David Cullinane
Waterford · Sinn Féin · Ireland
“I met many of those patients and people with the illness yesterday. Many of them were here in Leinster House. They told me, as they have in the past, they cannot walk and they cannot swallow and, as the Taoiseach acknowledged, it is also very difficult for their families who have to watch as their condition worsens and the disease progres…”
“In fact, in the programme for Government the Government committed to reviewing that process because it was accepted it does not always work. The technical review group obviously now needs to be convened and needs to meet urgently. Emily cannot afford more delays.”
“Yesterday, as the Taoiseach knows, the HSE drugs group met to consider reimbursement of Skyclarys, the first approved treatment that can slow the progression of Friedreich's ataxia. Patients hoped for a positive decision. This process has been ongoing for years.”
“They were left desperately making phone calls, checking for updates, asking journalists and asking politicians if they had heard anything. They were treated appallingly. Then, when the news did eventually filter though, they were left devastated.”
“Richard Walsh, consultant neurologist and co-director of the National Ataxia Clinic, has described this drug as a ground-breaking development. He has said that he would prescribe it if it were available in Ireland and that it may reduce the rate of disease progression.”
“"We are not going to regain any of the abilities we've lost, but Skyclarys will give us time. Time when you're dealing with our progressive relentless disease is everything. We all deserve time with our loved ones." Those are the words of Emily Felix, a 28-year-old trainee solicitor from Kilkenny who is living with Friedreich's ataxia.”
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“I am proud of all the Sinn Féin representatives and others in opposition who spoke in favour of the issues that those crews have been raising and that they want to be resolved.”
“It is not meant for people who are fully on duty, in uniform, restricted to base and required to respond without delay. The IAA is the competent authority. The CEO of the IAA should be dragged before as many Oireachtas committees as possible - including the transport committee and the public accounts committee - and the chief operations officer should be brought in with him to account for how they can stand over this. That will happen, and I want the committees involved to do as I suggest. The Minister of State has some responsibility here. The Minister for Transport did not even bother to come in to take the debate. That shows the interest he has in this issue. Search and rescue crews have been watching the debate. They know, because they have been raising these issues for years, that the Government is simply not on their side.”
“These are not different shifts; these are the same 24-hour duty periods with the same restrictions, the same requirement to remain at base or in nearby accommodation and the same obligation to respond immediately. If the engineers are working for 24 hours, then logic would say that the pilots and technical crew are also working 24 hours. The legal position, from my perspective, is clear: EU and Irish working-time law define working time to include on-duty call where the worker is required to be physically present at the workplace and ready to respond, and not anything else. That brings me to what appears to be the mechanism used to under-record these hours. We are told that standby factoring is applied to duty crews who are already rostered on shift. Stand-by factoring is meant for periods where someone is off duty but available.”
“The motion goes to the heart of whether the State is allowing a vital emergency service to operate in a way that is incompatible with the law, that is unfair to workers and that is dangerous in the context of public safety. Search and rescue crews do not work in an office environment; they are front-line emergency responders and they are work 24-hour shifts because the public needs a 24-hour service. Let us put some facts on the record. A standard 24-hour search and rescue shift includes six crew. Two duty engineers are recorded for the full 24 hours, and rightly so, but the two pilots and the two technical crew are recorded for only 16.5 hours. The Government seems to think that is fair. That difference is not illogical - it is indefensible.”
“Both Ministers of State who spoke gave good impressions of Pontius Pilate. Both washed their hands of any responsibility when it comes to the safety of crew and fatigue management. You cannot outsource this to the Irish Aviation Authority. Yes, it is the regulator but the Government has political responsibility and it is letting down all those valuable search and rescue crew who have been raising fundamental issues in relation to how their time is clocked and reported by the authority. I want to close this debate by bringing us back to what the motion is really about. This is not some technical argument about rostering, and it is not a narrow industrial relations matter.”
