Seán Power (Kildare South, Fianna Fail)

The subsection further provides that the principal residence of the applicant will not be taken into account if that could give rise to destitution or homelessness of a person with a close connection to the applicant. This provision is to allow for exceptional circumstances and would generally apply in the case of a relative who does not fall into the categories prescribed in the subsection.

Subsection 7C outlines the basis on which the HSE determines subvention applications, the amount of subvention payable and grounds on which they may refuse to pay a subvention. The rates of subvention, as outlined in the regulations, are not outlined in this Bill. It is intended to put down an amendment on Committee Stage to insert the rates of subvention into the Bill in order to ensure consistency with other aspects of the scheme contained in the Bill, such as the thresholds used when assessing a subvention. This subsection provides that the HSE may pay an enhanced rate of subvention, which is referred to in the Bill as an "alternative subvention", where a person cannot meet the costs of care without undue hardship. The amount of alternative subvention will be decided after taking available resources into account. The section provides the HSE with discretion to refuse to pay a subvention if the value of the applicant's assets or principal residence exceeds a certain threshold and his or her income is above a certain level. These thresholds were recently increased by way of the Health (Nursing Home) (Amendment) Regulations 2005. The threshold for assets to be disregarded for the purpose of subvention assessment is €11,000, the asset threshold above which subvention may be refused is €36,000, the income threshold above which a subvention may be refused is also €36,000 and the threshold of principal residence value above which subvention may be refused is €500,000 if the residence is located in the Dublin area or €300,000 if the residence is located outside the Dublin area and where the income of the applicant is above the threshold of €9,000. The Dublin area is defined as Dublin city and county. The threshold on income was not included in previous regulations but has been added to this Bill for the purpose of consistency. This section also provides that the HSE can, at its discretion, pay a subvention to the proprietor of the nursing home in question instead of directly to the applicant.

Under subsection 7D, the HSE can arrange for a review to be carried out of the level of dependency or means of a person in receipt of a subvention. If the HSE is satisfied that a person no longer qualifies for subvention or qualifies for a different rate of subvention, it can arrange for the payment to stop or be altered appropriately and for notice of same to be sent to the applicant and the nursing home proprietor, if appropriate. Where a person's subvention payment is discontinued or decreased, the HSE will not implement this decision for 60 days in order to give the person time to get their affairs in order.

Subsection 7E allows for an appeals mechanism against decisions made by the HSE in respect of the level of subvention paid or where applications were not considered because a condition of the application was not met. The HSE must appoint a person to consider the appeal, who may but does not have to be an employee of the HSE. The person appointed must consider the appeal based on guidelines issued by the HSE, make a decision as soon as he or she reasonably can and send a copy of the decision in writing, together with the reasons for making the decision, to the appellant. A further appeal is possible to the High Court, the decision of which is final, except where a further appeal is made to the Supreme Court on a specific point of law.

Subsection 7F states that a nursing home owner must inform the HSE in writing of the death, discharge or permanent departure of a resident within 48 hours. This is to ensure that subventions do not continue to be paid in respect of persons who no longer reside in the home. Where the nursing home proposes to discharge a person, the proprietor must inform the HSE in writing 14 days in advance and must outline his or her reasons for doing so. The Bill provides for an offence where a nursing home proprietor does not fulfil his or her obligations with regard to either of these situations. This subsection also provides that, where a person in a nursing home starts or ceases to be paid a subvention, the HSE shall inform the nursing home proprietor of this fact as soon as possible.

Subsection 7G provides that the HSE may recover all or part of any payment or overpayment if it is satisfied that an overpayment occurred or that the payment was procured through fraud or misrepresentation.

Subsection 7H allows the Minister to make regulations, with the consent of the Minister for Finance, on rates of payable subvention, the amount of assets to be disregarded when assessing a person for subvention, the thresholds above which subvention may be refused, the percentage of the family home to be disregarded and the percentage of the spousal income to be assessed, as required. It provides that the Minister will take into account the cost of living and nursing home care in the State and the rate of inflation when making regulations. This section provides that the Minister will only make regulations on the rates of subvention after taking into account available resources and the prevailing cost of nursing home care for persons falling under various dependency categories. It also provides that the maximum rate of subvention payable to a person based on his or her level of dependency is reduced by the amount by which the person's means exceed the weekly rate of the old age non-contributory pension payable at the time of assessment. This represents no change from current practice. The section also outlines the basis on which it is decided whether a person falls under category I, II or III dependency, otherwise known as maximum, high and medium dependency, according to such factors as the degree of mobility and the extent to which the person is confused or disturbed.

