Olwyn Enright (Laois-Offaly, Fine Gael)

I am concerned that this Bill, unusually, has been introduced to the House without an explanatory memorandum. This has not happened in my short time in the House. It may have occurred in respect of the previous Health Bill, although I am open to correction. This Bill will be sent to the Seanad where, had it been introduced there, would have required an explanatory memorandum under that House's Standing Orders. This matter should be examined in this House. When Bills have come before the Supreme Court in the past, explanatory memorandums have been examined prior to the court giving its judgment. This is a strange departure from precedent and one which has not been adequately explained by the Minister for Health and Children. I call on her to explain why this is the case.

I commend Deputies Perry and Kenny for their pursuit of the issue of illegal charging in nursing homes. It is clear from the Supreme Court decision that, despite Government attempts to muddy the waters in recent months and the Tánaiste's statements, the issue of overcharging became much more apparent from 2001. Moreover, there is strong evidence to suggest that the Minster for Health and Children at the time, Deputy Martin, and his Ministers of State abdicated their responsibilities in their handling of the issue from December 2003.

Part of the reason for this Bill being presented is the outcome of this position. It is a shame that the Travers report is not available to the House. We are told we should learn from our mistakes but it is very difficult for the former Minister for Health and Children, Deputy Martin, current Minister, the Tánaiste, Deputy Harney, and her Ministers of State when they and we cannot see the report into the handling of the issue before we discuss another Bill which effectively deals with the same issue. This is a pity because it would have been good to have had recourse to the report while discussing the Bill prior to its enactment after Friday, 11 March next.

I refer to the issue of overall care for the elderly. The Minister of State, Deputy Seán Power, attempted to deal with the matter in his speech to the House. It is nice to have noble aspirations, a term used by other Ministers in recent times, but we need more than that. We must have long-term planning, not only in terms of public and private nursing home care, but also in terms of the adequate provision of long-term care of the elderly within their homes. There are people who would rather be cared for at home if all the facilities were in place.

Many inroads have been made in this regard and better facilities have recently been provided for the care of people in their homes than existed ten or 15 years ago. However, we have a long way to go to make it a viable alternative to long-stay nursing home care and we have not yet bridged that gap. This is an important consideration which requires long-term planning because stop-gap measures will not work.

We will perhaps never reach the optimum number of nursing home beds but we must aspire to it. The community nursing unit in Birr opened recently having lain idle for two years. I am glad it is finally open now, the staff having been provided to run the beds as promised. However, this goes back to long-term planning. How can we decide we need a unit, provide the money for it and yet leave it lying idle for two years? It is a serious question. People are concerned to see other facilities supposedly coming on stream but which could be left lying idle. For example, Riada House in Tullamore and Ophalia House in Edenderry, where extensions were promised years ago to provide the needed beds, have not come on stream. This brings one back to the issue of overcrowding within hospitals and the use of beds by people who would perhaps be better cared for elsewhere. The lack of available beds is unfortunately forcing people into private nursing homes at great cost to themselves or their families. The care is not necessarily any less but it is not always the optimum choice for people and many find they cannot afford it. In this context, one must consider the issue of the variation in the cost of subvention.

It is difficult to describe the position one is in since the abolition of the health boards. People write the same letters to the same people with similar titles and addresses, except that it is the Health Service Executive midlands area rather than the Midland Health Board. I had hoped that the one good aspect of the abolition of the health boards would have been that anomalies between regions would have been addressed and we could have achieved a better, fairer and more equal standard of care throughout the country. However, this has not happened yet. Subvention is a perfect example in this regard.

I accept that owing to pressures of population, private nursing home care may be more expensive in some parts of the eastern region than others. It might be more expensive in some parts of the eastern region to secure private nursing home care but I cannot understand why enhanced subvention in the eastern region should be up to €520 whereas in the midlands region the rate paid is only between €50 and €90. That is a huge difference of up to €430. It is unacceptable.

The midlands region borders the eastern region and many of the same population pressures affect places such as Portlaoise, Edenderry, Mullingar and even Longford. I do not understand why such a disparity exists. Furthermore, 1,098 people in the eastern region were able to avail of the enhanced subvention whereas only 32 people in the midlands region could avail of it. These matters must be addressed. It is important that the Health Service Executive deals with such anomalies and ensures that people are treated properly and equitably. It certainly is not happening at present.

Recently, I attended a meeting of an Alzheimer's group in my constituency. The difficulties it faces are no different from those faced by other groups. However, the main points the group raised with me were the cost of care, subventions and the availability of care. Not every nursing home is willing to take in a person suffering from Alzheimer's disease. They generally require a greater standard of care than other residents of nursing homes. Care is often far more expensive because of the greater care requirements. This must be addressed.

I believe there is only one bed dedicated to Alzheimer's patients in County Offaly. Compared with the number of people at the meeting who have relatives suffering from Alzheimer's disease, it is a negligible allocation and has no impact. That is unfair and wrong. Certainly, public community nursing units and nursing homes have a duty to address this. It might be more difficult to force private nursing homes to do it although I would have no difficulty with such a decision being taken. They should not be in the position of picking and choosing the residents they accept. When they have the facilities available they should ensure that everybody is able to avail of them.

There is a lack of help for carers in their homes. Due to the shortage of spaces, many people are forced to deal with patients and relatives suffering from Alzheimer's disease in their homes. That imposes huge burdens and involves 24-hour care. There is no way around it due to the nature of the illness. The Government should examine and address this issue.

Deputy Dennehy spoke about opposition to charging for public nursing home care. It certainly did not come from this side of the House. We accept the principle that people must pay for care and nobody in Fine Gael has stated otherwise. The Bill provides for an 80% charge across the board. The Minister should consider that different people have different needs. A person who is bedridden in a nursing home might not need the same amount of money by virtue of the fact that he or she is bedridden and might be incapacitated either mentally or physically.

However, there are others in nursing home care who might be able to go to Mass or to the shops for the newspapers and so forth. This leaves such people with a small amount of disposable income. I am not suggesting a scale but we should examine this provision to ensure that it could be applied in a fairer manner. Everybody, regardless of whether they are in a nursing home, has the right to a quality of life, and a resident of a nursing home has the same desires as other people to buy things, have their hair done and the like. We must ensure that we give them the dignity and quality of life of being able to do that. It is important that this point is made.

The current Minister for Health and Children has not handled this issue well — she has handled it badly. There has been little clarity. Legislation was rushed through the House before Christmas, despite warnings from all sides of the House. The end result is as expected. Despite the fact that the Minister was rushing the legislation through the House, she made a tokenistic and patronising gesture of paying everybody €2,000. There is a different figure for everybody in terms of what the care cost, what they paid and how they were illegally charged. The payment of €2,000 across the board was nonsense. The end result is that this matter will cost us a fortune, while dealing with it will be an administrative nightmare. There should be clear guidelines from the Government on how it intends to deal with the issue.

The doctor-only medical card was a good idea. Deputy Twomey suggested it initially, before the Tánaiste, but as a temporary measure. The means-testing method in the Bill is extremely interesting. There will be another trip to the Supreme Court if the Government is not careful and if the Minister does not accept amendments to it. It is certainly discriminatory and an attack on marriage. That is unusual and a pity. Why should a married couple be treated in a more negative way than a couple who are cohabiting? A married couple will be means tested against the spousal income but that will not happen to a couple who choose to live together and not get married.

See this speech in context