“One of our councillors, Catherine Burke, raised a motion at Waterford City Council that was supported by all parties, which I think has gone to the Minister of State as well. This is an issue across many constituencies. Everybody understands the hard work and dedication of our search and rescue services. We in Sinn Féin are not going to stand by when they raise very serious risk and fatigue issues and then have them dismissed in the manner in which they have been dismissed in the Government's amendment.”
“Fatigue is not solved by redefining hours but by respecting the hours, counting them honestly and rostering accordingly. The motion calls for a number of immediate steps, the first of which is that the Minister for Transport directs an urgent review of how 24-hour SAR duties are being recorded. I do not accept, with the Minister's amendment to the motion, that he has no responsibility. The Minister has a responsibility to ensure the health and safety of crews is respected and implemented in this case. Second, we want the IAA, Bristow Ireland and the IALPA to appear before the relevant Oireachtas committee to answer questions publicly and transparently. Third, we want the crews' concerns are engaged with in good faith, not brushed aside. Deputy Conor McGuinness and I, and one of our local councillors, Jim Griffin, met with staff members.”
“They are absolutely clear that the current system breaches the EU working time directive and domestic law. They are also clear that crews on these 24-hour duties are not merely on standby. They are in immediate readiness, on-site, at the employer's disposal and that time must be counted properly if fatigue is to be managed in any meaningful way. The Irish Aviation Authority, IAA, has responded to media queries on this issue by pointing to aeronautical notice 58 and to fatigue risk management systems. I have two comments on that. Rules and notices are only as good as how they are interpreted and enforced. References to fatigue management systems in the context of hours is disingenuous. Fatigue management systems are about identifying fatigue risk and mitigating it; they are not a substitute for properly counting duty time.”
“It is simply unacceptable that in the years since, we have a system that appears designed to squeeze more 24-hours shifts out of crews who are already raising legitimate safety and fatigue concerns. Over the past number of weeks, along with Deputy Conor McGuinness, I have met with SAR crew members from across the State. Those meetings have been detailed, honest and deeply concerning. The crews spoke with one voice. They are dedicated to the job, proud of service and worried about where this is leading. They described a steady erosion of working time protections, real fatigue and fear that if this continues, it is only a matter of time before another serious incident occurs. We cannot ignore that warning. In recent weeks, I also met with the Irish Air Line Pilots' Association, IALPA, which represents many of these crews.”
“If crews are required to work on base at their employer's disposal, ready to launch within minutes, that is work, that is duty and that is not rest. Let us be clear about the reality of the 24-hour search and rescue duty. These crews are not on standby in the ordinary sense of that term. They are in a state of immediate readiness. They cannot go home or switch off. They must be prepared to respond at any moment, often after a long day, and be sometimes into a second or even a third mission. That is why the recording of time matters. Fatigue in aviation is not a theoretical risk. It is a known killer. We have learned this through tragedy. In 2017, we lost four crew members in the Rescue 116 crash. That tragedy led to hard-won safety recommendations that everybody in this House supported, including a strong focus on fatigue risk management.”
“We owe them more than applause. We owe them safety, fairness and lawfulness in how they are treated. The motion notes the serious concerns raised by search and rescue crews and their unions about the way 24-hour duties are being counted. It is a fact that under the current system, a 24-hour shift is not being recorded as 24 hours; it is being recorded as 16.5 hours. That may sound like a technical or administrative detail but it has very real consequences. By counting 24 hours as 16.5 hours, the operator is able to roster many more 24-hour shifts across the year. The result is that crews end up working longer overall, with more long shifts and more cumulative fatigue. The union view is crystal clear. This is a breach of the EU working time directive and the Irish legislation that transposed it. I agree with the union.”
“No. 507/2006, Council Directive 2000/79/EC, and all relevant European Union (EU) and national safety legislation; — end the use of factoring schemes, that prevent accurate recording of the full 24-hour working period undertaken by SAR crews; and — ensure that working time, not merely duty time, is properly recorded and regulated in accordance with EU law. What is at stake here is very simple: the safety of the men and women who fly Coast Guard search and rescue, SAR, helicopters, and the safety of the public they serve. These crews carry out some of the most dangerous work in the State. They fly in atrocious weather at low altitude, often at night, often lifting people from cliffs or rough seas. They are literally the last line of rescue for families in Waterford, across the south east and right around our coastline.”
