses that exist there but it is not to take away from those who work in it. All of us and our families have received great care there but we also know about the issues with waiting lists and we know about the costs. We all welcome this Bill in the sense that it will reduce some costs but we can go further.

We also believe we can have a better health service and that is what we want. We want a first class or first world - call it what you want - healthcare service. We all agree on the idea of Sláintecare and universal healthcare and one of the few lessons I hope we retain from the pandemic is the necessity for a public health system to deliver when necessary and we have to all play our part in making that happen. We welcome the abolition of inpatient hospital charges for children and we would like to see that go further. Many have spoken earlier about the difficulty with universal GP care and none of that will exist unless we have a greater level of GPs. I would also agree with what a number of colleagues said earlier about dealing with stakeholders as we make that difficult journey. I can make an argument that we might need to plan better, work harder and negotiate better, but if there are obstacles and difficulties it would not do any harm for the Minister to appraise the rest of us of that. Sometimes it can be that if you are in the right, if you have put your arguments and if you are not being dealt with fairly then it is fair enough that we have that argument out there in the public domain and we will see where the chips fall when it can be done.

Since the Minister has been appointed and in the short period of time I have been a Deputy, I have spoken many times on the DTSS and Louth, and Dundalk in particular, was one of the first areas where an issue had blown up when my dentist informed some of his patients that he would not be able to take care of them. Like many others he spoke about the difficulties with the system so we need a real fix in that regard. I accept that some works have been done and we need to go further.

I notice that, as per normal, I have left myself with insufficient time; maybe I was a bit too dramatic. A number of us would have met Debra Ireland and those people who are suffering from epidermolysis bullosa, EB. We know that it put forward straight asks about securing flexible care packages and it is talking about a fund of €786,000. It is also talking about a nurse who would be able to work between hospitals and the community and that would cost around €75,000. Due to the mental anguish and issues that relate to the condition it is asking for a psychological service that would cost in and around €80,000. If that could be considered many people would find that really useful.

I know I am taking liberties at this stage but the Minister and I have spoken many times about Dealgan House Nursing Home and I mention the loss of 23 people there. The families are-----

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The Deputy is wandering a little away from the subject matter of the Bill.

Photo of Ruairi Ó MurchúRuairi Ó Murchú (Louth, Sinn Fein)
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-----under severe pressure but the Minister had met-----

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The Deputy is taking advantage of my gentle nature.

Photo of Ruairi Ó MurchúRuairi Ó Murchú (Louth, Sinn Fein)
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-----some of those families and they had spoken about the fact that they needed a mechanism to provide them with the necessary answers. We always look for a public inquiry but the Taoiseach and others have talked about the type of inquiry they do not want. We need to see what sort of inquiry the Government will come up and we need it as soon as possible. I apologise greatly-----

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Put down a Topical Issue on the matter and we will give the Deputy an opportunity to engage with the Minister.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I welcome this Bill and it is good the Government is abolishing the inpatient charge for children under 16 and that parents will no longer have that as an additional worry when their child gets sick and has to be admitted to the hospital. The Minister made the point that it will ease the financial burden on parents and ensure that cost is not a significant consideration for families when children have to go into hospital, which is good.

However, it begs the question of why anyone should have a financial burden when they have to go into hospital. The bar is set pretty high to be admitted to hospital. You are seriously ill if you are admitted to hospital and you need some kind of procedure. To stay there one night is not something you have any control over or that you can do anything about in terms of going anywhere else or getting it done on the cheap; there is no alternative to that. When somebody is admitted to hospital for one night they are charged €80, and many people would be in for ten nights so that is a charge of €800. This is a problem that applies to all families that do not have private health insurance. What exactly is the rationale for that? I cannot see how there could be any rationale for it. If somebody has to go into hospital they have to get treatment and they are seriously ill and we charge them for getting that treatment. Why do we do that? In the case of most families, particularly in the present climate, where do we expect that people will get €800 to pay a hospital bill? It is not as if we are talking about people who have money in the bank or who have savings. Why are we continuing to charge people for going into hospital for a procedure? It makes no sense whatsoever and in most other European countries this is unheard of. It is grand to finally be moving on children under 16 but there is no justification for charging people for being admitted to hospital. That was one of the key things that was looked at in Sláintecare.

