John Dennehy (Cork South Central, Fianna Fail)

I welcome the opportunity to contribute to the debate on the repayment of charges which were found to have been levied illegally on elderly people, but the debate should go beyond that issue. The primary objective should be to discuss the type and level of care an elderly person can expect to receive when he or she needs it and the debate should also include the question of whether there is agreement on the principle of people paying towards the cost of care and how much they should pay. Previous speakers have dodged that issue and we will not have such a debate. We have mainly witnessed attempts at political points scoring and I will fall into the same trap during my contribution as I comment on the issue raised by Opposition Members.

I have been involved with health boards for more than 20 years and I have always been concerned about catch-all phrases such as "care of the elderly" which are used to categorise people. Care of the elderly is a handy category for anybody aged over 65 and it is easy for administrators to use such a description. The equivalent description of those aged under 65 who need high level care is the "chronic young sick". These are two examples of how the State tries to depersonalise the services needed by such people. I would not like my contribution to be totally negative because great work is being done throughout the State on behalf of the elderly and younger people in need of long-term care. We are afraid to get too personal about the people needing such services and I am concerned about the tendency to lump people into a suitable category.

Field workers such as those implementing the southern region's Ageing with Confidence project know their client's names, needs and personal requirements but legislators, departmental officials and other decision makers prefer to categorise them in easily identifiable groups because that is handier. It is only when we, as public representatives, deal with the problems facing people at the coalface that we gain an appreciation of what we have legislated for in this rarefied atmosphere. We must never forget that we legislate for individuals, no matter how we categorise them. I fall into that trap when I refer to people aged over 65 and so on. Every elderly person has needs, which are changing, many for the better. Activity programmes promoted by health boards and other interest groups such as the Irish Heart Foundation have had hugely positive benefits. On the other hand, unfortunately, the incidence of Alzheimer's disease is increasing and it has not been properly addressed. The State must be prepared to respond more quickly to changing needs.

I do not blame the Department because Ministers can make their own decisions, but there is a reluctance to address issues when they are highlighted. When private nursing home subvention was introduced in the late 1970s, a condition was laid down that if the elderly person owned his or her own property, it had to be sold if the need arose to fund the service. A threshold of £75,000 was set and if the value of the person's property exceeded that, it had to be sold. Despite fighting and arguing for between ten and 15 years about the need to recognise increased property prices, the Department was reluctant to adjust the threshold. That is an indication of how reluctant the State is to respond to changing circumstances.

If it is agreed the underlying principle is to work to cater for all the medical needs of an individual, we will have made a good start. If we decide that such care should come free of charge or that some level of payments should be made after a certain stage, that is also okay. However, we need to be consistent. Those in this House who state they are opposed to the principle of means testing for services for old people should not also be critical of the decision of the former Minister for Health and Children, Deputy Martin, to give medical cards to the over 70s. I argued for that initiative for many years. People at a certain age should be entitled automatically to free medical cards. However, we have got complaints about this from the same people who now urge no means testing.

When I started my career in local government, the most humiliating aspect in the care of the elderly was the pensions board. That board was made up of the honourable members of a local council who could delve into the personal details of any elderly person applying for a pension. I am glad that I personally boycotted that board, but there is still an element of that old-fashioned thinking. After the medical cards initiative, we received complaints that millionaires would avail of it. It is ridiculous to think that a millionaire would queue among 20 or 30 others so that he could avail of his medical card, yet people still made political points out of it.

Such convoluted thinking also arose during another welcome initiative for the elderly for which I lobbied successive Ministers. Concern has been expressed in this House on many occasions about our unfortunate people who had to leave this island. We often say that we owe them a debt. The best example of repaying that debt came with the courageous decision made by the former Minister for Finance, Charlie McCreevy, to give those people credit for pre-1953 stamps. Contributions at that time did not contain a pension element and successive Ministers of Finance had opted to follow the Department's guidance on this issue, which was not to give credit. Elderly Irish emigrants in many countries are now enjoying a reasonable pension thanks to that initiative. I believe that the payment from this country is their entitlement. Did those who raise concerns about our elderly emigrants applaud and support this initiative? No. They and their parties questioned and criticised the cost. So much for the concept of caring for the elderly and doing away with means testing. We need to establish standards and levels of care, but we also need some degree of consistency in supporting that concept.

These issues have been raised at the Committee of Public Accounts and criticism has been levelled at those who took such courageous decisions. They were easy targets and the cheap criticism was that it cost too much. We can be a caring community or we can be a firm of accountants, trying to get the balance sheet right all the time. Our population is growing older and while we once had the distinction of having the youngest population in Europe, the obvious outcome is that at some point we will have one of the oldest. This legislation has one eye on the past, but also has one eye on the future and the implications of this Bill will be far reaching. We must make some decisions such as whether we provide services that are required by the elderly, whether we respond to their needs in a humanitarian way or whether we take the side of the accountants. We should not criticise decisions that affect the balance sheet if we do not make an allowance for the good of a particular initiative. It has distressed me, as a member of the Committee of Public Accounts, to hear critical comments when the figures do not turn out as projected. I would prefer to take the initiative when we see the justifiable need for it.

