Liam Twomey (Wexford, Fine Gael)

I thank the Minister of State for his contribution. Deputy McManus and I have come from an almost four-hour long meeting of the Joint Committee on Health and Children. If some of the officials feel we are somewhat all over the place with our contributions, I hope they will take that into account. At the committee meeting we experienced the Tánaiste going through another one of her routines of being nine years in denial. The way the Tánaiste and Professor Drumm were speaking, one might believe the Government changed in 2004 and the Tánaiste has only been in Government for the past 18 months. It appears difficult for her to comprehend that her Government has been there since 1997. What we heard at the committee meeting was total nonsense.

Where do we start with this Bill? The delay in delivering it to the House is indicative of the delays this Government experiences in bringing legislation to the Oireachtas, especially if such legislation relates to the health service. The Minister of State mentioned some of these in passing, such as the legislation to clarify entitlements. That legislation was part of the health strategy published in November 2001; we are now moving into its fifth year and the legislation has not been published, which is a disgrace.

The HIQA legislation mentioned by the Minister of State, which has been given a raised status by the Government on the backing of the Neary report, was meant to piggyback the establishment of the HSE and not come two years after. I often wonder if it would have made a difference to the presentation of this legislation if the then Minister for Health and Children, Deputy Martin, had read his briefing notes regarding illegal nursing home charges. It has taken a long time for the Government to put forward the legislation.

The Minister of State, in mentioning dealing with issues regarding the elderly, discussed the policy for funding care of the elderly in future. This matter is of momentous importance to the Irish health care services. For the Government to deal with it as if it is a minor side issue which it will get around to when time is set aside is disgraceful. Our population is getting older and one in 20 of our elderly population will need some type of long-term care. At the committee meeting we heard that a large number of the acute beds in our hospitals are taken up by patients who would be more appropriately placed in long-term care.

Where does the Government stand on this and other issues which have been around for the past ten years? It has published four reports, including the Mercer and the O'Shea reports. There were probably more reports. If a question was put down to the former Minister for Health and Children, Deputy Martin his usual response was another report. The matter has now gone to Cabinet, which is considering another report, although it has not yet published it. One would have to ask if this is complacency, incompetence or whether the Government is sound asleep on such a major issue? There are many issues cropping up in this House with regard to care of the elderly and I am shocked to think we do not yet have a published a policy.

The Tánaiste leads a charmed existence. I believe Deputy McManus and I are asked more questions about what we would do in government than the Tánaiste is asked regarding what she is meant to be doing in government. Every time Deputy McManus or I are on the radio we are asked what we would do. The easiest answer I would give is that I would do more than the present Government. This would not be all that good, as it would not give the patients any significant improvement in the current service. We should question the whereabouts of all the policies and legislation promised. It may be time for the national media to take notice of what is happening in this House.

Would the Minister of State care to speculate on how many major health Bills go through this House every year? Disregarding amendments, the average for the past three or four years is one per year. At today's committee meeting, the Tánaiste stated we would have legislation on the Medical Practitioners Act, although we have waited ten years for it; the pharmacy Bill, although we have waited five years for it; HIQA legislation; and nursing legislation. I fell asleep at that stage, perhaps Deputy McManus can remember the rest of the list. The Tánaiste has promised five major Bills between now and year's end, when her average record to date has been one per year. I do not believe it will happen, and we should be realistic.

I have a point on which the Minister of State might comment before this legislation goes through the Houses, as it requires a clear answer from Government. The Government was caught out on this issue and belatedly responded to it, although officials from the Department of Health and Children did their best to inform the Minister and Ministers of State. However, the then Minister for Health and Children, Deputy Martin, and his Ministers of State did not take much notice at the time. There is a big question which could make this look like small change. The 2001 legislation gives everybody over 70 a statutory entitlement, and there is a difference between a statutory entitlement and something at the discretion of a CEO.

