Amendment No. 1 is out of order as it is not relevant to the provisions of the Bill as read a Second Time.
Health (Amendment) Bill, 1991: Committee and Final Stages.
Section 1 agreed to.
SECTION 2.
An Leas-Cathaoirleach
Amendment No. 1 not moved.
Question proposed: "That section 2 stand part of the Bill."
I accept the ruling in relation to the amendment which stated "that the Minister shall provide, by regulations, for the preparation of a charter of patients' rights in relation to hospital services and community health services". My amendment went on to explain the nature of the charter. Before I could agree to the passing of section 2 may I say that I find it regrettable that the charter is not part of the legislation. Giving this charter a statutory basis in legislation would have been a tremendous boost for the health services and would have ensured that people could have recourse to some document or regulations when they wished to protest about a particular situation in a hospital. It would have set an acceptable level of waiting list, if such a thing were possible and would be much more acceptable than what exists today. A right of access to medical records would be part of such a charter and there would be a procedure for dealing with peoples' complaints.
I welcome the Minister's commitment to a charter in his reply on Second Stage but I am disappointed that it has not been included in this legislation. Will the Minister indicate when the charter might become a reality and in what way does he think the charter can be made effective. My concern is that we could agree a charter of patients' rights which in itself would be good and welcome and would have the complete support of my party but may not have teeth or a basis in law, to give the patient the right of recourse to some forum. I would like the Minister to indicate his plans in this area to the House and I will consider my attitude to section 2 in the light of the Minister's reply.
We touched on this charter on Second Stage. I went through the various aspects and principles of the charter which we were agreed upon. Yesterday the Minister for Health, Deputy O'Hanlon indicated in the Dáil that once this legislation is enacted he will move immediately to implement the charter. It will not be implemented on a phased basis, necessarily, but he will issue instructions through his Department to the health boards to begin the proper implementation of all the principles contained in the charter once this legislation is enacted.
If I can take it that I have a commitment from the Minister that the charter will be implemented immediately and will be a reality before autumn I will not obstruct section 2.
Question put and agreed to.
Section 3 to 5, inclusive, agreed to.
SECTION 6.
I move amendment No. 2:
In page 3, line 35, after "health boards" to insert the following:
"and these regulations shall inter alia provide—
(i) for the provision of sufficient public beds to provide care for all those who seek access as public patients in an equitable manner with the beds provided for those seeking private care, and
(ii) for the annual review of bed mix and case mix to ensure that equity continues to prevail in the allocation of in-patient hospital services".
The purpose of the amendment is to ensure that it will be written into the legislation that there be sufficient public beds to provide equitable care for those seeking access as public patients with those seeking private care. It suggests an annual review of bed mix and case mix to ensure that equity continues to prevail in the allocation of in-patient hospital services. This is a worthwhile amendment and I urge the Minister to accept it since he indicated to the House in his Second Stage speech that he was going to ensure such a provision of beds. If that is the Minister's commitment I cannot see why he should have any difficulty accepting an amendment which seeks to write that into the legislation.
My party are concerned, as I indicated on Second Stage, about the general state of the health services but I do not propose to go over that ground again. Our greatest concern is that there might not be equitable bed distribution resulting in an unfair advantage to some groups over others. We are very concerned that the allocation of beds be done justly and the Minister should accept this constructive amendment which will basically write into the legislation what we all aspire to. The acceptance of this amendment would be a litmus test of our genuine concern.
I am very concerned that we are not implementing a common waiting list system which, despite organisational difficulties, is the best system because it takes people in on medical priority alone. This reasonable amendment does not seek to cause difficulty but to assure people that there will be a fair mix in hospital beds, that justice will be done and I urge the Minister to accept it.
This is a worthwhile amendment but I cannot understand how it does not impose a potential charge on the Revenue but, presumably, things sometimes get past the vigilant eye of the Cathaoirleach that might not otherwise be in order. It is a worthwhile amendment which is entirely in keeping with the spirit of the Bill and deserves for that reason to be supported.
It may sound a little cavilling to say that Senator O'Reilly and Fine Gael have caught up with the health services having conspired with previous Governments to destroy them but I am glad they have rediscovered the importance of them after two or three years of silent toleration of the job done on them between 1987 and 1990. For the philosophical conversion it represents from Fine Gael and for the principle involved I am happy to support the amendment.
I want to reply to the remarks made by Senator Ryan. I do not think the Senator seriously believes them himself but is engaging in jest because of the late hour and the holiday atmosphere prevailing. This amendment is an indication of Fine Gael's constant concern for equity in the health service including complete availability within a just and fair system. When we operated under economic stringencies in the past we always maintained a high level of service to patients and I know Senator Ryan is not serious in what he says.
