I move: "That the Bill be now read a Second Time."
Health (Amendment) Bill 2023: Second Stage
You have ten minutes, Minister.
Go raibh maith agat, a Cheann Comhairle. I thought I had 15 minutes. That is what I was told.
The Minister does not even have to take ten.
I will be briefer then.
I am really pleased to introduce the Health (Amendment) Bill 2023 to the Dáil. The Bill means that adults will for the first time have free access to inpatient care in public hospitals. At the moment, people are charged €80 a night for a stay in a public hospital, up to a maximum of €800 a year.
That is a very large bill for people to face. Many have to face it when they may be very sick and unable to work, or only able to do so part time, and are finding it harder to make ends meet. Last year, we abolished this charge for children aged under 16 and this Bill now does the same for everyone else. It is an important measure in its own right but it is also important as a very clear symbol of our path towards universal healthcare - a public health service that is free or affordable for everyone in the country.
Colleagues will be aware that over the past three years we have radically cut the costs of healthcare for patients and their families. In 2021, we reduced prescription charges, increased medical card access for those aged 70 and over and extended to two years medical cards for patients with a terminal illness diagnosis. Last year, we abolished inpatient hospital charges for children, introduced free contraception for women aged 17 to 25 and reduced the maximum monthly amount families pay for medicines, in 2020 and last year, from €114 to €80. Already this year we increased the age at which free contraception can be accessed from 25 to 26 years in order that no woman is aged out of the scheme. The Bill abolishes inpatient charges for adults. In the coming months, we are providing GP cards to approximately half a million more men, women and children. This will mean that, for the first time ever, more than half the population will have access to fully State-funded GP care. Later this year, we are increasing the free contraception scheme age to those aged between 16 and 30 and we are introducing State-funded IVF for the first time.
All these measures are welcome but, combined, these cuts in costs for patients amount to a radical shift towards universal healthcare in our country. These measures are already making an important difference to many patients and families using our public health services throughout the country. They are being introduced in tandem with new services for patients, such as IVF and many other women’s healthcare measures, including, for example, specialist services in endometriosis, perinatal mental health and menopause. In tandem with better access to medicines, I was delighted to be able to share the news last night that Kaftrio will now be funded for the 35 children who were excluded by the company involved last year.
At the same time as rolling out new services and medicines, we saw last year an important fall in the number of people on waiting lists, particularly those waiting longer than the Sláintecare-agreed times of ten and 12 weeks. While I fully acknowledge there is a long way for us to go on waiting lists, this is the first fall since 2015 and is an important step. I am determined this year will be the second year in a row when the number of people on waiting lists falls again. We are focusing, in the first instance, on "long waiters" and those waiting longer than the agreed Sláintecare targets. This three-pronged approach of reducing costs for patients, providing new services for patients and speeding up access for patients is how we are pursuing universal healthcare, which is the simple idea, core to the values of our Republic, that people can get access to great quality affordable care when they need it.
Specifically on this Bill, I acknowledge the work done by officials in my Department and, importantly, by several patient advocacy groups, including the Irish Cancer Society, which advocated for this charge to be abolished for many years. I will now provide a brief explanation of the sections of this very short Bill. Section 1 repeals section 53C of the Health Act 1970. Section 53C provides that: "Charges shall be made for acute in-patient services provided by or on behalf of the Health Service Executive". Section 1 also revokes the Health (Acute In-Patient Charges) Regulations 2021, SI 213/2021. These regulations currently provide the legislative basis for the persons liable for the acute public inpatient charge and that the maximum number of days this daily charge may be imposed over a period of 12 consecutive months shall be ten days. Section 2 contains standard provisions setting out the Short Title citation and provides that the Bill shall be subject to a commencement order. The key effect of these amendments is to remove the acute public inpatient charge of €80 a day for people accessing care as a public patient in all public hospitals.
While we have the opportunity, I will give some details on other eligibility measures being introduced this year. As provided for in the budget, from April, eligibility for GP visit cards will be extended to people earning up to the median household income. This measure will remove the cost of accessing GPs from those for whom cost is most likely to prevent access, helping to reduce the cost of living for young adults and young families in particular. We believe between 400,000 and 500,000 individuals, who would otherwise have attended their GP on a private basis, will now be able to attend essentially on a public basis, funded by the State. We are also working with the Irish Medical Organisation, IMO, on expanding GP care, without charges, to all six- and seven-year-olds this year. Coinciding with the median income expansion, a significant funding package is being prepared to support GPs in hiring many more GP practice nurses, as well as other supports GPs will need to manage the additional demand this measure will inevitably bring into place.
As colleagues will be aware, we are expanding the free contraception scheme. We launched it last September and have had very positive feedback on it. It was an historic initiative providing free access, for the first time, to prescription contraception and directly supporting women and their partners in sexual and reproductive health. The scheme will be expanded further to women aged 30 and under in September. Some €32 million has been allocated to that and, as I promised in the House last year, this funding includes expansion of the scheme to 16-year-olds, subject to consultation, legal advice and legislative amendments, which are required for this.
We are also looking at assisted human reproduction, as colleagues will be aware. We have made a commitment to introduce publicly-funded care for fertility treatment. Phase 1 involved the establishment of five regional fertility hubs throughout the country. These five hubs are operational and it is anticipated a sixth will be operational later this year. Essentially, these hubs are for the management of a very large portion of patients presenting with fertility issues at this level of intervention, without the need to undergo invasive advanced assisted human reproduction, AHR, treatments. Phase 2, however, will see the introduction of tertiary fertility services, including IVF. The plan, ultimately, is that all these services will be provided by the public health service. We are expanding those services but we do not want to wait the several years it will take to wrap up those services in order to provide them for all women and couples who want to avail of them. In the shorter term, we will subsidise private care and will then ramp up public care so that, ultimately, it is fully publicly delivered.
We spoke about Kaftrio. It is obviously very important that we create better access to medicines. Since the formation of the Government, we have allocated approximately €100 million for new medicines. The full-year costing for that is significantly higher. That has meant 112 new medicines or new uses for existing medicines and, critically, 34 of those are for rare diseases. These are the so-called orphan drugs that usually cost significantly more than mainstream drugs. We are also committed to delivering faster access to new medicines for patients. I want to see improvements in the transparency of the process and I have asked the HSE to bring forward proposals to that effect. Colleagues will also be aware that we have allocated €15 million this year for new State-funded oral health services for children, from birth to the age of seven, which is a public health initiative that will make a big difference in the coming years.
The programme for Government is committed to universal healthcare and Sláintecare as a key enabler of that. One of the three pillars of universal healthcare is free or affordable care. Much progress has been made and more will be made. This Bill does two very important things: it removes a charge of up to €800 a year from patients and their families and, critically, for the first time, inpatient care in public hospitals will be free for all patients. It is a very important step on our way to fully free or affordable public healthcare provision in our country.
I welcome the Bill. Sinn Féin will support the abolition of any charges. We have long argued for the abolition of such charges we believe fundamentally in a public health service and that public health services should be free at the point of delivery and delivered on the basis of need. We are travelling in the right direction and the new public-only contract for consultants in hospitals is another step forward to building truly public hospitals where we can once and for all separate private healthcare from public healthcare. This is something we all supported when we passed Sláintecare.
I have to point out to the Minister in the short time I have that while I welcome the abolition of these charges, the big challenge we have in hospitals and in healthcare at the moment is access to care, overcrowding and people waiting too long. While people want to see these charges abolished and will obviously welcome this, the critical issues right now are people being on trolleys, people waiting far too long waiting lists and a staff who are facing morale injury every day from working in a healthcare system that is at breaking point. Those staff deserve tremendous credit for the work they do and I am the first to acknowledge much of the good work which is happening in healthcare right across all of the strands of it from primary care, community care to acute care but it has many challenges. Part of that challenge is the lack of capacity, the high demand for care, particularly in emergency departments, which is not a winter problem any more, but is all year around. We have a lot more to do.
