Pat Carey (Dublin North West, Fianna Fail)

Much has been said and much more will be said on this issue. I do not disagree with much of what Deputy Quinn said. The last thing we want to do is use vulnerable people in nursing homes as a political football. I do not suggest that anybody is deliberately trying to do so. There is no point in apportioning blame at this stage. I am sure this will be investigated at some other time. We need to try to achieve excellence in public administration in our health service. If we do so we will be working in the interest of patients, the public and staff.

It is important that people in long-term care and their families should have clarity about how care will be provided and paid for. It is important too that where mistakes are made, they are recognised, responsibility is taken and the lessons are learned and applied. Many mistakes have been made and many changes of direction have occurred, some of which have been poorly thought out. Let us not apportion blame. The issue of charges for those in long-term care has been ongoing for some time and has continued under various Governments of all political parties. The issue of the charges is being addressed in as good a way possible in the circumstances.

Notwithstanding that the policy had consistent support and that people received a benefit for their payment, the Government believes that repayments should be made because a mistake was made. We should all be sufficiently honest to hold up our hands and say the money belongs to those people and they need to have it returned. I heard other contributors make valid points. The issue that triggered the matter in the public mind was the debate about Leas Cross nursing home, many of whose 116 residents regarded it as their home, which became the pilot for the investigation into how this debacle took place.

The Bill will ensure that all those fully eligible persons who were wrongly charged and are alive, and the estates of those eligible persons who were wrongly charged and died since 9 December 1998, will have the charges repaid in full. The issue of the Statute of Limitations and related issues may need further clarification. As 20,000 people who are still alive and a further 40,000 to 50,000 estates will benefit from repayments under the scheme, it indicates the scale of the problem. Even if €1 billion needs to be repaid, so be it. However, let us try to learn from what happened.

Essentially we are discussing the care of the elderly. It is a moot point whether this has been a priority for Governments of all parties up to now. However, from now on we must put the needs of the elderly at the forefront. While the Bill concentrates on repayments of money illegally charged to people in nursing homes, let us try to get to the stage where fewer people need to end up in nursing homes.

I heard another speaker refer to the county homes. In their time they did a fantastic job. The Acting Chairman, Deputy Costello, will know that St. Mary's Hospital in the Phoenix Park provides the very highest possible quality of care for the elderly. While it is a fairly austere building, the quality of provision is second to none. We need to ensure that level of care is replicated elsewhere. While they have been much criticised, I pay tribute to the health boards and now the Health Service Executive for the way they have developed homes in the public sector. I would much prefer to see more provision delivered through the public sector than through the private sector. However, we are where we are.

Last week a senior official in a hospital in the Dublin area told me that it had been given permission to purchase additional public beds in private nursing homes. He also told me that those beds would be acquired in places as far away as Wexford, Drogheda and Dundalk. Most of the patients in my constituency go to a northside hospital where they are being accused of being bed blocking. Transferring them to somewhere in Drogheda or Wexford would be a great imposition on their families. It is unfair and the issue of distance needs to be borne in mind. We should drive our policy to ensure families can expect that their mostly elderly parents can be looked after in their own homes. I have heard other people referring to the home help service, which was an amateur Cinderella service for many years. The Government has been much criticised, but it should be credited with putting the home help service on a much more secure footing. It is not that long since the providers of that service were paid not much more than pocket money. I accept they are still not being paid much more than the minimum wage, but they are now working towards the provision of a paramedical service. That is an area we could develop much more.

The issue of nursing home packages trips off the tongue very easily. I have learned, from the inquiries I have made, that it may be more difficult than people think to put together a nursing home package. Not only will nurses have to come in to look after patients in their homes, but services like occupational therapy, doctor on-call services and physiotherapy will also have to be provided. We need to ensure, before we raise people's expectations by deciding to provide thousands of nursing home packages, that we are able to put such packages together.

I raised the issue of appropriate housing for elderly people during a debate on another Bill. Local authorities should step up to the plate in that regard, but they are not all doing so. I am most aware of the experience at Dublin City Council level. I credit that council for pioneering good quality housing for elderly people. I have noticed recently that the council is working in partnership with organisations like Respond and co-operating with the HSE to provide centres in which a model of care that works and could be replicated is offered. Respond, Dublin City Council and the HSE are working together in Finglas, which is in my constituency of Dublin North-West, to provide and manage a centre in which elderly people can live in a manner that is quite independent. Although they have their own homes, they are dependent on the provision of services like those offered by nursing homes, such as meals and medical services. That is an example of an approach that works.

The Minister of State, Deputy Seán Power, is familiar with the Odenswood day care centre in Finglas, which is another example of an intervention facility provided by the HSE. The centre provides care, in the form of medical and personal services, for up to 80 patients each day. Those who want to spend half a day in the centre have to stay on a waiting list for six months or a year. There is a need for many more centres of that nature.

I cannot understand why much more use is not made of the disabled person's grant scheme, which is probably administered reasonably well in Dublin, as a means of keeping people at home. I have heard of sorry cases, like the case of a woman whose leg had been amputated. Her family wanted to provide hand rails so that she could get into her House. She had to be kept in hospital for an additional 12 weeks while an occupational therapist was found to write a report, to supplement a report which had already been written, to recommend that hand rails and a walk-in shower, etc., should be provided. There is no reason such issues cannot be more speedily resolved, with a little more inter-agency co-operation.

I am sure the Acting Chairman, Deputy Costello, is aware of the imminent transfer of some long-stay patients from certain units in James Connolly Memorial Hospital in Blanchardstown. Their families have not been given sufficient notice of the transfer of their relatives to public beds in private hospitals throughout the Dublin area while units 3 and 5 are being refurbished which, in my experience, will take two years or more. Although the families will be able to cope with the disturbance that will be caused, the patients will experience great difficulty. I know of patients who have been in the units in question for up to eight years — the hospital is their home. We know about the trauma that can be associated with the onset of Alzheimer's disease, for example. We need to streamline such issues and learn from such cases.

This Bill represents an effort to address the injustice that was perpetrated on elderly people and their families by all parties. There is no point in saying that one party was more responsible than another. It should not have happened, but it did. I hope the repayment scheme will be administered with minimum fuss. It should be done speedily, efficiently and in a most transparent fashion. The Money Advice and Budgeting Service has a role in this regard. It worked quite well when awards were being made by the Residential Institutions Redress Board. The Department of Health and Children should encourage those who operate this repayment scheme to engage with the budgeting service to ensure that people to whom a fairly substantial amount of money is suddenly paid look after that money properly and wisely. The budgeting service has a good record in that regard. With that caveat, I welcome the Bill.

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