Mark Daly (Fianna Fail)
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I welcome the Minister of State at the Department of Health, Deputy Butler.

Mary Butler (Waterford, Fianna Fail)
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This might be my last time speaking in the Seanad as Minister of State with responsibility for mental health and older people with Senator Daly as Cathaoirleach. I thank him and all the other Members for the courtesy shown to me over the past two and a half years. I want to say a special word of thanks to the Cathaoirleach for the way he has magnified the importance of the Seanad.

Victor Boyhan (Independent)
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Hear, hear.

Mary Butler (Waterford, Fianna Fail)
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The celebrations over the last few months have been very timely. I was honoured to see the portrait downstairs of Tras Honan who is a Waterford woman and is originally from County Clare. She was the first ever female Cathaoirleach of the Seanad and it is fitting to mark her achievement. I say well done to the Cathaoirleach on all of his work and all the support he got from Members.

I am pleased to have this opportunity to address the House on the Health Insurance (Amendment) Bill 2022. The Bill was published on 24 November and concluded its passage through the Dáil on 7 December. I welcome the support received in this House for the Bill and the core principle of community rating, which is a long-established and well-supported Government policy for the health insurance market.

Currently, over 46% of the population in Ireland hold private health insurance. This amounts to 2.4 million people and represents a total annual premium income of approximately €2.97 billion. Health insurance in Ireland is provided according to the four principles of open enrolment, lifetime cover, minimum benefit and community rating. In our community-rated health insurance system, customers are not charged based on their risk profile. This means that the premium charged for a particular health insurance product is the same for everyone. Insurers cannot take into account personal circumstances like health status, risk or age in which case older and sicker people would pay much more for health insurance than they currently do.

Risk equalisation is a mechanism designed to support the objective of a community-rated health insurance market. The risk equalisation scheme has operated in the health insurance market since 2013 and is provided for under the Health Insurance Acts. Under the risk equalisation scheme, insurers receive risk equalisation credits from the risk equalisation fund to compensate for some of the additional costs of insuring older and less healthy members. The risk equalisation scheme is a carefully calibrated and highly complex scheme. Risk equalisation credits are funded by stamp duty levies. The levies are payable by health insurers on all health insurance contracts written and are paid into the risk equalisation fund. The risk equalisation scheme is designed to be Exchequer-neutral. It is not funded by the State, nor does the State derive any funds from it. None of the stamp duties on health insurance contracts go to the Exchequer. They are all used to fund the credits.

This is an annual technical Bill comprising eight sections, all of which focus on the specific area of health insurance. A health insurance Bill is necessary each year to update the amounts of risk equalisation credits paid to insurers and the stamp duty levies required to fund them. The rates of credits and levies are based on recommendations from the Health Insurance Authority, HIA, following an evaluation and analysis of health insurance claims. The Minister for Health has approved the risk equalisation credits to apply in 2023 and the Minister for Finance has approved the corresponding stamp duty levies. As the risk equalisation scheme is deemed to be State aid, it must be approved by the European Commission. It was duly approved in March 2022 to operate until March 2027.

In addition to the standard technical amendments, this year's Bill provides for the specification of the end date of the act of entrustment. This is the legislative mechanism under which the risk equalisation scheme operates. This is a requirement of the European Commission as part of its approval of the risk equalisation scheme earlier this year. The end date of the act of entrustment should be viewed as a technical end date required under European law. This date matches the duration of the Commission's approval of the operation of the risk equalisation scheme. The Bill provides for the Minister to specify a new date after consultation with the European Commission and the Minister for Finance.

The Bill makes further provision for the appointment and powers of authorised officers of the HIA, thus strengthening the enforcement powers of the authority in carrying out its role as regulator of the private health insurance market. I will now outline the specific sections of the Bill.

Section 1 defines the principal Act as the Health Insurance Act 1994.

Section 2 amends the principal Act by inserting a new section 6B, which specifies the end date of the act of entrustment - the legislative mechanism under which the risk equalisation scheme operates - as required by the European Commission as part of its approval of Ireland's risk equalisation scheme. The end date for the period of entrustment should be viewed as a technical end date, which is required under European law. This section provides for an order-making power for the Minister to specify a new date after consultation with the European Commission and the Minister for Finance. This power will provide the Minister with the authority to extend the duration of the period of entrustment in exceptional circumstances to ensure the continuity of the risk equalisation scheme.