There are many elements of Sláintecare which were all phased in detail over the ten-year period in the report. Under the heading of reducing and removing charges the first action mentioned is to remove inpatient charges. The proposal is that all of the charges should be removed in the first year of Sláintecare because there is no justification for them. They only cause hardship to people and the Government needs to make much more progress on this. I accept that the past two years have been difficult and have cut across the implementation of Sláintecare. We have lost the implementation people and all of that and it is regrettable that this was allowed to happen but things are getting back on track somewhat and I expressed the view at the most recent meeting of the Joint Committee on Health, when we had Mr. Watt and Mr. Reid in talking about regionalisation, that for the first time I got a sense that this is taking shape. In particular, the appointment of Liam Woods to head up the regionalisation is a positive development and it is a statement of intent on behalf of the Minister and other senior people in the health service, which is welcome.

The progress is painfully slow, however. There is all the structural and legal stuff, which is complex, but the fundamental problem with our health service is that it is inequitable because it denies care. It often denies lifesaving care to people because they cannot afford private health insurance and that is the only reason the care is denied. We are a complete outlier when it comes to the rest of Europe. The idea of paying to see a GP or because you have to be admitted to hospital is unheard of elsewhere and the idea of paying for medicines is unheard of in many countries. We are completely out of line with everywhere else in that. This measure is fine and grand but it is only a drop in the ocean in what needs to be done to remove that barrier to healthcare and cost is a massive barrier to people accessing healthcare.

Given the way things operate at the moment, I have a concern that while we are talking about Sláintecare and slow moves are being made to go down the road towards implementation, there is at the same time creeping privatisation in the health service. The worse the public health service is, the more demand there will be for private healthcare and the more money to be made from it. The reverse is the case too. If there is a really good public health service, there is not a demand for private health service and people are precluded from coining it. They are the vested interests, the people who will knock on the Minister's door and are continually, I am sure, trying to prevent the implementation of Sláintecare because it interferes with their business and profit-making. That should not be the concern of the Minister or Government because the number one responsibility in healthcare is to make sure people have access to it. Affordability is critical, as is adequate supply. At the moment, large numbers of people find their care delayed, deferred and, in many cases, denied. That is because they do not have the money in their pocket. That is completely wrong and inequitable, and that is one of the key principles behind Sláintecare. At this stage, cost should not be a barrier for people accessing care.

With regard to that creeping privatisation, we are seeing more and more that GPs and consultants are gatekeepers to care, particularly in respect of diagnostics. Because there are such long delays and waiting lists for diagnostics of all kinds, we have a practice whereby people are advised to go off and raise the money. They beg, borrow and steal to raise the money if somebody is seriously ill in the family. They are advised to get the money to go privately for an MRI scan, CAT scan or whatever it is. By doing that, they can skip the queue because they then get quicker access to public healthcare. That is wrong. It should not be like that and it is putting enormous pressure on people. One can understand it very well. For any of us, if a family member is sick, we will do anything to get them treatment. People are being forced into debt and all kinds of difficult circumstances to get that initial diagnosis so their family member can access the care they need. It is unfair and wrong and we should not allow this situation to happen.

I was at a meeting of the Joint Committee on Disability Matters a few weeks ago and listened to parents talking about the fact they could not get an assessment of need for their kids with a disability. They had to go off and borrow money if they could, get it from their family, credit union or whatever to get the assessment of need. By allowing a situation like that to continue with the health service, it drives behaviour for people, not only for trying to access it but for staff in the health service. The health service is becoming more and more difficult to work in but there is a perverse incentive for people to go into private practice. The people who do assessments of need, rather than dealing with a massive waiting list, can go out privately, do private assessments of need and get paid better on the basis that they get a payment for each assessment they do. It is much more lucrative and less stressful. People are incentivised to set up in private practice because the services are so dysfunctional. Families with children with disabilities may borrow that money and get a private assessment of need but then the therapies are not available because there are so many vacancies among therapists.

Time and time again, people who do not have private health insurance are being hammered for the fact that they cannot afford health insurance. It should not be about that. People should not be forced into a situation where, if they can possibly afford it, they will take out private health insurance. Private health insurance is an additional health tax being forced on people. If people pay their taxes, the least they can expect is a functioning public health service. We do not have that and there is no great sense of urgency about implementing the programme that is there. This is a unique opportunity the Minister and the Government have to deliver something really substantial. They will not have opposition from other parties here. It is a great opportunity to do something of massive significance to huge numbers of people in this country. It would be a great legacy for the Government to leave behind. Healthcare and access to it is so fundamental to people's lives, welfare, quality of life and general well-being that it has to be prioritised.

