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Seanad Éireann debate -
Wednesday, 19 Jun 2013

Vol. 224 No. 2

Health (Amendment) Bill 2013: Second Stage

Question proposed: "That the Bill be now read a Second Time."

I welcome the Minister, Deputy Reilly, back to the House.

I am pleased to have an opportunity to introduce the Second Stage debate on the Health (Amendment) Bill 2013. The Bill amends the Nursing Homes Support Scheme Act 2009 and the Health Act 1970. The primary purpose of the Bill is to give effect to the budget 2013 announcements relating to the nursing homes support scheme, public acute hospital inpatient charges and the charging of private inpatients in public hospitals. The Bill also amends certain charging provisions under the Health Act 1970 and enables the outsourcing of functions under the Nursing Homes Support Scheme Act 2009.

It was announced in budget 2013 that the asset contribution under the nursing homes support scheme would be increased from 5% to 7.5%. It was also announced that the entitlement for State support to be backdated to 27 October 2009 for people who were in nursing home care prior to the commencement of the scheme would be abolished. The HSE's 2013 national service plan sets a target of 22,761 people to be in receipt of financial support under the nursing homes support scheme at the end of 2013. Given the extreme pressure on HSE funding across the full range of its services, it is necessary to increase the asset contribution. However, residents' contributions will continue to be based on the means of the individuals concerned and on their ability to pay. Even after the increased asset contribution comes into effect, the HSE will continue to meet the greater part of the cost of an individual's nursing home care. Despite the increase in the asset contribution, it is important to note that the scheme contains several safeguards which ensure the person in the nursing home and their spouse or partner, if applicable, are adequately provided for. These are unaffected by the provisions of the Health (Amendment) Bill 2013.

The increase from €75 to €80 in the acute public hospital inpatient charge and the charging of private inpatients in public beds were announced as part of budget 2013. These measures will raise approximately €120 million in a full year. The Government believes that the new private inpatient charge makes sense in light of the serious situation we have had up to now. Insurers have been enjoying a significant subsidy. Private patients in public beds have paid a standard charge of just €75 per night. By contrast, private patients in private beds have paid up to €1,121 per night. In both cases, the patient sees their consultant privately and pays the consultant's private fees. When one realises the cost of providing this service to private inpatients is at least €200 million more than the amount public hospitals are currently allowed to raise, one can see the imperative to address the situation. The subsidy is equivalent to the cost of running a large hospital, or the cost of treating approximately 30,000 public patients every year. We cannot allow this situation to continue.

Everyone is entitled to use a public hospital. However, some people choose to be treated privately, in which case they have chosen to pay the consultant and the hospital. The Government believes that users of private services should pay for the costs of providing them. The charge for private care in a public hospital should cover the costs of providing the service, including non-consultant hospital doctors, nursing staff, medicines, blood, medical and surgical supplies, radiology, diagnostics, operating theatres, laboratories, administration and support staff. This approach is entirely in keeping with the move to universal health insurance, where public and private providers will compete on a level playing field, free of unfair subsidies. Indeed, we will need to remove this subsidy one way or another as we move to universal health insurance.

The Bill updates certain provisions relating to charges and contributions under the Health Act 1970 and enables outsourcing under the Nursing Homes Support Scheme Act 2009. Section 53 of the Health Act 1970, as amended in 2005 and 2009, now covers three different charges: public acute hospital daily inpatient charges, charges for long-term residential care under the nursing homes support scheme and long-stay charges for inpatient services. The language and concepts used in the provisions for long-stay charges have become quite outmoded due to the development over the years of a wide range of different models of residential care service provision that are tailored to meet needs in the disability, mental health and care of older people sectors. The Bill provides for the repeal of section 53. It provides in distinct and separate sections for charges for long-term residential care under the nursing homes support scheme, for public acute hospital daily inpatient charges and for an updated framework to replace long-stay charges, namely maintenance and accommodation contributions for residential support services.

The Bill updates and replaces arrangements under the repealed section 53 for maintenance charges required from those in receipt of long-stay inpatient services other than acute hospital care or services covered under the nursing homes support scheme. The replacement provisions will apply to the provision of residential care by or on behalf of the HSE in hospitals, convalescent homes, nursing homes or residential accommodation in the disability or mental health sectors, excluding residential settings already subject to their own charging regimes, namely acute hospital care and long-term residential care services provided under the nursing homes support scheme. A key and well-established principle is that people who are given residential care should make an affordable contribution towards the cost of their maintenance and accommodation.

As quality service provision is expensive, it is fair and equitable for all of those who receive publicly funded residential care to make appropriate payment toward the maintenance and accommodation costs associated with providing such services, if they can afford to do so. Funding derived from maintenance and accommodation contributions will continue to be directly applied by the HSE towards the provision of health services. There will be a continuing requirement to pay an appropriate and affordable contribution towards the maintenance and accommodation costs to the State of providing such services. Contributions will be in line with current long-stay charges. The actual contribution will depend, as it does now, on the individual's income level. Long-stay charges are currently just below 80% of the non-contributory State pension. The maximum contribution will remain at this level. The exemptions that apply to long-stay charges will continue to apply to residential support services maintenance and accommodation contributions. The HSE will continue to have the discretion to reduce the level of contribution required depending on individuals' financial circumstances, the extent to which they provide for their own maintenance and their assessed needs.

There is a commitment in the programme for Government that a Government-wide review will be carried out to identify and eliminate non-priority programmes and outsource non-critical functions, where appropriate. With this in mind, a provision enabling outsourcing is being inserted into the Nursing Homes Support Scheme Act 2009. However, no specific outsourcing proposals are under consideration at this time. The Bill also contains a provision which extends section 53A of the Health Act 1970 to public nursing homes. It is worth highlighting that the Government is committed to enhancing the quality of life of older people. We are acutely aware of the evolving health and care needs of Ireland's older population. When the nursing homes support scheme commenced, a commitment was made that it would be reviewed after three years. A public consultation to inform the review was carried out last year. A summary report of the submissions received was published on the Department's website in December. Work will continue on the review in the coming months with a view to its completion late this year or early in 2014.

I propose to outline briefly the main provisions of the Bill. Section 4 provides that the HSE may outsource its functions under the Nursing Homes Support Scheme Act 2009. Section 6 abolishes the entitlement for State support to be backdated to 27 October 2009 for people who were in nursing home care prior to the scheme commencing. This provision was originally inserted in anticipation of a large volume of applications in the initial months of the scheme. It ensured applicants would not be disadvantaged if any backlogs occurred at that time.