I am aware that other Members want to speak and I do not want to delay the passage of this Bill. We all support it. It is a very short Bill and possibly one of the shortest the Minister will bring forward as it simply abolishes an existing Bill, but more importantly, it abolishes those inpatient charges in full which I support.
Sinn Féin will be supporting this Bill. There should be no restrictions or deterrents for people accessing healthcare. Sinn Féin has long campaigned for the abolition of inpatient charges so it is very welcome to see that this is finally happening. The €80 charge a day has been a barrier for people presenting to hospitals. There are so many individuals and families who simply do not have the means particularly during its current cost-of-living crisis.
One issue which I wish to bring up, which I have raised with the Minister in the past, is the use of private debt collectors by the HSE to chase down debts. I said that this is an abhorrent, draconian and an inhumane practice. The HSE has paid over €500,000 per year to private debt collection companies to go after people who are simply not in a position to pay their fees and I hope this is the end of this practice.
When I raised this issue in the Dáil on the previous occasion, the Taoiseach, who was the Tánaiste at the time, responded to me by saying that “People have a social obligation to pay their bills and taxes and settle their debts ... [and] have a moral obligation to do the right thing.” This was in the midst of the pandemic when many people had their employment curtailed. I ask now where was his moral obligation in this response considering that the group of people we were speaking about were those who were sick, who needed inpatient care and were not able to pay. Given the Government’s response ten minutes ago to the lifting of the eviction ban and to putting thousands of people at the risk of becoming homeless, I cannot say that I am surprised. This is just another example of how out of touch this Government is.
We need a health service that is open to all but more needs to be done to tackle the waiting lists. Some 75% of people who present to emergency departments are not admitted and in some cases they may not have access to GPs, so there is no other appropriate alternative for them. The Government must prioritise the move towards free GP care and the expansion of GP numbers so that services in our hospitals can flow more freely. People need access to appropriate health care when they need it and when in need.
I welcome the Health (Amendment) Bill 2023. The abolition of inpatient charges in all public hospitals is a welcome step that will hopefully alleviate some of the financial concerns facing patients who have had the misfortune of having to attend hospital. The inpatient charge of €80 per day was a burden for many, particularly for those who had the misfortune of having to return and stay in public hospitals on multiple occasions, often multiple times a month.
It follows on from the Health (Miscellaneous Provisions) Bill which removed the same charges for persons under the age of 16. Again, that was a welcome move and one which helped patients but there are additional concerns which patients face and these need to be addressed urgently.
Those on outpatient waiting lists still face the burden of long delays and car parking charges when they have hospital appointments. Perhaps the scrapping of these charges would be a positive step for those who need to attend hospital. Regretfully the outpatient waiting lists are even more stark than those of inpatients.
Again in University Hospital Limerick, UHL, there are 28,505 people on outpatient waiting lists with nearly 18% of those, 5,121 people, waiting 18 months or more for an appointment. These lists show no sign of reducing because the staff at the hospital have been pulled away to deal with the trolley and capacity crisis at the hospital. The trolley crisis, recruitment across the services, and access to waiting lists are crucial issues to be addressed in the health service and yet we hear very little from the Minister on these issues.
Already in UHL there have been 3,931 people on trolleys so far in 2023, with 106 people on trolleys yesterday and 107 languishing on trolleys today. Patients and staff deserve much better than this. The people of Limerick and the mid west deserve much better than this.
At UHL in Christmas week the hospital was overwhelmed with presentations, which I have said in here in the Dáil on a few occasions. An emergency plan was implemented in the hospital and this reduced trolley numbers for that month. As soon as the emergency ended, the trolley numbers shot up again and the February 2023 figures were worse than those in February 2022. Unfortunately, this March will see figures higher than in the past year.
Regrettably, if the figures continue like this, we will have more people treated on trolleys than the massive 18,012 who were treated in this manner in UHL in 2022. Let us call this what it is. This is a national disgrace. The metrics keep going the wrong way and they seem to be consistently doing so under this Minister’s watch. The members of the Irish Nurses and Midwives Organisation, INMO, are approaching their limit in terms of working conditions which they advise are neither safe for the nurses, for other staff, or for patients. The INMO is balloting for industrial action in pursuance of safe staffing. Is the Minister not embarrassed by this? They have advised that nurses in each hospital have stated that unsafe staffing is the norm. They want and deserve a fully funded workforce plan for the coming winter. In UHL there is funding for 91 ICU nurses yet there are only 70 available to be rostered. These kinds of staffing deficits have a very significant impact on patients and nurses. Nurses work long and hard and many a day deal with the heartbreak and tragedies which are natural in a hospital setting. They need a work-life balance and need to see this Government step up their efforts to recruit and to train nurses.
In January 2022 doctors in the UK issued a paper in the Emergency Medicine Journal showing that the delays to hospital inpatient admissions of more than five hours were associated with an increase in mortality. They noted that for every 82 admitted patients whose waiting time was delayed more than six to eight hours, there is one extra death. At UHL these types of wait times are quite normal at the accident and emergency unit.
Last March Health Information and Quality Authority, HIQA, inspected the UHL accident and emergency department and in its report the health watchdog noted that the overcrowding and the understaffed department posed a significant risk to patient care.
Little adjustments like removing the €80 inpatient charge are welcome but they are low-hanging fruit in terms of addressing the crisis in our health service. We need to see the Minister reach higher now and seriously commit to tackling the issues of overcrowding, especially at UHL, together with the unsafe staffing levels there and the ongoing capacity levels as we have consistently called for him to do. The Minister cannot sit back and see figures rise exponentially in UHL, which they are going to do again and, unfortunately, 2023 will see even higher trolley numbers.
This is a simple but a very important measure to abolish the inpatient charge for adult public patients in public hospitals. The Bill, as the Minister has indicated, repeals section 53C of the Health Act 1970 so this is a thing that has lasted a very long time, together with the associated regulations. This is all very welcome and will certainly assist in the cost-of-living pressures that so many people are acutely feeling right now. The notion that people would be inhibited from even going to a hospital because of a charge makes it right that this charge should be abolished if we are in a position to do so. It should be abolished.
The abolition of inpatient charges is of value only if one can access inpatient services. Too many of our citizens are on long waiting lists to be diagnosed, in the first instance, for their treatment. Then, finally, having been diagnosed and having seen a consultant, they are again on ever-longer waiting lists to receive treatment.
The general story one hears from people is that once they get in to access the health service, it is an excellent service.
The problem is getting in in a timely fashion. Certain illnesses are often compounded by the wait.
There are, as we know, insufficient hospital beds and insufficient staff to serve those beds. Thankfully, we have an ever-increasing population and are living longer. We know all this and we also know some of the strategies needed to address these enduring, ever-recurring deficiencies. There has been all-party support for a new strategy, Sláintecare, and to implement that we need, among other things, more hospital beds, a single-tier acute hospital system and no more experimentation with issues such as co-location, which has in the past distracted us from doing what was really needed. We need a functioning primary care facility to be available to all. I acknowledge all these things are happening. Primary care centres are being built, and more and more services are being delivered through them. That is the sort of ongoing pressure we need to see delivered. We have a political consensus, at least regarding the direction, such that a change of government no longer means an entire change of direction in healthcare, and that is important.