Funding has not been a massive issue in recent years and money is being provided for services at budget time. It seems great and one hopes that will solve problems in that aspect of healthcare but invariably halfway through the year or at the end of the year we discover that the money was not spent because it was not possible to recruit staff. That is because we do not have staff. We have driven many healthcare workers out of this country because they cannot take the pressure, dysfunction and the fact they have to continuously apologise to their patients for poor service.

There also seems to be very little workforce planning going on, which is a huge issue. When we were doing the Sláintecare work, we had Stephen Kinsella in speaking to us and at that stage there was a plan to bring him in to look at the question of workforce planning. I do not think anything came of that. Is there any connection between the demands of the population in terms of healthcare workers and the places provided in third level colleges? I am not aware of any connection there. At this point, there are serious shortages almost cross the board in the health service. We are hearing more and more from Ministers that the issue is not money; it is availability of staff. It is fine in theory to provide funding for this, that and the other but the services do not follow because we cannot get staff.

There are many issues about workforce planning that need urgent attention but the primary thing in respect of staff is ensuring we keep staff here and that they are encouraged to be part of the reform programme and leading that reform in healthcare. If people are given confidence that we are serious about reform and Sláintecare will happen in a reasonable time, they will get involved because it is potentially a transformative plan and hugely exciting for the country. It could change people's lives but they have to have the confidence that people are serious about it and that it will happen. They have to be invited back to lead the reform programme.

That brings me to the question of consultants and GPs. There are shortages across the board but particularly in doctors. It is unforgivable that negotiations on the new consultant contract have been in abeyance for six months. Why is this the case? There is an attractive Sláintecare contract for consultants. Why are we not going out of our way to attract back consultants on the basis of those attractive contracts? We should be doing everything possible, not leaving it aside and ignoring it.

I have said frequently that most young GPs do not want to be businesspeople. The business model involved in the GP contract is massively outdated. Most young GPs want to be GPs and to practise medicine.

They do not want to buy premises and set up a business nor have they the capital behind them to do so. We should be employing GPs. We should have salaried GPs. There is a shortage of GPs generally and also a shortage of GPs who are in a position to provide their own premises. There are also shortages of GPs for disadvantaged urban areas and remote rural areas. There is a shortage of GPs to carry on out-of-hours services. Many qualified GPs would happily come back to do that work. There are also many GPs who want to work part time or to job-share but those options are not open to them. Why are we not availing of these opportunities to strengthen the health service? I just cannot understand it. The Minister would have the full support of people on this side of the House if he pressed ahead with the implementation of the Sláintecare contract and introduced salaried GPs or different arrangements in respect of the employment or contracting of GPs. Just because we do things a particular way with regard to the employment of consultants or GPs - and we know that both areas are problematic - and have done so since the beginning of time, it does not make it right nor does it mean that we have to continue to follow those problematic approaches. I strongly urge him to change that.

There is another thing I wish to say about this legislation, apart from that it should apply across the board to all of the population. Will the Minister at least prioritise one more very important group of patients, that is, cancer patients? As he will be aware, the Social Democrats moved a Private Member's motion on this issue a few months ago. It is unconscionable that people who are diagnosed with cancer and who have to go into hospital to get treatment, whether radiation therapy or chemotherapy, are faced with a bill of up to €800 for that treatment. People have told us that they were in the process of getting life-saving treatment and, before they got home from hospital, a bill had arrived for their inpatient care. What on earth is the justification for that? Within a matter of weeks, if they have not paid the bill, the hospital gets the debt collectors onto them. These debt collectors are ringing people up and calling to their homes. They are telling people that their credit rating will be affected and so on when those people should be concentrating on their recovery following their diagnosis and treatment rather than worrying about where they are going to get money to pay for that treatment. The amount involved here is not very big. I ask the Minister to give priority to this group of patients in October's budget because what is happening at the moment is just wrong.

