Dan Boyle (Cork South Central, Green Party)

I am glad to be able to speak now because there is a transition year group, which includes my daughter, in the Visitors Gallery. I hope to have the opportunity to meet them when I finish my contribution. The business of legislating should be complex, involved and considered. There is a particular responsibility on Government before presenting any legislation in this House to illustrate that it has undergone such a process. Unfortunately, the convulsive history of nursing home charges shows that not only this Government but successive ones have failed to tackle this issue properly.

I remember being involved in a debate on the Health (Amendment) Act in the final days of the session before the Christmas recess in 2004. All Stages were dealt with on the one day. Despite the many protestations of Members on this side of the House that this was the wrong way to consider the Bill, and that any apparent flaws in it would be shown up quickly, the Government insisted on pursuing this course of action. It was left up to the judicial arm of the State to highlight the exact legislative flaws of the Bill. The lesson that should have been learned is that rushed legislation is never good.

Later amending health legislation was given more consideration. However, the time allowed for this was short by comparison to the average time allowed for considering a Bill in the House. The questions that should have been addressed at all Stages of the debate went unanswered. There was a considerable interval between this and the Government's substantial presentation on how it wants to deal with repayments of what are coyly referred to in the explanatory memorandum as "wrongful" nursing home charges, which affected elderly patients in particular.

It was somewhat ironic that some weeks after the publication of the explanatory memorandum to this Bill, a second explanatory memorandum was produced with a note of information on the original. It states the original contained a number of errors and that it had been reprinted to correct them. It also stated all copies of the original should be disposed of. If anything is illustrative of the utter cock-up the Government has made of the matter, it is that piece of paper. It indicates a lack of consideration and of appropriate political will to deal with the issue properly.

The Government, along with all previous Governments since the mid-1970s, has been indifferent, has prognosticated and has not really wanted to deal with it. However, since court decisions brought it into the open, its response has been hurried and panicky. Ultimately, those who have been affected and who seek proper redress are not being properly served. That said, the issue of repaying nursing home charges is still only a single element of what should be a more comprehensive response as part of the Government's general care policies. The idea that the State sponsors, through the taxpayer, tax reliefs for the creation of private nursing homes and buys bed space in a number of private nursing homes at full market cost to remove those who have been charmingly referred to in the public health system as "bed blockers" indicates the philosophy of the Government and the priority it affords to care. The same emphasis is not placed on care within the home by close relatives, nor is it placed on voluntary care within the community or on supported care through the home-help system.

If the amount of State resources or taxpayers' money forgone by the Exchequer in support of what is a health industry were given, in proportion, to those caring within the home, members of voluntary organisations and those supporting semi-supported care through the home help system, the nature and scale of the problems in private nursing homes would not even begin to become as pronounced as they now are. The Government is not interested in the holistic approach I advocate. It wants a quick reaction to dig itself out of a hole of its own making. This approach will not be of any long-term benefit to the mainly elderly people who have suffered as a consequence of the Government's lack of thinking and foresight and its general lack of policy.

Some years ago, the home help scheme in the then Southern Health Board area was run by individuals who were more or less voluntary in most aspects of their work. The rate paid by the health board was 50p per hour. At the same time, the State was adopting an approach involving private business ventures and the use of taxpayers' money which did not necessarily meet the care needs of many thousands of citizens.

If we are serious about having a proper care environment for all citizens, a Bill of this type should consider these wider issues. It should certainly address the care environment in which many find themselves in private nursing homes, which are often situated miles from anywhere and certainly miles from the communities from which the patients hail. This lack of connection and ongoing community support is such that many are forced to live their final years with a quiet indignity because the State and their communities have somehow given up on them.

