Seymour Crawford (Cavan-Monaghan, Fine Gael)

I thank Deputy Ring for sharing time. Like other Deputies, I question why no explanatory memorandum was included with this important Bill. The previous Bill was rushed through the House without proper consultation and we are all aware of what happened. I pay tribute to the President because she saw sense in the issues we raised. I was one of those who raised questions about the Bill's legality at the time and we were proved correct, for which I am thankful. I also thank my colleague, Deputy Perry, and our party leader, Deputy Kenny, for raising the issue of the illegal charging of nursing home residents.

The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, who is in the House, along with his colleagues, Deputy Callely and the former Minister for Health and Children, Deputy Martin, were all present at the meeting in 2003 when this issue was discussed and yet nothing was done about it. This issue is extremely serious and it seems to have been ignored. If it had not been for the tenacity of our party leader, Deputy Kenny, in continuing to raise the matter in this House on a weekly basis, I am not sure it would have ever seen the light of day.

The Minister of State at the Department of Health and Children, Deputy Seán Power, stated yesterday that this Bill is intended to establish a sound legal basis for the policy to charge residents a contribution towards their shelter and maintenance in long-term institutions. That may be possible. I hope for everyone's sake that the legal position is correct. However, I am worried about the lack of information available regarding how the means test will be applied to those requiring subvention in private nursing homes because of the shortage of places in State run nursing homes.

For example, at the time of the last election, 254 people in Cavan-Monaghan were in receipt of subvention but when the election was over, an effort was made to reduce this number to 150 or 170. Eventually, we achieved agreement on 214 and, thankfully, we have now achieved a level of 234 people in receipt of subvention. The trauma which many families have to endure in order to get this subvention is unreal. On Tuesday I sat with an aged man who is in respite care in St. Mary's nursing home but is being turfed out because there is no room for him. Although he owns his own house, he has had great difficulty finding ways and means of support. This man had paid his way all his life and this is a traumatic situation for a man without a single family member closer than second or third cousin, with whom to discuss the issue. We must have a more caring and realistic approach.

The trauma endured by a patient from Monaghan in a west of Ireland nursing home in order to receive subvention was nothing ordinary. Furthermore, the subvention was not even paid from the time of the patient's arrival. The personnel in charge of the nursing home stated they had never come across the like of it before. There is a major difference in how the elderly are treated in different areas and I hope that under the new health structure this issue will be sorted out once and for all. Every patient, no matter where he or she lives, should have similar access to accommodation and receive similar treatment.

Before the laws changed in Northern Ireland in the early 1990s, many people from Cavan and Monaghan were sent across the Border because they could receive full care there for free. Moreover, the health boards encouraged this practice. This leaves the constituency with a seemingly low base from which to judge the situation. However, we must remember that the former North Eastern Health Board area has experienced the single biggest increase in population anywhere in the nation and the numbers of people over 85 years are also increasing. Therefore, we have a bigger problem than anywhere else, which cannot be ignored.

I am dealing with the case of an elderly man who received legal advice from a solicitor that he should retain 20 acres of his small farm holding. However, the man's son needs every inch of the farm in order to make a living without having to pay his father. This is accepted and acknowledged but the father is in a nursing home and the family must pay €350 per week along with the man's pension in order to keep him there. The family has only in recent weeks received a small subvention but the situation is crazy because the man's wife is still alive. Does she have no rights? It is impossible to understand.

In another case, a mother in a nursing home had owned her own house and when she married her husband bought all the land around it. Their son is now the only person living in the house and he farms the land. The house is being used as collateral as far as the health board is concerned. This must be examined. I am pleased with the Tánaiste's comment this morning that the repayments of money to those who are entitled to it will be simplified and dealt with without legal complications. It is a serious problem because it will be a complicated process but I accept the Tánaiste's commitment and hope it works.

This Bill provides that 80% of patient's pensions must be paid for maintenance and so on, which will leave €30 or €35 depending on the pension. However, there must be some flexibility in this regard. I would not like to see the situation in which a relatively fit person who enjoys taking a drink or a cigarette or having his or her hair done would be tied to such an amount. If the person wants to buy birthday presents for grandchildren, €35 will not go very far. I want to see that situation made reasonable and respectable.

More than 100,000 medical cards have been removed from the system because of the failure to increase the limit for the means test. This issue has already been addressed by many Deputies on both sides of the House. However, I have a major question to ask about how eligibility is evaluated in different areas. From January 1997 to September 2004, County Cavan lost 3,630 out of 22,000 medical cards, County Monaghan lost 6,000 out of 22,000 and the four former North Eastern Health Board counties together lost 28,000 out of 113,000 medical cards. However, in County Cork, the home of the former Minister for Health and Children, Deputy Martin, out of 139,000 cards available in January 1997, only 8,097 were removed by September 2004. One must ask how this came about and why there was such a difference. This difference is more than 20,000 when one takes everything into account. There is talk about 300,000 new medical cards being issued, but we have already lost 100,000. Where are we going? Reference has also been made to 200,000 new doctor-only cards. My colleague, Deputy Twomey, proposed such cards as a means of dealing with the problem. As a member of the British-Irish Interparliamentary Body, I had the privilege of touring a number of hospitals in Wick in the north of Scotland, Wales and other places. It was clear that where proper, free primary care was available it removed enormous pressure from the accident and emergency services. That area of services must be improved dramatically but the Minister's proposal does not go far enough.

The Tánaiste said that the traditional medical card would continue to be held by 85% of medical card holders. Does that mean that some of the 200,000 doctor-only cards will replace the medical cards or will there be 200,000 doctor-only cards as well as 30,000 extra medical cards? That must be clarified. The 200,000 doctor-only cards, the 30,000 extra medical cards and the existing 100,000 medical cards must remain in place to ensure people have proper access to primary care. It will remove many of them from the accident and emergency departments and alleviate much of the pressure.

I am grateful that Monaghan General Hospital is back on call for medical purposes. However, the Minister should ensure that something is done about the surgical service.

See this speech in context