I know there are always many requests particularly on Tuesdays for the Adjournment. I thank the Chair for his indulgence in recognising that this is a very important matter and for allowing me to raise it this evening.
On Monday, 20 February it came to public attention that the VHI were changing the circumstances of their insurance and they were no longer giving satisfactory cover to people faced with substantial medical bills arising out of road traffic accidents. I am specifically relating to rule 6.15 and rule 1.8 of the VHI under which victims of road traffic accidents are now being told that under the Health (Amendment) Act, 1986, whereby hospitals were entitled to charge those victims for hospital maintenance and other medical bills, VHI would no longer in all cases pick up those tabs even though those people might have been in the VHI. This is very upsetting to many people in that they do not know where they stand in relation to cover for the simple reason that the VHI in clarification in a statement issued on 21 February said that the VHI will provide the normal benefits
through the discretionary powers contained in Rule 1.8. This rule has been included specifically for this purpose and reads "VHI reserves the right to waive the strict compliance with any of the Rules in exceptional circumstances and in the interest of an insured member".
What they are now saying is that there are now discretionary powers under which they may or may not pay the bills. An accident is not something that occurs by design but victims of accidents now do not know whether or not they are covered. This is unacceptable and can only result in the VHI losing more members.
Where someone with full comprehensive insurance cover has an accident the insurance company will pay the bill, but because of this decision it seems that people will be forced to come up with very substantial up front cash outlays and they have no guarantee that they will be covered. Where a person with only third party insurance cover has an accident which is his own fault he will not be covered by third party insurance.
There are two types of cases, one where the motor insurance company will eventually pay and the other where they definitely will not pay. I want a categoric assurance from the Minister that where there is no motor insurance liablility the VHI will cover the person, as 34 per cent of the population are in the VHI, and that where someone is not in the VHI and is in a public bed, the State will pick up the tab. I also want a clear cut commitment that people will not be faced with the hardship of substantial cash outlays.
My case may seem unreal but I will give a couple of cases where this will be a very practical concern. It has been brought to my attention that members of personnel working in our emergency services, the fire brigade for instance will be in difficulties. The fire service because of its nature has staff on a part time basis; they are on an on-call basis. What is their position? As of Monday, 20 February the VHI were saying one thing in their statement and on Tuesday The Irish Times of 21 February in referring to the assistant chief fire officer of County Cork said:
Mr. Donal Doonan, assistant chief fire officer for County Cork, said that when he rang the VHI in Dublin yesterday to ask about accident cover for himself and colleagues whose work involved intensive travel by road, he was informed by a senior supervisor that the change in the rules meant "absolute exclusion".
"When I asked what would happen where there was no third party involved, I was told `Well, under the circumstances, you'd have to fall back on the State and go public'." Mr. Doonan claimed.
This is no way to treat our essential emergency public services personnel whose life and limb are put at risk in the course of their duty. Are these people to be left high and dry by the Minister and the VHI?
This is a problem that can be easily resolved. There are many cases where the motor insurance industry have lobbied this House for changes to help themselves. I refer to the very substantial pressure that was put on all parties to abolish juries in civil liability cases. Because of that pressure we have a committee in the Department of Industry and Commerce which deals with for instance cases of refusals of car insurance for young people and so on. Why could this Minister before a decision was taken not call in the Federation of Irish Motor Insurers and thrash out some agreement whereby in the event of a hospital bill some arrangement would be made so that the VHI would pay it or the bill would be left in abeyance until the motor insurance company would pay it so that whatever happens the victim would be covered one way or another? It is simply a matter of getting heads together and streamlining the procedure. That procedure should be based on the following principle: If a motor insurance company accepts responsibility for repairing a car it is only reasonable that they should be responsible for repairing the occupant of the car. There should be clearly established cases where there is responsibility for the motor insurance company and a victim should not be asked to pay the bill. In cases where people are not covered, for instance a person with a third party liability involved in an accident which is his own fault, the VHI should honour all of those cases and where a person is not a member of the VHI the State should pay the bill. In case this seems academic, I will refer to a bizarre case which was outlined in a letter I received from a parent:
In May-June 1987 my son was "knocked" down and hospitalised at Mullingar and then Temple Street. I had Plan B VHI cover. The situation re non-payment by the VHI applied and thereby followed a series of unbelievable events. Temple Street Hospital issued bills to me to the value of £2,800 approximately, VHI would not pay and then they (Temple Street) issued a civil bill. Then they wrote at a later date to state that they would waive the action and await the outcome of civil proceedings but that their bill would now be £6,000 approximately.