My next point relates to the amendment he proposes to table on Committee Stage next week about something very worthwhile. The free contraception scheme is very good. With regard to this legislation, I am concerned that it is happening so late in the day. It is obviously outside the scope of the legislation, which is why the Title had to be changed. The Joint Committee on Health got a briefing on it yesterday. When I then went to submit amendments yesterday evening, I discovered that the deadline was yesterday morning, which was before we got the Bill, saw the amendment or anything like that. I thank the Ceann Comhairle, who acceded to a request to extend the deadline for amendments. I hope the Minister and his officials learn a lesson from that and that they now know it is not a good way to do business. It is also not very respectful to the House. Notice needs to be given. This was a commitment in the programme for Government and fair dues to the Minister because he is now delivering on it. It should have been handled differently, however. Although he mentioned the amendment in his contribution, we have not yet seen it. It will be sometime this evening before we do. It is a popular thing and a very worthwhile addition to the legislation. I very strongly welcome it and the removal of inpatient charges, to the extent that is being provided for, although it needs to go much further much more quickly.

3:10 pm

Photo of Jennifer Murnane O'ConnorJennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I welcome the Bill, which provides for certain exemptions from charges for acute inpatient services, particularly for children younger than 16 in all public hospitals and for persons who have chosen to avail of private acute inpatient services. When enacted, this legislation will ease the financial burden of parents and guardians when bringing their child to hospital for inpatient care and will help to ensure that cost is not a significant consideration when children require access to inpatient treatment.

The Minister has also received Government approval to table a Committee Stage amendment that will insert provisions to provide for the free contraception scheme for women aged 17 to 25. The proposed contraception amendment aims to remove cost barriers to contraception for those women. This will be particularly significant for those who are just above the means-tested limits for medical and GP visit cards and those who are still in full-time education and financially dependent on parents and guardians.

Public patients, including children, are subject to a statutory public inpatient charge of €80 per night for up to a maximum of ten nights a year, which equates to €800. Medical card holders and certain other persons are exempt from these charges. The Bill will remove the statutory acute public inpatient charge. I really welcome this as it will ease the financial burden on parents and guardians when children are going into a hospital. That is very important.

I still have many concerns, however. Medical cards have been mentioned a lot in the debate. The Covid pandemic has been extremely hard for people, particularly older people. A great number of people have come into my clinics in recent months to ask about hospital appointments and how long they are waiting for them. These are mainly medical card holders. Many older people have come into my office because some doctors are charging for blood tests. In the context of the current cost of living, everybody is finding it hard to make ends meet. The issue of extras, such as blood tests and medication that people need, is becoming very serious for me. The Minister brought up the issue of dentists. I welcome the €10 million he has put into this area but I have received several phone calls from people in County Carlow who tell me their dentists are not taking medical cards. There is a reason that people have medical cards. It is important that they get the treatment they deserve. I ask the Minister to try to sort this issue out. It is very hard if you have a pain in your tooth or if you need a filling but are not in a position to pay for it and the dentist tells you he does not take medical cards. That is one of the most serious issues I have been trying to work with people on in recent months. I ask him to address these issues and to do something as soon as possible. I do not know whether more funding is needed in this area. If it does, it needs to be provided. We have to make sure that the most vulnerable people in our society have access to doctors and dentists and are not forgotten.

Photo of Paul DonnellyPaul Donnelly (Dublin West, Sinn Fein)
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I welcome the Bill to exempt certain groups, including children under 16 years of age, from statutory charges for inpatient and day care services in public hospitals. I am sure this will be a welcome relief for hard-pressed families given the increase in the cost of living in all other aspects of life but it needs to go much further. The fact that these charges were introduced in the first place is actually quite unbelievable. As a parent of four children who has had to visit Temple Street hospital on several occasions, it was very annoying to be faced with an enormous bill when all I was thinking about was my sick child. This is a small step in the right direction, that is, towards a centrally funded health service that is free at the point of delivery.

The Government needs to ensure we move to full implementation of Sláintecare as quickly as possible.

I also welcome the provision of contraception and reproductive healthcare. This is very positive news but I am concerned that like other promises made, it will be easier announced that done. We are awaiting several measures the Minister announced this year and last.