Subsection 7I provides that, where a person is in receipt of subvention immediately before the passing of this Bill, he or she will continue to receive a level of subvention equivalent to the payment received prior to the Bill's enactment. However, the HSE may still carry out a review of the degree of dependency and means of any person in receipt of subvention at any time and may discontinue paying subvention or pay a different level of subvention if the review shows that the correct level of subvention is not being paid.

Section 7J provides for guidelines to be issued by the HSE to provide practical guidance in respect of the provisions of the Bill and the working of the subvention scheme, for example, the process to be followed when deciding the amount of subvention to be paid to an applicant.

Sections 4 and 5, like section 1, are minor technical provisions which insert a heading into the Health (Nursing Homes) Act 1990.

Section 6 replaces section 14 of the Health (Nursing Homes) Act 1990 with a new section which provides that regulations will only be made after a resolution approving the regulations has been passed by both Houses of the Oireachtas. At present, regulations are made before being laid before both Houses of the Oireachtas and can subsequently be annulled by them.

Sections 7 to 10 also contain minor drafting and technical provisions. Section 7 repeals section 3 of the Health (Miscellaneous Provisions) Act 2001. Section 8 amends Schedule 7 of the Health Act 2004 by deleting subsection (6) in Part 4, as this subsection updates a section of the 1990 Act which is being replaced under section 3 of this Bill. Section 9 revokes the Nursing Homes (Subvention) Regulations 1993 because the provisions contained in those regulations are now contained in the Bill. Section 10 cites the Short Title of the Bill and cites the Health Acts of 1947 to 2006, collectively, as the Health Acts 1947 to 2006. Section 10 also contains a provision relating to commencement.

I want to briefly discuss the Health (Nursing Homes) (Amendment) Bill in the context of other developments and legislation pertaining to services for older people. The Second Stage reading of the Health (Repayment Scheme) Bill 2006 commenced in the Dáil recently and the Bill will continue its passage through the Oireachtas over the coming weeks. This Bill provides a legal framework for making repayments to those wrongly charged for inpatient services in publicly funded long-term residential care. It is currently envisaged that repayments will commence shortly after the Bill is approved and signed into law and an outside company has been appointed to make the repayments. The HSE is currently undertaking a procurement process for the selection of a company to administer the scheme. The final steps in the process are being completed and an announcement in this matter is expected in the week commencing 22 May. The Tánaiste has requested the HSE to proactively determine the details of repayments due to living persons so that prompt repayments can be made following the appointment of the company to administer the scheme. The key elements of that Bill include making the repayment process as user friendly as possible while also providing appropriate safeguards to prevent the fraud and exploitation of recipients who are not in a position to manage their own financial affairs.

The provisions of the Health (Repayments Scheme) Bill include exempting repayments to those who are still alive from income tax, allowing for repayments to take account of inflation by means of the consumer price index, allowing repayments to living persons and their spouses to be disregarded in means assessment for health and social welfare benefits and allowing for a streamlined process where an application is made on behalf of a deceased person. An independent, transparent appeals process will also be established.

The Bill will regulate patient private property accounts by introducing a statutory framework to protect patient interests, particularly in the context of large repayments which may be placed in these accounts. There has been extensive consultation with the oversight committee appointed by the Tánaiste to provide an independent input into the design and monitoring of the scheme. The committee has been fully briefed on all aspects of the scheme and has provided valuable input into the drafting of the legislation. The governance of the scheme allows the Minister to request and receive reports on the operation of the scheme, the appeals process and the donation fund to be established under the scheme. These reports will be laid before the Oireachtas. The Comptroller and Auditor General will be able to audit all funds and accounts associated with this scheme.

A draft general scheme and heads of Bill which provides for the establishment of the Health Information and Quality Authority, HIQA, incorporating the office of the chief inspector of social services within HIQA, has been prepared by my Department. Public consultation on the legislative proposals contained in the draft heads of the Bill is currently under way. Under the proposals in the draft heads, HIQA will set standards on safety and quality of services provided by or on behalf of the HSE. It will monitor and advise the Minister and the HSE on the level of compliance with those standards. We are making provision to give HIQA the power to investigate, at the request of the Minister or the HSE, the safety, quality and standards of any such service, and make any recommendations it deems necessary. It will also have a role in accrediting services and will be able to provide an accreditation service for the private sector, should that sector wish to avail of it.

The chief inspector of social services will be required to monitor against standards set by HIQA.

See this speech in context