Brian Cowen (Laois-Offaly, Fianna Fail)

It is not a question of decreasing the number of them. There may be some nursing homes in the private sector which could and should be criticised in terms of their location or for some other reason, but we should remember that people have lived in the public nursing home sector for years in facilities which predate any private nursing home the Deputy might mention. Some of them date from the last century and some date from the previous century, and I was in a few of them. I was in a position as a result of an increased capital allocation from my predecessor in this office to deal with some of those problems.

Were we to depend on the public nursing home sector in my county, the Deputy's county or borough, or anywhere else, we would not be able to deal with the numbers. It is as simple as that. While continuing with the commitment to invest in the public nursing home sector, the private nursing home sector is making a serious contribution to nursing home care. Nursing home care is provided on the basis of those who require it. We want people to live in the community for as long as possible.

We also have a scheme of tax relief for the construction of housing units for the aged and infirm — for those capable of more independent living. There are community sector developments in an embryonic stage and retirement villages, of which unfortunately, we have had some bad experiences in Wicklow. Sometimes if there is one bad experience of a concept, everyone tends to walk away from it when what we need is to see what lessons can be learnt to improve on the working of the concept.

There are a range of options available having regard to the level of dependency of the individual concerned. There are conditions and degrees of infirmity among elderly people that require full-time nursing home care. We all know of such needs. Families will do their very best for as long as they possibly can but it gets to a point where a home care nurse will not be able to provide the 24 hour care that is needed. The person concerned will need an institutional or a nursing home setting. In many cases because private nursing home facilities are more recently constructed, they can have better facilities than are available in some public nursing homes, although there are some excellent ones. I say that in the context of recognising the professionalism of everyone who works in these places.

As we extoll the public nursing home provision, we know in our hearts and souls that there are many facilities which historically we would like to see replaced pretty quickly. They have provided facilities for as long as they possibly could. The Deputy knows of them in his town and I know of them. The people in those facilities did the best they could for as long as they could and we need to try to replace some of those facilities. The Deputy might not see an increase in the numbers of places because we have to remove places that do not meet the standards, but we have also opened new units. I recall that in a facility in Birr food had to be brought across an open yard which probably contravened the regulations. That was the practice until a new community nursing unit was opened. In saying that I am not in any way criticising the staff who worked there. The same position applied in a facility in Mullingar. I recall being in a facility in Thurles on another occasion. I am sure there were people accommodated on the third storey of that facility whose feet had not hit the ground floor since they were admitted, not to talk of some of them making it down to a pub. This facility was in the middle of the town. The design of the facility was no longer relevant to modern care facilities. These are the realities.

There is only a certain amount of money available and we want to do right by these people. That means providing more public funds for public nursing home care. It also means in many cases replacing antiquated and unsuitable facilities despite the efforts of everyone to keep them going for as long as possible with refurbishment works and so on.

We should acknowledge in a pragmatic way the role that has been played by the private nursing home care sector. The number of nursing home beds has increased by more than 6,000, from less than 7,000 to approximately 13,000, since the end of 1997, when the system of tax relief for nursing home fees was introduced. How many beds would we have if it had not been introduced?

We should not decry the role of the independent sector. Of course we want to maintain the availability of the best possible facilities for everyone, regardless of income, etc. We understand that basic concept, but we should be pragmatic. We should continue the public investment programme, examine the role that can be played by the independent sector, consider how we can encourage more facilities such as St. Brendan's Village in Mulranny, assess the concept of retirement villages and increase the take-up of the tax relief scheme that is available to help those who do not need full-time nursing care to lead more independent lives. All such matters are positive. I appreciate that people have concerns about capital allowances, for example, but such matters are being examined at present.

One should not assume that the schemes under review were introduced just to reduce the tax burden of those on high incomes, although I am sure such people have benefitted from the schemes. The system of tax relief for nursing home fees is providing a community benefit. People will sleep tonight in beds of the highest quality in the independent and private sector. How would it reflect on this House if the beds, which were made available through the tax relief scheme, had not been provided? The private sector can provide certain things more quickly because it benefits from greater flexibility in some respects. There was no problem when the health boards contracted out beds in the private sector. If a person from Ferbane were to stay in a contracted bed in a private nursing home in Shinrone, the person's family would be as happy for him or her to be there as they would for him or her to be in Tullamore or Athlone. Families do not mind who is the proprietor or owner of the nursing home as long as a bed is made available for the person who needs it. We should be pragmatic and sensible.

I would like to be fair to all Members of the House, including my partners in Government. The Tánaiste is as anxious as everyone else to ensure that the elderly receive proper care. All Deputies have family experience of the limitations and constraints of the system. We cannot address such problems as quickly as we would like, but we can and will address them. The independent sector makes an important contribution. I do not suggest that the private sector offers a qualitatively superior service, but I am simply making the point that it offers what people want by providing beds.

I have reminded those who have claimed there is an absence of regulation that the 1990 Act applies. Those who are worried about tax relief arrangements can rest assured that they will be considered as part of the ongoing comprehensive review of capital allowances under the tax relief schemes. Deputy Burton suggested that the tax relief might work if it were focused in a slightly different area, in addition to this area. Deputy Paul McGrath pointed out that the demographic trends are against us.

We did not make provision for this tax relief scheme to dump or maroon elderly people in nursing homes in urban or rural areas. That is not the purpose of the scheme, but some people might think it is happening in some instances. The purpose of this tax relief is to ensure that sufficient nursing home placements are available in the private sector for those who need them. Regardless of whatever else one might say about the scheme, one cannot deny that it has helped us to provide an additional 6,000 places over the last eight years. We could not have expected 6,000 places to be provided under the enhanced public capital investment programme, which has funded the replacement of antiquated facilities which needed to be closed. We would not have been able to increase the number of places by means of public provision alone.

We should be pragmatic and sensible, for example by considering how we can marry the benefits of a public service ethos, which helps to provide public beds, with the efficiency and effectiveness of the private sector, which can quickly deliver beds to the standard set out in the 1990 Act. The House took a decision on the matter 15 years ago. I look forward to hearing the opinions of Deputies when the review of the system of tax relief for nursing home fees has been completed. I would like to issue an open invitation to them to do so. The desired outcome is the expansion of tax relief schemes which focus on the priorities we want to be addressed. Perhaps some of the negative comments about the role the Government has played will be modified in the context of the emerging crisis. The scheme ensures that the private sector can deliver beds quickly. The regulatory framework is in place. We are reviewing the scheme to see how we can provide a broader spectrum of care that is beyond acute hospital care, but is devoted to assisting the elderly as they pass through various degrees of infirmity.

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