Arising out of this the question must be asked why is it that when it goes to litigation they want £6,000 when there are no costs involved for the hospital concerned? The second question that arises is that this person was a category 2 person and had a hospital services card. Why is the full economic cost being charged to this patient who has statutory entitlement to a free hospital bed under the 1970 Health Act?
To add insult to injury she goes on to say that not only did she get letters from the hospitals but that the consultants went after her separately and were not prepared to accept the circumstances of waiting until subsequent litigation would take place. This was all because her son was unfortunate enough to be a pedestrian on a particular street at a particular time and knocked down. In my view this is not acceptable. The outcome of this episode, which is typical, is that she and her family have left the VHI because they are not prepared to accept this type of treatment.
Recently we had a debate in this House in relation to another aspect of the VHI recovery programme. I will deal with it very briefly. It related to the drugs refund scheme. A very strong argument was put forward by the Minister and the Department that they would not countenance continuation of that scheme because for long term illnesses there would be a predictable need for this medication, that next year and the year after an asthmatic would need this medication, that that was not an actuarial risk, that it was not real insurance because these were predictable needs. How more unpredictable can one get than to be involved in a car accident? It is quite extraordinary that the VHI and the Minister are having it both ways so far as both predictable and unpredictable illnesses are not being covered.
The Minister said — and it is quite extraordinary — in the same article in The Irish Times of 27 February 1989 that he did not know how hospitals and health boards would react if no VHI funding was available for accident cases and if patients asked for their bills to be deferred until their cases went through the courts. The new practice has interesting implications which the Department should be looking into immediately. Here we have the Department sitting back again with no preparation or no anticipation of these decisions at a time when it is clear that the whole basis of the VHI goes back to the Voluntary Health Insurance Act, 1957. This is very important because this Minister seems to be unaware of the provisions of the establishment of the VHI. Section 4 (1) and (2) states that:
The Board shall make and carry out a scheme of voluntary health insurance for defraying, to such extent as the Minister may from time to time specify, the cost to persons paying subscriptions to the Board in respect thereof, and to dependants of such persons, of such medical, surgical, hospital and other health services as the Minister may from time to time specify.
The Board may make and carry out such other schemes of voluntary health insurance as it may think fit, subject to the consent of the Minister in regard to the scope and extent of the benefits.
This legislation is not in any way ambiguous. It says that the VHI cannot alter their plans without ministerial approval. Either the Minister is not discharging his duty or he is not fully aware of the fact that he is ultimately responsible. Therefore, this is very appropriate. The Health (Amendment) Act, 1986, specifically entitles the authorities of the hospital to charge the cost of providing treatment where there is a likelihood of damages or compensation from a third party. There are two roles in which the Minister is involved, first, because his hospitals are producing these bills the problem has arisen and, secondly, he is responsible for the VHI.
I call on the Minister to initiate talks immediately between the VHI and the motor insurers to ensure that the public know that whether they are in the VHI or are public patients, they will be fully protected from the stress and tribulation of these bills. If the VHI are saying that the sole problem here is that, say, someone has an accident and is injured and the hospital come up with their bill, the VHI pay the bill, a settlement is made on the steps of the court for the victim, the motor insurance company pay the victim but the victim does not pay the VHI that is fair enough but why is it in every other respect in relation to civil damages that we have a standard accepted practice whereby solicitors can issue letters of understanding, whereby a solicitor where he is confident that he will win a case can issue to any third party a letter of understanding stating, "we are expecting a claim to be successful"? He would then go along to a bank and say "I will personally authorise clearance of, say, £4,000 to pay this". If the VHI could only make payments in instances where there is a letter of understanding that would get over the problem. I have spoken to members of the Incorporated Law Society and they said it would not be difficult, given the nature of other types of claims where there are other types of bills and services provided in the event of accident, to devise such a system. All in all, and I do not wish to detain the House too long, it is unacceptable that the public should be treated in this cavalier way.
I am not satisfied with the Pontius Pilate way in which the Minister has tried to wash his hands of this problem. I now call on the Minister of State at the Department of Health, Deputy Leyden, to give an assurance that, first, where there is a motor insurance liability people would not be forced to pay cash outlays and, secondly, where there is no motor insurance cover that people will be assured, if they go public, they will be fully covered and if they are in the VHI their bills will be honoured fully. If that can be done and a streamlined arrangement for payment can be brought into effect through practical negotiations which ensure that the VHI are not left holding the baby it would be a welcome step. I call on the Minister without further delay to attend to this matter.