“I move: That Dáil Éireann: notes that: — the Irish Coast Guard's search and rescue (SAR) helicopter service serves a vital role in saving lives at sea and supporting emergency responses across the State; — SAR air crews are required to work 24-hour shifts, yet these shifts are being recorded as only 16.5 hours of duty time under Irish Aviation Authority (IAA) approvals; and — this under-recording arises from "factoring" schemes, normally applied only to standby or reserve crews, which reduce a full 24-hour continuous duty period to 16 hours and 30 minutes on paper; recognises: — the dedication and professionalism of Coast Guard SAR crews, who protect coastal communities across Ireland; — that SAR crews are required to be fully deployable within minutes throughout the entire 24-hour period, meaning the time cannot reasonably be classified as rest time; and — the necessity of ensuring strict compliance with all working-time, safety, and fatigue-management regulations; expresses its full support for Coast Guard SAR crews and affirms their right to safe, fair and legally compliant working conditions; and calls on the Minister for Transport and the Irish Aviation Authority to: — urgently review the system of recording SAR crew working hours; — ensure full compliance with S.I.”
“I hope the Tánaiste will accept the amendment, and if he cannot, I hope he will accept the thrust of the arguments we have put forward in a constructive way. We hope it is something he will look at in the future with potential alternatives to ensure every one of those patients is covered and given the support they need.”
“What the amendment is asking for is that the Minister would look at this issue and come back with a report with different options. One of them could be a grant system that might work. It is reasonable that we would want to be fair to everybody. If there are those who are probably the most deserving and most in need but are not getting the financial support, it does not make sense. At a time when we want more people to be treated at home and to reduce the need for people to go to hospital where we can, which would mean these patients would save the State millions of euro every year as estimated by Deputy Doherty, then it is important for us to make sure they are properly looked after. We have made our point.”
“Obviously, if you are getting home dialysis, by its nature, your house has to be extremely warm. That requires a lot of extra power and electricity. The tax return benefits some of those patients and that is great. It does help and is a generous payment. However, as Deputy Doherty said, there are some patients who do not benefit, whether they are pensioners, people who may not be working or those who are carers. There is a range of people who stay at home, for example, single parents. There are categories of patients who are not covered by this. Deputy Doherty outlined some alternative ways in which we could compensate people. Maybe it does not have to be a tax credit. You could look at a refundable tax credit.”
“It also means that patients are not going into hospitals. I have spoken to healthcare practitioners and people in the HSE on the wider issue of treatment at home where it is possible, where patients can be monitored and treated and do not have to go to hospital. That is what we should strive for if the technologies are there. They told me that one of the huge benefits of home dialysis was that it reduced the risk of infection for those patients, because people can get an infection or pick up an illness if they go into hospital. If you are on dialysis, that is the last thing you want, particularly now when we are coming into the flu season and there are respiratory illnesses. There are a lot of benefits, and we want people to avail of and benefit from this.”
“We have seen over the past ten years real improvements in healthcare technology, which are bringing tremendous benefits for patients and real opportunities for more care at home. I am sure Deputy Harris saw some of that when he was Minister for Health, and some of that evolving. However, it has changed and expanded exponentially over the past four or five years. We now see the HSE rolling out virtual wards and virtual beds where patients can be monitored at home. All of that is for the good. The issue Deputy Doherty raises relates to home dialysis, which is a success story. We have 344 patients treated annually. Approximately 110,000 home dialysis treatments per year are carried out at home. That saves the HSE a lot of money. It obviously saves thousands of visits to hospital for the patients in the first instance.”
“We look at costs in relation to public health, how much we are spending in health and how we can get more efficiencies in healthcare. We could talk all day about how we can achieve efficiencies but we also have to look at the private health insurance market, which is a big market. People are paying a lot of money and they want to know they are getting value for money and not being ripped off. When they see increases in premiums, they want to understand fully why that is happening. That was the purpose of the amendment.”