Section 3 amends section 11C of the principal Act to provide for 1 April 2023 as the new effective date for revised credits payable from the risk equalisation fund.

Section 4 amends section 18E of the principal Act by making further provision for the appointment of authorised officers of the HIA. The amendments outline in more detail who may be appointed as an authorised officer and when the appointment may cease.

Section 5 amends section 18F by extending the current legislated enforcement powers to non-registered businesses purporting to be carrying on health insurance business in Ireland. This amendment bridges a limitation of the existing legislation which permits investigation of registered undertakings. Again, this section follows, insofar as possible, the Central Bank (Supervision and Enforcement) Act 2013, as amended.

Section 6 replaces table 2 in Schedule 4 of the principal Act. This table revises the applicable risk equalisation credits payable from the risk equalisation fund in respect of certain classes of insured persons. The amounts are applicable on or after 1 April 2023. The Bill provides for a decrease in the age-related risk equalisation credits payable across approximately half of the age groups over 65. These decreases are to facilitate the redistribution of high-cost claims credits, which results in a more targeted distribution of credits based on health status rather than age.

Section 7 amends section 125A of the Stamp Duties Consolidation Act 1999 to specify the stamp duty rates to apply to the market in 2023. The amount of stamp duty levy is calculated to offset the costs associated with the payment of risk equalisation credits. The HIA recommends the amount of stamp duty levy to the Minister each year, having regard to the risk equalisation fund. For next year, the stamp duty payable on non-advanced health insurance contracts from 1 April 2023 will be €109 per adult. This is a decrease of €12 from 2022 rates. The rate per child will be €36, which represents a decrease of €4. On advanced health insurance contracts, the stamp duty will be €438 per adult. This is an increase of €32 from 2022 rates. The rate per child will be €146, which represents an increase of €11. A surplus of €55 million, or 7% of the fund, is expected next year as there was a lower level of claims on the fund than anticipated. The HIA recommended that this €55 million should be used to reduce the amount of stamp duty to be charged from 1 April 2023. The rates of stamp duty payable incorporate the €55 million surplus. This surplus has built up because of lower claims due to lower levels of hospitalisations as a result of Covid-19, and an increase in expected stamp duty receipts due to higher numbers of people entering the health insurance market than had been projected.

Section 8 provides for the Short Title, commencement, collective citation and construction of the Bill.

While the Government continues to maintain the community-rated private health insurance market, I will conclude by highlighting its commitment to improving public health services under the Sláintecare programme. As access to these services improves, the Department will monitor the impact on the health insurance market over time. I commend this Bill to the House.

Jerry Buttimer (Fine Gael)
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I am standing in for Senator Conway. I welcome the Minister of State. I hope this is not her last time to address the Seanad as Minister of State at the Department of Health because, to be fair to her, she has been a very proactive Minister of State. I do not say that patronisingly. As a former Chairperson of the Joint Committee on Health and Children I found it refreshing to see her take on vested interests in her Department. I commend her on the work that she has done during her time in office. I hope that if she is not promoted elsewhere next week, she stays where she is in the Department of Health.

As the Minister of State has said, this Bill is important as it deals with risk equalisation and private health insurance. However, I will begin on a discordant note. The HIA produced a report last summer which found that some private health insurers were not fully compliant with the Health Insurance (Amendment) Act 2020. I hope that the whole issue about the obligations under risk equalisation being fulfilled will be dealt with, and the incidence of non-compliance will be identified and published, but in the main it has been well done.

This whole issue is about the march towards universal healthcare and Sláintecare. In welcoming the progression of Sláintecare, which is the proposed model to deliver the healthcare system, and the advances we are making, I would have a fundamental worry about Sláintecare. On a personal level, I worry that it may not deliver what we want. Having said that, last week the Minister for Health was successful in being able to get the new hospital consultants contract over the line and I congratulate all involved.It is positive that we will see public hospitals being used as such and the whole reverse in terms of private and weekend use and so on. It is important that we recognise that delivery is working.