If people over 70 went into a private nursing home because a public bed was not available, on the basis of their statutory entitlement will they be able to claim a refund for private nursing home costs if somebody succeeds in bringing the issue to the Supreme Court? It is currently going through the courts. That is my reading of it, and I may be wrong. However, the issue is being evaded by the Minister, and the focus is on what is now legal and how the problem has been dealt with. This is similar to what Deputy McManus and I discussed with regard to the Travers report.

We believe this issue came up in bright flashing lights in the Department of Health and Children during the construction of the 2001 legislation. Two years later we still have no clear answer as to whether we are right. Before this Bill is processed we need a clear answer on whether the patients currently going through the courts looking for refunds for private nursing home charges on the basis of the 2001 legislation are wasting their time or if they will succeed. If they succeed we may be here next year or the year after thinking that the €400 million or €500 million now under consideration is very small change.

Paradoxically, the Minister has in the past been criticised because of undue haste in putting legislation through the House. The manner in which the Health Act 2004, which established the HSE, was put through was seen to be with undue haste. We are now paying the price. The same can be said of the original legislation from which this Bill emanated. It was rejected by the Supreme Court and had to be submitted again to the House because the Government got it wrong. The Minister gets it wrong so often when legislation is rushed, but the Government was very slow in getting this legislation before the House. Why are we dealing with this legislation 14 months after the problem? Why was the legislation not dealt with last year? These people are, for the most part, in their final years in long-stay care and will only have a short time to enjoy their refund. I return to what the Minister said about people in long-stay care. The average length of a person's stay in a nursing home is two to three years, not a long time. The Department of Health and Children made ex gratia payments of €21million to 10,800 people and, as the Minister of State pointed out, the HSE, which assists the new organisation making the repayments, will have to repay people who are alive first. He said they accounted for approximately 10,000 of the cases with which the HSE is now dealing. The Minister of State may correct me but I deduce from those figures that anything up to 5,000 people eligible for repayment from the time of the first legislation in November 2004 are now deceased. If the Government continues at that rate most eligible people will have passed away before it even starts making the repayments. All the fine words about looking after those who are alive and about being a caring Government is so much bunkum.

The Supreme Court reinforces this in its statement that, whatever expectations may exist, it is an indisputable fact that the Bill will affect very many people who are old, poor, disabled mentally or physically or, in many cases, all of these. As already stated, patients so situated will have little or no capacity to understand their rights under the legislation or to protest the unlawfulness of the charges. Nor will they, as it seems, have the pleasure of enjoying the refunds being made by the Government.

An explanatory memorandum provided by the Government, which the Minister of State had to correct, was very thin, only consisting of one page. We are accustomed to receiving more detailed memoranda like the Minister of State's speech, wherein he covered each section of the legislation and explained it in more detail to us. I would have expected that, with more than a year to prepare the legislation, the explanatory memorandum would have contained more detail. It makes it difficult to understand what is happening.

Section 3 allows the executive to enter into an agreement with a person to provide services for the purposes of this Act. During the period in which we were waiting for the Minister to publish this legislation we were told the delay was due to the fact that outside companies were quoting up to €50 million to administer the scheme. As Deputy Kenny said, we have asked on a number of occasions why the HSE cannot do this. As the Minister of State has pointed out the HSE seems to have successfully dealt with the 10,000 people who are alive in a very short period by making the ex gratia payments, which means they must have accessed a significant number of their records. I am surprised we are considering an outside company and paying it up to €40 million to make the additional repayments for the 40,000 to 50,000 people who are deceased. If there is a delay caused by the HSE doing the work, it will not make much difference to their estates and certainly will not make any difference to the patients. I am surprised that the HSE states it is not capable of doing the job, when it seems to have been perfectly capable of dealing with matters up to this point. In some respects the Government is passing a vote of no confidence in the HSE by outsourcing something which is a public administration matter. The mistake was made by the Government and should be dealt with by the HSE if it is to demonstrate the improvement it has supposedly brought to the health services. The HSE began collecting information on who is entitled to repayment. Employing consultants to administer the scheme sounds strange when the HSE has already managed to make ex gratia payments worth €20 million to more than 10,000 people.