“Fortunately, he has now got on to the National Treatment Purchase Fund, NTPF, and I think he will be seen in the next few weeks. That is great, but we should have these elective hospitals doing these treatments at scale. I know we have had discussions about how long they will take and whether the capital funding is there. I believe that is one of the biggest reforms we can make. If we do make it, fewer people will feel the need to take out private health insurance if they believe they can get access to these types of procedures quickly and rapidly. I can accept or understand why the Minister is not accepting the amendment from her perspective. Irrespective of the amendment, it is important to us. She is right that the Oireachtas health committee is a place where we can do this and constantly look at these issues in detail.”
“I have described this before as reform with a big "R" in the health service. If we really want to reform waiting lists and want to transition to a single-tier health service, with people not having to take out private health insurance because they are fearful or are looking for rapid access, these four elective hospitals, providing on scale and at speed, rapidly, within weeks, elective procedures, would make such a difference. I raised with the Minister, also at the Oireachtas health committee, issues coming to me almost daily in my constituency, including hip, cataract and hernia procedures. Sometimes people wait over a year. One good friend of mine has been waiting 18 months for a hernia operation. Another friend of mine has been waiting over 18 months for treatment for cataracts.”
“We are talking about private health insurance and a lot of money being made by private health insurance providers. I am not against private health insurance. I personally do not have it but I am not against it. If somebody wants to take out private health insurance, good luck to them. It is a benefit to many people if they feel they cannot depend on the public system, and there are advantages to it, particularly in relation to planned procedures, elective procedures. I see them myself in my own circle of family and friends. They can get day case procedures done much more quickly if they have private health insurance and go to a private hospital. That is all the more reason, from my perspective, for us to prioritise the four public elective hospitals, complementing the surgical hubs.”
“All of that, in my view, is in the best interests of consumers, as is, as I said, looking at the rate of health inflation. It seems to me it is difficult to estimate and it fluctuates. I am not even sure if there is a perfect science in relation to health inflation. Certainly, it seemed to be extremely high a number of years ago. It seems to have come down. We were told previously that was down to the costs of, for example, equipment, consumables in hospitals and even food and that those costs were driving up health inflation, while pay was less of an issue. As I said, I support an annual analysis of the ongoing impact of the removal of private practice from public hospitals. I will not delay the passage of the Bill; I just want to make this point. I raised it very forcefully yesterday on Second Stage.”
“Previously, maybe two years ago, when we were having discussions about existing levels of service and what additional funding would be needed for the health service to stand still, we were told health inflation was running as high as 10%. Notwithstanding that, however, and even with inflation having come down, unfortunately premiums have gone up and up. In some cases, providers have put up costs twice. It is important then for consumers to know that the Oireachtas and the Minister are constantly looking at the profits private health insurance companies are making and the trend of providers' profits. What are the trends from 2019 onwards? Are they making more? Why are they making more? Is it because they have more customers or is it because they are charging more and making more money?”
“What we were looking for was a report that would look at a number of things. If the Minister looks at what the amendment actually calls for, it is for the preparation and submission of a report from the Minister for Health, having undertaken a review of the current profit rates of health insurance providers. The Minister will have noticed over the past year that most of the private providers have increased their premiums. One of the reasons they give, similar to what we are seeing in the public health service, is high health inflation. When I asked this at the Oireachtas health committee I think I was told that it had come down to about 3%.”
“The purpose of the amendment, however, is to ensure the Oireachtas is prepared for any potential consequences for consumers and ready to legislate to offset this against industry profits insofar as possible and if necessary.”
“(3) The Minister shall, on foot of this report, bring forward proposals for off-setting inasmuch as possible the rising costs for consumers against profits on the basis of the analysis conducted by the Authority.”.”. We have tabled an amendment to require the Health Insurance Authority to prepare a report on raising insurance costs, industry profits and the potential impact of the removal of private healthcare from public hospitals on insurance premiums. The HIA publishes an annual report and various other reports and is constantly monitoring the industry and the market. The removal of private practice from public hospitals is, from my perspective, a positive move, and we discussed that at length yesterday on Second Stage, but it may have consequences for premiums.”