Section 6 of the Bill amends section 55 of the Health Act, 1970, by substituting a new text which provides that the health boards may make in-patient services available to persons who do not establish entitlement or who are deemed to have foregone their entitlement by choosing private medical services. This is broadly what was in the original section 55 with an adjustment to take account of the charges made in section 5 of this Bill which have already been addressed earlier. Section 55 was, therefore, further amended by the new provision for the making of regulations setting out these services and how they are to be provided to private patients by the health boards.
It would help to clarify the purpose of this amendment of the Health Act for Senators if I briefly sketch out the arrangements I propose putting in place by regulations. Under this section the proposed regulations will put in place the key elements of the new arrangements for the admission of private patients, which will be that all beds will be designated either private or public beds. Certain special categories of beds, such as those in intensive care units, will not be designated as these must be available as required. Elective private patients will be admitted from a private waiting list to a designated private bed. Elective public patients will be admitted from a separate public waiting list to a designated public bed. Emergency admissions will be accommodated in whatever bed is available at the time and to avoid unnecessary disruption of hospitals when category 3 is abolished from 1 June I propose to phase in the new arrangement for admission to a hospital over a three year period.
The first move will be to designate beds in all hospitals either private or public. Officials of my Department have already held meetings with all the voluntary hospitals and health boards around the country to explain how the new arrangements are to operate. Hospitals have been asked to submit their plans for designating beds and for the phasing in of the new admission arrangements. My officials are now holding a series of follow up meetings to finalise these plans which will require my approval. I will not approve plans which result in any reduction in the number of beds available to public patients and this has been made clear to hospitals. Once the plans are put into effect my Department will be monitoring their implementation very carefully and reporting back to me on how the new arrangements are operating.
Reference was also made to the common waiting list and I want to point out that the new arrangements will require the operation of separate waiting lists for private and public patients. Senators will be aware that the Commission on Health Funding recommended a common waiting list and as I have already pointed out in the previous debate, I have two serious reservations about the commission's recommendation in this area.
The first one is that the recommendation could result in the public patient being disadvantaged. The commission's recommendation relied on the monitoring of admissions to ensure that private patients were not admitted to the available beds ahead of public patients with greater medical need. However, there could be great difficulties, in practice, with this recommendation since the decision to admit a specific patient is, and always must be, a clinical decision of the consultant concerned. For this reason the Government and social partners believed that the public patient could be best protected by ensuring that for non-emergency treatment, public beds were available exclusively to public patients. Secondly, as I have already stated, I am of the opinion that it is in the interests of the public hospital system and of the public patient to maintain the balanced mix of public and private care in public hospitals.
Turning to the amendment put forward by Senator O'Reilly, I am not in a position to accept this amendment because it contains vague aspirations to provide sufficient beds in an equitable manner without defining this or saying how it is to be done. The regulations which I propose to make under this section will include concrete measures for improving equity of access to hospital services by ensuring that publicly funded beds are available for public patients. The designation of beds as public or private which will be required under the regulations will require my approval and I have already given a clear commitment to the House that there will be no reduction in the number of beds available to public patients.
The second part of the proposed amendment calls for an annual review of the bed mix. I will be carrying out a continuous review of the bed mix and of private and public care to ensure that the new arrangements are operating in the way I intend and if there is any need to take corrective action that will be done arising out of the ongoing continuous review. I think they will meet the Senator's specific requirements with regard to the annual review; this review will be continuous.
I take the point about the regulations being introduced but I feel this amendment would have improved the legislation and I cannot accept that there is a difficulty with incorporating this statement of principle and policy in the legislation. We should be writing this in and eliminating all the waiting lists on a once off basis, which is our present party policy. This statement, together with the regulations, could only improve the legislation and give people the necessary reassurance.
I am pressing the amendment.
Amendment put and declared lost.
I move amendment No. 3:
In page 3, lines 36 to 42, to delete subsection (3) and subsititute the following new subsection:
"(3) Where it is proposed to make regulations under this section, copies of them shall be laid before each House of the Oireachtas and the regulations shall not come into effect until a resolution approving of them has been pased by each such House".
What is involved here is very straightforward and should be readily accepted. It is based on the acceptance which we would all defend to the last, that the Houses of the Oireachtas are the primary legislative body and, as such, that regulations under this section should be put before the Oireachtas for scrutiny.
That is reasonable and acceptable and I cannot see a practical difficulty with it, nor do I think it needs further elaboration, except to say that if regulations are in order they will gain the immediate approval of the Oireachtas. If they need improvement then it is only right that they go through a process of scrutiny and I urge the Minister to accept this amendment.