At the Seanad 100 celebration last Monday, Dr. John Bowman spoke about his Japanese political scientist. I often wonder how an outsider would view our healthcare system in terms of the way in which we administer and pay and fund it. I should put on record my appreciation to those men and women who work day in, day out in all parts of the healthcare system. They do a tremendous job.

Mary Butler (Waterford, Fianna Fail)
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Hear, hear.

Jerry Buttimer (Fine Gael)
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I thank them for that. I know first-hand from my own experience this year of how much work they do and the care and attention they give to the families and those patients who need it.

The Sláintecare consultant contract is transformative. A public-only hospital contract is to be welcomed. Then, in tandem with that, there is €23 billion in the healthcare budget for this year. We have increased the number of acute beds with a 26% increase in critical beds. Senators Gavan or Maria Byrne will come into the Chamber and speak about capacity in places like the emergency department in Limerick hospital. I see it in Cork. To be fair to the Minister of State, she has tried very hard to apply the model of care in the community at home. I hope that in the next round of Sláintecare, however, we will take that piece and augment and add to it in the context that the best place to care for people is in the community and at home. The Minister of State has been a champion of that.

We have an issue of capacity around emergency departments, however. They are chock-a-block. Whether that is because of the variety of delivery of free schemes to people now I do not know. GPs will tell the Minister of State they are swamped, however. They have an older and younger cohort in the middle. They cannot cope. They cannot get people. Staffing is a big issue across the whole country. In conclusion, rather than delay the House, we will obviously be supporting this as a party. The advance of Sláintecare is to be welcomed. I thank the Minister of State for being here tonight.

Victor Boyhan (Independent)
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I welcome the Minister of State. At the outset, I echo what Senator Buttimer said. I thank the Minister of State for her ongoing engagement and support in this House at all times, be it for Commencement matters or legislation. She is always willing and ready to come to the House and meaningfully engage with Members. That is acknowledged and appreciated across the House. I wish her well at the weekend's deliberations and all that goes with that.

To get back to business, we are dealing with the Health Insurance (Amendment) Bill 2022. The Minister of State set out the rationale and I understand that. It is an annual event that happens every year. Indeed, the Minister of State might have done it last year as well. What I really wish to say is that we need greater scrutiny and clarity in terms of the options for private healthcare. It is one of a facet of choices people have in healthcare. The Minister of State spelled that out too. It is an option. People are entitled to take out private healthcare and they pay for it. It is an expensive care package, really. That is the reality of it. Most of us will have had private health insurance for many years and never made a claim, but we never quite know when we will have to make a claim. There is a comfort in that as well. It is costly, however. The big issue in terms of consumer protection is that there are so many differences and different packages and policies. I would like to have a debate another day on how we can be clearer about what people are getting for their money and what it says on the tin. I know myself it is always difficult to ascertain. There are always variations and changes within one's own policy, be it Vhi Healthcare or whatever. I ask the Minister of State to take that away with her.

I will deal with two or three points from the Minister of State's presentation to us today. She referred to a surplus of €55 million or 7% of the fund. She went on to say: "This surplus has built up because of lower claims due to lower levels of hospitalisations as a result of Covid-19." We know that. In some cases, some of us would have received money back from Vhi Healthcare and private health insurers last year and the year before unexpectedly. One could call it a refund or bonus or whatever but we got cheques back, which are always nice to get. We need to see all around the policy of that, however. It is clearly a Government decision to ring-fence this money. The Minister of State set that out and I have no difficulty with it. I would like if we could have a bit more background paper on that from the Department at some stage in terms of the policy and the surplus. We know it is €55 million. That is a considerable amount of money. There are various choices around that. I do not expect the Minister of State to go through them today but it would be helpful if we could have a briefing note on the policy, governance and decision-making around how she apportions that percentage of funding. She went on to say that "the programme for Government commits to retaining access to private healthcare ... " I would agree with that too.