“(1) The Authority shall, before and by 31 July 2026, prepare and submit a report to the Minister for Health having— (a) undertaken a review of— (i) the current rates of profit health insurance providers, (ii) the trend of profits of providers since 2019 to date, and (iii) the rate of health inflation from 2019 to 2025 and the corresponding changes in the costs of health insurance, and (b) conducted an analysis of the potential impact of the removal of private practice from public hospitals on the cost of health insurance. (2) The Minister shall, as soon as may be after the receipt by them of a report under subsection (1), cause copies to be laid before each House of the Oireachtas.”
“I move amendment No. 1: In page 3, between lines 17 and 18, to insert the following: “Report on profits, rising costs, and potential impact of removal of private practice from public hospitals 3. The Principal Act is amended by the insertion of the following section after section 33: “Report on profits, rising costs, and potential impact of removal of private care from public hospitals 33A.”
“There is a responsibility on the State, including the Department and the Government, to ensure that when the crews we send out in the worst seas, in the worst conditions and in the worst weather raise very serious safety issues, fatigue issues and workers' rights issues, they and their representative trade unions are listened to. We ask again that the Minister would intervene, notwithstanding what has been said here about the role of the regulator. There is a role for the regulator, but as importantly, there is a role for the Government.”
“I think the Minister of State is conflating fatigue risk management systems with accounting of hours. Crews would say they are two completely different things. Of course there should be fatigue risk management systems but this is counting one quarter of their hours as rest time. The Minister of State acknowledged in his response that these crew had to remain on base and were ready to be deployed at a moment's notice. The Minister of State said that this was a HR issue, was not for the Department, and was between the employer, the Irish Aviation Authority and the crew. This reminds me of the HSE where everything is at arm's length, where it is not the Minister's fault, it is not the Department's fault, it is some other agency's fault.”
“They are raising very genuine safety and fatigue issues. We ask the Government to intervene and that the Irish Aviation Authority ensure they are fully compliant with the European working time directive for these vital workers.”
“These are crew members who work 24-hour shifts. They are required to be on site and remain on base for the full 24 hours. At any moment, they can be called to be deployed. They are in a state of immediate preparedness and have to respond, sometimes in a matter of minutes, and they do. We saw that last week. Bizarrely, the Irish Aviation Authority and, by extension, the Government do not recognise their full 24 hours as work time. In fact, one quarter of the time they do as part of these 24-hour shifts is bizarrely labelled as standby time or rest time. That is clearly not the case. We are asking the Government to listen to the concerns that have been raised by the representative trade union and by crew members whom Deputy Conor McGuinness and I met over the course of the past few weeks.”
“In fact, the only funding that was given from the Government this year was to buy out the contract of the company that actually did the work on the preferred route. There are real concerns that this vital road is now being put on hold. The Waterford to Limerick road really needs to be improved. Deputy Conor McGuinness and I, and all the Oireachtas Members from across the affected counties, will continue to raise this to ensure that it gets proper funding next year. Today, we are here to raise very important issues about workers whose bravery goes above and beyond the call of duty. These are our air search and rescue crews. We saw that recently in a tragedy in Waterford when an aircraft crashed just outside Waterford airport. Unfortunately, there was a fatality. The air search and rescue service was on the scene very quickly.”
“They are telling us the essence of the Bill makes sense. We must listen to victims, make sure the laws of the State, particularly when it comes to sexual offences, are geared around the rights and needs of victims and, as I said, take away any power the perpetrators have. I fully support the Bill and commend it to the House. I again thank Deputy Carthy for proposing it.”