There is a conflict between those who want rushed legislation and those who say that such legislation is seldom successful. The same people again seem to be on both sides of that argument. We need to be consistent. The Minister spoke about the possible exploitation and manipulation of the repayments scheme. The majority of the people to receive money are elderly, but in some cases it will be their estate and a proportion will also go to the mentally impaired. When the potential abuse of a patient's private property is considered, it is crystal clear that safeguards must be put in place as part of this Bill. Not everyone is happy with the current position regarding patients' accounts in the general medical services, despite several recent changes. Due to the existence of eight health boards in the past, there has been much inconsistency throughout the country in how these accounts were handled, especially the charges that could be levied for staff wages. There have been many debates on the issue, such as the use of patients' funds to provide a better environment for them. However, proper legislation is not in place to cater for patients' accounts, especially for those who are mentally incapable of making their own decisions. We need a standard formula for patients' accounts generally. I have no objection to a reasonable charge to deal with the millions of accounts throughout the country, but the system should be transparent with no opportunity provided for anyone to delve into the funds. These people have been wronged once and we must ensure they are not wronged again.

In its last budget, the Government put new measures in place to fund child care and this Bill is a means of helping those at the other end of the spectrum. It will assist in providing for older people in their community, but we need much more transparent rules on what will be provided to whom. For the past 30 years, there has been much confusion about what is involved. We have had three or four different Acts in this area, including an Act dealing with subventions for private nursing homes. That was very welcome at the time because families were going destitute trying to cater for an elderly relative or friend. That Act was amended to allow for extra subsidies and there were three or four Acts that covered care and related issues. It was so complicated that even Members of this House had no idea from where it came. On the original issue, Deputy McManus, now a member of the Labour Party, stated that the kernel of the problem was that the State broke the law and mugged the elderly and frail. I remind Deputy McManus that it was a former leader and Minister from the Labour Party who brought in the original legislation. I may be wrong in crediting her as a junior Minister in the early 1990s but she has certainly been around for a long time and, given that she holds a brief on health care, I would have expected her to familiarise herself with the genesis of this problem. She could at least have found out who was in the wrong.

Every Government of the past 30 years has failed on this issue. I have raised it on a number of occasions but instead of being given satisfactory replies, I was quoted articles, financial subventions and bed contracts. The problem became so convoluted that nobody knew what was happening. However, Members of this House should be familiar with the basic fact that the former Minister for Health, Mr. Corish, introduced a Bill without also bringing primary legislation to allow for charges. The various people who have tried to tamper with it since then are equally guilty and we have all failed in many areas of care for the elderly.

We need to change our ways and to stop patronising people. A great deal of good work is being done. The active age concept is being fostered by the Minister of State, Deputy Seán Power. We do not need to patronise people because for the most part they are capable of looking after themselves. If they need hospital care, they should get it, regardless of whether that involves beds in Bantry, which I costed against nursing home care in 2001, or elsewhere.

The reason we have so many nursing homes, which are most welcome, is that the State failed to provide beds for elderly people in need of care over the past 30 years. Having failed to cater for these people, the final insult is then to tell them that they are holding up beds or to degrade by calling them bed blockers.

As a long serving Government Member, I felt guilty when I was informed of the result of a survey carried out in 2002 which indicated that 200 extra beds were needed in Cork alone to care for the elderly. Despite the shouting I have done with regard to care for the elderly, I believe I let my people down and we need to redress that failure. This Bill will deal with historical aspects but I appeal to the Minister of State to build a new regime for the future. We have the money to do so and should be frank in deciding whether a charge should apply or if the full pension, which is topped up for the over 80s and others who need extra help, and the cost of a bed will be paid. People cannot be Tadhgín an dá thaobh on every issue and sooner or later they will have to admit they are concerned for the elderly and that free medical cards and beds should be provided. They cannot have it one way here and another way in the Committee of Public Accounts. I appeal to them to put the elderly first because, although many elderly people will never require any services, thanks be to God, the population is aging and people will need help. For example, I have concerns about our inability to cope with Alzheimer's disease.

This Bill is a sort of a fait accompli in that nobody will vote against it but we should use it as a fulcrum to improve services. A great deal of money will be available. There are patriotic people who will refuse the refunds because they want the money to be used for care. Any such money should be ring-fenced for the care of older people. I hate categorising people but, being in the older age group myself, I must be careful when describing us. I foresee a positive outcome and wish the Minister of State well in the job he has been given of sorting out 30 years of political incompetence.

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