Jerry Cowley (Mayo, Independent)

This Bill is a fiasco and is 29 years too late. Serious questions need to be asked on how we arrived at this situation. There should surely be some mechanism in this State to ensure that this sort of thing does not happen. We have already had the situation regarding medical cards for persons over 70, where the Department of Health and Children did not know how many people were over 70. That scheme cost many more millions of euro than was ever anticipated. In the course of time, memos from the Department will tell their own story, but I wonder will the report that we are to receive tell the full story.

The Minister has spoken about systemic maladministration in her Department, which shows how she feels about it. I do not think that anybody is blameless here. The entire fiasco does not augur well for the organs of the State and it cries out for reform. I do not begrudge anyone the repayment from the scheme to be set up. It is estimated that €6,000 will be paid for each year that someone spent in public care. However, I fear that relatives who had very little to do with older people will do well out of this. There will certainly be people who will have passed away and on whom little or no records will have been kept. There will, therefore, be money that will go unclaimed. The dormant accounts fund might be considered as a source of money which could be made available where it was impossible to repay it to the people concerned. This has been a great victory for the property rights of older people.

There are many things that could be done with such a fund. For example, we have no social workers for the elderly in many of our health boards. Older people must try to find the wherewithal to go to medical clinics which they are obliged to attend. They are unable to go because of lack of funds from the Government. There has been a campaign running for a home for elderly people in south Mayo since 1971. Just €400,000 would bring this project to design stage. I met the Minister of State, Deputy Power, with the people of Ballinrobe to discuss this. An assessment of need was done and it was designated a priority. It would certainly do wonders for the trolley count in Galway and Castlebar.

I ask the Minister to consider guidelines on how this money can be distributed. Guidelines must also be drawn up for staff in institutions. When they see relatives arriving like flies to a honey pot, they need to know what to do, what to say and how to say it. There is great room for the exploitation of elderly people so the Minister should set guidelines to address this issue. An old colleague of mine, who has since passed away, used to say that where there is a will, there is a relative. That will be the case in this instance more than ever. Elderly people need someone to represent them. When they cannot have a guardian or a ward of court, they need some advocacy system.

I am calling for an advocacy system similar to that proposed under the Disability Bill. A group such as Comhairle should be set up under this Bill to act as an advocate for older people. Where people can afford it, a small amount should be deducted for maintenance. However, it would be much better if the amount deducted from the pension left more to the older person so that they could keep body and bone together. For example, 70% should be deducted, rather than the proposed 80%.

Does this Bill represent the beginning of the process where doctor-only medical cards end up becoming the only medical cards? This is not what was promised. We were promised 200,000 medical cards, but now we have 200,000 doctor only medical cards. I welcome the fact that the parents of children will be allowed to continue to get treatment without having to reapply, but this will only apply to a small number of children with very serious illness, according to the Minister. The Minister can surely do better than this. I ask him to look at this measure again and extend it to children suffering from any illness.

Pharmacists have been saying that the new doctor-only medical cards will create great confusion. There is a suggestion that some letter be put on the prescription so that when someone presents at a pharmacy looking for a GMS prescription, the pharmacist will understand that this is a doctor-only medical card. Confusion arising in this regard might represent a roundabout way of introducing a prescription charge. There is a great need for fair play. What has been happening speaks volumes on how we treat our older people.

There has been a diminution in the number of beds in institutions for elderly people. In my area, we are down about 100 beds in the past few years. People have been forced into the more expensive, profit-driven, non-community nursing home sector. This is not a criticism of nursing homes, where the staff are doing a good job in the absence of a community alternative. People should have the opportunity to stay in their own area. It is not acceptable that beds are taken out of the system and not replaced. The Minister should give serious consideration to breaking down the barriers that prevent communities from looking after their old people. I have yet to meet someone who wanted to leave his or her own area. Nobody wants to leave his or her own area and be part of the sad, silent migration of older people to institutions, where they lose heart and die like the old Indian.

I have considerable experience in this area and our older people can be maintained at home for a longer period if they have the necessary supports to stay at home. Such supports include proper home help provision and appliances, neither of which has always been available. When a person can no longer be maintained at home, the least they should expect is to be maintained in their community. While it may be second best, it is certainly an option people should have. Services provided through facilities like St. Brendan's village in Mulranny include low, medium and high support at home together with day centre support. The service guarantees that no matter how old or disabled a person is, he or she can remain in the local area. It is what we would all like to do.

We must ensure the continuation of the trend to reduce the numbers in institutional care in State facilities. With the increase in the number of private nursing homes comes the need to ensure the provision of a community alternative. An alternative can never be provided in the absence of proper support. Communities have been involved in providing sheltered housing which successfully caters to people who do not have great needs. People with greater needs who can forget to turn the heating on and the cooker off pose a danger to themselves when they are on their own. While sheltered housing and alarms allow them to be maintained in the community for longer, when they can no longer look after themselves they must enter a nursing home. If it is a strange place, they will not do well there. Communities should be involved in the provision of high-support facilities.

It is possible to support older people in the community. Low-support facilities require a defined funding scheme to meet people's needs. The necessary high support facilities require capital funding as well as a revenue stream. These can only be provided if the Government has the will to replace lip-service to community care with the resources to make it a reality.

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