Support for GPs is critical in all this. This is one area where we have not addressed a looming crisis. In my constituency, Wexford, I have talked to dozens of GPs. Rural, single-handed practices, in particular, cannot get locums to cover them and allow them to attend important events, whether tragedies such as funerals, celebrations such as weddings or family occasions such as communions, while those who are coming to an age of retirement cannot get replacements. It is clear that throughout rural Ireland, in particular, we will not have the pattern of GP coverage that we currently have into the future. More and more multi-GP practices are operating out of towns, and people in large rural areas are no longer covered by a GP, which has always been an essential part of health provision here. The fundamental issue of resourcing GPs, training more GPs and getting more doctors to opt for general practice as opposed to the automatic stream must be very high on the Minister's agenda. An acceptable consultants' contract will now, I hope, be implemented. I again commend the Minister on finishing the negotiations but it is important that it be rolled out and effected and that we will have, for the first time, an understandable, single contract for consultants that will provide the sort of public cover we have all sought for a long time.
We also need the appropriate range of specialists to ensure all the needs of recovering patients will be met. All of us Deputies come across every day in our clinics and offices people who have been treated but need physiotherapy, speech and language therapy, occupational therapy and all the other ancillary supports, but they are just not available and that is hampering their recovery, and in some instances, pushing them backwards.
The importance of an acute hospital for a population base is critical and that is only fully realised, as the Minister knows, when it is threatened. Wexford General Hospital, my local general hospital, faced that threat not through any political action or staff action but through an unprecedented fire that happened there on 1 March and shocked us all. The immediate response, as I indicated to this House the following day, was nothing short of amazing. The HSE staff, the firefighters, the voluntary organisations, the local community, the National Ambulance Service and so many others - everybody who was asked - rallied and the response was amazing in that all 200-plus patients in the hospital, including people who were critically ill and two women who were in the process of giving birth, were evacuated safely. I should say, the two women stayed and delivered. I can imagine the conversation the nurses had, saying, "We are grand. The place is on fire but carry on." It is magnificent that nobody was injured in all that, and 100 ambulances arrived to remove people.
All that is magnificent, and all that effort is absolutely to be praised and lauded, but the question now is what is next. The Minister and the Taoiseach have visited the hospital and, I am glad to say, have put a number of clear commitments on the public record. We were briefed at the end of last week on what is happening. Obstetrics and midwifery is back open and fully operational. The patients who were removed have, by and large, been returned and are back in the hospital. The medical assessment unit has opened, as has a minor injuries unit on an 8 a.m. to 8 p.m. basis and to move shortly, I hope, to a seven-day basis as well. The outpatient clinics for endoscopies and other procedures are all operational, and we are using Ely Hospital as a support base for services. In combination, there has been a magnificent effort.
The big question that remains, however, relates to the return of accident and emergency services. Unfortunately, that concern has not been addressed, and we need to know when that will happen. I have been told it could be up to six months, which would really put pressure on the adjoining hospitals as well as being a big burden for the people of Wexford to carry. I ask the Minister, therefore, to look again urgently at ensuring the accident and emergency services will reopen at the earliest possible date. That is the will of both the people of Wexford and the staff of Wexford General Hospital.
The Minister will not be surprised at me making my final point, which concerns the building of the 97-bed unit. It was to comprise 96 beds but one of the treatment rooms has been changed to a 97th bed. It is an essential part of the next phase of the hospital. A month ago, the Minister told us he was awaiting an assessment report, but he has been more positive in his utterances since. Both he and the Taoiseach have raised the issue of planning permission as one of the possible impediments to getting it done. I ask the Minister, on the record of the House, to use his powers. I have talked to the planners about this. Section 181(2)(a) of the Planning and Development Act 2000 gives powers to the Minister for Health where it states:
Where development is proposed to be carried out ... the Minister of the Government concerned ... if he or she is satisfied that the carrying out of the development is required by reason of an accident or emergency, by order provide that this Act or, as may be appropriate, any requirement or requirements of regulations ... shall not apply to the development.
Effectively, that means the Minister can construct the new 97-bed unit and restore the building in respect of the damage done by order under the planning Acts without planning permission. Will he look at that and avail of those powers, which are designed to meet an emergency situation such as this? He will have not only the full support of the people of Wexford but also their gratitude if that can be done, and I ask him to do it.
I welcome the Bill, which will remove public inpatient charges that exist of €80 per day up to a maximum of €800 in a year. Medical card holders and certain cohorts are already exempt from these charges. The change is really good and it is important people will not feel when going into hospital as though they will not be able to pay their bill. There are significant challenges within the HSE given people are living longer, although it is great that is the case.
I was delighted to welcome the Minister to Carlow a few weeks ago. We spoke about Caredoc, which he visited, an excellent after-hours facility that does a great job.
There cannot be many Ministers remaining whom the Deputy has not welcomed to Carlow.
I might start on my second round of Ministers now. Carlow is growing very much, which is important, but our nearest hospital is in Kilkenny.
The Minister referred to keeping things local. When he spoke to members of Caredoc he referred to an injury clinic for Carlow. That is the way to go. It would help hospitals as they would not be as busy but it would also help the staff. I know the Minister is trying to bring things locally. It is important that we look at keeping things as local as possible and that the Minister consider the provision of an injury clinic for Carlow.
I spoke to the HSE on two other issues last week. A commitment was given to Tullow regarding a primary care unit. Tullow is in quite a rural area. There is also Hacketstown and Rathvilly. We have been given the go-ahead for a primary care unit but the timeline seems very long. I ask the Minister to examine that. I met the HSE last week regarding a primary care unit for Borris, another rural part of Carlow, which takes in Tinnahinch and St. Mullins. As all present are aware, there is an issue with the availability of doctors at the moment. We are in a good position in Carlow. If the Minister were to consider these primary care centres and an injury clinic, that would benefit the people of the county. It would also help Kilkenny hospital. I compliment all the staff for the great work they are doing under significant pressure. The Minister has given an extension there and extra beds have been provided. I know that is a priority for the Minister but I ask that consideration be quickly given to funding these centres. They will be a good way to help people, especially those in my constituency of Carlow.
I have limited time so I will shoot through a considerable amount. Everyone welcomes the fact that hospital inpatient charges will be abolished but it should have been done better and more quickly. It should have happened a long time ago but we welcome it. There is a long journey ahead to reach the final destination of a decent universal healthcare system. We know we do not have such a system. We know the issues in respect of hospitals, disability services and community. None of it is where it needs to be.
I have a few asks. I spoke to the Minister earlier regarding engagement with the Irish Dental Association and, in particular, with Fintan Hourihan. That needs to happen as soon as possible. In my town and county, a huge number of people on medical cards cannot get dental care. It is a significant problem that needs to be dealt with.
Like many other Deputies, I am sure, I have met many people from a lobby representing what is a fair ask regarding a neurorehabilitation team for each community healthcare organisation, CHO. Many people dealing with multiple sclerosis, MS, and other ailments do not have the services they need. It is sometimes the case that they need hospitalisation because they are not being provided with those earlier services.
Something still has to be done in respect of car parking for patients receiving cancer care, as well as other patients, although I accept there are issues in that regard.
I spoke to the Minister of State, Deputy Butler, regarding the need for mental health assessments in the evenings and at night at Our Lady of Lourdes hospital. This issue requires hospital management, the Royal College of Surgeons in Ireland, RCSI, and mental health services to get around a table. The solution is there, so I will chase it up.
The Minister has to go back to the families of those in Dealgan House whom he met previously. We are getting closer to an inquiry but the Minister has to engage with the families.
I do not know what I can say about the eviction ban and the long-term impact the housing crisis will have on people.
The Deputy does not have to say anything about it. He is out of time.
It is crazy that it was pulled before we had even the Government's proposals and solutions in place. That is the crazy bit of it.
Thank you, Deputy. Our next important contributor is Deputy Gino Kenny.
Deputy Shortall is next.
My apologies.
Am I important too?
Absolutely. I hope I am not in the early stages of something.