Given that the scheme has now been in operation for almost four years, it is considered appropriate to abolish this provision.

Section 7 increases the asset contribution to 7.5% for new entrants to the nursing homes support scheme after the enactment of the Bill. This will be capped at 22.5% in the case of the principal private residence. In the case of a couple, the cap on the principal residence will be 11.25% where one member of the couple enters long-term nursing home care.

Section 8 amends section 51 of the Health Act 1970 to add definitions of "acute in-patient services" and "long-term residential care services" to the existing definition of "in-patient services". Section 10 repeals section 53 of the Health Act 1970. The repealed provisions are either relocated to or replaced by parallel provisions in new sections of the Act which are inserted by sections 12 and 19 of this Bill.

Section 11 amends section 53A of the Health Act 1970. At present, section 53A enables the HSE to apply an economic cost of care charge to a person in an acute hospital if they are no longer receiving medically acute care and treatment and have been certified as requiring long-term residential care services. The charge applicable is the average cost of long-term residential care in public nursing homes.

This amendment will extend the provision to public nursing homes. Where a person enters a public nursing home for services other than long-term residential care - for example, respite or rehabilitation - and has subsequently been deemed by a registered medical practitioner to require long-term residential care services, the HSE may charge them the average cost of care in public nursing homes. This and the existing provision under section 53A are enabling provisions and will only apply where an individual refuses to co-operate with the application process for the nursing homes support scheme.

Section 12 inserts two new sections, 53B and 53C, into the Health Act 1970. Section 53B is a technical amendment arising from the repeal of section 53. Section 53C provides for the public acute hospital inpatient charge and raises it to €80 from its current level of €75. Currently, this charge applies for a maximum of ten days in a rolling year and, as there are no plans to change this maximum, the charge will be capped at €800 over this period. Section 53C also sets out the categories of persons who will be exempt from the charge, including medical card holders.

Section 13 amends section 55 of the Health Act 1970 and sets out the basis for the charging of all private inpatients in public hospitals. In future, where a person waives eligibility to services as a public patient, the HSE, or someone providing a service on its behalf, may impose the relevant charge. The charge is set out in the Fourth Schedule.

Section 14 inserts section 74A in the Health Act 1970 and provides for the collection of outstanding charges or contributions where the service has been provided on behalf of the HSE. Section 15 inserts as a Fourth Schedule to the Health Act 1970 a list of charges in respect of inpatient services provided to private patients in public hospitals. The charges depend on whether a patient is accommodated in a single or multiple occupancy room, or on a day case basis, and to which Schedule, as outlined in sections 16,17 and 18 of the Bill, the hospital concerned is assigned.

Sections 16, 17 and 18 insert, respectively, as Fifth, Sixth and Seventh Schedules to the Health Act 1970, the lists of hospitals to which the charges set out in the Fourth Schedule apply. Section 19 provides for the insertion in the Health Act 1970 of new sections relating to residential support services maintenance and accommodation contributions. These will replace the present maintenance charges required from those receiving long-stay inpatient services, other than acute hospital care and long-term residential care provided under the nursing homes support scheme.

Section 67A defines "residential support services" as services - other than outpatient, acute inpatient or long-term residential care services - provided by or on behalf of the HSE to a person residing in a hospital, convalescent home, nursing home or residential accommodation for persons with physical, sensory, mental health or intellectual disabilities, where the person's accommodation is provided by or on behalf of the HSE. Section 67B enables the HSE to make residential support services available to persons with full or limited eligibility.

Section 67C provides that HSE shall collect a contribution towards the cost of maintenance from a person who is receiving residential support services if the person has previously received specified services on at least 30 days within the 12-month period ending on the day in question. It provides that the Minister for Health, with the consent of the Minister for Public Expenditure and Reform, may make regulations specifying the amounts of the contributions required from persons or classes or persons, which may not exceed 80% of the maximum rate of the non-contributory State pension, as currently applies to long-stay charges. It also exempts certain categories of people from paying the contribution. These categories are consistent with current exemption provisions relating to long-stay charges.

Section 67D allows the HSE to waive the contribution, in whole or in part, in certain circumstances and requires the HSE to prepare guidelines, which must be approved by the Minister, with the consent of the Minister for Public Expenditure and Reform, setting out the circumstances in which the HSE may waive or partially waive a contribution. These guidelines will be published by the HSE.

Under this section, provision is made to take account of the extent to which an individual may provide for his or her own maintenance or partake in activities which are, for example, beneficial towards the individual's rehabilitation or address agreed care plan objectives. This will be of particular relevance to those residing in settings in the community where there is a strong emphasis on ensuring each individual is supported to the greatest extent possible in living in the community and managing his or her own affairs.

I commend the Bill to the House and look forward to hearing the views of Senators.

I welcome the Minister. Anybody can be late and we understand that, so there is no difficulty, particularly as the Minister is one of the best attenders in the House. Nonetheless, it is customary that we get a copy of the speech when a Minister begins speaking. We did not get it until the end, and three were given to the Government side-----

I offer many thanks to Senator Gilroy for sharing one of those copies so we could have a quick preview of the closing pages of the speech.

We will not be supporting this legislation and I have several questions in this regard. Mr. Colm McCarthy prepared a report on health insurance but it would seem that not much cognisance has been taken of its findings. There is very serious concern that an increase in health insurance premia will inevitably result from this. I have heard a suggestion from the Department that the Minister has actuarial data to show this will not happen, so I would be most interested that he publish this information given independent economists such as Mr. Colm McCarthy are saying it is inevitable we will have an increase. All of the insurance companies are also saying this, with some suggesting there will increases in premia of over 20% and as much as 40%, and they are collectively agreed it will be close to a 30% increase across the board.

As somebody who has private health insurance with VHI, I have found that, with a family of five, I have had to adjust the kind of cover I have. We were paying in the region of €3,200 per annum and we have had to cut back on a number of items to leave it now in the region of €2,000. That is against a backdrop where approximately 1,100 people a week have pulled out of health insurance, which is greatly upsetting the sustainability of our community rating system. This is the forgotten generation - people like Senator Darragh O'Brien, myself and those of that age group - who are struggling to nurse mortgages and so on, and are now asking: "Will I stay in the health insurance market or not?"

