Seán Power (Kildare South, Fianna Fail)

It is very important that charges for long stay care are put on a sound legal basis and this is what we are endeavouring to do. In this regard it is good to note that the Supreme Court has not found the approach to the proposed charges in the Bill repugnant to the Constitution.

This judgment only deals with the charges issue in long stay. It does not deal with the overall issue of eligibility and entitlement which was previously raised by the Ombudsman and which must be the subject of further consideration as a separate issue. The Department is committed to an overall review of eligibility generally with regard to the health services and this can be tied in with the key programme of reform being implemented at present to produce a much more effective and efficient health service in the future underpinned by a sound legal basis. The Supreme Court judgment will help us in that regard.

It has been the policy of successive governments to endeavour to help older people maintain themselves in the community while at the same time providing for residential care which is not prohibitively expensive. The policy of the Government, in terms of development and delivery of services for older people, is to maintain them in dignity and independence at home for as long as possible in accordance with their wishes, as expressed in many research studies; to restore to independence at home those older people who become ill or dependent; and to encourage and support the care of older people in their own community by family, neighbours and voluntary bodies. It is clear, therefore, that the roles of all community care services are vital to the implementation of this policy.

Long stay charges represent approximately 10% of the total cost of medical care and maintenance in the public residential homes involved. However, it still remains important that some contribution is made by patients to the cost of maintenance as this can help free funds towards services and initiatives that will also serve the key objective of helping older people remain at home in their communities wherever possible.

As with investment in health services in recent years, there have been very significant investments in the services for older people generally. Additional revenue funding of €17.228 million was provided in 2005 for these services, including palliative care. Between 1997 and 2004, total additional funding allocated was approximately €287 million. This includes nursing home subvention spending, which increased from £28 million in 1997 to over €115 million in 2004. A further €5.7 million was allocated in 2005, targeted at increased service provision. Over €126 million was provided in 2004 to develop the home help service and train home helps. A further €5 million was allocated in 2005 to relieve service pressures. Since 1997, additional consultant geriatricians have been appointed with appropriate staff support. There are now 57 approved geriatrician posts, nine of which were approved in 2004. The working group on elder abuse presented its report in November 2002. A national implementation group has been established and a further €0.9 million was allocated in 2005 to continue with the implementation of the recommendations in the report.

The Health Service Executive, HSE, areas have been piloting home care grant schemes as an alternative to long-term residential care to assist older people living at home in the community. Older people who are being discharged from the acute hospital system and those living in the community are being targeted under these schemes. People have been discharged from acute hospitals under the Slán Abhaile and Home First pilot projects in the HSE eastern regional area. The Department has been working with the HSE to develop a national home care grant scheme. A draft of the scheme is being finalised by the HSE for presentation to the Department. Funding of €2 million has been allocated to the HSE in 2005 to introduce the scheme.

The national implementation group to monitor the implementation of the recommendations in the elder abuse report has commenced its work. The working group to review nursing home subvention has been established and the group has received a number of written submissions and heard a number of oral submissions on this topic. Funding was provided in 2004 to develop models of good practice in the care of older people and the HSE has undertaken a number of pilot projects. The HSE has introduced personal care packages for older people as an alternative to long-stay residential care. Personal care packages, including home care grants for older people, are specifically designed for the individual concerned and could possibly include the provision of a home help service, home subvention payments, arrangement for attendance at a day centre or day hospital and other services such as twilight nursing. Personal care packages allow older persons the option of remaining living in their own home rather than going into long-stay residential care.

In November 2004, the Tánaiste announced additional funding of €70 million to implement a ten point action plan to improve the delivery of emergency services. The Tánaiste has met senior management of the HSE and the Department of Health and Children is working closely with the HSE to ensure early implementation of these measures. Theses include the transfer of 100 high dependency patients to suitable private nursing home care, negotiating with the private sector to meet the needs of 500 people annually for intermediate care of up to six weeks and an expansion of home care packages to support 500 additional older people at home.

Funding of €16.8 million was made available to the former Eastern Regional Health Authority which will result in over 600 patients being discharged to more appropriate settings. A total of €5 million was also provided for the Southern Health Board under the delayed discharges initiative in 2003-04 to facilitate the discharge of patients from the acute hospital system. Total funding of €21.8 million has been provided under the delayed discharges initiative to assist with the discharge of older people from the acute hospital sector.

This is the context in which the issue of long stay charges must be seen. The principle that people should contribute to the costs of their maintenance when in long stay care has operated over the lifetime of 11 Governments and nothing in the Supreme Court judgment is at variance with that principle. Charges in this regard can only help in the provision of services for older people.

I have listened to the contributions to this debate. When the Tánaiste took office and following the legal advice of the Attorney General, we acted swiftly and took the best legal advice available in introducing the legislation. We must accept the decision of the Supreme Court. We will act immediately to introduce new legislation and to provide compensation to the people from whom money was illegally taken.

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