There is no danger of that. I thank the Ceann Comhairle.
I very much welcome the Bill, which the Social Democrats will be supporting fully. It is an important move in the context of access to healthcare. Cost is a significant barrier to people accessing healthcare and it is very welcome that these charges, which can total €800 per year, are being removed. I have stated many times in the House that there is no justification for charging people for getting treatment when they are sick. There is no rationale whatsoever for doing so. It is very difficult to get into an acute hospital, as the Minister is aware. A person is admitted only if it is essential that he or she receives inpatient treatment. The idea of charging patients for that is outrageous. One would have to ask why it has been going on for so long. I welcome the fact that it is now being removed. This important issue arose when the Sláintecare plan was being drafted, however, and a number of measures were proposed, with timelines on them, for the removal of various costs that act as an inhibitor to people accessing care. It is important to point out that the proposal to remove inpatient hospital charges was to be implemented in the first year of Sláintecare, that is, 2018. Better late than never, but it is important to point out that it is coming in five years after it was first intended to happen. Nonetheless, it is a welcome move.
There are other hospital charges that are applied in a very unfair way, such as the €100 charge for attending emergency departments, EDs. I would like that charge to be removed but the reality is that the pressure on EDs is such that the intention of the charge currently is to encourage people to access services elsewhere before turn up at an ED. The problem is that the number of options in terms of alternative healthcare services to an ED are limited. Previous speakers referred to Caredoc, D-Doc and other out-of-hours services. The problem is that those services are wholly inadequate. Of course we should be encouraging people not to go to an ED if their health issue can be dealt with elsewhere but there are no options, especially out of hours. The minor injuries clinics are very good but 8 p.m. is probably the latest they stay open. Where else can a person who suffers an injury, such as a sports injury, go? Similarly, young children often get a very high temperature or other symptoms. The parents get very worried and need medical advice but, very often, that advice is not available.
It is very difficult to access medical care after hours. That is not a criticism of general practitioners, GPs, who are being expected to attend at night-time after they have concluded their normal surgery hours during the day. As it is an additional service being offered solely to comply with the GP contract and there is an effort to keep people away from those services, the services are not well advertised. That makes no sense. If there are alternative services, fewer people will present at EDs.
We need to look again at the option of having salaried GPs. There are many fully qualified GPs, particularly young female GPs, whom, for various family reasons, it does not suit to work in a practice during the day but who would certainly be available to work sessions at night-time on a contract or salaried basis. The Minister should pursue that. At one point, his predecessor was very much in favour of having salaried GPs. The contract for GPs is 40 years old. It is not suitable for the present day or to meet the needs of young graduates coming out of college who want to work in different ways.
First of all, they may not have the money behind them to set up in practice themselves. They want to work as part of a multidisciplinary team. Why are we not providing opportunities for those GPs to work here? Why are we forcing them out of the country to work in other healthcare systems? I ask the Minister to look at that idea of salaried GPs in order that we can facilitate those younger GPs who want to work on that basis. It need not threaten the existing GPs who are operating on the old contract and who have invested in their premises. They need not have any fears about that. We can have a twin-track approach, however. We can leave the existing ones with their existing contract if that is appropriate. Certainly, this is not a threat to their investments. However, we can provide opportunities for people who want to concentrate on providing health services and who are not really interested in the business end of things. I hope the Minister will look at that.
I also wish to refer to the consultants' contract. I congratulate the Minister on the work he has done. I have congratulated him privately but I want to do so publicly because it is a really good piece of work. I am very pleased to see the Minister is pressing ahead with that now. Again, it is another way of recognising the fact that time has moved on. Medical graduates want to work in different ways. Again, I will cite the research done by Dr. Niamh Humphries looking at the reasons hospital doctors emigrate. Money is down the list a bit. They want a decent work-life balance. They want to be treated with respect. They want to work in a system where they do not have to keep apologising to patients. I certainly hope that the new contract, which is very attractive, will attract back Irish graduates who have gone off to other healthcare systems. I hope the Minister will be promoting that very strongly and that as part of that, he will be aiming to give confidence to our medical graduates that things are going to change and we are going to see the much-needed reform and that the Minister will invite them back to lead that kind of reform. That is the kind of energy we need within our healthcare system. It is really important that we get that new blood back in.
Another point, which the Minister has raised, is the issue of the free contraception scheme. That is a very good scheme. It is very welcome. However, I ask the Minister to look again at the idea of contraception being available without a prescription, and available from pharmacies that are very happy to provide it. They want to be part of the solution. The Irish Pharmacy Union, IPU, appeared before the Joint Committee on Health very recently. It is keen to provide that additional capacity that is required. It is great for those women who qualify within that age group to be able to avail of free contraception. However, having to go to a GP and fork out €60 for a prescription just does not seem to make any sense at all. Will the Minister look at that?
I also want to ask the Minister where we are at with regard to the service plan. We are now at the end of the first quarter of the year and we have still not got the service plan for 2023. I know it is with the Minister at the moment. He expressed his desire to make some changes to it, as is his right. However, the delay is just unacceptable at this stage, three months into the year. There are many people working in services all around the country who are still waiting to hear about their allocation for this year. That is greatly hampering them for making plans, recruiting staff etc.
My final point is regarding GPs. The Irish College of General Practitioners, ICGP, told us very clearly that there is a problem with clinical placements and that is a factor in the difficulty in having enough GPs in training. I ask the Minister to look at that point again. I very much welcome this Bill. It is a positive move and we are happy to support it.
I thank Deputy Shortall and apologise for not calling her at the start. The next available slot is for Sinn Féin, which I assume Deputy Patricia Ryan will take.
I thank the Ceann Comhairle. As Sinn Féin's spokesperson for older people, I welcome the opportunity to debate this Bill, which we support. It is a sad truth of life that due to age and infirmity, older people are more likely to require inpatient treatments. The cost incurred disproportionately impacts pensioners and those with fixed incomes. A figure of €80 per night is a lot of money for those only on a State pension.
I am glad that the Minister has finally heeded Sinn Féin's calls to abolish inpatient charges. This is a step in the right direction but I fear that without additional measures, this will not be enough. As the Minister is no doubt aware, there is severe lack of GPs, nurses and healthcare assistants all over the country. Due to staff shortages, many older persons are told by the HSE that they cannot receive their full allotment of home support service hours. This is simply unacceptable.
I am sorry, a Cheann Comhairle; will I continue?
I apologise.
Would the Ceann Comhairle like me to continue?
Yes, please do.
That is simply unacceptable. The Government needs to do more for older people to treat and support them in the community. I urge the Minister to act now to increase staffing levels and invest urgently in GP capacity and primary care facilities, particularly in County Kildare, where we need to ease the pressure of the acute services.
I am sorry; I am afraid the Minister probably did not hear anything I said because he was talking to the Ceann Comhairle. That is very disingenuous. I have to say that; I am sorry.
I offer our apologies for that. The Minister was listening intently to the Deputy. The record will be available for him to study afterwards.
I thank the Ceann Comhairle. I appreciate that.
I thank the Deputy. Deputy Gino Kenny is next.
I, too, welcome this Bill. It is quite progressive and long overdue. We always said that inpatient charges have not been conducive to a universal public health service. This has been very contentious in the last number of decades. We have always argued that inpatient charges have been a barrier to many people gaining access to healthcare. Even the collection of these charges is an onerous and bureaucratic task. I do not think a public health service should be chasing after people for inpatient charges. Obviously, that has a very stressful effect on people who have to access healthcare. Debt collection by debt collectors is not acceptable for people who have run up a bill. People cannot work because of their illness and debt collectors are sending them letters. They may have come out of a very serious illness. That is not conducive to universal healthcare in a fair system. This Bill is welcome. All these stealth charges have an effect on people trying to access healthcare.