The Minister in his commentary on this issue has pointed out that health insurance claims are up, but that is hardly a good sign. Of course they are up, given the people who are still in there are the ones who are older and less healthy, regrettably, and it is the younger people who are pulling out. This is what the data that has been made available to us seems to suggest. In the recent figures, we see that 79,000 customers under the age of 40 left the market while the number of insured people over the age of 50 increased by 14,000. That is simply unsustainable.

I am sorry the Minister has to leave and I thank him for taking the time to attend.

No doubt, the Minister of State with responsibility for disability, equality and mental health issues, whom I welcome, will pass on all of my sentiments and listen as intently as ever.

I have just spoken about how I inquired about what data were available in the Department to show that we were not going to have an increase in premia of 30%. The Minister has said the health insurance companies are scaremongering. However, it stands to reason that if I, as a taxpayer with health insurance who contributes to the same public health system through my taxes, must now be charged €900 or whatever the figure is per night for a bed in a non-teaching hospital as opposed to €75, or €80 following the passage of the Bill, it will inevitably affect the solvency of the insurance companies. That is borne out by a number of issues that have been raised by Mr. Colm McCarthy in his report. Inevitably, there will be fewer people in the health insurance market and those who stay will be over 50 years in the main. They are more likely to be sick and a heavy burden on the system and those who leave will put increased pressure on the public system, creating additional costs. It does not seem to add up and is very woolly. We do not know how it will pan out. In terms of the basic economics and if we are to listen to those involved in the system, this will not play out very well, which is a major concern for us. For that reason, we cannot support it.

There appears to have been no consultation with the insurance companies. Perhaps there is a line of communication with VHI, given its connection to the State, but in the case of the other companies, there seems to have been no formal contact to ask them what they think could be done and how we should respond to the financial challenges in the health service. I gather the insurance companies made a submission on a collective basis a month ago containing suggestions about how savings could be made. It is our information that there was no response to that submission. Is that the case because if it is, it seems like a very bad practice to come up with a plan and then consult after it has been implemented?

Yesterday the Minister announced a new health forum, which will aim to lower the cost of health insurance. Who announces such a forum the night before legislation is published? It is like saying, "This is the new car that we are selling into the market and we plan to test its performance after we sell 50,000 units." It is just ridiculous; it is planning in reverse and haphazard. If there is a master plan behind this, the Minister of State should share it with us because it looks very haphazard and loose. Regarding the announcement of a new health forum that will aim to lower the cost of health insurance plans and "knock heads together", based on what the insurance companies which contacted us stated, it seems that they were available to talk for a long time.

Is the Directorate-General for Competition in Brussels in any way concerned about this measure? On the one hand, the private insurers negotiate directly with private hospitals, whereas the Minister of the day sets the price in the case of public hospitals. Is there a competition issue? There might be. The Minister should look into the possibility that some insurance company will refer it to the Directorate-General for Competition.

The Bill was to provide for the roll-out of free GP care, but we do not see anything in it about this. That was our understanding of the position. The measure seems to have been pushed out further and further.

There is an adjustment being made to the fair deal scheme whereby a higher proportion of the elderly person's estate will be sought. Age Action Ireland has made its views very clear on this and other budgetary measures announced before Christmas. The other measures such as trebling the prescription fee are being interpreted by Age Action Ireland and quite likely the elderly as a further attack on them.

What are the Government's plans to attract young healthy people to the health insurance system? At its peak, 2.5 million or more people had health insurance across the full system. This figure has been substantially reduced and it has been predicted that 300,000 will leave as a result of this Bill. What measures will the Government introduce to entice people to take out health insurance because I see nothing in the Bill to that end? People in Senator Darragh O'Brien's age group and mine - what the ESRI called the forgotten generation - pay between €2,000 and €3,000 per year if they have a few children; therefore, it is a no-brainer. That figure must come down or other measures will have to be put in place because it is simply unsustainable.

While I appreciate that the Minister of State is deputising for the Minister, I ask that she try to answer some of my questions. In terms of the figure of €75 which is to increase to €80, we are supportive, but we cannot support the other measures proposed. If they come to pass which they clearly will because the Government has a majority, a universal system of health insurance will be even further away because the Bill will inevitably bring down the numbers already with private health insurance. As Mr. Colm McCarthy said in his report, the lower the number with private health insurance, the more difficult it will be to implement a universal system of health insurance.

I call Senator Colm Burke.

I would like to call for a quorum. The way this debate has been conducted has been most unsatisfactory. The Minister has not been able to stay and we only have three Government Senators present.

Notice taken that 12 Members were not present; House counted and 12 Members being present,

I welcome the Minister of State. It is not often that I agree with Senator Marc MacSharry, but it would have been helpful if the Minister's speech was given to us before the debate commenced.

I am a little disappointed. I made two calls to the Department yesterday seeking clarification not only on this matter but also another health Bill to be discussed after this and I find it unhelpful that I do not even know as I go into the next debate what the approach will be in dealing with the next Bill. As a result I will support the Bill on the next Stage.

This Bill amends the Nursing Homes Support Scheme Act 2009 and the Health Act 1970. The 2009 Act was brought in to set up a proper structure to provide funding for nursing homes. As far back as 2001 the Ombudsman's report had identified several deficiencies in how we were providing nursing home care. It was amazing that it took nine years before any major development took place. That followed court hearings on the matter in 2004 and 2005 and it took another three or four years to develop a proper structure. This has worked well over recent years and this Bill makes some amendments to it. We face challenges in elderly care over the next few years. There are many young people in the Visitors' Gallery. By the time they reach retirement age people will be living even longer than they do now.

In 2003 there were 441,900 people over 65. By 2012 that had risen to 549,300 and by 2030 it is expected to rise to 926,000. The year 2030 may seem to some of us a long way off but it is only 17 years away and that highlights the planning that we need to do to make sure that when we provide nursing home care there is adequate funding. The figure for 2030 represents an increase of 141% on the number over 65 from 2011. That is a major challenge for the health service. One of the interesting figures emerging from research too is that there are fewer people in the older age category who have disabilities. People are far more active now. Since 2006 the number over 85 has increased by 22% which further emphasises the need for long-term planning to continue to provide the level of support that we are giving.

The budget for 2013 provided over €13.6 billion for health care which is a huge budget. It is important that we manage that and provide maximum care for all the citizens of the country and elderly care is an important part of that overall programme for the year. Maev-Ann Wren identified a need for 13,000 additional residential places by 2021 which is only eight years away. I do not think that will have to be delivered but we need to develop new programmes and try to provide more home care packages so that more people can stay at home longer when they need support. This Bill provides for increasing the asset contribution of 5% per annum for three years up to 7.5%. While the Opposition may criticise that increase we need to plan ahead.

