Seán Power (Kildare South, Fianna Fail)

I welcome the opportunity to address the House on the provision of services for older people and to outline what the Government is doing to meet the needs of this group. The significant growth in funding available for this sector in recent years is indicative of the Government's commitment to the ongoing development of health funded services for older people.

Advances in medicine and health care, more in-depth knowledge of health and of how to lead a healthy lifestyle and an increase in environmental standards have all contributed to people living longer. The increase in life expectancy is one of the great achievements of western societies in the 20th century. However, as our population ages, the number of new challenges in health care, housing, transportation and quality of life increases. One in five of the population of the European Union is an older citizen and the ratio is set to rise to one in four quite rapidly. The Central Statistics Office estimates that there will be more than 1 million people over the age of 65 living in Ireland by 2036.

The Government has made services for older people a priority. This means supporting older people in dignity to live in their own communities, for as long as possible. Studies have shown that older people are happier living among family and friends and that they lead healthier lives if they are allowed remain in their community. It is for that reason most of our funding is directed towards community care and allowing older people make that choice.

Since 1997, spending on health care services for older people has increased by more than €302 million. Additional funding for services for older people, amounting to €150 million, was allocated to these services in the December budget. This was the largest ever increase in funding for services for older people and reflects the new emphasis on home and day care. Almost three quarters of the additional funding, €109 million of the full year costs, is being committed to community care supports.

The investment package is focused on caring for people at home in accordance with their expressed wishes. The budget day package provides for a number of community and home-based initiatives, including home care packages, the home help service, day and respite centres, meals-on-wheels, sheltered housing, etc.

It is important to have a high quality of residential care available for those who require it and additional funding was made available in the 2006 budget for the subvention scheme. However, many older people in residential care have a low to moderate dependency level and they might very well have continued to live at home if the right supports had been made available to them. The budget package focuses on providing care for people at home, rather than in residential care, as a first option. Often it only takes a little extra to enable people stay in their homes rather than have to go to a hospital or nursing home.

Home care packages have been piloted successfully in several regions in recent years, with 1,100 provided by the end of 2005. In the 2006 budget a further €55 million in full year cost was allocated for this area, €30 million of which will be spent in 2006 and €25 million of which will be spent in 2007. This will allow for the phased introduction of a further 2,000 packages by the end of this year, almost trebling the service previously provided. The Health Service Executive has advised that 249 such packages have been commenced since 1 January this year. I acknowledge the role of the HSE and its commitment to rolling out these packages that make such a difference to patients and their families. We intend to almost treble the number of home care packages provided last year.

Home care packages are delivered through the HSE by a range of providers, including the Health Service Executive, voluntary groups and the private sector. The scheme is intended to be as flexible as possible and highly responsive to the real needs of the individual in order that where a family or friends of an older person wish to provide these services, they will be encouraged to do so with support and through linking in with the HSE or the voluntary or private sector.

Home care packages are multidisciplinary and may include services such as nurses, home care attendants, home helps and various therapists such as physiotherapists and occupational therapists. These packages will be targeted at those persons who have maximised their use of existing core community services and who might otherwise require long-term residential care.

The home help service also plays an important role in keeping people at home for as long as possible. An additional €33 million was allocated to this service in the 2006 budget, €30 million of which was for 2006. This will provide a further 1.75 million home help hours this year.

A comprehensive collective agreement between health employers and SIPTU was finalised in 2000 regarding the terms and conditions for the employment of home helps. This agreement provided for a significant improvement in the pay and conditions of home helps with the result that they now receive the same benefits as all other staff in the health services, including premia pay, paid annual and sick leave, etc. It was agreed with SIPTU in February 2006 to establish a high level group with an independent chairman to address issues pertaining to the standardisation of home help services, including clarification on the nature of the service and standard criteria for entitlements.

Home helps make a significant difference and provide good value for the substantial investment in them. In many cases they make the difference between existing and living. The difference in quality of life for people receiving home help is significant and they appreciate the help they get.

Day and respite care can give a much needed break to carers. Additional funding of €9 million has been allocated for this, €7 million of which is for 2006. This will allow for an additional 1,325 places per week in respite centres.

Meals-on-wheels are another area where there is increased investment. Additional funding of €2.5 million will be provided in 2006 with a further €2.5 million in 2007. This service is important and I acknowledge the role played by volunteers in the implementation of the scheme. Apart from the provision of a meal, the social contact involved is important. The service is a means of keeping in contact with older people, many of whom live in isolated areas or suffer from loneliness.

Sheltered housing for older people provides an alternative to residential care and reflects the desire of older people to live with as much independence as possible. To support the development of sheltered housing, a full year commitment of €1 million was allocated in the budget day package, split evenly between 2006 and 2007, to provide frontline health service support, such as therapists and public health nurses, in this area.