Circumstances could be so different. This Saturday, in what is my constituency but which because of redrawing will unfortunately become part of Cork North-West in the next general election, I will have the opportunity to attend an awards night at the Westgate Foundation centre in Ballincollig. It is a centre of excellence for the care of elderly people. It is such because of its integrated approach. It marries all the elements I have described and has a large number of voluntary service providers and paid and specialist staff. It receives some funding from the Health Service Executive and also from other State bodies, it has adopted a community outreach approach and people use its services on a myriad of levels. Some use it as a day service centre for social outreach or for health care needs and others attend for long-term care. A community of elderly people has chosen to live in a retirement village at the centre and it comprises volunteers and support workers as much as anything else, yet Government funding is not such that the centre is being recognised as a benchmark for the provision of other such centres throughout the country.

The Westgate Foundation had an opportunity to locate another centre in Macroom, approximately 20 miles from Ballincollig. Lynch's Lodge Hotel, which was bought by the Department of Justice, Equality and Law Reform through the OPW for a sum of €4.5 million to accommodate asylum seekers and refugees, was subsequently deemed unsuitable for this purpose. The organisation behind Westgate made an attempt to acquire the premises to develop a second centre for a new cohort of people in the mid-Cork area. Unfortunately, the State agencies' approach, involving the Health Service Executive, the OPW and the Department of Justice, Equality and Law Reform, did not make the premises available but put it back on the market and sold it for €3.5 million. During the biggest property boom the country has ever experienced, a building on which the State had already spent €1 million could have been used for productive, care-giving purposes to benefit the community. That this was not done was all too indicative of an inadequate Government response to care provision.

The Minister of State represents the larger party in the coalition. I have given up attaching any care-giving qualities to the junior partner in the coalition. I hope that someone in the background of the Minister of State's party would at least be concerned, troubled, prepared to ask questions about and make changes to the current policy, but unfortunately I do not get that sense. The priority that could and should be given to this area is not given because it is deemed that the people most affected are those least likely to vote, who are least likely to have a political voice and are not likely to change political configurations in this Chamber for future Governments. It is a damning indictment of any representative in this jurisdiction that the generation that helped to develop the State and brought us to the degree of prosperity we now enjoy is being treated so shabbily.

The Bill could have been broadened and given more meaning for the wider population regarding care in the family setting. As people in nursing homes have their capital assets assessed and the income of their sons and daughters is also assessed, it means that out of necessity many people's health needs can only be met in their family homes. The State offers a bandage solution to meeting the needs of many such people through the home help system. Despite the Government's promises of increased funding, the personal experience of Members of the House is that this is being spread ever more thinly as the population grows older and hours are taken from individual elderly people and given to new applicants to the scheme rather than properly resourcing it.

The greatest neglect in State resources and the need for support relate to family care cases. I have spoken in the main about the elderly as this legislation largely addresses them. I could as easily talk about those in long-term health care and those with disabilities. A woman in my constituency has an adult daughter with spina bifida. In the past her accessing the available State resources in terms of direct funding, services or materials needed entailed being exposed to a regime whereby special nappies needed by her daughter were subsequently weighed in their soiled state to determine whether that woman and her adult daughter were entitled to additional funding. That situation has only arisen in recent years. Our health and social welfare systems are still riddled with such anomalies.

People are trying to live ordinary lives with an additional burden thrust upon them. The State chooses to stay out of cases where it is most needed while at the same time uses taxpayers' money to buy beds in private nursing homes and support those who are only involved in the care business in terms of the commercial imperative it offers them. This is most readily seen in the decision of the Tánaiste and Minister for Health and Children to support a private care agency, called "care givers". If anything sums up the Progressive Democrats approach to care giving, the need for people to get care and how that service should be provided, it is the attitude that it can be reduced in every circumstance to euro and cent. As long as we have an attitude that the problem can be solved through finance and not through other forms of support and acknowledgement, the type of legislation circus in which we have been involved since the first Health (Amendment) Bill was presented in the House will continue.

The Government's majority determines that the Bill will be passed. However, the Government cannot have any certainty that it will not be open to subsequent challenge, judicial review and change. Such a scenario is more likely than not because the Government failed to take the opportunity to be considerate and involve itself in addressing all the complexities of the issue. When we go to the doorsteps and meet individual carers the Government will get a very resounding answer about its callous and indifferent approach to the issue.

See this speech in context