Senator Buttimer touched on Sláintecare and universal healthcare. That begs the question about universal healthcare, which is something we have been promised for many years but do not seem to be making real progress on. It was very much on the platform of the manifestos two or three elections ago. It continues to raise its head and we do not seem to be any nearer to it. I know we have had different setbacks. I welcome anything that sees further progress of Sláintecare. While we are not really dealing with Sláintecare, I will take the opportunity to say there is progress. It is slow and it could be faster but I recognise there are many constraints. It is something on which we need to continue to focus. I think the Minister of State very much for her presentation today.

Catherine Ardagh (Fianna Fail)
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I stand again today for my colleague, Senator Clifford-Lee. I thank the Minister of State for coming to the House. It is always great to see her. She has done some super work in mental health and in her portfolio. I wish her the best of luck.

Fianna Fáil will be supporting this Bill. The Health Insurance (Amendment) Bill 2022 is somewhat akin to the Finance Bill and Social Welfare Bill, arriving in November or December every year just like Santa. The measures within are designed to support risk equalisation and sustain community rating in our health insurance market in order that older citizens and people with illnesses can afford health insurance and are not discriminated against in favour of younger and healthier people.

The Health Insurance (Amendment) Bill provides that stamp duties on non-advanced health insurance contracts will increase to €109, which is a decrease of €12. This comes on top of a decrease of €35 this year. Stamp duties on advanced health insurance contracts will increase to €438, which is an increase of €32.

It should be pointed out that despite this increase, the levy on advance cover will still be lower than 2021. The stamp duties collected on health insurance contracts do not go to the Exchequer. They are collected into the risk equalisation fund and redistributed in the form of credits to health insurers to compensate for the additional cost of insuring older and less healthy people. I very much welcome this Bill.

With regard to health insurance and how it links with orphan drugs, we know many health insurance providers such as Vhi healthcare and others are now paying for orphan drugs. They would have been under a lot of pressure from large policyholders and multinationals to pay for these drugs because they are available when they pay for health insurance in other countries. However, I would like to see a space where orphan drugs are more widely available to the public and those who do not have health insurance. I am hopeful that is something at which the Minister of State can look.

This next item is not related to the Minister of State's Department. It is more of a matter for the Department of Finance, but I would hope that the Minister of State would bear her weight when raising it with Minister for Finance. The Central Bank (Amendment) Bill 2022, which deals with the right to be forgotten for cancer survivors, came before this House recently. I am Chair of the cross-party group on cancer that came up with the Central Bank (Amendment) Bill, which received massive overwhelming cross-party support in this House. The Bill seeks to ensure that cancer survivors who have had cancer in the last five years will not be asked questions regarding their illness when they apply for life insurance policies or other financial products.

This is not something novel we are starting in Ireland. This legislation is well-entrenched, especially in France. It was one of the main election items in President Macron's manifesto. They started out with people having a right to be forgotten for ten years and President Macron reduced that to five years during his presidency . There was strong rebuttal by the insurance companies and much lobbying was done in France. We are obviously seeing similar pushback in this country. I am hopeful it is something the Minister of State could raise with her colleagues, however, because it is really important. The Minister of State has spoken out about her own survival journey. I am sure she will be supporting this.It is one of the main priorities of the Irish Cancer Society.

I will refer to another matter in order to finish to a very positive note; we have done great work this term on women's health and mental health services. We have menopauses clinics, endometriosis clinics, “see and treat” clinics, and a significant decrease in gynaecological waiting lists. Yesterday, we saw announcements about surrogacy. There have been significant advances in women's health and mental health.

Mary Butler (Waterford, Fianna Fail)
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Perinatal clinics.

Catherine Ardagh (Fianna Fail)
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Yes, the perinatal clinics also. I also refer to the funding that has been allocated for IVF. The Department has done a lot of work and has covered major areas.

The consultants’ contract that was agreed last week was a significant body of work. I do not know if people realise the amount of time and effort the Department and the IHCA have put into it. We will see the benefit of the removal of that significant bottleneck when we go to hospital.

Vincent P Martin (Green Party)
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As always, the Minister of State is very welcome to the Chamber. As has been stated, Ireland has a community-rated voluntary private health insurance market, which means all people pay the same price for the same health insurance policy. The risk equalisation scheme is the mechanism designed to support the objective of our community-rated health insurance market.

The content of this Bill, which is largely technical in nature, is to be broadly welcomed as a fair approach to health insurance provision.