We have not seen any figures for the recovery of money from people who signed up under the fair deal scheme over the past three or four years and unfortunately have since died. Will we get an annual report of that collection? I have not seen any evidence of the collection process in place. I know that it is a very short period in real terms but I imagine that the State is entitled to collect from people who signed up to the fair deal scheme.

This Bill provides for several changes not only in respect of elderly care and its cost but also of charges in hospital. My opposite number raised concerns and is not supporting this Bill. There is a problem in the cost of health care both in terms of the overall cost and the way the health care service has grown. It is far more comprehensive now. Over the past ten or 15 years the number of people attending outpatient appointments has gone from 2 million a year to over 3.5 million a year. While I regularly see letters in the paper criticising the health care system, a recent one even said the health care sector is in a shambles yet we have one of the best maternity care services in Europe, with one of the lowest maternal mortality rates. It is important that in providing health care we make sure that there is adequate funding to allow that develop and grow. While the Opposition is raising serious concerns about this Bill in order to continue the level of services required there must be a cost factor. This Bill is dealing with that cost factor and planning for the future.

I welcome the Minister of State back to the House. When many of the minor health care reforms such as this, which are coming through the system in preparation hopefully for the big bang of the move to a fully insurance-based system, come up I find myself selectively approving of them through gritted teeth because they increasingly resemble a series of Band-Aids put over the gaping wound – I am going to start mangling metaphors here- which is our incredibly inefficient, dysfunctional, two-tier health system. As Lincoln said, a house divided against itself cannot stand and that is exactly what we have. As a result there are several severe inefficiencies. Having said that, we need the private system at the moment. If it were to collapse it would cause an unsustainable burden to fall on the current public system. I speak with a colossal conflict of interest because I make most of my income from the private insurance system. I have to say that now or someone will remind me of the fact. Until we move to the model whereby everyone is treated the way a private patient is now we will be dealing with these inconsistencies. The ultimate logic of the insurance-based system is one which is socially responsive, in which people like me, who make a lot of money, pay more for the care that people who make less money will get for a whole lot less.

Let me point out one or two matters. From the coalface, there are patients who at some stage because they have private insurance get some consultation or some part of their treatment in the private system but because there are holes in the private insurance coverage here they decide to have their scans or X-rays done on the public side because they cannot afford the out-of-pocket expense and subsequent reimbursement. Increasingly we find people who go to the public system being told that even though they are citizens, taxpayers, members of our society who allegedly have the same rights as anybody else, being denied these rights and told that they must register as private patients when they go to a public hospital. That is inconsistent, irrational, and wrong. Will the new arrangements as outlined in this Bill enshrine the rights of people who wish to exercise their rights as citizens to become public patients, not skipping any queues but going in the same way as anybody else, and to continue to do that or will it be incumbent on them to exercise their private insurance which many have as a fall-back position in case they need to come into hospital? I cannot see this outlined here.

Will the new arrangements, as outlined in this Bill, enshrine the rights of people who wish to exercise their rights as citizens to become public patients, not skipping any queues but going in the same way as anybody else and to continue to do that, or will it be incumbent on them to exercise their private insurance, which many have as a fall-back position in case they need to come into hospital to receive treatment for some catastrophic illness? I cannot see this outlined here.

I cannot stress enough the importance that the VHI be sustained. I will tell the Minister of the State a story. I was hoping to have the opportunity, and no disrespect to the Cathaoirleach but when I raised this issue during the past two days the Leader of the Seanad suggested that I raise it in this debate as it is somewhat relevant. Several of the commercial private health insurers have made a decision not to cover those people who have been diligently paying their premia to them, sometimes for many years, for cancer drugs. I do not refer to exotic, obscure, dubiously beneficial cancer drugs but to cancer drugs which have been approved for public patients through the national cancer control programme's approvals process and by the VHI. It is troubling to me that in meetings with delegations of oncologists recently some of them were happy to say that they had never paid for one of these drugs. The drug in question is ipilimumab. I am sorry if I sound reduplicative but malignant melanoma is a condition which when I was a medical student we thought of as being a rare condition but it is now quite common in Irish people because of our fair hair and fair skin and the fact that God designed us for living under grey skies and never seeing the sun, and it is a disease to which we are uniquely susceptible.

The incidence of this dreaded disease doubled between 1998 and 2008 from 400 to 800 cases. It is likely that it has increased substantially since 2008. More troubling, the number of people who present with secondary malignant melanoma, which is generally not curable, also doubled during that period. This was a disease that had a ferocious reputation, when it was secondarily spread, for being highly resistant to chemotherapy and to other drugs and one which in recent years has become moderately sensitive to some of the newer drugs that have emerged, one of which is ipilimumab. It is not a panacea or a miracle drug but for a minority of patients who get it, it is a drug which can produce extraordinary results. Now we have insurance companies saying they will not cover it.

I have had patients on the private side come to me who I have had to send over to the public side following a process of appeal to their insurance companies. I will go on record and say to anybody listening to this debate, and as usual our colleagues from the journalism galleries are not present, that I do not believe anybody should take insurance with GloHealth or with Aviva. If they are thinking of changing from VHI, they should not do so because these companies have now decided that they will not provide cancer drugs to their clients. Laya Healthcare Ireland has not taken an official position to approve the treatment but on a case-by-case basis it has grudgingly approved it for individual cases. Sadly, some of the insurance companies, which are not-for-profit insurance companies, which represent members of the public sector and the allied public sector such as the Garda and the ESB, have also been extremely difficult on this issue.

What I find troubling, and I would like the Minister of State to convey this to the relevant Ministers, is that there is strong circumstantial evidence that anti-competitive practices have been practised by the private insurance companies. I find it odd that a group of them simultaneously decided they will not approve a drug and quote the fact that the other companies will not approve the drug. When I pulled one of them up on this a month or two ago I said that what they are saying they did sounds suspiciously cartel-like to me. I said that when a group of people who are supposed to be competing on the grounds of cost and service decide, apparently collectively, to deny an essential service to people, this is anti-competitive. I would like the Minister for Health and the Minister with responsibility for trade who oversees competition to inquire of the companies if any such collusion has occurred because if it has, I believe it is illegal. In the meantime, I do not know what pressure can be brought to bear on these companies because these drugs - which are expensive, for which approval in the public system was hard fought and having regard to people who have paid taxes and their health insurance premia - are now being paid for out of the public purse and I think that is wrong. Insurance companies that market themselves as providing choices and who then deny the choice to patients are behaving dishonestly.

