James Reilly (Dublin North, Fine Gael)

-----those 500 patients who are currently described as delayed discharges will receive approval and will be prioritised.

Universal health insurance is a goal of the Government. Free general practitioner care for all will be delivered in this term of Government and much of what needs to be done to deliver universal health insurance at the end of five years will have taken place, but it will take a second term to be fully established.

Deputy Catherine Murphy and others mentioned the issue of physiotherapy. Those who have medical cards still get their physiotherapy but these ancillary services should not be paid for out of a fair deal subhead or pot of money that was designated for accommodation only. The Deputy had a concern about the two and a half years now becoming over four years. No matter how excellent nursing home care has been, it could not cause an increase in longevity of that nature in one and a half years. There is something else afoot. What I am suggesting here, and will examine, as I stated in my opening statement, is a further evaluation of the assessment tool. If there is variation, both in terms of geography and in terms of the sort of patients that are being recommended for nursing home care, I want to check that it is appropriate to their need and that they are not ending up in long-term institutional care before they need to be there. As I stated earlier, people are quite entitled to stay, and should be supported, in their homes, which is where most people want to be.

Deputy Wallace raised the issue of eligibility. It must be worked on and clarified by my Department. There is a host of issues in that regard, not only in this regard but in regards to medical cards etc. I agree that society should be judged on how we look after the most vulnerable and I believe that the Government will not be found wanting in that regard.

There was an assertion that we see private nursing homes as the solution to our problem. We do not. We acknowledge the good work they do in the main, and that 11,600 people are cared for in private nursing homes in this country at a cost of €300 million versus 11,000 - 600 fewer - at a cost of €700 million in the public sector. There are ancillary costs included therein but when one strips all of them out, it is still 50% more expensive to care for the elderly in the public sector. Part of our valuation and examination will also include assessing the degree of disability among patients to see if there is a difference in the dependency level between the public and private sectors, or what other factors might be involved.

I thank everybody who took part in the debate. I reassure older people and their families that the scheme will recommence approvals on Monday and we will keep the matter under constant review.

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