Liam Twomey (Wexford, Fine Gael)

All vulnerable adults, such as those with a disability, in this society deserve the protection of the State but they are not getting it. Children do not get the protection of the State, as we have seen time and again in regard to vetting, which is not coming through. The proposals I have for the social services inspectorate will protect elderly people in every setting in society. The Government has only paid lip service to this idea in the past 12 months. Words are not enough, it is time for the Government to stand up for what it believes or it will have zero credibility with the people at the next election.

The Taoiseach, the Tánaiste and the Minister of State at the Department of Health and Children, Deputy Seán Power, promised legislation before the end of 2005, but not even the heads of a Bill have been delivered as we start this new Dáil session in 2006. It is worth remembering what was said. The Tánaiste stated in April that there are commitments in the health strategy, Quality and Fairness — a Health System for You, in Sustaining Progress, the social partnership agreement for 2003-04 and An Agreed Programme for Government of June 2001 on the establishment of a social services inspectorate on a statutory basis and the extension of its remit to other social services, including residential services for older people. In the nine months since those words were spoken, nothing indicates any more commitment on the Government's behalf to the establishing of a social services inspectorate than there was in April 2005. It is a shocking indictment of the Government.

The former Minister of State at the Department of Health and Children, the self-styled champion of the elderly, Deputy Callely, in July 2003 told the Dáil that health boards were involved in the preparation of draft standards of care for residential institutions for older people. These draft standards were to build on the standards required of private nursing homes under the Nursing Home (Care and Welfare) Regulations 1993 and to have regard to international good practice in this area. It is obvious neither Deputy Callely nor the Government chose to follow up and ensure these standards were finalised or implemented. If they were finalised, where are they now and why were they not implemented in the past two years by the Government?

In 2005, we tabled a parliamentary question to find out what services for older people, promised by the Government in the health strategy, which was Fianna Fáil's manifesto on health prior to the last general election, were being provided. We were promised 600 day hospital beds but none was delivered, at least to the best of our knowledge because the HSE could not tell Fine Gael how many day hospital beds for the elderly were provided since 2001. We were promised 1,370 assessment and rehabilitation beds but how many have been delivered since 2001? There was a total of 95, a 7% success rate. We were promised 7,000 extra day care places in 2001. How many have been delivered? Only 2,250 were delivered, 32% of the figure promised. We were promised 5,600 beds in community nursing home, community care, community support and extended care beds — the Government pledged to provide 800 beds every year for seven years. How many have been delivered? A total of 537, a 9.5% success rate in delivery of Government promises on services for older people.

Should it come as a surprise, therefore, that the Government has totally failed to implement legislation that would protect the elderly or establish an inspectorate that would protect elderly people from abuse in public and private residential nursing homes? I will not go into detail on what has happened in many of those nursing homes. I will leave that to Deputy O'Dowd, who has done trojan work on this issue in recent years.

Other promises were included in the health strategy, specifically in the care of the elderly area, that have become stuck in the 2001 time-warp, promises made before the last election. Legislation was enacted to clarify entitlements because many elderly people still do not know their entitlements, but under the HSE, which was supposed to equalise services across the State, there are still differing rates of subvention in different health board areas and different interpretations of entitlements. This basic legislation has not been implemented.

Every time a Minister discusses care of the elderly, it is pointed out that our population is aging and the percentage of people over 70 is increasing year on year, but where is the framework policy to address this? After five years, the Government has failed miserably to even publish a policy document on care of the elderly. Many ideas have been bandied about, with report after report, such as the O'Shea report, the Mercer report and another Cabinet working group that is to report back to the Ministers for Health and Children and Social and Family Affairs. As we move further into the century, the Government has no idea how it will fund care of the elderly in future.

This lack of commitment was demonstrated in the last budget, where the Government trumpeted the broadening of subvention criteria as a great step forward. Broadening the criteria for the subvention is not much use if the rates of subvention patients can get are still stuck in the 2001 time-warp. How much help would it be for patients to receive between €131 and €160 per week to pay nursing home charges? Has the Minister any idea of the changes in the cost of nursing homes since 2001? If he thinks they have not changed, he is also stuck in a time-warp. There has been a dramatic change in the cost of nursing home care.

The Government is also failing miserably to provide services for people in the community. We will need to keep a close eye on events because there appears to be a drift towards privatising much of this service. I wonder whether a large number of home help hours are being repackaged into small parcels to be delivered by the private sector, without an overall increase in the delivery of care in the community.

Not only is the Fine Gael Party calling for the immediate establishment of the social services inspectorate — we have had enough dilly-dallying from the Government on this important issue — but all the issues which arise as a result of its establishment must be acted on immediately. Legislation on entitlements must be introduced and applied equally throughout the country. The purpose of establishing the Health Service Executive in what the Government describes as a reform process — it is far removed from reform — was to have a uniform approach.

With regard to subvention payments, only 5% of the elderly population reside in a nursing home or avail of any other form of residential care. Those who end up in such care should be given the utmost protection and comfort. Families should not have to go broke looking after elderly relatives. The Government must have the courage of its convictions and deliver a policy on funding care for the elderly, rather than continuing to tinker at the edges. The funding package of €150 million for care of the elderly the Government announced for 2006 suddenly dropped to €110 million when the details emerged. This figure must be scrutinised more closely in future to ascertain what precisely is being delivered in the area of care for elderly people.

In terms of expenditure, the only advance the Government made in this area since 2001 was to introduce medical cards for those aged over 70 years. The delivery of this measure was considered stroke politics at the time. While giving medical cards to all those aged over 70 years is not a bad idea, giving them to multimillionaires and paying general practitioners three times the rate paid for less well-off medical card holders demonstrates the major shortcomings in the system. Unless this measure is followed up with all the other Government promises and the Government demonstrates a commitment to the care of the elderly, its credibility will be completely undermined. The reason the Fine Gael Party is putting pressure on the Government in this area and making primary care and care of the elderly in the community our political priority is to embarrass the Government into looking after elderly people properly in their communities.

During questions earlier, I was shocked by Ministers' lack of knowledge about services they claim to be providing in the community. The current position must change and the Government must take as its starting point the need to provide care for the elderly. The messing around must stop. The Government must quickly provide proper care of the elderly in the community and residential institutions and ensure that those living in such institutions are protected.

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