I also draw the Minister of State's attention to the fact that Aviva, which has a substantial UK presence, states on its UK website that it will never deny any cancer drug to any patient which is approved. Clearly, it is practising by different rules in the UK and in Ireland and, conceivably, it is practising by different rules in Northern Ireland and in Ireland, although I cannot verify that.

There are a number of troubling issues. Fundamental reform of our health service will make many people with the most vested interests very unhappy. I am referring to the health service administrators, HSE executives, civil servants, a cadre of hospital managerialists who have emerged, and all the PR companies for all of the agencies. It will make them unhappy because if the reform that was promised prior to the election occurs, it will empower patients to make their choices and it will disenfranchise many bureaucrats. I ask the Minister of State not to take this pejoratively, but we have a Band-Aid over the knee approach to reform.

The Minister of State is welcome to the House and it great to see her back here again. The Health Act is probably second only in complexity to the Tax Consolidation Act and it is therefore necessary and appropriate that it would be reviewed and updated from time to time. I would have preferred if these reviews did not come as part of the budgetary process and that they formed a stand-alone review of the various schemes under the Health Act.

Every Member who was a politician prior to the nursing homes support scheme being put in place would know that the greatest amount of our time as politicians was consumed in assisting people who were trying to access the services for long-term and ongoing care for their elderly relatives. Since the scheme was introduced it has provided a very good solution to what seemed at one time to have been a rather intractable problem for politicians but mainly for patients. That the nursing homes support scheme is in place is a positive development.

The Opposition has said that it has some concerns about this measure. We all have concerns when the mere mention of increasing costs comes to the fore. That is something that gravely concerns us. I think it is reasonable to expect that the asset contribution might increase. I read during the week that people who were born in the 1960s might now have a reasonable expectation of living to their 85th year. That represents an increase in the average life expectancy of nearly seven years over a generation. Arrangements need to be put in place to ensure the sustainability of this scheme but it would have been better if it did not come as part of the budget, which might give rise to the accusation that this measure is merely a revenue-raising initiative. Of course it is not, it is part of a move - a Band-Aid move as it appears to Senator Crown, and indeed often to more of us as well - in the direction of the universal health insurance scheme that we are committed to bringing in. It is important that this would be acknowledged. Health is about public health but it is also about public confidence in our health system. If we cannot have a public confidence in our health system, we are in trouble and the undoubted problems that exist will become exacerbated as people lose confidence in our system.

I want to focus on that part of the Bill and also on the idea that private patients should pay for beds in public hospitals through their insurance or otherwise. It is a matter of social justice, social equity and social solidarity that would happen. Approximately 50% of the public are covered by a medical card and 40% are covered through the medical health insurance scheme. If the system is as equitable, democratic, fair and as republican as we might like it to be, we must ask ourselves why people feel it necessary to have health insurance. We saw the leader of Sinn Féin recently express a lack of faith in our services when he twice used the private services of another country to access medical treatment.

There is undoubtedly a benefit in having private health insurance because otherwise why would one pay money for something that was not necessary? Private health insurance might well be one of the reasons for the ongoing and traditional historical legacy of the two-tier health system, which do not enjoy in this country but with which we have been landed. It is reasonable that a private patient accessing public services would be required to pay for those. I think that any reasonable democrat would have to agree with that.

Notwithstanding the pragmatic idea that as health insurance premia rises people will leave due to economic constraints. That is a problem. Insurance companies need to get with the programme.

Recently the mother of a young man in Cork told me that her son developed chest pain while playing rugby a year ago. When he was assessed it was discovered that he had a serious complaint that could be corrected by a medical procedure. Unfortunately, the 15 year old boy could not access treatment under the public scheme due to a waiting list of two years which would have meant that he could not play the sport that he loves for two years. Presumably he would have reached 17 years of age before undergoing the operation and have had to wait a further six months before being allowed to play rugby again. The family had private health insurance so decided to use it to cover the cost of his two-night hospital stay. I shall outline the timeframe. Let us say he was admitted to hospital on Monday night, the procedure took place on Tuesday and he was discharged on Wednesday. The bill amounted to an unbelievable €17,000. At the time I was informed that a family consisting of a couple and their three children could travel to Florida and stay three weeks in a top grade hotel for €5,000. That puts the hospital bill in perspective. There must be room for savings. My example proves that insurance companies could do better and that the negotiation skills of hospital administrative staff or the people in the service responsible for pricing must do better.

My party will have plenty more to say when we debate amendments at Committee Stage but I shall leave it at that for now. We must acknowledge that there are concerns. The previous Administration introduced the nursing homes scheme. When my party was in Opposition it may have criticised the scheme in its initial stages. However, my party acknowledges that the scheme has been beneficial, that it is one of the better schemes and provides the widest range of services for older people.

I welcome the Minister to the House. Senator MacSharry has outlined my party's opposition to certain provisions of the Bill.

With no disrespect to the Minister, he could have answered some of the questions. On three occasions I have asked him when he will extend the publicly-funded free GP service but he gave different dates. Last April it was stated that the Bill would include a provision to roll-out the service but that has not happened. There is still no timeframe. I am anxious to learn when it will take place. Originally it was proposed to roll-out the service during the first year.

Medical cards for specific long-term illnesses have been a major plank of the Minister's reform agenda. The provision has gone off the radar. Where is it? I have private health insurance and I joined GloHealth last year. It is thanks to Senator Crown that I shall now examine its policy document in great detail. Price and long waiting lists are considerations when purchasing health insurance. A tonsillectomy is an easy procedure for adults and children but one must wait over two years for it in the public system. That is why people who can afford to buy private health insurance but most people cannot afford health insurance.

I am concerned about private health insurance and I have raised the matter on a number of occasions. I am not saying that private health insurers are 100% correct but the new measures will increase premia. The Minister has stated that he has independent actuarial evidence that the measures will not, or should not, increase premia. It would be in the best interest of his Department and the Minister to publish the actuarial evidence. I formally ask him to publish the actuarial advice. It will give us something to discuss with the insurers.

Why did the Minister have no direct consultation with the private health insurers? Over 2 million people have private health insurance but the number is decreasing. Why did he refuse to meet the private health insurers in order to negotiate savings? He refused to meet one health insurer. Did he refuse to meet other health insurers? Did he meet the VHI? If so, then he has a serious problem if he did not meet the others. I want him to answer my questions and I shall pursue the matter at Committee Stage.