I will take this opportunity to outline another cost associated with visiting a hospital. It is incredible that, on arriving at a hospital in a hurry when visiting for treatment, or even going to visit a family member who is an inpatient, the first thing people have to do in most hospitals is pay for car parking. It is the last thing they should be worrying about when having to attend hospital. I have raised this issue with Connolly Hospital in Dublin 15 on many occasions. Local Sinn Féin members organised a free cark parking day in the hospital, where activists stood there all day and if clampers came along, we paid the car parking. That was just to highlight how wrong it is that people going into hospital have to pay for car parking. Just up the road in the Blanchardstown shopping centre, there are 6,000 car parking spaces. I could go to the shopping centre, do my shopping, spend all day there and even leave the car overnight and I would not be charged a single cent. Yet if I go to visit a sick relative, or if I am sick or have to go to the emergency department, I have to pay for that. If I do not, I get clamped and charged €80 or €100. The system we have in place is wrong. I spoke to people in hospital management, who said this was worth €250,000 to them each year. That may seem like an awful lot of money but in the scheme of things it is a very small amount. This must be addressed. My colleague, Sinn Féin MLA Aisling Reilly, successfully got a motion passed in the Assembly to make car parking free at hospitals across the North. It will abolish this unfair tax on health workers, patients and visitors. It is time we follow suit.

3:20 pm

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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People Before Profit welcomes this Bill. It is quite progressive, as is the contraception scheme. Outpatient charges are not conducive to Sláintecare whatsoever. I think the Minister would agree with that. Most people listening will be asking themselves why we pay inpatient charges in the first place. This is welcome but there is a long way still to go. Children who attend the emergency department will still be charged €100 for every visit if they do not have a medical card. That is not progressive. The charges will also still exist for inpatients. Those inpatient charges can be a financial burden on those who have to visit hospital on numerous occasions. That is not conducive to the Sláintecare policy.

There is a juxtaposition between outpatient and inpatient charges and debt collection. In the past three years, the HSE paid €1.3 million to debt collectors. That is an incredible statistic. The HSE paid all that money over the past number of years to debt collectors to chase people up because they had not paid their charges. That is a complete waste of money. That money could easily have been spent on healthcare and on people presenting themselves in emergency departments.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Do we know how much they collected?

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Do we know how much of the €1.3 million-----

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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The €1.3 million was spent by the HSE on debt collectors.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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How much did the debt collectors collect?

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I am trying to get that information. It would be very interesting to see how much money they actually gathered.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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It would.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Charges should be abolished, full stop. The amount of bureaucracy that goes into this, between paying debt collectors and the administrative work involved in inpatient fees, is not efficient. This is in the context of the cost-of-living crisis many families are going through. This Bill is welcome so people will have to access healthcare and so forth. It is welcome that this is happening but there is a long way to go regarding stealth costs in our health system. The aim of Sláintecare is to have a universal healthcare system so that when people need access to healthcare, there is no financial penalty to pay. That is a good thing but there is still a long way to go to complete the policy of Sláintecare.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank all Deputies for their contributions. It has been a very useful debate. I have taken several notes and the officials and I will work to go through some of the thinking and some of the suggestions, particularly in the context of the upcoming budget. The programme for Government sets out the pathway for expanded access to healthcare. This is all with the singular purpose of achieving universal healthcare in our country. The measures being introduced in this legislation are intended to support access to care for those who need it and to make sure we have fair and affordable care. Abolishing the acute inpatient hospital charges for children under 16 is important but there is more to be done; I fully agree with Deputies on that. The Bill is focused on easing the financial burden for parents and guardians when bringing their children to hospital for care. That is why I am committed to putting it in place very quickly so we can get on with enacting it. I am also very keen to have the free access to contraception scheme in place as quickly as possible. That is why I propose to amend the Bill on Committee Stage. The proposed amendment will bring about the scheme so we can introduce it as early as possible. My intention is for the scheme to be live within the next few months.

There has been a lot of very good discussion this afternoon on universal healthcare. Universal healthcare is a very simple and profoundly important concept. The principle of universal healthcare very simply states that when any man, woman or child needs access to healthcare, whether preventative care or care when they get sick, they will get that care quickly, it will be good quality care and it will be affordable. That is it. There are three tests. As we all know, in some areas of healthcare we are there but in far too many aspects we are not. This is one of the most important unfinished projects of our Republic. For us to realise the Proclamation and the ideals of some of the people staring over us every day - those bronze busts and heads around this Chamber - we must achieve universal healthcare in this country. It can never be acceptable that the level of care a child gets could have anything to do with how much money their mum, dad or guardian makes. That is something we must also consign to history.

