Trevor Sargent (Dublin North, Green Party)

Ba mhaith liom mo chuid ama a roinnt leis na Teachtaí Connolly, Healy agus Ó Caoláin.

This legislation is in many ways an attempt to mop up, but the health service requires much more than mopping up. It is important that we have this debate to try to tease out some of the areas which have not been addressed in this legislation. I want to stay with the legislation because while an overall debate on the health service is necessary, it will not be justified simply by this legislation. Time must be set aside for it.

A number of my constituents are affected by the illegality of the Government's actions in terms of payments for nursing home care. Included in the number are young adults as well as the elderly. People with learning disabilities in particular are concerned that they are forgotten in the overall debate. I do not take from the enormous concern that exists among elderly patients and their relatives. However, we should perhaps give a more comprehensive breakdown because the headlines tend to focus on the issue of the elderly, and, while it is right that they do so, the whole picture must be seen and understood.

There have been enormous problems in the area of elderly care, as has been mentioned by other speakers. Deputy Twomey spoke earlier of the overall condition of nursing homes. In the past, for example, people requiring residential care fell between two stools, not only in terms of entitlements, enhanced entitlements or the bureaucracy involved in making applications, but also geographically. Enormous distress was caused when an ambulance did not arrive from the nearest location but from the centre of a health board area that was much further away. There was a lack of co-ordination in that regard but it is to be hoped that we have left that behind us now. It was a needless cause of distress to people in my area of Balbriggan which was closer to Drogheda than Dublin for ambulance services.

The overall issue of nursing home standards and the provision of public nursing home facilities in particular requires further debate. I would welcome such a debate if it could be arranged. The Minister of State, Deputy Seán Power, will be aware of the extent to which home help is being cut back because his brother, my friend and colleague, Councillor J.J. Power, has probably told him about it. That cutback has a knock-on effect and is part of the important debate that needs to take place concerning nursing home care. People who find it difficult to manage generally prefer to stay in their homes. The availability of a home help can make the difference between having a good quality of life or, sometimes, losing the will to live. Home helps represent exceptionally good value for money but they earn meagre pay. That problem needs to be addressed by providing proper remuneration for the work done. There is no comparison between the cost of providing home help and the cost of a nursing home place. The amount saved by not having to provide a nursing home place makes the provision of home help more than worthwhile. The Department should examine how it can satisfy the need for home helps thus avoiding the fall-back position of providing nursing home places, because that appears to be the only available option. The Minister of State is in a good position to address that matter, so I would like to hear his views on that question which is relevant to the general discussion on nursing homes.

In his opening remarks, the Minister of State referred to general practitioner-only medical cards. A trend is developing whereby people find they are unable to attend their GPs as often as they used to. They find there is only one option, which is the GP who happens to be available. The solution may involve discussions with the GPs themselves. Yesterday was work balance day, so GPs need to take this matter into account as well. When somebody cannot visit their own GP who is familiar with their case history, it represents a lowering of health care standards. Their local GP represents a better chance of providing holistic health care because he or she knows the patient and may know their family members as well. That is a help when it comes to treating hereditary diseases.

In dealing with the Bill on Committee Stage, I hope we can examine those issues, which are relevant. They may not fall directly within the terms of the legislation but, nonetheless, they represent an opportunity to raise expectations through upgrading the provision of services.

Tá díoma ar dhaoine atá ag fiosrú mar gheall ar na haisíoctaíochtaí altranais mar, de réir dealraimh, níl aon duine fostaithe ag an líne chabhrach náisiúnta chun déileáil le daoine trí Ghaeilge. Tar éis do dhaoine fiosrú a dhéanamh óáiteanna sa Ghaeltacht, no sa Ghalltacht, níl duine ar fáil le cúrsaí a phlé trí Ghaeilge. Is trua é sin agus seans go bhfuil sé míbhunreachtúil. Tá an Coimisinéir Teanga ag plé na ceiste ach tá sé go dona do dhaoine ón Ghaeltacht atá aosta agus atá a phlé cúrsaí trí Ghaeilge ó thús saoil amach nach bhfuil siad in ann déileáil leis an cheist seo trí Ghaeilge.

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