Some private health insurers can make savings. Bed charges are based on the procedures so there has been a 15% reduction in the costs private insurers are charged by private hospitals. The cost of cataract and angiogram procedures has fallen by 27% but the cost for a private bed is the same regardless of the procedure. We must also examine the astronomical professional fees and consultants' fees.

Senator Gilroy mentioned a specific case. Presumably fees were charged for an anaesthetist and consultants. Their work is very important work but savings can be made. The Government intends to increase a bed charge fee from €75 to €860. I may have private health insurance but I am also a taxpayer. One must cut one's coat according to one's cloth and I, and other people like me, will have made a financial sacrifice to have private health insurance. I am also a taxpayer and shall be charged more for using the same bed in the same facility. Public private partnerships are used to build schools yet the Government still funds private schools. For the past two years 1,100 people per week have cancelled their private health insurance which will put pressure on the public system. Senator Crown has day-to-day knowledge of the public system. He and others can vouch that it is creaking at the seams.

As Senator Colm Burke acknowledged, every day thousands of people do excellent work in the health service. Will another 60,000 people have left the private health insurance scheme by this time next year? Last year 79,000 people under the age of 40 withdrew from the private insurance scheme. The figures are factual and indisputable.

Last night around 9 p.m. the Minister announced a forum to lower the cost of health insurance. When will it be launched? Has it been planned for a number of months? When will the forum be established? Who is on the panel? He said that the chairperson will be independent. Who shall it be? The market should have been consulted about the forum but it was not. Will the forum act like to cloak and hide the deficiencies of the Bill? There will be substantial increases in private health insurance but the Minister's knee jerk reaction is to establish a committee to "knock heads together." I hope that I am wrong but I am sure that he will set me straight on the matter.

I call Senator Conway and he has five minutes.

I welcome the Minister here to debate this important legislation. I shall commence by giving credit to the last government for introducing the nursing home subvention scheme. It is one of the better schemes and is reasonable. A sign of a good scheme is one that can be tweaked and improved. Senator Darragh O'Brien wondered whether we would be back here next year to debate certain issues again. I sincerely hope that we will not but we may have to return here to improve the scheme.

Senators must deal with constituents on a daily basis. Most of my constituents that contact me about the scheme and their loved ones who avail of the scheme are reasonably satisfied. There are exceptions to the rule. I spoke to a retired public servant whose wife suffers from Alzheimer's disease. Unfortunately, even with two pensions and the scheme, he must pay up to €800 per week for his wife to avail of nursing home care.

The way he looks at it is that he worked and contributed all his life for what he would consider a good pension and to have that amount of the pension going into the scheme is regrettable because he is in a situation in which he is struggling to survive. He has appealed it unsuccessfully.

It is a good scheme. Much is happening to support the elderly. We have been requesting an increase in the level of inspections for a long time. We are seeing much more activity there. We all commented on the worrying "Prime Time Investigates" programme on crèches a couple of weeks ago and we all wonder if there are horrific scenarios in nursing homes. We have had reports of that in the past. The Minister is deeply committed to ensuring that the highest possible level of care is available to older people, that inspections are increased and that the standards expected of these nursing homes are maintained and improved on.

We are facing a situation in which the age of the population will increase considerably, we hope, due to advances in health care and treatments. We heard earlier of the average lifespan pushing up to the 80s in the future. Society must plan for that scenario. The fundamentals are there. We are in an atrocious financial abyss, but we must get certain priorities right. Incrementally, we are working on that. Those who run nursing homes are, by and large, very committed to their work and profession and are making a big difference to the lives of people. The standards have increased dramatically over the last number of years and I hope we will see a further increase in the future.

The Minister of State is very welcome. She is a regular in this House and I am glad to see her here. I am not so sure about the Bill. I am wary of supporting anything that has the potential to push up health insurance premiums and thus force people to leave the health insurance system. Senator Crown has described this very well today. It was interesting to hear the Minister say that, according to the report, the Government hopes to raise €120 million from the combined measures in the Bill next year. It is regrettable that the motivation for this Bill seems to be cost saving rather than benefiting the customer - that is, the patient.

If a person has paid for private health care, why can he or she not be entitled to a public bed, similar to a public patient? This case was made very well by Senator Darragh O'Brien. If one has a private car, surely one should also be entitled to take public transport at the same cost as someone without a private car. That is what is happening here. We must take a much more long-term approach rather than focusing on short-term gain. Colm McCarthy predicted that the market could shrink by 40% in the coming years if premiums continue to rise, and said the Government needs to take a longer-term approach rather than what he terms "patching up a cash hole". His report found that around 85% of customers said they would give up their health insurance if premiums rose by 30%. That is staggering to consider.

I will speak about the wider issue of insurance incentives and encouraging people to stay healthy to save money. According to the World Health Organization concept, health is not to be seen as mere absence of disease but as part of one's complete physical, mental and social well being. Perhaps we have to examine the deeper causes of ill health and try to find ways the Government can encourage people to take exercise instead of sitting in front of a television like a couch potato, as they call them. Behaviour economists call this "nudging". It is a lovely word. The word "nudge" has been used by the British Prime Minister. He has established a nudge unit in Downing Street. The recent health care law passed in America has a provision to encourage employers to offer wellness programmes. Should we go deeper and see how we can link things such as health insurance to activity? Has the Minister had any consultation in this area? Might she follow the example of the US President, Mr. Obama, and examine how economists could help reduce the burden of our health system?

I know two particular instances in the supermarket business. One is a man called Steve Burd of Safeway, a very big US company. He developed a system to pay his employees huge benefits if they went to the gym, stopped smoking, lost weight, etc. It really worked. He had to put a control system in place to do it, but to hear the enthusiasm with which he talks about it is so interesting. There are other innovative developments, such as the ones by the Discovery group in South Africa. Again, a supermarket company there, called Pick n Pay, has had major success with this. Discovery has introduced a programme called Vitality that applies the air miles model to health care. Customers earn points by exercising, buying healthier food or hitting certain targets. They receive a mixture of short-term and long-term incentives ranging from reduced premiums to exotic holidays. Discovery formed alliances with a host of companies to provide rewards linked to one's vitality levels. Pick n Pay, which is a very large grocery chain in South Africa, provides discounts of up to 25% on 10,000 healthy foods. Retailers here could look at this example. Airlines offer discounted flights for members of the scheme. Discovery can measure whether people go to the gym, rather than just joining, because they must swipe their membership cards.