Significant progress is being made on our way to universal healthcare. We all know it cannot be done in one, two or three years. It is a huge project. Even if there was infinite money, we have to build up capacity and make changes that take years. A lot of progress is being made. I note some of the supportive comments that were made on affordability, which is the topic of this debate. We have reduced the threshold under the drugs payment scheme.

We are bringing in free GP care for six- and seven-year-olds, abolishing hospital charges for children, bringing in free contraception starting with 17- to 25-year-olds, and expanding the dental treatment scheme, notwithstanding the very real challenges. In the past two years, we have increased the budget for access to new drugs by €80 million, which is huge. That is what we have done so far to address affordability. I fully agree that we have to go further, but those measures are just those introduced this year, which is a lot to achieve in one year.

The second big focus is quality. The narrative in Ireland is that care can sometimes be hard to access, but once someone gets access to it, it is world class. We can never take that for granted, which is why we are investing so much money in clinical strategies, including the national cancer strategy, the maternity strategy, the trauma strategy, the paediatric model of care and so many more, and it is why I have focused so much and the Government has invested so much in women's healthcare. While the quality of the care and the services in most areas of our healthcare system are world class, there are areas where we have much more to do. We need a revolution in women's healthcare, which is what we are aiming to achieve.

We have to be able to access healthcare when we need it. We are doing a few things. First, we are investing in a waiting list action plan of €350 million. It is an ambitious plan. Its aim is to reduce the number of people waiting by 18% by the end of the year. If we achieve that by the end of the year, we will have the lowest waiting lists in five years. There is a long way to go and we could be derailed by Covid, but that is the plan. To date, we are on track. Some bits are going better than we thought and other bits are not going at the speed we wanted. So far, we are on track, so we will keep pushing with that. Second, we are adding permanent capacity. I will respond to some comments that we are moving slowly on permanent capacity. The facts tell a different story. In the past two years, we have added more clinicians and other staff to the HSE than in any two years since the HSE was set up. The past two years are the first and second where we have added clinicians to the workforce. We have also added five years' worth of beds in just two years. Sláintecare has a 14- or 15-year plan for capacity and investment in beds. We have done five years' worth of that in the past two years, which is important. That includes inpatient hospital beds, critical care beds, and other areas. We have added diagnostics at a level that has never been seen previously. GPs now have access to diagnostics that they never had. Some 138,000 additional scans were funded last year under a €25 million programme. This year, there have already been more than 100,000 scans, so there will be many more scans this year than last year. It is by no means sorted but there has been significant progress.

Another part of this is hospitals. We are progressing four hospitals at present, including the national maternity hospital and three elective hospitals, as well as finishing the national children's hospital. Those will make a big difference.

Finally, there is a modernisation agenda, which involves building an entire community care service. I have sanctioned 3,500 new therapists for community care. Despite the recruitment challenges, 2,000 of the 3,500 are now in place or will be deployed shortly. Some 81 or 82 of the planned 96 new primary care teams are up and running. Many of the other specialist community teams are now in place. We are deploying advanced nurse practitioners and advanced midwifery practitioners. Ireland will be a world leader in advanced practitioner practice. It will be one of the biggest changes we have seen in healthcare. We are changing the models of care so that people are cared for in their home or community rather than going into the hospitals.

It is nice to hear the acknowledgement that we are deadly serious about moving to regional health areas. We are doing so, with a serious team involved, as well as a serious advisory team led by Leo Kearns. Much work is going on there.

It sounds like the Bill will be supported with regard to both children's hospital charges and free contraception. I thank Deputies for that. I agree with colleagues that there is much more to do. Ireland is an outlier with regard to paying for GPs and some charges in hospitals. These are only two steps but they are two very important steps. For the first time, we are removing inpatient hospital charges for children. That is an important signal in respect of where we are bringing our public healthcare system. I believe the introduction of free contraception is a landmark policy change. We are starting with 17- to 25-year-olds and younger women. It is an important move. I thank colleagues for their ideas, the challenges and the support for the Bill.

Question put and agreed to.

Cuireadh an Dáil ar athló ar 4.06 p.m. go dtí 2 p.m., Dé Máirt, an 5 Iúil 2022.

The Dáil adjourned at 4.06 p.m. until 2 p.m. on Tuesday, 5 July 2022.