I will mention a number of issues regarding hospital car parking charges. I could never understand, and nobody could ever convince me, why people have to pay car parking charges in hospitals. I do not see the logic in it at all. I do not see the logic that when people go to hospital, they must sometimes pay enormous amounts of money per week to park their cars. Sometimes they have to bring their cars to the hospital. I just do not get that. Could somebody explain to me why people have to be charged to go to hospital and park their car? Sometimes public transport is not available, and they are then charged for parking. It is disappointing that the national children's hospital charges for car parking. It has capped it at €10 per day, but if a person has to go to hospital every day with his or her child, that is €50 over one week. I do not get that. Can the Minister properly explain why car parking charges per day are being implemented in the national children's hospital?
The Minister referenced Kaftrio earlier in his speech. There is obviously good news for those 35 children who now have access to that drug. I raised this with the Taoiseach today.
I believe that what this company did was unforgivable. Vertex Pharmaceuticals is based in Dublin. To drag this out for one year and to deny those children that drug for one year is absolutely unforgivable, given that the amount of money Vertex Pharmaceuticals made from the drug is absolutely obscene. They have made billions, not millions, of dollars yet they dragged this out with the HSE. I do not actually blame the Government on this. I blame the company for dragging this out to get more money from the Government and from families. It is unforgivable and the Minister would probably agree with me that this should not have been dragged out for one year. Those 35 children should have got that drug when they needed it. While it is good that they have it now, it is unforgivable that pharmaceutical companies have the Government over a barrel with regard to pricing. I am aware that the company has a monopoly on it but it is unforgivable given the obscene amount of money they have made from this drug alone. Hopefully this will never happen again. There are lessons to be learned about reimbursement and children not being given a drug when they need it.
The programme for Government, under Sláintecare, sets out a pathway for expanded access to healthcare in keeping with the vision of universal healthcare. We need to get to a point where we truly have healthcare delivered free at the point of delivery. Three principles should underpin all of our approaches to healthcare - affordability, accessibility and accountability. With regard to affordability, all of us have received great care in the public system but we also know about the issues with costs. We welcome this Bill in the sense that it will reduce some costs but we can go further to help ease the financial burden already being experienced by many families. For example, the cost of parking in hospitals was debated last week, as well as additional costs for families such as accommodation and childcare while their child is in hospital. While the biggest ever investment package allocated to health demonstrates the Government’s commitment to deliver universal healthcare, how are we to achieve the Sláintecare commitments with few or no staff?
On accessibility, I am dealing with issues in my constituency clinics every week relating to people who are unable to access health services. Just last week I spoke to a young man who has been waiting for a clinic appointment for two years, with letter after letter explaining that the clinic is postponed. The problem is chronic.
Within the budget, we committed to increasing access to GP care without charge for more than half of the population. This is an important healthcare measure that removes a prohibitive cost barrier to accessing GP care. However, we know the challenges faced by patients in accessing healthcare at every level, including long waiting lists and long waiting times in accident and emergency departments.
We will never deliver or realise universal free GP care unless we increase capacity and have a plan to increase training places. Healthcare workers are no longer attracted to what the HSE has become, so we are short of staff. The Minister could also address the consistent loss of rural GPs by expanding primary care. It is no wonder that people must go to accident and emergency departments when they cannot get a GP or they are not eligible to attend the local injury unit, such as the Louth County Hospital. What is the point in having a medical card if there is no access?
Lastly, I will touch on accountability. The Sláintecare progress is painfully slow with complex structural and legal barriers, but the fundamental problem with our health service is that it is inequitable because it denies care. Parents are forced to borrow money to get an assessment of needs done privately. By allowing a situation like that to continue, it drives behaviour, for both patients and medical staff who are incentivised to set up in private practice. The number one responsibility is to make healthcare affordable and ensure adequate supply. We need to recruit staff. The Minister has my full support with this amendment if he presses ahead with the implementation of the Sláintecare contracts and introduces salaried GPs or different arrangements in respect of the employment for required roles. My colleague Deputy Seán Canney will come in soon and when he arrives I will stop.
A person's health is their wealth. The demand for doctors is unreal. The amount of people who are telling my constituency office that when they ring up GPs they are being told that it could be two or three weeks is not acceptable. These people are sick and badly need a bit of help and they end up in emergency departments. I will be honest and say that the Louth County Hospital out-of-hours service provided by the doctors there is second to none. I was up there two weeks ago and I believe there were 25 people waiting to see the doctors. If that service was not available, there would be something seriously wrong.
The Minister is going to have to sort out the situation around GP care and we are going to have to sort out the situation with medical cards. This Government has promised to issue medical cards to a lot of young children. Families are suffering and the cost of living is going very high. I am aware that the Minister is trying hard and his name is popping up a lot at the moment. We do want to support the Minister, but there is a serious situation with GPs. In my area we have the Louth County Hospital. Maybe people in an emergency could call there during the day to see a doctor and so on, with no cost or whatever it is. A person's health is their wealth. I thank the Minister for listening.
I welcome any efforts made by the Government to reduce the costs on families in accessing healthcare. There is no doubt that health has a significant cost to many people and that it is a barrier for many people in accessing healthcare. The level of ill-health is far higher among people who live in lower socioeconomic groups, and people's life expectancy is far lower in those areas too. Every single step the Minister and Government take, which reduces the cost to people, must have a positive benefit for their access to healthcare and for their health.
A key question for me is that when people look at the health service at the moment the vast majority of people will identify other issues rather than cost causing a barrier to accessing healthcare. For the vast majority there is a situation where the lack of capacity in the health service is the barrier for people accessing healthcare. I am conscious that whenever the Government gets rid of certain charges, for example for GP care for children, it can actually make it harder to access GP care in the round. If one reduces a cost it creates more demand for service, and if that capacity is reducing in size it is actually making it harder for the general public to access that service. We have an incredible situation where last year 400 GPs left Ireland in the first six months of that year. Yet, we have many GPs at the moment closing their lists so people cannot access those lists to get a GP. If a person is a newcomer to this country, or if somebody moves from one end of the country to the other, he or she is unlikely to be able to get access to a GP list at the moment.
It is also important for me to raise the issue of Our Lady's Hospital in Navan. Just a couple of days ago there were 31 people who had been triaged and who still had not been seen by a nurse or doctor in relation to what was wrong with them. That is just the number of people who had made it past triage station, not the number of people who were in the waiting room at the hospital such is the level of demand that exists in Navan at the moment for accident and emergency services. Again, most people would come to that scenario and say that we need more capacity there to be able to deal with the demand. What we have, however, is reducing capacity unfortunately with ambulance bypasses and so on. I am told that the HSE senior management have contacted the doctor-on-call service to ask them what staff they need for the closure of Navan hospital accident and emergency department. I commend the Minister on the reduction of costs to the citizen in accessing healthcare but I would really urge him to focus on the key capacity issue, which is the biggest barrier to good health in this country.
I add my support to the abolition of hospital charges amounting to €800 in one year. If we were to provide universal health insurance those charges would have no place in the system. I ask the Minister to also look at the charges for hospital parking. Some hospitals do offer discounted assistance for regular visitors but, for example, I know of one family where the family members were coming in four, five and six times a day to hydrate their mother in the hospital and they were all paying for parking every day, and getting very little discount for it. I do not believe it is fair to put that burden on people. I ask the Minister to look at that. This also applies around the country.
I acknowledge the recent heroism of the staff in Wexford General Hospital who, through their actions, undoubtedly saved lives. We could have had a terrible tragedy down there had the fire occurred at night time when the full staff complement was not available. They did a tremendous job, including moving four people on ventilators out of the intensive care unit. I do not believe they got enough recognition for that at all. I am aware that the Minister is looking at trying to figure out capital supports to get the unit back up and running, but in the meantime that fire has caused significant movement of patients into the University Hospital Waterford accident and emergency department, as the Minister well knows.
