Seán Power (Kildare South, Fianna Fail)

The average rate of subvention paid by the HSE generally exceeds the current approved basic rates. The subvention scheme is currently provided for in the Nursing Homes (Subvention) Regulations 1993. These regulations, made under section 7 of the Health (Nursing Homes) Act 1990, outline the scheme in detail, including such matters as how an application should be made, how an application is to be determined, how to appeal a decision made under the scheme and so on.

Legal advice received from the Attorney General has indicated that new primary legislation is needed to sufficiently underpin the principles and policies of the scheme. Sections 6 and 7 of the Health (Nursing Homes) Act 1990 were amended by section 3 of the Health (Miscellaneous Provisions) Act 2001. The purpose of this amendment was to incorporate principles and policies into the 1990 Act which would facilitate the making of new subvention regulations under the Act. However, the legal advice available indicates that section 3 of the 2001 Act does not adequately provide for the making of regulations under that Act. Therefore, section 3 of the 2001 Act has not been commenced and this section will fall on the enactment of this Bill.

The Tánaiste and the Minister for Social and Family Affairs established an interdepartmental group last year to examine the whole area of long-term care for older people. The group included senior officials from the Department of the Taoiseach, the Department of Health and Children, the Department of Social and Family Affairs and the Department of Finance. The group was chaired by the Department of the Taoiseach. The group had a number of reports available to it, including the Mercer report on the future financing of long-term care in Ireland, commissioned by the Department of Social and Family Affairs. The group also considered Professor Eamon O'Shea's report, Expenditure Review of the Nursing Home Subvention Scheme, commissioned by the Department of Health and Children. These reports were published in 2003. The group's report was recently discussed at Cabinet and it was agreed that a number of principles contained in the report should be discussed with the social partners in the context of the current round of partnership talks with a view to bringing the report back to Cabinet once these discussions have taken place.

The issue of funding long-term care needs for older people, both residential and in the community, is amongst the most difficult and complex areas in the health sector. The demographic challenges which are facing all countries must be tackled and sustainable programmes put in place, but while there are many different approaches taken by governments in addressing these challenges, there are no easy or simple answers. Nevertheless, the pace of change from a demographic, social and clinical aspect requires a coherent response from Government and from society generally so appropriate funding and service delivery programmes can be implemented. Although the report of the working group on long-term care is still being considered by Cabinet, the Attorney General has advised that immediate steps should be taken to incorporate the principles and policies of the 1993 subvention regulations into primary legislation, which is the purpose of this Bill.

Consultation has taken place on this Bill with the Department of Finance, the Department of Social and Family Affairs, the Office of the Attorney General, the Office of the Taoiseach and the Health Service Executive regarding its provisions. There will be ongoing discussion with the relevant Departments on any developments or changes made in the area of services for older people, including any regulations to be made under this Bill. Discussions have taken place with the Health Service Executive, which has responsibility for the implementation of the subvention scheme, throughout the drafting of the Bill.

Section 1 contains a minor drafting provision and simply inserts a heading into the Health (Nursing Homes) Act 1990. Section 2 of the Bill amends section 2 of the Health (Nursing Homes) Act 1990 to specify that subventions shall only be paid to a person maintained in a premises in which a majority of its residents are members of a religious order or priests of any religion if the premises is a registered nursing home. Section 3 is the main section of the Bill. This section replaces section 7 of the Health (Nursing Homes) Act 1990 and inserts the provisions of the Nursing Homes (Subvention) Regulations 1993 into primary legislation. These regulations are then revoked in this Bill. Given the length of this section, and the amount of detail contained in it, I will go through it subsection by subsection.

Section 7 defines the various terms used in the Bill. Subsection 7A outlines that all dependent persons may make an application to the HSE for a subvention. It outlines that an application must be made to the HSE and the manner in which it must be made. It also provides for an offence where false or misleading material is provided in a subvention application. Subsection 7B provides that once the HSE receives an application for subvention, it shall arrange for an assessment to be carried out on the degree of dependency and the means of the applicant. The assessment to be carried out on the degree of dependency of the applicant will be based on the applicant's ability to carry out the activities of daily living, such as walking and dressing. Other factors affecting the applicant's ability to care for himself or herself will also be taken into account, such as medical services and the receipt of family support. The subsection provides that the person carrying out the assessment must be suitably qualified to do so in the opinion of the HSE, and may or may not be an employee of the HSE. This allows the HSE to arrange for suitably medically qualified professionals to carry out such assessments, such as physiotherapists not employed directly by the HSE.

Subsection 7B also provides that the HSE shall arrange for the means of an applicant to be assessed, either by an employee of the HSE or a person nominated in writing by the HSE. It provides that the financial assessment shall take into account all of the applicant's assets and sources of income, such as salary, pension, savings etc. It also provides that certain assets and income shall not be taken into account, including the applicant's principal private residence, where occupied by certain relatives, as prescribed in the subsection, as well as the first €11,000 of the applicant's assets. Where an applicant is married or cohabiting, the means assessment will be based on half of the combined means of the couple. Where an applicant's principal residence is not continuously occupied by a relative as prescribed in the subsection, such as a relative whose sole income is the old age pension or a spouse, the HSE shall exclude 95% of the estimated market value of the principal residence from the financial assessment of the applicant. This means that an imputed income of 5% of the market value of the principal residence shall be taken into account.

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