Discovery says it has solid evidence that participation in the programmes more than pays for the rewards. The active participants are less likely to fall ill, and if they do they spend a shorter time in hospital. It is interesting that Discovery, which is South Africa's leading health insurer, with some 5,000 employees, is entering new markets. It has formed a partnership with Prudential in the UK. Could we attract companies such as this to the Irish market or even take on some of their ideas to nudge people towards a healthier lifestyle so they spend less time in hospital? It is essential, as 80% of health activities in Ireland relate to chronic diseases. Perhaps that is where the private investor and the health service in Ireland can do something to improve the lives of our citizens. I am talking about prevention of illness rather than just curing people. I think it was in China that doctors did not get paid if patients took ill; they got paid if people stayed well. It was the doctor's job to keep people well rather than to cure their illnesses.

I welcome the Minister of State. On the issue of public beds and private health insurance, when I visited Taiwan in January as part of a delegation we met representatives of the bureau of health information, their equivalent of the HSE. I asked the head of its delegation if Taiwan had a problem with waiting lists. They said there was no such thing as a waiting list in that country, where they have both a public and a private system. Taiwan's population is approximately 25 million, in a country half the size of Ireland. I did not know whether the information was being embellished, so that night when we met some Irish people working there I asked the same question and they agreed that there were no waiting lists. They told me that if one needs to see a brain surgeon or an orthopaedic consultant, one sees him or her that day or the next day.

I asked why people would opt for private insurance if that was the case and was told that they might like a larger room or a newer hospital. The system seemed to work very well. We must get to that situation in Ireland.

Private companies pay approximately €75 per night for public beds whereas we are paying €1,200 to the private hospitals. Letterkenny General Hospital has a cardiac unit and the cardiac surgeon there tells me he is qualified to perform stenting. He carries out angiograms and a range of other treatments. Stenting is common. I have a stent myself and know how traumatic it can be for someone to have the procedure. The surgeon cannot carry out the stenting procedure in Letterkenny. He has the funding and equipment but does not have the staff. If Letterkenny General Hospital got €1,200 per night instead of €75 per night, the money could be used to employ an extra nurse or specialist. Private insurance companies are aware that this is coming. They cannot expect to be subsidised. A public patient in Donegal who needs a stent may have to wait three months. I had to wait a weekend between the angiogram and the insertion of the stent. It was psychologically and physically demanding. To tell someone he or she can wait three months as he or she is not at serious risk does not provide real comfort. I encourage greater analysis of this. A contribution of €1,000 to Letterkenny could help it to employ the extra staff needed to provide and expand services. It has the surgeon and the equipment but it needs the support staff.

This would help the staffing levels and represent a win-win for the hospital. Private insurance companies are profit-making organisations and it is their business to maintain their premia at a rate that people will buy into. They know they have to do that. They will not put up their fees hugely because if they lose their clients, they will not make any money. The private insurance companies are scaremongering. I was very interested in Senator Crown's assertions about the companies which he mentioned in relation to drug treatment. It was very worrying. He has the expertise to give the House a view. I am delighted he raised the matter today. I ask people to go along with this. Private insurance companies can and will survive but small hospital services like Letterkenny cardiac unit are under funding pressure. This could help to fund those units.

I welcome the Minister of State, Deputy Lynch, to the House. We have had several debates on the health service with her over the course of the last number of years. Unfortunately, the Minister for Health has not given of his time to take Second Stage debates on Bills as much as we would like.

I cannot support the Bill. Frankly, if the Minister of State and her Labour Party colleagues were sitting where I am, they would oppose it. This is about increasing charges for public inpatient services. It increases the asset contribution for those who avail of the nursing home support, or fair deal, scheme. It is unreasonable to ask people to pay more for those services when they are getting less. I had a debate in the House with the Minister for Health recently on increased outpatient waiting times in Waterford Regional Hospital where orthopaedics, ophthalmology and ENT represent pressure points. People are waiting for well over the 12 month limit to see a consultant to get into the system. We all accept that when people get into the system, they receive good treatment. Unfortunately, they have to wait very long periods to see a consultant. After they have seen a consultant, they must wait longer again to get the treatment they need. Private patients can get access more quickly although many of them are forced to take out private health insurance. I do not agree with Members who say it is reasonable to increase these charges when we have fewer services, hospitals are overcrowded and staffing has been reduced with a resulting impact on frontline services.

There has been a lack of investment in geriatric care facilities and some community nursing units have been closed. Other community nursing units which it was promised would be built, including one in my city, Waterford, have not been provided. The necessary capital funding is not being made available. There is a lack of services across the health sector for public patients, yet we propose to increase charges. It is not the right thing to do. It is being done in a context in which people pay PAYE, PRSI and, more recently, the universal social charge. People are asking why they are paying these charges. The universal social charge was coupled with the health levy. People pay these charges on top of their income tax and then pay for private health insurance, but still have to pay at the gate when they go to hospital. It is not fair to increase the charges.

The Bill seeks to allow the HSE to outsource the management of the scheme. It introduces charges for private patients in public beds in public hospitals, which I agree with. It is outrageous that people who have private health insurance, especially the wealthier in society, are taking up beds in public hospitals for which their insurers are not being charged. Consequently, those customers are not being charged while public patients are not getting the treatments they deserve. I do not have a difficulty with private patients having to pay for the privilege of obtaining services in public hospitals.

The Bill has a number of key aims. The fair deal scheme is currently run by the HSE to provide financial support to 22,000 people in long-term residential care. Currently, individuals contribute 80% of their incomes and 5% of their assets per year, which is fixed at a maximum of three years or 15% for their principal private residence and, in some circumstances, farms and other assets. The Bill seeks to increase the maximum payable proportion of a person's assets from 5% to 7.5% per annum. It abolishes the ability to backdate the entitlement for people in nursing home care before the scheme was commenced, which is particularly unfair. The digest of the Bill sets out that it is not known how many people this change will affect but indicates an approximate figure of 700.

Unfortunately, I cannot support the Bill. There was a great deal more that I wanted to say in that regard. I agree with the changes on the charging of private patients in public beds but cannot not agree with the charges for inpatient services for public patients. The latter will have a disproportionate impact on those on low and middle incomes who have borne the brunt of tax increases and pay cuts. I am not in a position to support that at all.

I was hoping the Minister would be able to return to make the final reply. I apologise on his behalf. It is not as if he is swanning off somewhere. He had to attend a Cabinet meeting.