I will use some of my time to point out that the Bill highlights and reminds us about the divide in the Irish health provision, between public and private services. While it is a very important Bill for people who rely on private health insurance, it is worth noting that it also ensures fairness across the system and guarantees that sicker people or those at risk are not paying more for their policies. However, as I stated, it highlights the unfairness in the health service that forces people to take out health insurance for fear that if they get sick the public health system will not be able to treat them in a timely manner. The health budget in Ireland is approximately €22 billion, yet around 50% of people here take out private health insurance. We are very much part of a two-tier system. The current two-tier health system has failed many. The creation of a waiting list acts as a perverse incentive, creating a need for patients to purchase health insurance in order to access treatment, as it offers the safety net of being able to access treatment if the need arises. That is because they are aware of the two-tier system. The result is a system of unequal access to healthcare with arbitrary barriers to access and often preferential access for those who have the financial wherewithal through taking out private health insurance.

In all, there are currently approximately 897,000 on hospital waiting lists in Ireland. There are more than 97,700 children on waiting lists, which is one in four children on their respective lists for more than a year. The child and adolescent mental health services, CAMHS, have a waiting list of 3,914 children. Some 53% or 1,808 of them are waiting for less than 12 weeks for an appointment, while 9% or 221 are waiting longer than 12 months.

We hope Sláintecare will herald a change. The Green Party policy on health is to support the reform of the health system through Sláintecare. This includes a single-tier health system based on need rather than the ability to pay, which is funded through general taxation. It includes multi-annual budgeting, activity-based costings and blended capitation schemes to incentivise efficient, targeted use of resources through our health system; a fully-funded national service of public health nurses at an advanced level, who would engage with patients in their own homes and who could refer patients, as appropriate. We must properly fund the wonderful people on the front line.

Sláintecare includes increased numbers of advanced paramedics who could treat patients in their own homes so that they would no longer have an essential need to go to hospital. It is intended to have extended services in community pharmacies to increase the support for general practice services. Sláintecare will provide for more investment in general practitioner services to allow for minor procedures and specialist services to take place outside of hospitals. It is intended to reform the Health Service Executive and to set up local community health organisations which will include a balance of community and patient participation as advised by healthcare professionals.

There is a process in place through the Government to respond to the ongoing waiting list situation, but it has not yet resulted in what I would consider to be significantly reduced waiting list numbers across the public system. The Government says it is working with the Department of Health and the National Treatment Purchase Fund to improve access to care, fund weekend work in public hospitals, use private hospitals and provide virtual clinics. The latest news is the effort made to get consultants to work in public hospitals. It is all to be welcomed if people will buy into it, and if we attract consultants home.

The cancellations that occurred during the height of the Covid-19 shutdown continue to have an impact and the health service is still catching up with it. A task force has been established as part of the 2022 waiting list action plan to reduce waiting times, yet they continue.

I have used much of my time to concentrate on the elephant in the room, but I want to be fair – I know the Minister of State, Deputy Butler, in particular and the Government have made progress. I would like to put that on the record and commend it. Much progress has been made, but at a time like this when we are discussing a technical Bill, I want to draw attention to the long-standing reality of inequality in the system which is still a two-tier one. In the longer term, I would like to see that addressed.

Jerry Buttimer (Fine Gael)
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Senator Martin is absolutely right.

Mark Daly (Fianna Fail)
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I welcome Councillor James Geoghegan and his guests to the Gallery. They are most welcome to Seanad Éireann today. I hope they enjoy their time in Leinster House on our 100th birthday, plus three days. They are more than welcome to buy us cake any time they want.

Niall Ó Donnghaile (Sinn Fein)
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The Cathaoirleach should not mention cake during a health debate.

Mark Daly (Fianna Fail)
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It has no calories.

Jerry Buttimer (Fine Gael)
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What about a good Ulster fry?

Mark Daly (Fianna Fail)
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A Christmas cake.

