David Cullinane (Sinn Fein) | Oireachtas source

I welcome the Minister of State, Deputy Lynch, to the House. We have had several debates on the health service with her over the course of the last number of years. Unfortunately, the Minister for Health has not given of his time to take Second Stage debates on Bills as much as we would like.

I cannot support the Bill. Frankly, if the Minister of State and her Labour Party colleagues were sitting where I am, they would oppose it. This is about increasing charges for public inpatient services. It increases the asset contribution for those who avail of the nursing home support, or fair deal, scheme. It is unreasonable to ask people to pay more for those services when they are getting less. I had a debate in the House with the Minister for Health recently on increased outpatient waiting times in Waterford Regional Hospital where orthopaedics, ophthalmology and ENT represent pressure points. People are waiting for well over the 12 month limit to see a consultant to get into the system. We all accept that when people get into the system, they receive good treatment. Unfortunately, they have to wait very long periods to see a consultant. After they have seen a consultant, they must wait longer again to get the treatment they need. Private patients can get access more quickly although many of them are forced to take out private health insurance. I do not agree with Members who say it is reasonable to increase these charges when we have fewer services, hospitals are overcrowded and staffing has been reduced with a resulting impact on frontline services.

There has been a lack of investment in geriatric care facilities and some community nursing units have been closed. Other community nursing units which it was promised would be built, including one in my city, Waterford, have not been provided. The necessary capital funding is not being made available. There is a lack of services across the health sector for public patients, yet we propose to increase charges. It is not the right thing to do. It is being done in a context in which people pay PAYE, PRSI and, more recently, the universal social charge. People are asking why they are paying these charges. The universal social charge was coupled with the health levy. People pay these charges on top of their income tax and then pay for private health insurance, but still have to pay at the gate when they go to hospital. It is not fair to increase the charges.

The Bill seeks to allow the HSE to outsource the management of the scheme. It introduces charges for private patients in public beds in public hospitals, which I agree with. It is outrageous that people who have private health insurance, especially the wealthier in society, are taking up beds in public hospitals for which their insurers are not being charged. Consequently, those customers are not being charged while public patients are not getting the treatments they deserve. I do not have a difficulty with private patients having to pay for the privilege of obtaining services in public hospitals.

The Bill has a number of key aims. The fair deal scheme is currently run by the HSE to provide financial support to 22,000 people in long-term residential care. Currently, individuals contribute 80% of their incomes and 5% of their assets per year, which is fixed at a maximum of three years or 15% for their principal private residence and, in some circumstances, farms and other assets. The Bill seeks to increase the maximum payable proportion of a person's assets from 5% to 7.5% per annum. It abolishes the ability to backdate the entitlement for people in nursing home care before the scheme was commenced, which is particularly unfair. The digest of the Bill sets out that it is not known how many people this change will affect but indicates an approximate figure of 700.

Unfortunately, I cannot support the Bill. There was a great deal more that I wanted to say in that regard. I agree with the changes on the charging of private patients in public beds but cannot not agree with the charges for in-patient services for public patients. The latter will have a disproportionate impact on those on low and middle incomes who have borne the brunt of tax increases and pay cuts. I am not in a position to support that at all.