Seymour Crawford (Cavan-Monaghan, Fine Gael)

The Minister of State might explain why a County Monaghan resident with an amputated limb and other serious problems receives two hours of home help per week. She previously lived in County Donegal, where she was given 12 hours of help. These issues must be addressed on a regional basis. Every person, wherever he or she lives, is entitled to equal treatment. Further home care subventions are needed because, while the carers allowance is all right, it is means tested. The allowance could help to keep people out of hospitals and nursing homes and would relieve accident and emergency problems.

This Bill was not drafted by accident but as a result of the extremely hard work done by Deputy Perry in bringing this issue to the attention of our party leader and others, having it discussed in this House and, eventually, forcing the Government to admit that it was operating an illegal system. The former Minister for Health and Children, Deputy Martin, was fully informed of this issue in 2001 but it is only today that action is being taken. How many elderly people have suffered because of this practice and passed on to eternity without knowing that the money would be refunded? The media are quick to condemn this House and to allege we do not have a role to play, although there are few from the media listening to this debate. This issue came to light through the activity of this House and an astute Opposition. Many Deputies will issue press releases in the next few weeks and months about how many millions of euro they got back for their constituents. Not one penny would have been reclaimed for constituents but for the work of Deputies Perry and Kenny and the indepth efforts of Deputy O'Dowd to expose the nursing home scandal.

The Bill only puts in place the legal basis to make repayments to those who were illegally charged in public nursing homes. People who are still alive, or their representatives, will have the right to claim back what was illegally taken from them. What scares me most is that a private company will be employed at a cost of some €40 million or €50 million to send out these payments. I know more about agriculture than about health, and I make no apology for that. The Department of Agriculture and Food can press a few buttons and pay the cheques that are needed for all aspects of farm payments without a private company being involved. Who will dig out information on each patient? I suggest it will be the HSE at local level, which will hand on that information to this private company. It does not make sense to employ a private company to collate this information and issue the cheques. It would be better to give €40 million or €50 million to the HSE and employ extra people if necessary, although with the number of administrators maybe some people could be moved from other areas to do the job. Last week I was trying to have a medical card replaced for a person who was clearly having personal difficulties. The community welfare officer has known the family for years and is convinced the person should have a medical card. However, unlike a few years ago the community welfare officer must go through four or five layers of bureaucracy before that card can be issued. Each layer has to raise some queries to justify its existence. If that process were costed I wonder if it would show that it is better to spend the money on people in need than on administration. Personnel could be taken from this process and used to administer the refunds. I ask the Minister of State and his senior Minister to reconsider giving so much money to a private company to deal with the issue.

When the Bill goes through and the structure to pay the money is set up the forms should be made as simple as possible. We do not want a situation where the elderly or their families cannot understand the forms. Former Minister for Agriculture and Food, Deputy Walsh, once told us the EU insisted on certain forms for farm building grants, and they were approximately 50 pages long. When I was in Cavan for a publicity stunt and got my first look at the forms, I could not believe I was getting a book rather than a form. Some years later somebody who understands farming better, the Minister, Deputy Coughlan, and I give her credit for that, provided a short, readable and usable form that satisfies the EU. All things are possible if the will exists. I urge that the form be readable and as simple as possible. I acknowledge that millions of euro are involved and applications must be scrutinised, but let us not go over the top. If it has to be done by legal people, that service must be paid for but we should not allow costs to escalate on a large scale.

This Bill deals only with patients in public beds, such as St. Mary's Hospital in Castleblayney or the beds owned by the HSE in nursing homes such as the Sacred Heart Nursing Home in Clones, where my mother was well looked after, along with many others. Many were forced into private nursing homes because public beds were not available and they are as entitled to a refund. Their pension was taken from them although the subvention covered the balance. The same amount was taken from people in private nursing homes and I suggest it would be better to deal with this than to let it go into a long legal battle that will cost everybody more money and delay the right of people to be repaid. I do not suggest that everybody who went to a private nursing home is entitled to a refund; some people decided to go there and did not try to get into a public nursing home. However those who requested a place in a public nursing home, who filled in subvention forms and who had no means other than their pensions are as entitled to get their pensions back as anybody else. I urge that this element be examined and treated seriously. As I said earlier, the delay has meant that many people have died before this issue was dealt with.

As one who was involved in the debate on the over-70s medical cards, it also worries me that there is no definite figure on how many are entitled to a refund. I apologise that I was not here to listen to the Minister's speech. I question that situation. Although we have been discussing this situation for a number of years and it is over a year since this Bill was promised, we still cannot put an accurate figure on it. The over-70s cards were originally estimated to cost €19 million but finally cost over €52 million and I wonder how long any business that was run like that would survive. Although I want people to be paid as quickly as possible, and in that context we will not object to this Bill, I want to return to people who were forced into private nursing homes. I know one father who had Alzheimer's disease and whose family desperately wanted to get him into St. Mary's Home in Castleblaney, but there was no room. This was nobody's fault. He had to be moved to a nursing home in Cavan and family members had to pay a significant amount of money towards that through no fault of their own. It would be very unfair if somebody who was lucky enough to get a bed in the special unit in Castleblayney got their money refunded, to which such a person will be legally entitled under the Bill, and that simply because there was no bed, this other family was not repaid. The man's widow must now provide for herself but because the €20,000 or more in their savings was utilised, she has little or no income to live on.

I will move to another part of the Bill which has major implications, in particular for the people of my part of the country, where nursing home subvention has been very difficult to access in recent years. From memory — I apologise if I am not exact — there were approximately 270 subvention cases in Monaghan at the time of the previous election. Immediately after, a catastrophe occurred when it was found that there was insufficient funding to justify that number of cases and an attempt was made to reduce the figure to 150. It was then increased to 170 and, eventually, following much pressure from me and others, it was increased to approximately 210 or 220. People of 90-odd years of age were on a waiting list to get subvention. It is in that context that I suggest subvention is very important to my area.

In one case, a lady was put into a nursing home in the west. She was dealing with a home that had never had dealings in the north east before. The executive was amazed at the difference between the areas, in particular due to the lengthy and tight scrutiny of a person with no means and because there was such debate whether the person would be covered from the day she entered the nursing home. Eventually, a compromise was reached and the family paid for a month or so. No other case made it clearer to me the differences in practice in different areas.

There is an urgent need to reconsider the funding in the north eastern health area, whether it is called a health board area, HSE area or otherwise. The area has experienced an enormous increase in population, in particular in the Louth-Meath area, and a similar increase in the need for care of the elderly. However, it has not received anything but the national increase in funding. There have been cutbacks in subvention, home help and similar issues. These are facts I stand over. The situation in that area is not comparable with other areas.

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