The latest price increases by VHI Healthcare have exposed the ailing health of our national care system. VHI premiums will rise by an average of 7% from 1 March. That hike comes on top of two previous increases in March and October of last year. It means people who have private health insurance with VHI will have to front up anywhere from an additional €180 up to nearly €700 for just one year. Families may expect an increase of between €400 up to nearly €600 at a time when so many families are struggling with rising cost-of-living issues.

In a country with a well-functioning public health system, this might not be such a huge news story because in other countries, it might be a price increase affecting just a small minority of people but in this country, nearly 2.4 million people have health insurance policies. This is nearly half the population. The reality is that many others just cannot afford the cost of private healthcare. Compare our level of additional private health coverage to that of other OECD countries. In Portugal and New Zealand, a third of the population has additional voluntary health insurance while in Spain, that figure is much lower at just 15%. In Great Britain, where we so often hear complaints about a beleaguered NHS, only 22% of adults now have private healthcare of this type.

Access to affordable quality healthcare is not a luxury nor should it be. Decent care is not something that should be the preserve of those with deeper pockets. For far too long, there has been an over-reliance in Ireland on the private market to counter the failures of and fill the gaps in the public system so we see long waits and delays and heroic health workers working and doing their best in overcrowded settings. I raised the latter issue last week.

This affects more than just healthcare for people who are unwell. This week, my colleague Deputy Duncan Smith has been raising concerns about the privatisation of long-term residential care and home care. An ESRI report this month said 15 large private groups now control 38% of the almost 32,000 nursing home beds in the country. That same report says that the Government must better balance the profit incentives of private business with the needs of those receiving care. When will we finally see the Government make that necessary public investment in our healthcare systems? In particular, will the Government put an end to the dangerous recruitment embargo in the HSE? How will it address the projected deficit of 49,000 nurses by 2041, as reported by Sean Murray in today’s Irish Examiner? When will we see an end to the unfair low pay model in the community and voluntary sector, which is causing such problems in the delivery of home care to those who need it most?

It is a real concern for roughly half the population that will see an increase in their premiums depending on their provider. If the VHI increase of 7% is mirrored by others, it will be of real significance for those families. We must be careful to make sure we protect everyone's living and health as we manage that.

My understanding is that the main reason for this is a huge increase in demand, similar to many other areas in the healthcare system. One statistic jumped out at me. Attendance at emergency care by those over 75 since pre-Covid times has increased by something by like 23%. That is one example of a very significant increase in demand for healthcare. This is something we must manage by resourcing our healthcare system through the Sláintecare programme and investment in public health so that people are guaranteed a high level of health service.

Deputy Bacik and I would have a similar position on the left in terms of the benefit of public investment and public services, particularly public healthcare. I have a slight concern that if we on the left are forever talking down what our public health service actually delivers, that might sap public confidence in what is actually happening. The truth is that since 2000, we have employed, I think, an extra 26,000 people in the health service. This is not insignificant. The other truth is that the outcome is starting to be seen in significant improvements in our health service. I know it is never perfect. We can never be satisfied, particularly in the area of disability and some of the discrimination mentioned by the Deputy between those in the section 38 sector and those in the HSE. I accept that point but the Deputy should similarly accept basic facts. In the past ten to 15 years, our life expectancy as a country increased by five years. That is phenomenal. Each of us is living five years longer because of the quality of our health service among other things. That is the ultimate test and we are not failing. I read with interest an article by David McWilliams in The Irish Times at the weekend. It was a very good article and I agree with a lot of his commentary but was slightly worried about one thing I read. A particular risk for the left is if we are forever talking down our strengths as a country regarding what we do provide in our health system. If you are sick in this country, ask any doctor about where you want to be. You want to be in a public ward in our hospitals because for all its failings - warts and all - we have one of the best health systems in the world. We have massively increased spending and staffing. Over the past two years, waiting times have been falling. That is the reality and we on the left should celebrate that as well as being critical of where there are problems in the system.

I thank the Minister for his response, I think, but regardless of whether you are on the left or not in this country, what saps public confidence in our public healthcare system is lack of Government investment. I listened carefully to the Minister's commentary and it sounded to me as if he was observing rather than speaking as a member of the Government. As a member of Government presiding over what has been a good time for the public finances, why have we not seen the level of investment necessary to deliver on public healthcare? The roll-out of Sláintecare has been far too slow. The Minister mentioned that himself.

He did not respond to my three specific questions about necessary investment by Government to end the HSE's recruitment embargo. He did not address the projected shortfall of nurses we are seeing, which will cause serious shortfalls in the delivery of healthcare, or address the serious gap in pay for those in the community and voluntary sector who provide much-needed home care and community care services - a topic Labour has raised consistently for many months. Our hospitals and acute settings cannot function without that investment by Government in community and voluntary care. I did not hear a response from the Minister to any of those three questions. Proper investment would restore faith and public trust in our healthcare system.

The spending has gone up under this Government. It is incredible. We are up to €22.8 billion this year.

It is not enough.

There is a €1.15 billion increase in current expenditure.

Why are they underspending?

Trust me, every Department, including the Departments of equality and children and heritage, is looking for such funding. It is a demonstrable fact that the Department of Health has received a huge increase compared with other Departments. We have to spend on so many things. The Deputy can go down to specific examples such as the broadening of applications for the free medical card, the introduction of free IVF, the reduction of inpatient charges for people in public hospitals, free contraception and the reduction in the drug invoice charge-----

The recruitment-embargoed nurses.

I could keep going on.

But the recruitment-----

Yes, there is a recruitment ban because last November the numbers employed had exceeded what had been expected, and we had to pause to say, "Hold on a sec", as we had gone beyond-----

A fictional budget.

-----what was already an ambitious expansionary programme. The Deputies should look at the figures across the board we set out. The only story that can be told is massive expansion in spending, but what we are starting to see now-----

There is a massive expansion in the Minister's speaking time.

-----is a commensurate reduction in waiting times and improvements in health outcomes.

Your time is up, Minister.

That is why I come back to that point. People have the confidence that when we spend the money, we get a return.

We are not seeing enough.

Why are they not hiring home helps since last November?