“I have spoken to many women who told of their sense of fear, not feeling safe and the worry when they hear the perpetrator is going to be released. Women must speak up, obviously, but so too must men. We have to call out the perpetrators of sexual violence and, of course, say it is wrong. We also must ensure perpetrators of sexual violence are properly held to account. It makes sense that the Bill be supported. At the core of most, if not all, sexual offences against women is control. We must take any amount of control we can away from the perpetrator, and this is one way of doing that. It makes perfect sense. I commend Deputy Carthy on bringing the Bill before the Dáil and giving us an opportunity to discuss it. I welcome Senator McCormack and all the women in the Public Gallery. They want action.”
“Respectfully, the Minister seems to have missed the point of the Bill. He has argued that victims who have reason to fear for their safety following the release of a convicted perpetrator have several legal avenues available to them to seek protection. The problem is that for many victims, those legal protections, as the Minister called them, are simply not fit for purpose because they force the victim to go back to court, retraumatise that person and put the onus and responsibility back on the victim, which is wrong. We need to ensure victims feel safe and can get on with their life rather than having to look over their shoulder, worried about whether they must go back to court to get a restraining order. The Bill makes sense and complements everything else in terms of existing supports.”
“We are going to hit a spend of €800 million on agency staff, yet nurses and other healthcare professionals who want to work in the public system cannot be hired, which makes no sense. Insourcing is going through the roof. It has now been stopped because of potential conflicts of interest but hundreds of millions of euro are being spent. The same is happening with outsourcing through the NTPF. We are not building elective hospitals and will not fund 3,000 beds. Elective hospitals, which are a big game changer, will not happen. Agency spend is up. Inefficiency is everywhere in the health service, yet patients are waiting for basic procedures. It does not make sense. It is wrong. They are the key issues that need to be sorted.”
“This is the reality of the health service at the moment. It is very difficult to get new money for new measures. While that is happening and families are paying for private health insurance because they cannot depend on the public system, this year €800 million will be spent on agencies. My partner is a nurse who left her job in Castlebar to move to Waterford about three months ago and is on a waiting list to get a job in a public hospital. There is still no offer of a contract. She is one of many people due to the strict embargo and bureaucracy that has been put in place in respect of staff recruitment. Workers like her were told to work for an agency and get a few shifts here and there. A premium of 30% is being paid. It is not ideal for the worker, taxpayer or anybody but that is what we are dealing with.”
“For me, that is a massive failure and lack of ambition from the Government. It also tells me that this is a Government that is happy to see people continue to pay private health insurance. I have no doubt that if people had rapid access to elective procedures like those I mentioned, namely, day case procedures, that would negate the need for many low and middle-income families to take out private health insurance. It would be the fastest way to eliminate that for many families and reduce the sphere of influence of private insurance companies. We talk about efficiencies in health care and the fact that we are spending record amounts of money on health, which we are because health inflation is high and we have to spend between €1 billion and €1.5 billion every year just to stand still.”
“There are regulatory requirements, which comes under the remit of the Minister of State. HIQA costs money. The former Minister, Stephen Donnelly, promised 3,000 beds, half of which have not been funded. That was another mirage by a Minister who made loads of announcements but never followed through on most of what he announced and left a mess, including the roll out of free HRT. I referenced GP only cards and hospital beds, most of which have not been and will not be funded. There are other elements of the health service which require capital funding, including every acute hospital and mental health and disability services. The money does not go. At a meeting of the health committee, we were told the best we can do for elective hospitals is get them to planning by 2031.”
“The surgical hubs which are being rolled out will help somewhat in that regard but the biggest game changer will be elective hospitals. I have raised with the Minister, head of the HSE and Secretary General of the Department of Health the fact that €9.5 billion in capital funding was given to health up to 2031. I met all of the officials, including those responsible for capital investment in the Department of Health, before the last election. They told me that what was needed was €13.5 billion. They have to finish the national children's hospital and the new national maternity hospital. There is digitisation and the roll out of measures which could cost up to €1 billion or more, and money has to be ring-fenced for that. There are climate action measures.”