Members are genuinely interested in asking the Minister for Health these questions.

Any question pertinent to the Minister will be relayed to him.

I thank Senators for their contributions to what has been a very good debate, of which I heard the last hour. The Bill is essential to give effect to necessary budgetary measures to support the continued provision of important services at a time when there is extreme pressure on HSE funding and in keeping with the move to a universal system of health insurance. The Bill will also make an important contribution to simplifying, modernising and enhancing the charging and contributions regime in hospitals, nursing homes and other residential settings.

I hope Members will not mind if I do not respond in order to the points raised. Certain points need to be made. I take on board Senator Feargal Quinn's point about the importance of maintaining ourselves in good health, even though we will always have acute episodes.

I always find Senator John Crown's contributions interesting. He referred to the administration of the health service, which is very important. As someone who was a recent beneficiary of the public health service, having had to be treated urgently, I know that the service provided is very good. We should be in no doubt about this. When people are in urgent need of health care, our experts kick into gear and respond well. The Senator's point is that difficulties arise because of the way we have allowed the health service to develop in terms of charges, administration and the crossing between the elements in our two-tier system. I will not refer to his comments on private health insurers, but I have no doubt that his experience is correct.

What is amazing about the fair deal scheme is that only 8% of the 22,000 applicants have applied for the loan element. The reason is that the average contribution is only €267 per week. It is a pity Senator Martin Conway is not present because there is a reason the family to which he referred is paying so much. The average contribution is what makes the scheme sustainable. In opposition we were critical of the scheme, but in hindsight it has worked extremely well in its operation. It has given a degree of comfort and security to families and older people that the intensive, long-term State care people need at that time in their lives is affordable. We can thank the previous Minister for Health and Children for this. The proposal to charge patients, as raised by Senator Marc MacSharry, was first announced in 2011 and meetings have since taken place on an ongoing basis between the Department and private insurers.

Not with the Minister.

As the Senator pointed out, the younger, healthier cohort is leaving the system, but because it is younger and healthier it has not placed an additional burden on the public sector. I hope we will all age and it should not be considered such a burden because it is also a contribution. To grow old is positive. As we age, the burden begins, but I hope economic circumstances will change. I also hope the health service will change in that we should not all end up in a long-stay care setting. Senator Feargal Quinn rightly points out that we will live longer and stay healthier for longer periods. It is appropriate that we charge everyone who uses the public health service because, as it is, it is reimbursing the private health system to the tune of €200 million per year, which is unsustainable.

I had not seen any evidence that insurance costs would increase by 30%. When making our case, we are inclined to exaggerate in our arguments, which is not wrong. Premiums will not increase by 30% and the Minister has asked for evidence from insurers in this respect. I will pass on to him the request made by Senator Darragh O'Brien that the evidence be published, but I do not have it. The Minister would not be so adamant if he was not sure of his figures.

The Minister did not announce a new health insurance forum. He established the consultative forum on health insurance last year to identify ways of addressing costs throughout the industry. I spoke to the officials when Senator Darragh O'Brien asked about the matter. Work has been ongoing on the matter, not intermittently but on an intensive and regular basis. The Minister has not decided on who the chairperson will be, but that does not mean the forum has not worked. It has several subcommittees which have been working.

The figure of 8% tells us something. If health is about social protection and our well-being, it is equally about actuarial figures. With regard to the fair deal scheme, we collected a sum of €6.4 million, in which Senator Colm Burke was particularly interested. In 13 cases, the sum not collected amounts to €14 million.

With regard to Senator Darragh O'Brien's comment on free GP care, the Minister of State, Deputy Alex White, is responsible for that issue. He is examining options for the roll-out of the universal GP service. He briefed the Taoiseach on this work and the Taoiseach has reported to the Dáil on it. I meet the Minister of State on a regular basis.

This morning someone said that if we were to introduce a universal system of health care, we would not start from here. The difficulty is the chaotic system of payment, fees and levies and how the money is collected. It is not simple and straightforward, but if matters were simple, we would have done it a long time ago.

The provision of medical cards for people with long-term illnesses was never proposed. It was proposed that people with long-term illnesses receive GP cards as a first step towards universal GP care.

I should have referred to such cards.

However, the Minister of State, Deputy Alex White, is concerned that this temporary or interim step would be overtly bureaucratic. I do not have time to explain it, but it is not as easy as first thought. It will not help us in having a universal system of health care. If Senator Darragh O'Brien wishes to have a full explanation, I will have no difficulty in getting it for him.

I thank the Minister of State. It would be appreciated.

The Minister for Health has stated he will introduce the model of the money following the patient as part of the universal system of health insurance. He has started this process with the development of the new charging regime.

Opposition by its nature is about holding the Government to account. That is fine and I have no problem with that but we have to be realistic as well. We cannot continue to have the public sector continuously subsidising the private sector. The reason many people have private health insurance is so they can call on it when they need it. It is interesting that younger, healthy people are leaving the system. We need to ensure every citizen has the same access to the health system that those who can afford private health insurance have at the moment. I commend the Bill to the House.

Question put:
The Seanad divided: Tá, 23; Níl, 12.

  • Bradford, Paul.
  • Brennan, Terry.
  • Burke, Colm.
  • Clune, Deirdre.
  • Coghlan, Paul.
  • Comiskey, Michael.
  • Conway, Martin.
  • D'Arcy, Jim.
  • D'Arcy, Michael.
  • Gilroy, John.
  • Harte, Jimmy.
  • Henry, Imelda.
  • Higgins, Lorraine.
  • Keane, Cáit.
  • Kelly, John.
  • Landy, Denis.
  • Moloney, Marie.
  • Moran, Mary.
  • Mullins, Michael.
  • Noone, Catherine.
  • O'Neill, Pat.
  • Sheahan, Tom.
  • van Turnhout, Jillian.

Níl

  • Byrne, Thomas.
  • Crown, John.
  • Cullinane, David.
  • Daly, Mark.
  • MacSharry, Marc.
  • O'Brien, Darragh.
  • O'Donovan, Denis.
  • O'Sullivan, Ned.
  • Ó Clochartaigh, Trevor.
  • Power, Averil.
  • Quinn, Feargal.
  • Reilly, Kathryn.
Tellers: Tá, Senators Paul Coghlan and Marie Moloney; Níl, Senators Marc MacSharry and Ned O'Sullivan.
Question declared carried.
Sitting suspended at 4.25 p.m. and resumed at 5 p.m.
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