Niall Ó Donnghaile (Sinn Fein)
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That is a different story. As other colleagues have noted, the Minister of State is very welcome to the House. I also appreciate her regular engagement with this Chamber. Before coming to speak to the Bill before us tonight, I am sure she and other colleagues will join me in sending our solidarity and support to the nurses in the North of Ireland and in Britain, who are on strike at the moment. They will go out onto the picket again tomorrow. It is an absolute disgrace that they have to do that, not least in sub-zero temperatures. I call on the British Government to bring forward a deal that meets the needs of those workers, who are out for fair pay and better working conditions. In particular, I note the sterling work of Pat Cullen, the secretary general of the Royal College of Nursing, RCN. She is a Tyrone woman, but she has lived in south Belfast for many years and she has provided first-class leadership to the nurses there. I thought it was important to make reference to that.

I have spoken on this legislation previously. I must reflect on my own experience as this State moves ever closer to a universal healthcare system. I am very conscious that I have had the privilege to grow up with a universal healthcare system, free at the point of delivery, in the North. It is deeply regrettable and hugely regressive that it seems the British Government is moving further away from that all of the time by hollowing out the NHS and moving to a privatisation model. We are seeing the consequences of some of that in the strike action by the nurses, but sin scéal eile.

I want to set my comments on the Health Insurance (Amendment) Bill in the context of how people in need of the health service or those who work in it currently experience it at the point of delivery. I am stating the obvious when I say that our health is our wealth. Is fearr an tsláinte ná na táinte. From the cradle to the grave we all, at some time on the spectrum of life, will use the health service. I am also stating the obvious when I say that the health service of this State is not in a particularly healthy state. Currently, there are 1.3 million people on some form of health waiting list; 897,000 people on hospital waiting lists - 200,000 waiting for more than a year, which I acknowledge is down since last year, but nowhere near where it needs to be. Some 200,000 people are waiting on a diagnostic scan; 97,000 children are on hospital waiting lists; 100,000 children are on community waiting lists; and 18,000 on children disability network teams, CDNT, waiting lists. The Minister's approach to waiting lists is failing.

It is no wonder that half of the population hold onto their private health insurance. However, we must recognise the shortcomings of private health insurance.Sinn Féin tabled an amendment previously when the Government saw fit to increase the profit allowed for insurers from 4.4% to 6% with no improvement to those services. We sought to reverse this increase and to undo it at a time of rising costs of living for families across society. We are all caught in that cost-of-living crisis, whether it is rising energy costs, insurance costs, food costs or all the other costs that people face.

All of that said, as the Minister of State will know from contributions in the other House, Sinn Féin will support this Bill as we always have. We recognise the reliance of many people on health insurance. It is an annual Bill that renews the risk equalisation mechanism that supports the community-rated health insurance market. The Bill revises the stamp duty levy on policies and the risk equalisation credits payable to insurers for 2023. It is a self-funded system. Risk equalisation ensures costs are constant across the lifespan of the individual. It seeks to ensure, where possible, that age, gender and health status do not influence the cost of insurance product.

In supporting this Bill, I want to make our criticism of the current insurance market and the two-tier healthcare system in this State clear. The two major areas in which little progress have been made and that are relevant to this Bill are, first, removing healthcare from public hospitals and, second, expanding universal GP access and free GP care. The lack of action is driving much of the private sector activity in healthcare, which is embedded in our public hospitals. We need, once and for all, as other colleagues acknowledged, not just to agree but to deliver on the commitment to disentangle private healthcare from public hospitals. In addition, the Government needs: multi-annual capital funding to enable quicker delivery of hospital expansions; a strategic workforce plan to expand training and the number of workers to deliver universal GP care or expand primary and community care to reduce the burden on acute hospitals; to address the shortage of home support assistants or transitional step-down beds; and a plan to remove out-of-pocket charges and make all health and social care free at the point of delivery.

While Sinn Féin supports this Bill, we do so because it is technical legislation. We do not support a two-tier health service. That is the crux of the issue. When it comes to removing private healthcare, to free GP care, investing in public health care, and reducing people's need for private health insurance, Government policy is defined by a failure to plan. This Government is without a health service plan and, unfortunately, it shows.

Mark Daly (Fianna Fail)
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I welcome the Minister of State and thank her for all of her visits to Leinster House. We wish her all the best over the next few days.