I cannot accept this amendment. The course being taken is the normal practice in such situations and it would not be practical, or desirable, that a debate in each House of the Oireachtas be required each time it was necessary to make variations in the regulations, no matter how minor. Under section 6 (3) of the Bill, the Oireachtas will be able to annul any regulations should it choose to do so, so I do not think it is necessary to make the provisions proposed in the amendment.
Amendment put and declared lost.
Section 6 agreed to.
SECTION 7.
I move amendment No. 4:
In page 4, between lines 9 and 10, to insert the following new paragraph:
"(e) Where it is proposed to make regulations under this section, copies of them shall be laid before each House of the Oireachtas and the regulations shall not come into effect until a resolution approving of them has been passed by each such House.'.".
Essentially this amendment has the same objective as the previous one. I do not accept the difficulty posed by the Minister if the regulations come before the Oireachtas. I do not think the Oireachtas would obstruct any minor adjustments to the regulations that might take place over a period. The amendment stands on its merits and I am not convinced that it is inappropriate to involve the Oireachtas at this stage because of the sensitive and serious nature of the regulations. I cannot accept that the practical difficulty is a problem and we should not allow such considerations to interrupt us in an area so important as the delivery of health care.
I could not support this amendment. Section 7 of the Bill, which the proposed amendment relates to, involves inserting into section 56 of the 1970 Health Act, as amended by the Health Amendment Act, 1987, a provision to enable the Minister to make regulations specifying the circumstances in which a person may avail of consultant out-patient services. I could not, therefore, accept the proposed amendment because I regard it as undesirable that a debate in each House of the Oireachtas should be required each time it was necessary to make variations, no matter how minor, in the detailed regulations.
I am satisfied that the procedure set out in section 7 is the appropriate one and is in line with arrangements made in similar situations up to now. Also of relevance is the fact that changes to the regulations may be required as a matter of urgency and having to debate the regulations in the Oireachtas would cause unacceptable delays.
Amendment put and declared lost.
Section 7 agreed to.
SECTION 8.
An Leas-Chathaoirleach
Amendment No. 5 is ruled out of order as it involves a potential charge on the Revenue.
Amendment No. 5 not moved.
Question proposed: "That section 8 stand part of the Bill."
There has always been a problem about health contributions from those not in the PAYE sector. Many of the health boards have a problem with the health levy supposed to be due from the farming community and many health boards have relatively large sums of money outstanding which are a necessary part of their funding. Since we are talking about changing the Health Contributions Act, does the Minister have anything to say about all those who should be paying their contributions in the same way as PAYE workers who have their contribution assessed on the basis of their income? What is being done about those who are outside the PAYE sector to ensure that they make an equivalent contribution?
Section 8 of the Bill deletes all reference in the Health Contributions Act, 1979, to the income ceiling on health contributions. The income ceiling was, until now, increased each year. For the 1990-91 tax year it stood at £16,700. Payment of the 1.25 per cent contribution, therefore, ceased when income reached that figure. The removal of the ceiling will obviously have no effect on anyone earning less than £16,700 per year and a person earning above £16,700 per year will now pay 1.25 per cent on the balance. For example, a person earning £20,000 who would previously have paid an annual health contribution of £208.75 — the maximum payable based on the ceiling of £16,700 — will now pay £250 per year which is an increase of £41.25 or about 80p per week. The health contribution has often been criticised as a regressive tax bearing proportionately more heavily on people with lower incomes. Anyone less than £16,700 has until now been paying 11.25 per cent. Because of the income ceiling a person earning say, £30,000 has been paying the health contribution at an effective rate of 0.7 per cent, dropping to only 0.4 per cent, for someone earning £50,000. Everyone, regardless of income, benefits from the availability of health services and it is certainly fair that everyone should contribute in proportion to their ability to pay.
The yield from this measure is estimated at £19 million in a full year most of which will accure in the January to March period as outline in more detail during the Second Stage debate. This money will go part of the way towards meeting the very high cost of the commitment to a major development of a community based service which is included in the Programme for Economic and Social Progress. It will also be put towards any increased costs arising from the extension of eligibility although, as discussed earlier, there are grounds for believing that any such cost will not be significant. Health contributions are now collected by the Revenue Commissioners and health boards are collecting arrears due before this change, that is before 1984.
Health boards have pursued a vigorous line in the collection of outstanding amounts and have notified defaulters of their intention to take legal action for the recovery of arrears. Solicitors' letters have been issued and some health boards have selected cases for proceedings if demands are not met. It is likely, therefore, that a considerable portion of these arrears will have to be regarded as written off, unfortunately, because of factors such as death of person originally assessed, change of ownership of farm, etc.
Question put and agreed to.
Sections 9 to 11, inclusive, agreed to.
Title agreed to.
Bill reported without amendment, received for final consideration and passed.