Mr. Ed Murphy:

I have only an opinion. The HSE provides 70% of the care and it will cost it hugely to implement any standards or guidelines because it must employ a few extra thousand people to carry out the necessary supervision and training to comply with the standards that might be introduced. The HSE is by far the largest provider of care in the country. It may cost the State over €30 per hour at the moment but the HSE is the largest provider and it would cost far more if it had to comply with the standards. That is my opinion. Therefore, it would be very expensive to bring that in. We would love to see it happen because we believe it is absolutely necessary.

We should always go back to the older person. Older people want to stay at home. We want to keep them safe and secure and we want families to be able to obtain care at a rate that is as affordable as possible if they must pay for it. The largest problem we have at the moment, in addition to the cost of care, is the fact that older people are not given a choice. If they are provided with care, they are told they must use Mrs. Murphy or Jane O'Neill or whatever. We would like to see a tender situation, although not necessarily to give it all to the private sector. I would not want that. We should have a tender system and a number of options for older people, but we should make sure they are approved from the point of view of quality, policies and procedures. We can then offer older people and their families a list of those high quality providers and let them choose whom they would like to use their funds for. If we hand back choice to older people and their families, it will be far more equitable and fair than the current situation.

I have a quick story to tell about the fair deal scheme.

This will take two minutes. There is ring-fencing of the fair deal scheme, which is currently being reviewed, with spending at €1 billion. I have an older aunt in Wexford and about six months ago she was in hospital with a urinary tract infection. There was a discharge planner and when she was coming out of hospital, her family wanted to take her home, which was what she wanted. She had just gone 95 but was reasonably able-bodied and had only had a urinary tract infection. The family asked about the possibility of getting a home care package, or home help, from the State, and they asked for ten hours per week - two hours per day for five days. Much of the family worked and they thought such assistance would help out. It would have cost approximately €200 or €220. They filled in the applications and hoped they would be successful. The discharge planner indicated that just in case the application was not successful, the family could fill in an application for the fair deal scheme and a stay in a nursing home. The family indicated that my aunt did not want to go to a nursing home, but they were asked to fill out the application anyway. The following day the woman was told there would be no home care package funds to give her the service but two days after that she was given the "great" news that she had been accepted into the fair deal scheme at a cost of €850 per week, which was four times the cost of the home care package that she and her family wanted.

That is the point with the fair deal scheme. We should give choice to people and not ring-fence funds into one form of care when it is possible that approximately 35% of people in nursing homes do not need to be there. The previous Minister said the same thing. We are not talking about heavy-duty cases but medium and low-dependency people, who should be given an option. There is a common assessment tool coming out so we are asking that people be given a choice in terms of nursing homes. If we can get people home, we will save at least half the money per head for each person.