Joan Burton (Dublin West, Labour)

I move amendment No. 12:

In page 13, between lines 15 and 16, to insert the following:

"4.—The Minister shall review tax relief arrangements for private nursing homes to determine their compatibility with health criteria and in particular health and welfare related criteria regarding the size and location of facilities.".

I appreciate the Minister may not have had an opportunity to get a full briefing on this issue when I raised it last week on Committee Stage. During his predecessor's time there was a move to give very generous tax breaks of up to 42% to people who made capital investments in various medical and nursing home facilities. The Tánaiste, in her role as Minister for Health and Children, seems determined to privatise as much of our health and care systems as possible. While she may be ideologically driven in her desire to do so, we need a debate on whether it is appropriate. I mention this in the context of the development of large numbers of private nursing homes with generous tax breaks of 42% provided that they continue to operate as nursing homes for a maximum period of only ten years. We do not know what will happen at the end of that period. Will they continue to provide nursing care or will they move into another area?

Regardless of any kind of joined up policy on social provision, the Minister's predecessor said on a number of occasions that he had expanded these areas of medical and social care related tax breaks on the basis of a hunch or what had been said by whoever he happened to meet in the run-up to his various budgets. He met somebody who told him about the difficulty of getting a psychological assessment for their child and that change was brought forward in one year. He met somebody else, a doctor in his constituency, who talked about tax breaks for private hospitals and that was brought forward on Report Stage two years ago. Similarly, the provision of nursing home tax breaks was made on an ad hoc basis.

I am not aware of any study that indicates what role this plays in the long-term provision of quality care for older people. I reiterate that all the evidence from Age Action Ireland and other groups which deal with older people in society is that the overwhelming preference of older people is to stay at home, either with or in the vicinity of their families, and as they become older and more dependent, they should still be able to live independently but with increasing support. If that is the model to be followed, it is certainly not the logic of the tax breaks the Minister's predecessor sponsored.

I spoke about the Hanly report which laid down various criteria regarding survival sizes — 300 to 400 beds — for hospitals and certain facilities. About one year ago that was the gospel according to the Government. When it comes to policy on tax breaks for health and social provision, there seems to be no study. I do not know whether the Department of Finance ever even sent a note to the Department of Health and Children or the Department of Social and Family Affairs on the various tax breaks being introduced.

I have raised the issue of the proliferation of nursing homes in the Leinster region which are out of town, a mile or two away from villages. While the physical finish of these homes may be very good, the opportunity for an old person who goes into one of these homes to live any kind of independent life is severely curtailed unless their family are highly supportive on a regular basis. Most of the nursing homes in rural Ireland, including in north County Dublin in the Fingal area where they are proliferating, are very remote. There are no footpaths. The nearest village is probably well over a mile away. The majority of the residents of nursing home facilities are more than 70 or 75 years of age and not up to walking a mile or a mile and a half on a road without a footpath where cars travel at very high speeds. Consequently, they have no access to their church, the pub or the post office. They have no access even to a Spar shop if they want to buy a few things for themselves.

The amendment is reasonable. The criteria should be linked to compatibility with health and welfare in terms of the size and location of the facility. When we look back to this tax break in ten years' time, we will see some nursing homes which will have made excellent provision and which will continue to do so. We will also see others, which were basically interim development strategies by developers who bought land at auction with an eye to future housing developments in areas like Fingal and the parts of Leinster near Dublin city. The old farmhouse or other buildings on such land will be converted to nursing home use resulting in extensive tax breaks. Ten years hence the developer may be far more optimistic that Fingal, Meath or Kildare county councils will allow full-scale housing development on the site and the nursing home facility will go. It will be used for some other purpose, probably housing development.

The nursing home tax break should have conditions. The Minister cannot tell me the number of nursing homes availing of this tax break or the cost of it. His predecessor has led him down the road of providing very significant tax breaks affecting elderly people, which do not emphasise independent welfare criteria for older people such as affording them as much independence as is possible for as long as is possible. Entering a nursing home should be the last resort for our older population rather than the first resort, which is the result of giving upfront tax breaks.

At budget time the Minister for Finance has some influence on departmental budgets. It is disappointing that some local authorities make no provision for sheltered supported housing for older people. Other authorities, for example Dublin City Council, are fantastic at doing so. The sheltered facilities and apartments it provides are superb and allow a high level of independence. As the Acting Chairman, Deputy Glennon, will know, Fingal County Council is decades behind Dublin City Council in this regard. If a pot of money is available to places like Blanchardstown, the Naul and Garristown most Deputies and most families would prefer to support those kinds of facilities for older people in sites in or near villages where people aged over 75 years can still go for a walk, visit the pub, go to Mass and do whatever they want to do. This is what keeps people young and alive. The staff in most nursing homes are excellent. Even if the quality of care is excellent, by placing them in an out of the way nursing home, they are nearly getting a life sentence. They will not come out again as independent individuals.

The Minister's predecessor introduced many tax breaks without any examination of the social, welfare and medical criteria, which should have accompanied them. I ask the Minister to do this from hereon. On Committee Stage the Minister gave us figures for increases in nursing home numbers. Crude increases in nursing home numbers are pointless without a good model of care. Presumably in 20 or 30 years' time, or perhaps later, 5% to 10% of those in this Chamber may, because of medical need, be dependent on having to use a nursing home facility. If the Minister wants to give tax breaks, they should be targeted at independent living in an environment where the older person can resource facilities. I gave the example of towns with a nursing home on the main street, which allows visitors ease of access. This is preferable to the proliferation of nursing homes in remote locations, driven by the tax breaks with no consideration for welfare or health criteria.

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