The Minister of State said the consultancy firm will be engaged in April. Is that the case? Have contracts been signed or will we have to wait for that to be announced at a later stage?

I hope the forms patients or their families must complete will be as simple as possible. I do not believe patients or their families should be required to make claims in duplicate. If the HSE has most of the information there will be no need for patients to complete additional forms. Whatever way it is administered I hope the forms will not be used as a delaying tactic to avoid making the repayments.

Section 5(3)(a) and (b) provide that applications made after 1 January 2008 or such later date as the Minister may prescribe will not be considered. However, there is no deadline by which repayments must be made. I have often thought it would be reasonable for such a timeframe to be included in legislation, within which people could expect a repayment to be made, especially when a time limit for claiming a repayment has been set. We need to speed the process up to make sure people who are alive are paid as a matter of urgency. A deadline should be set whereby repayments must be made having regard to when applications are received. Those who already made application to the Department could benefit from a shorter deadline.

As the Department has been dealing with this matter for so long I expected it to have more accurate figures for the number of people eligible to claim. We have calculated that there are approximately 5,000 people alive to make a claim. That the Department knows that and the details of the people involved means the money can be repaid quickly. I am surprised the Department does not have more accurate figure for those due a repayment. The average repayment to each person is between €12,500 and €15,000 so figures between €500 million and €1 billion are wild and do not stand up to scrutiny. I did not get the opportunity to divide €500 million by 15,000 but there is a huge difference between €500 million and €1 billion in respect of people who may be due a repayment. I am surprised the Minister of State has not distilled the figures into a more accurate number for presentation to the Dáil today.

It is unusual for legislation, even legislation pushed through the House on the back of a Supreme Court decision, not to be costed. I return to what Deputy McManus said earlier. If our parties made legislative proposals without costing them sneering Ministers on the other side would waste no time reminding us. They would ask us how much it would cost the State but the same geniuses, who have been sitting on this for the past three years, are bringing forward legislation they have taken two years to prepare and 12 months to bring before the House and cannot tell us how much it will cost. They say it will be somewhere between €500 million and €1 billion. If Deputy McManus or I brought forward a policy that we said would cost the State between €2 billion and €4 billion we would be laughed at. The Government does not know how much it will cost the taxpayer after spending a year and a half working it out. That is sloppy work from the Tánaiste and Minister for Health and Children, who prides herself on all things being transparent and on taxpayers getting the best deal. I am surprised she has not sat down and read the memoranda but has, instead, taken the figures as gospel without even picking up a calculator. She has more than enough advisers to do the work for her. I could have done the work for her myself if I was not present at the same joint committee meeting for four hours this morning.

Section 12 states the Revenue Commissioners may request, in writing, the scheme administrator to provide it with such information as will assist the commissioners in performing their functions relating to tax liabilities. Having regard to provisions made in the Bill, section 12 is a very general requirement. The number of people still alive and entitled to this repayment is quite small and they will not be assessed for means tests for social welfare schemes. This is something of a red herring because such people are patients in nursing homes and will not be applying for the home care package or anything else. All they expect to receive is the payment for illegal nursing home charges.

This section of the legislation serves to keep the Revenue Commissioners informed of money transferred to estates so the Revenue Commissioners can seek whatever inheritance taxes are due. Why is this not clearly stated in legislation? Some suggest we should use better and more simplified language and that certainly applies to this section. This could be clearly communicated by stating that information regarding moneys of those deceased will be sent to the Revenue Commissioners. There is no need to suggest that the Government is accountable to the people. A clause should be inserted on Committee Stage to make this clear.

This legislation also refers to patients' private property accounts. If this legislation is two years too late, considering patients' private property accounts is 20 years too late. The Minister of State referred to an oversight review and better management of patients' accounts. The reason we are concerned about this is that we are about to pay a maximum of €40 million into patients' accounts. Does the Minister of State with responsibility for elderly people in public institutions have any idea how much money is in patients' accounts?

See this speech in context