Mary Butler (Waterford, Fianna Fail)
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I thank all the Senators for their contributions to the debate. The Bill allows us to maintain our support for the core principle of community rating, which is a long-established and well supported Government policy for the health insurance market, and ensure that the cost of insurance is shared across the insured population.

The main purpose of the Bill is to update the amounts of risk equalisation credits paid to insurers and the stamp duty levies required to fund them. The amendments outlined in the Bill will ensure the ongoing sustainability of the private health insurance market. It will allow us to maintain the community-rated health insurance market and it will increase the effectiveness of the risk equalisation scheme.

On some of the comments made, it is quite right that almost 47% of people have decided to have private cover in Ireland. I also want to point out that 44% either have a medical or a doctor-only card. We will see more people receive the support of a doctor--only card in 2023.

We are making a lot of progress on Sláintecare. The public-only consultant contract signed recently is a huge step forward. This was one of the important pieces of the jigsaw. That is something that we have to recognise. We saw the best of Sláintecare during Covid, when the vaccine roll-out was one of the best not only in Europe, but in the world. The vaccines were free at the point of contact for all people who wished to receive one. That has to be recognised.

I am always conscious when I stand up in health debates that sometimes there is a lot of criticism of our health system. However, today I want to acknowledge and appreciate the 136,000 people who work in the system. I was in the Dáil last night at 11.20 p.m. taking a motion that was tabled on the challenges in emergency departments, and we recognised that. I was conscious at 11.20 p.m., when I was leaving the Dáil Chamber to go to my bed, that all over Ireland in acute and community hospitals, nursing homes, Caredocs and wherever, all of these people are working every night 365 days of the year to make sure that we are all safe, secure and that we receive the best healthcare possible. It is important to acknowledge that. These Houses go into recess for a month at the end of this week and we will see a new Taoiseach elected, but all of those people in healthcare will still be working. It is important that is acknowledged.

I wish to raise another point, because, as I said, we hear much negativity. This morning, for example, I was in Cherry Orchard and I was delighted to launch our 22nd integrated care programmes for older people, ICPOP, team. It is the most fantastic facility and a one-stop shop for older people to address the challenges they might have in, for example, their dietary requirements or whether they are risk of stroke or falling. A huge amount of work is being done. The most fantastic facility is being provided. Some 163 people were referred this year specifically for dementia. They are receiving the supports to age well at home with dementia, but also have the supports in the community. It is a lot of good work.

A huge milestone will be reached in University Hospital Waterford this Saturday. It will celebrate 1,000 consecutive days without a person on a trolley, which is an amazing achievement. I want to acknowledge Grace Rothwell, the general manager, her staff, the consultants, the doctors, the nurses, the healthcare workers, the porters and everybody who works in the hospital. To have that kind of an achievement is unbelievable. An awful lot of good work is going on and there is much more to do. I am happy to be in a position to try to effect change as best we can.

I will move back to the Bill again. It also makes further provision for the appointment and powers of authorised officers of the HIA, which is the statutory regulator of the health insurance market. These amendments strengthen the enforcement powers of the authority in carrying out its role as the regulator of the health insurance market.

The Government is committed to improving public health services under the Sláintecare programme, and the Bill demonstrates the Government's commitment to community rating. As access to public services improves, the Department of Health will monitor the impact on the private health insurance market. The programme for Government also commits to retaining access to private healthcare services for people in Ireland, ensuring choice for those accessing healthcare.

As Minister of State with responsibility for mental health and older people, I say every day that the voice and choice of people has to be listened to. This Bill continues our policy of ensuring solidarity with and affordable premiums for less healthy or older people.

Again, I thank all Senators for their contributions to the debate and for facilitating the passage of the Bill. I would also like to thank the three officials who have accompanied me in the Dáil and the Seanad to take the Bill. They put a huge amount of work into it and I thank them for all their work.

Mark Daly (Fianna Fail)
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When is it proposed to take Committee Stage?

Catherine Ardagh (Fianna Fail)
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Now.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Mark Daly (Fianna Fail)
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When is it proposed to take Report Stage?

Catherine Ardagh (Fianna Fail)
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Now.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Mark Daly (Fianna Fail)
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When is it proposed to take Fifth Stage?

Catherine Ardagh (Fianna Fail)
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Now.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.