In the last number of days 300 patients presented at the accident and emergency department in Waterford in a 24-hour period. Just 12 hours ago the hospital sent a tweet asking people not to attend because the accident and emergency department is overcrowded. What is the Minister doing to support the accident and emergency department in Waterford? What staff have been rotated out of Wexford and what additional budget is the Minister allowing for? What other movements of staff are happening to try to deal with the accident and emergency situation there?
I had a discussion yesterday with the Taoiseach regarding the catheterisation laboratory and the 24-7 situation in Waterford. I was glad that the Taoiseach acknowledged that the Government's position was to deliver that in due course, albeit that he put in a caveat today regarding a review. That is fair enough because it is a review based on numbers, which we will absolutely exceed.
The Deputy jumped the gun.
We need to get the second catheterisation laboratory up and running but that cannot be done without beds. The Minister and I have spoken about this a number of times and about the fact that there is no capital support available for beds but there is the possibility of bringing in a modular day ward which is being done in other hospitals around the country. That would immediately provide the bed capacity to allow us to activate the second laboratory. What proposals does the Minister have in that regard?
Finally, planning permission has been secured for three separate building projects at University Hospital Waterford. The planning applications were for a laboratory extension, the development of St. Otteran's and an oncology support building. At this stage, the permission for these projects has been in place for more than a year but there has been no action on them. I ask the Minister to address that.
As the Minister knows, University Hospital Waterford was the best-performing hospital in the country in terms of trolley counts. It cannot be the best-performing hospital any more in light of the current situation but I ask the Minister to outline the supports being provided to the hospital.
The Deputy should be careful in future not to jump the gun.
I appreciate the opportunity to contribute to this debate. The removal of the €80 charge, particularly for people who are ill on a regular basis, and sadly there are people who fall into that category, is welcome. This charge was a burden on them because for people who are ill, every euro is very important. I welcome the abolition of charges like this, especially for people who are ill on a regular basis.
I also want to use this opportunity to talk about another cumbersome issue, that of car-parking charges. I appreciate that our hospitals have to charge money for parking. I appreciate that because if they did not, they would be used like a public, free carpark and we cannot allow that to happen. I am aware that in University Hospital Kerry, for instance, exemptions are made if a person is going through a journey of illness. If they are in the hospital for a period of time, they can apply to management for parking-charge exemptions. I want to see that being streamlined.
There is another thing I want the Minister to do, although the Green Party would not be too happy with this. When I think of University Hospital Kerry, I want to see someone come along and blow some of the grass that is being cut on a regular basis, and in our way, out of it and I want to see black tarmacadam being put down and additional car parking spaces being provided. I want to see lining put out so that more people who are coming to visit their relatives and families will be able to park nearer to the hospital and will not be sent to Van Diemen's Land out on the side of the road because the car park is full. We cannot park on top of grass. The Green Party talks about being prudent with the environment but it is not exactly environmentally friendly to be out with lawn mowers all of the time, cutting grass. We should do the same with the car park outside Leinster House. We should blow half of the grass out of it and provide additional car parking spaces.
I am glad to get the opportunity to speak tonight. There is so much we could say about charges. I too have a gripe with parking charges in hospitals like University Hospital Kerry. We appreciate the exemptions that are available to some people when they are visiting a sick person on a daily or hourly basis but we need more such exemptions.
I want to speak about medical card holders or rather, people who do not have medical cards. I have dealt with situations where a farmer gets hurt or gets sick and is in hospital. He realises that he does not have a medical card so he applies for a card then, knowing that he is going to be in hospital for a while because he has had a stroke, a heart attack or has a serious illness. When he applies for the medical card, in due course, invariably if he is entitled to it, he gets it. However, this could be six, seven or eight weeks after he applied and in the meantime, he has incurred significant costs. I have asked about this several times. In many instances with social welfare claims, the payment is backdated to the day that the person applies. I am asking that the medical card be granted from day the person applied. I admit that when someone gets sick like that, it is possible that he or she does not send in all that is required so that they can be granted the medical card but God almighty, when it is granted it should be backdated to the day it was applied for.
I also welcome this legislation. I am often critical of the Minister for Health, and rightly so in my opinion, but I welcome his decision to get rid of these punitive charges. As previous speakers said, people can have long-term illnesses which mean they have to attend diabetic clinics, attend for dialysis as well as for many other treatments on a regular basis and the hospital charges mount up. Hospitals charge so much per day up to a certain number of days and those charges can be quite punitive and expensive. People get sick. They go to hospital to get better but they get sick with the fright and the worry of trying to pay these charges. We are talking about genuine, hard-working, decent people who would not owe a penny, not aon phingin amháin, to anybody. They would put money away for their turf delivery, for the milkman or anyone else and there would be no one owed or left short a penny. That is the kind of culture that they were brought up in and want to continue in. They appreciate the staff.
Regarding the car parking and the clamping business that goes on, it is disgusting. People go into hospital, and this happened to me although I am not complaining on my own behalf, and their cars are clamped while they are set down and trying to bring people into the accident and emergency department because there was no ambulance available. Clamping companies have members of the security staff of the hospital accompanying their own staff when they are clamping cars and releasing the clamps. These companies are taking away valuable members of the HSE workforce. They have a contract for clamping but they should carry out their contractual obligations without taking out a member of the security staff of the hospital, which happens in Clonmel. Such security staff are needed in the hospital for many other tasks.
We have to look after the people who are ill and try to support them and make their experience in hospital a happy one rather than imposing punitive charges. We should not be making them sick with worry about the consequences of bills.
A sum of €20.6 million was provided in budget 2023 to alleviate the financial burden of statutory hospital charges and I welcome that. Any reduction in charges for patients is welcome.
However, I was disappointed today when I attended a presentation by the Endometriosis Association of Ireland in the audiovisual room in Leinster House. Six women spoke about their issues today. They told us that they were so disappointed that not one person from the Department of Health turned up to the presentation in the audiovisual room today. They told us that they had to take medication to get there today. They took it from early morning in order to be able to make the journey to the audiovisual room and they were hoping that somebody from the Department of Health would be there, having been invited. However, nobody turned up. They told us that they travelled from all over the country, in pain, to make the effort to explain their problems but representatives of the Department could not even cross the corridor or cross the car park to hear their story. That was very disappointing. We are talking here about money and these people are in pain every day. They are looking for specialists in the field. They told us that 63% of the medical profession do not understand the prognosis for this and the rest are too busy within their own areas to diagnose it. All they need is a specialist to diagnose their issue. In the interim, they want to be able to go across the water to get the treatment that they need which is not available here. The Government should fund that. Let us get specialists to diagnose these problems and help these women to get the treatment they need. If we cannot provide that treatment here, it should be provided for them somewhere else in the world.
I welcome the fact that there will be fewer charges in hospitals. That is obviously a welcome move. There are more charges we would appreciate getting rid of. In fairness, there is ample parking at Bantry General Hospital and there are no charges for using it. This is very fair to people because the hospital is used so much. It could be used a lot more, however. That is the sad thing. Patients from Castletownbere, west Cork and places like that have informed me that in cases of small breaks etc., they have to drive past Bantry on their way up to Cork University Hospital in order to be landed into the back of an ambulance there where they will be waiting for half the day when they could have been looked after down below in Bantry in the first instance. It is sad that the Government destroyed the overnight service at Bantry. Even in the daytime, however, the hospital is trying to avoid taking people in, which is terrible.