As outlined, additional funding was allocated in the 2006 budget to the nursing home subvention scheme for residents of private nursing homes. This additional funding amounted to a €20 million full year cost. The aim is to standardise means tests and bring greater consistency to the different levels of enhanced subvention support throughout the country. When the scheme was first introduced in 1993 it had a budget of €5 million. This year we will spend approximately €160 million on it. A sum of €8 million has also been provided to cover the cost of 250 extra nursing home beds which the HSE has already sourced. The HSE is now in the process of acquiring a further 250 beds to relieve the delayed discharges situation in acute hospitals.

The Health (Nursing Homes) (Amendment) Bill 2006 was published yesterday. The purpose of the Bill is to ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation. This will help the HSE to implement the scheme on a standardised basis. There is some concern about the implementation of the scheme because it lacks uniformity. I hope we will deal with the Bill in the near future and, with the support of the Opposition, the legislation will pass through the House quickly and the scheme will be put on a sound footing. We will then see a standardised implementation of the scheme.

With regard to the repayment of nursing home fees, the Health (Amendment) (No.2) Bill 2004 was published on 16 March. It governs the repayment of long-stay charges for fully eligible people in an in patient setting. The Bill will allow for the full repayment of long-stay fees to 20,000 people who are still alive and to the families of 40,000 to 50,000 others who have died since December 1998. Priority will be given to those who are still alive.

The scheme will cost approximately €1 billion and repayments are expected to commence in June. The Health Service Executive will appoint an outside agency with experience in making mass repayments to administer the scheme. This year we have provided €400 million towards the repayments. I emphasise to those who are owed money that it is not necessary for them to appoint legal teams to collect the repayments on their behalf. They will be paid automatically. The Government introduced legislation more than 12 months ago, which provided for an ex gratia payment. We have most of the names and details of those who are currently alive on file and the money will be paid without any need for recourse to legal professionals. We had intended to pass the legislation before December 2005 but a number of issues had to be dealt with, including putting safeguards in place to ensure that the money is paid to those who deserve it and from whom it was taken. The Government made a commitment to repay the money and will do so.

Legislation is being prepared in the Department to provide for the establishment of the Health Information and Quality Authority, HIQA, and the social services inspectorate function, as part of HIQA, on a statutory basis. The social services inspectorate function will be vested in a new statutory office to be known as the office of the chief inspector of social services. The legislation will also provide for the establishment of a registration system in respect of residential services for children, for older people and people with disabilities to replace existing registration procedures detailed in the Health (Nursing Homes) Act and the Child Care Act. A working group to examine the standards in long-term care settings has been established and is currently examining minimum standards of care in both public and private settings.

The Tánaiste and Minister for Health and Children, Deputy Harney, and the Minister for Social and Family Affairs, Deputy Brennan, established a working group to identify the policy options for a financially sustainable system of long-term care, including improvements in community care and home care packages. The report of the working group on the future financing of long-term care has been presented to Government, where it is under consideration.

We are embarking on an era where future policies must reflect the needs of an aging society and when care in the home will be a first option. This is in line with people's preference to grow old in the homes and communities where they have lived for most of their lives. Older people must be given every opportunity to remain in their homes and, where possible, as active members of the wider community.

The recent budget package gives some indication of the Government's commitment to looking after older people. Having said that, I am conscious that many of the services for which we have now provided extra funding have been under-funded for a long time. In many respects we are playing catch-up. I acknowledge the important role the voluntary sector has played and from the Government's point of view, we have been highly dependent on that sector for the provision of a number of services for older people. It is vital that the investment made last December is continued and built upon. However, while money is very important in the provision of any service, attitudes in society must also change. For far too long, barriers have been placed before older people, preventing them from participating fully in our society. That must change. Just because a person has retired from employment does not mean he or she is any less valuable to society or is not in a position to play a contributory role. Very often, retirement can mean that people can play a more rewarding or fulfilling role. In any organisation one needs the enthusiasm of youth as well as the wisdom of age. Older people are often portrayed as being a burden on society but that attitude will have to change. I am delighted with the investment in, and priority attached to, older people by the Government and hope that will continue.

Last year media reports on a particular nursing home frightened many older people. The ill-treatment they saw some of their colleagues receiving in that nursing home upset them. However, having visited many nursing homes, my experience suggests that the care given to older people is exceptionally good in most instances. Nevertheless, we must ensure that safeguards are in place to prevent mistreatment of older people.

I am grateful for the opportunity to speak on this issue and emphasise the commitment of the Government to providing services for older people and building on the investment we announced last December.

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