“It is a similar system where diagnostic hubs on site or close to public hospitals carry out diagnostic tests which are important in terms of patients' healthcare journeys and provide results much more rapidly. Another benefit of elective hospitals is that we separate scheduled from unscheduled care. That will be a huge game changer. Every time we have a surge in our emergency departments, which we know happens almost every day in some hospitals and almost every other day in almost every hospital, one of the first casualties is elective procedures. That is the only option open to a hospital manager because they need to use all of the capacity in a hospital to deal with the surge of patients on trolleys. Separating scheduled from unscheduled care makes perfect sense.”
“The reply said 300,000 people were waiting for a scan - a CT scan, an ultrasound scan, very basic stuff. If somebody has private health insurance, they can go into a private clinic and get a scan or a scope done in a couple of weeks. If they are a public patient, they are waiting months and sometimes up to a year for a simple diagnostic scan. In fact, there are over 40,000 patients waiting over 18 months for a diagnostic scan. That is a shameful situation for us to be in. I told the Minister for Health in the Oireachtas health committee last week that, while I support the roll-out of the surgical hubs, we also need a roll-out of diagnostic hubs, which would be a sumilar system.”
“I contacted hospital management and they said he could be waiting 15 more months. He cannot see out of either of his eyes, so his quality of life is affected. His options are to go to Belfast, get it done there and recoup the money or he can get it done elsewhere through the National Treatment Purchase Fund, NTPF, which the hospital has now kindly agreed to. Why are people waiting so long for procedures like that? A new cataract unit was put into the hospital in Waterford, yet we still have people waiting. I have people almost every day asking how long more they are going to have to wait for their hip or hernia operations to be done. These are simple procedures where people should not have to wait for years. I submitted a parliamentary question last week asking about the number of patients waiting for a diagnostic scan.”
“The primary advantage for anybody with private health insurance is that they can get a hip done, a hernia operation done, a cataract surgery done and all those day case procedures, which are the low-lying fruit for the private health insurance market if we are being honest. That is where private health insurers step in by covering lots of those procedures and making lots of money on them. The logic of the elective-only hospitals is that we would have four of those, two based in Dublin, one in Cork and one in Galway. They would do these procedures on scale and rapidly, so people would be seen within a couple of weeks as opposed to waiting years. I am dealing with an elderly gentleman in my constituency of Waterford who needs two cataracts done. He has already been waiting eight months.”
“Part of the reason is because it is very complex for people to understand who qualifies. Even I, with my so-called wisdom, had a look at it and was still not able to figure out whether some families were entitled to the GP-only card. That needs to be simplified and better explained because it is far too complex for people to understand. The biggest reform we need to bring into the health service, if we are really interested in reform and dealing with waiting lists, is to build the elective public-only hospitals. That would be the biggest game-changer. It would be reform with a big R for a number of reasons.”
“I have always believed that public hospitals must be for public patients, where people are treated on the basis of equality and where we do not have, in our public hospitals funded by taxpayers, any form of two-tier entry or two-tier access. We are somewhat moving in the right direction in that area. There has been some progress made in recent years in relation to reducing the cost of healthcare. I would have proposed many of the measures that were brought in by the Government, and I supported them, but we are still a long way from where we need to be. For example, we do not have free primary care. Many people still pay for many primary care services, including GP access. I note that even the GP visit card, which was extended by the previous Minister, is not being taken up.”
“I accept that risk equalisation is important from the point of view of protecting certain cohorts of customers, which is why I am supporting the Bill, but we as a Parliament and as a people accepted when we signed up to Sláintecare that we wanted to move away from a two-tier system and embrace a single-tier health system, which exists in many countries in the world. They may not be perfect systems - no system is ever perfect - but I believe that universal healthcare systems are better than having a two-tier system. We are finally getting to the point where I can see, even in recent weeks, private healthcare is being removed from public hospitals. That is a positive step.”
“There are some people who will take out private health insurance for other reasons, but the vast majority of people I represent have private health insurance because they cannot depend on the public system and they are waiting too long on waiting lists for things like a diagnostic scan, sometimes for elective procedures, planned procedures especially and maybe for some key issues like cancer or cardiac where they can be seen in private hospitals. Most complex work is actually done in our public hospitals. It is the planned elective procedures where there is an advantage if one is a private patient.”