I have an opportunity to speak about a number of health issues in the context of the Bill. On respite beds, I want to ask the Minister what is happening in our community hospitals. Many people are looking for respite beds but cannot get them. A family gave me four pages of detail on the attention they have to give to their mother. They love their mother. They were going to a wedding recently and were promised respite in a community hospital in the eastern part of my constituency. They were telephoned two or three days beforehand and told that the offer of respite was being withdrawn because the facility in question did not have enough staff. From what I can gather, there is a staffing crisis in our community hospitals. There are people coming to my clinics in respect of this matter. Last weekend, a lady who has a very sick child came to the clinic. She rang SouthDoc, but it took between three and a half and four hours for the child to be seen. There are a lot of problems in our hospitals.
I raised an issue with the Government last week. The Government has given two dates, 13 and 19 March, on which the Rivotril drug was due to be back in stock in pharmacies nationwide. Those dates have come and gone and there is still no sign of this essential drug, which is vital for thousands of patients who suffer from Parkinson's, multiple sclerosis, epilepsy and other neurological diseases. We are now being told it is due to be back in stock on 2 April. However, patients who are urgently awaiting this drug have lost all confidence in the Government's announcement of its return. Maybe the Minister will be able to give us some clarity on that matter. He asked me to write to him and I did, but I still do not have the clarity we need in the context of the Rivotril drug, particularly for Parkinson's patients.
Cuirim fáilte roimh an mBille seo. Is dócha gurb é an Bille is giorra a tháinig os mo chomhair agus os comhair na Dála i m’amsa ar aon nós. Níl i gceist ach leathanach amháin. An rud atá i gceist ag an Rialtas a dhéanamh ná deireadh a chur le táillí d’othair chónaithe i ngach ospidéal. Cuirim fáilte roimh an gcinneadh sin. Is dea-scéal amach agus amach é.
I welcome the Bill. It is the shortest Bill that has become before us in my time. It is very positive and it will put an end to in-service charges of €80 per night up to a maximum of €800. I am delighted with that. It amends the 1970 Act and the regulations made thereunder. I welcome that because it is 53 years since the Act came into force.
I do not welcome that accident and emergency charges remain in place. I do not understand the logic behind the view that if we took away the charges, accident and emergency departments would be overwhelmed. Most people are reasonable and rational. A few weeks ago, my partner and I tried to avoid going to the hospital as best we could. Most people who are reasonable do that. I do not agree with the logic in this regard. I do not believe there should be a charge for accessing accident and emergency services.
It has taken a very long time for the Bill to be brought forward, as Deputy Shortall said. In the context of Sláintecare, all parties came together because at every election the biggest issues are health, housing, public transport, neutrality, hospitals and public services. They are at the top of the list. That is why Sláintecare came into existence. That is why there was a report. The implementation of that has been tardy.
I refer to the Bill digest. I thank the staff of the Oireachtas Library & Research Service once again for the work they do under pressure. They pointed out that a review of Sláintecare and its implementation showed that there had been some progress, but that progress in respect of removing the barriers to access has been slow. We finally now doing the latter, which I welcome.
I welcome the positive things the Minister outlined. I pay tribute to him for doing that and for his work on the public contract for consultants. I wish him the best of luck with that.
The Bill digest brought a certain matter to my attention. It is something of which, again, we are all aware. It remains the case that people who opt to be treated as private patients in public hospitals are subject to a charging regime as set out, I presume, in the Schedules to the 1970 Act, although they may have been amended in the interim. When I went to the hospital with my husband, the first question we were asked was if we had private health insurance. I am not sure why that would be at all relevant in a public hospital. Is it a throwback? Is it a legacy issue? Why are patients being asked if they have private health insurance? I presume there is no difference in the treatment offered to public and private patients in hospitals.
There can be.
Maybe the Minister could clarify the position. What is the difference? How can we possibly stand over treating public and private patients differently in public hospitals that are fully funded by the taxpayer? What is the logic to it, except for a source of income for a public hospital that is really in trouble? I am very familiar with University Hospital Galway, UHG. I continuously pay tribute to the staff there who work under pressure. The hospital is at a breaking point. I will give the Minister a little flavour of what is happening. If I have the opportunity tomorrow, I might return to this matter. In 2014, the then Minister for Health, Deputy Varadkar, the current Taoiseach, stated that a new building was the only solution to the problems at UHG. In 2015, Enda Kenny said that the emergency department in the hospital was not fit for purpose. Eight years have passed and we still do not have a new emergency department in Galway. In 2016, the programme for Government contained a commitment in the context of funding being provided, but this did not happen. The emergency department has progressed a little in the context of what is called a strategic assessment report. That is where we are at, even though it is now 2023. I will return to this matter tomorrow.
I am not sure what happened to the concept of a brand new hospital being constructed on the 150-acre site at Merlin Park. I am not sure how that became an elective hospital, while the congested site continues to be expanded out of all proportion. I will come back to that issue tomorrow as well. The Minister might come back to me about why public and private patients would be treated differently in public hospitals.
I welcome the removal of the acute public in-patient charge. This is a very positive move. I will be supporting the Bill. I also welcome the public contract for consultants. I congratulate the Minister on that; it is a big step.
The Bill gives us a chance to reflect on the mess our healthcare system has become over the past few decades. More than two decades ago, when the Tánaiste was Minister for Health, a bed capacity report showed that we needed 5,000 extra beds in our health services by 2011. These are nowhere to be seen. In 2022, we had 7,000 fewer beds than we did in 1981. The Government likes to publish reports and plans on increasing bed capacity, but on "Morning Ireland" last week, Dr. Mick Molloy of the Irish Medical Organisation stated that he could not see any extra beds in the system. The Irish Nurses and Midwives Organisation recently indicated that there were 10,040 patients on trolleys in February. Dr. Molloy also stated on "Morning Ireland" that these massive numbers of people on trolleys are no longer surges; they are the new normal. He also said there was very little we can do in respect of the current crisis without a dramatic increase in the number beds. He identified increasing the number of accident and emergency and acute beds as a priority in the context of investment.
Our accident and emergency departments are over-strained. They do not have enough staff and they do not have enough beds. Accident and emergency departments are at the centre of all the failings in our health service. The number of GPs is declining and people are having difficulty getting GP visits. This is pushing people into accident and emergency departments. Years-long waiting lists for surgery and treatment push people into accident and emergency departments. Failures in our care homes and the care system push people into accident and emergency departments. Yet, I can see no evidence of the Government making the investment that is needed to combat this.
The other matter Dr. Molloy highlighted is the need for a dramatic increase in the number of elective surgery beds. He used the phrase "at minimum" regarding our acute bed capacity. The ESRI estimates that we need between 4,000 and 6,300 acute beds. We need those in at least three new acute hospitals.
Successive Governments have been happy to allow a two-tiered system in which those who can afford private medical care get treatment and everybody else who is accessing public healthcare is on a waiting list to remain in place. I tabled a parliamentary question on behalf of a neighbour of mine who has been waiting for an operation on an incisional hernia, which was detected at St. James's Hospital in December 2018.
She is a recovering cancer patient and is under the care of one of the professionals in St. James's Hospital. She received contact from the waiting list co-ordinator in December 2019 to say that she had secured funding to have her operation at the Beacon Hospital in six weeks' time. I presume that was from the National Treatment Purchase Fund, NTPF. She heard nothing back. I put a parliamentary question in on this in 2021 and I got a reply in August to say that the patient was on the waiting list, that Covid-19 had impacted on scheduled care and that she would be brought in as soon as possible. I had not seen her for a good while but I met her yesterday and she is still waiting, from 2018 until now, for that operation.
It is clear to everyone that the Government parties, over successive Governments, have not done nearly enough to increase the bed capacity in the public health service. Large hospitals are supposed to operate at 85% capacity, medium-sized hospitals are supposed to operate at 75% capacity and we are now seeing Irish hospitals operating at 110%, 120% and 130% capacity while thousands wait on trolleys. This is just not safe. We know that the lack of timely access to healthcare in this country will be responsible for over 300 unnecessary deaths per year and we know that staff and bed shortages are causing unsafe situations in our hospitals for both patients and staff. Twice this month the INMO has had to ballot members over the unsafe staffing situation in hospitals up and down the country. It has called for a national response to the massive overcrowding crisis we are in the middle of.
We seem to see this time and again. The Government pushes new reports, plans and accolades about the successes but everything just gets worse. We are seeing record homelessness and record numbers of patients on trolleys, as well as staff shortages in hospitals, mental health services, social workers and housing services. The Government should start building the houses and hospitals and it should start providing the services and numbers that everyone is saying we need now.
I want to thank colleagues for their support for this Bill; it is great to see the House united on this issue. I want to reiterate that we are on the path to universal healthcare. There are significant problems in our system, as we know. People are waiting too long for care and there are services which are not fully rolled out across the country. There are issues that patients and families are dealing with every day, and every one of us in this House wants to do everything we can to help them as quickly as possible.
It is important, however, to remember that we are making progress and that we are on the path to universal healthcare. We are cutting costs for patients, we are seeing the waiting lists for patients beginning to fall and we are seeing important new services being rolled out across the country. That is important and it is important that we acknowledge the work of our doctors, nurses, health and social care professionals, GPs and all those working in the system, because they often hear a narrative on what is not working.
We understand that and we all must focus on what is not working to make it better but they hear again and again that this and that are not working. The reality is that a huge number of things are working and that we are moving in the right direction. In some cases, like on costs for patients, we are moving rapidly in the right direction. Since this Government has come in the following has occurred: prescription charges have fallen; medical cards for the over-70s have become more accessible; medical cards for those who are terminally ill have become more accessible, moving from one year to two years; inpatient hospital charges for children have been abolished; and tonight we are passing the legislation to abolish inpatient hospital charges for adults. The maximum amount a family will have to pay for medicines in any one month has been brought down to €80. Free contraception has been brought in for women aged 17 to 26 and later this year we will extend that to women aged 16 to 30. We will be introducing GP visit cards for nearly 500,000 men, women and children this year and later this year we will be introducing State-funded IVF for the first time. These things matter and it is important that we acknowledge the progress when it is made, just as we rightly call out the challenges for patients and our healthcare workers when they exist.
A lot of colleagues have spoken about access and it is my top priority and the top priority of this Government in healthcare. We want to provide access for scheduled care, be it for an outpatient appointment or a procedure, as well as access for urgent care, be that through out-of-hours GP services, an injury unit or an accident and emergency department. It is the top priority.
Again, it is important to acknowledge the real challenges for patients and to congratulate the healthcare workers we have on making progress. We are all signed up to the Sláintecare targets that no patient should wait more than ten or 12 weeks for inpatient or outpatient care. I am genuinely happy to be able to share with colleagues that from the Covid peak, the number of men, women and children waiting over those agreed target times has fallen by 150,000. That is a 24% reduction in the number of people waiting; some 150,000 men, women and children. We have a long way to go but it is important progress and I want to commend the doctors, nurses, health and social care professionals and everyone who has been involved in making sure we are moving in the right direction.
Many colleagues have quite rightly said that we need more beds, and colleagues have referenced safe staffing. Safe staffing is being rolled out and it is funded. For example, University Hospital Limerick was referenced earlier and safe staffing for both phases 1 and 2 of nurses in the wards and the accident and emergency department are fully funded. The hospital, therefore, is fully sanctioned to hire into those roles. Deputy Joan Collins and other have said we need more beds and we do. We also need more clinicians. While we say that, it is important that we also recognise that over the last three years we have added a huge number of extra beds. We have added nearly 1,000 extra hospital beds and we have added a huge number of staff to the workforce. This year it is our intention that we will have a fourth record year in a row for hiring into our public health services.
Because we are building and staffing all the extra beds and because we are rolling out the community-based services and giving access to diagnostics at a level we have not seen before, our health service is beginning to manage the increased demand from our population, partly due to Covid and partly due to a growing and ageing population. While managing that, it is also driving down the waiting lists. We are doing that because we have expanded capacity to a level that has not been seen in a long time, and working with the HSE and the Department. Most importantly, we are also working with front-line clinicians to do things differently. We have two Deputies here from Waterford and we know that University Hospital Waterford's accident and emergency department is being run incredibly well. We know that some of things that work in University Hospital Waterford are not being done in some of the other hospitals, including in some of the other hospitals that may have some of the loudest voices in wanting more capacity. They may be right on needing more capacity but we are also right about them needing to work in different ways and looking at places like Waterford, Portlaoise and Tullamore and other hospitals-----
Good Deputies.
-----and saying that this works for patients and that it has to work right across our system. If we are going to achieve our common goal of universal healthcare for people in this country, we need record levels of investment in capacity, which is happening, and at the same time we must see a radical agenda of reform right across the system. We have to achieve both.
Several Deputies have asked what is left in terms of hospital charges for patients. There are only two things left. First is a €100 charge for the accident and emergency department if a person does not have a medical card; otherwise it is free for a medical card holder. Second, there is a €75 charge for an injury unit. We would like to see those charges brought down over time. These €100 and €75 bills are significant for people to pay and if they have children, like I do, they might find themselves in these injury units and accident and emergency departments and paying those bills more often than they would like to. We want to bring them down.
GP care will become more affordable, and later this year for the first time ever over half of the population will have State-funded access to general practice, which is a big moment for our country. As we make GP care more affordable, we can look at bringing down those two remaining hospital charges. We all know the reason they are there. If it was cheaper for people to go to an accident and emergency department or an injury unit than a GP, inevitably at the margin people would do that. We know our accident and emergency department staff are already working flat out and working too hard in many of our hospitals. We do not want that to happen but it is something we can look at in the future.
I also want to take a moment to thank colleagues for the support across the House for the new consultant contract. It is an important contract and an attractive one. Later this year, the base salary at the top of the scale will go to about €261,000 and with on-call allowances, the amounts of which have been increased as well, many consultants in our system will be earning in excess of €300,000 per year for a 37-hour week.
A lot of them do a lot more than that unpaid and I acknowledge that. It is nonetheless a very attractive contract for doctors. Our hope is that the doctors we are training here as non-consultant hospital doctors, NCHDs, will take these posts when they qualify as consultants and that a lot of consultants around the world - Irish-trained consultants who living all over the world - will begin to come home and take up this contract.
Critically, this contract also works for patients. It does two very important things. First, it doubles the regularly rostered hours in which we can provide services in hospitals for patients, from about 40 hours a week to about 80. That will be phased in over time as we build up the workforce further. It is a fundamental change in hospital access for patients. That is important. Second, it helps drive forward another common goal, which is removing private care from public hospitals. Deputy Connolly asked why people are asked for their insurance details when coming into a hospital. That is because the hospitals want to make money out of it. In some cases the clinicians and consultants want to make money out of it. In some cases patients can end up with better facilities and may have more access to a consultant rather than the NCHD in an operating theatre, for example. That is not always the case but there would be a perception among some of the consultants I talk to that that is one of the reasons. We want to end that. More and more hospitals are now not asking for insurance details and patients are pointing out they are a public patient in a public hospital and their insurance details are not relevant. We have a role to play in government and in the Oireachtas in agreeing that the money lost by public hospitals must be replaced by the Exchequer because we want public patients treated. We cannot disadvantage the public hospitals in terms of that funding.
I again thank colleagues for their support for this Bill, for the direction of travel towards universal healthcare and for the very strong support I have heard this evening for the new consultant contract.
Question put and agreed to.