Liam Twomey (Wexford, Fine Gael)

I will leave that question open to the Minister to answer. I hope we receive the answer sooner because the Minister might not come back to reply for another four or five weeks. I ask the Minister for a reply to this as it is serious. We are prioritising the issue of standards in public and private nursing homes in light of what we heard from Leas Cross. If it transpires that a body established by the Tánaiste gave recommendations last November which the Minister this morning says he will publish in July followed by a three-month public consultation process, we may not expect these recommendations to be implemented to any reasonable degree until next November. That will be 12 months after they fell on the Tánaiste's desk and is too far away for my liking. I ask that the Minister examine that more seriously.

I will now examine the legislation. I have a difficulty with the legislation on the question of assessing the degree of dependency. The only people who can assess the degree of dependency of patients who might require nursing home subventions are occupational therapists. A GP should fill out a pro forma letter regarding what he or she knows about the patient, but we cannot have nurses, doctors, occupational therapists and whoever is available assessing who should get nursing home subvention, either category 1, 2 or 3. It must be the duty of one category of people and currently, the most suitable are occupational therapists. We are talking of putting a uniform system in place for the entire country, so we should first ensure that the assessors have the same standards and training, and will reach the same conclusions. As the Minister of State knows, it is occupational therapists who assess people for disability grants, for extensions to their houses, which are paid for by county councils, and the health boards also have occupational therapists who assess people's means and ability to look after themselves, and their needs for nursing aids and appliances to help them stay living at home. Accordingly, this would be simply an extension of the jobs of occupational therapists. The problem is that we have not got sufficient occupational therapists employed in the health service and they are almost seen as the financial controllers for the county councils and the health services. It is so hard to get occupational therapists out to assess patients that when they do so, and make their recommendations, the councils are almost buying themselves time before they have to pay out for the grants.

The Minister of State should tighten up this area. Occupational therapists must be given a proper role in regard to these assessments, and all that should be sought from doctors or public health nurses is a pro forma letter which is easy to follow to make the decision. That would be good governance in the system and banish the bureaucracy involving four or five different people giving an opinion with variable standards. How I might assess a patient's mobility might be quite different from how the public health nurse or the occupational therapist would do it. To have a proper standard, the occupational therapists should be the assessors. I trust the Minister of State will make the right decision in this regard.

There is a point in section 3 about the financial considerations to be taken into account. I understand that 95% of the estimated market value of the house will be excluded. Then there is reference to excluding a prescribed percentage of the market value, or whichever is greater. Perhaps it is because I have no training in economics, but I have not a clue what that means. I read the section when the Minister of State made his speech, when he was talking of 5% of the house being taken into account, though the legislation refers to a bigger figure, and I have not the foggiest notion what it means, or where it comes into play. Does it refer to 95% of the value of a house valued at more than €500,000 in Dublin and more than €300,000 in the rural areas, being more or less discarded? What does this 5% mean and what is the need for this prescribed percentage of the market value? I would appreciate if the Minister of State would at some stage give me a briefing in economics for simpletons when reading health legislation.

This legislation is meant to be a tidying-up process on subventions and entitlement to them, so it should be clear. The Minister might look at section 3(b), with regard to the excluding factors, and explain it to me. Deputies may say this legislation amounts to taking houses from people. The Government has been very slow to publish a policy on future care of the elderly. In the past, the Minister for Health and Children, Deputy Harney indicated she has no great difficulty in taking houses from patients to pay for their nursing home care. Even though the paragraph in question is short, its meaning is quite unclear and we deserve clarity with regard to what will be taken from people.

The same section states that one fifth of the weekly rate of the old-age non-contributory pension will also be given back. That is good, because though I may be misinterpreting this, it looks as if a basic standard is being set so that all people who go into public nursing homes will be entitled to keep, going by today's figures, approximately €40 of their old-age pension. In the past we had a problem whereby patients who went into public nursing homes were left with practically nothing for their own expenses when their old-age pensions were taken from them, because subvention rates were so low. I hope I am reading this correctly and that patients will be left with €40 weekly from their old-age pensions when they go into public nursing homes.

The Minister of State also said that patients can have only a minimum of €11,000 and a maximum of €36,000 if they are entitled to subventions. I would like to see more clarity in what happens in the area between those figures. A person with only €11,000 will get the full subvention but a person with €36,000 will get no subvention. What is the pro rata set-up in between? Will a person who has €20,000 get only half the subvention, or what are the percentages in this regard? This is not stated in the legislation and I would like the Minister of State to clear up the matter. I would have expected greater clarity on Second Stage.

Am I to understand that the legislation regarding a house valued at €500,000 in Dublin and a house valued at €300,000 in rural areas is already activated, that when the HSE is assessing somebody for subvention it is already discounting the first €500,000 of the value of a house in Dublin and the first €300,000 of the value of a house in rural areas? I want to be certain that this is being applied for everyone assessed for subvention since the beginning of 2006. The last budget allotted some €15 million or €20 million so that more people would be able to take up subvention. The Government suggested such a figure was available for subvention, which was a little disingenuous. The Government was trying to fool people in some regard because looking at subvention payments, whether category 1, 2, or 3, the payments patients actually receive after being deemed entitled to them have not changed since 2001. Nor is there any indication that change is now to be made. It is fundamental that subvention payments should be index-linked to something. What people could buy for €130 in 2001 would require more money now, in 2006. The Minister of State needs to look seriously at those figures and not somehow try to mislead people into believing there is more money available if they need to go into nursing homes.

The criteria have broadened a little but the maximum amounts of subvention available, some €130 to €150 weekly for people who need to go into nursing homes, are totally out of step with nursing home costs. The cheapest nursing home cost in this country is probably about €700 per week, while the average cost would be about €900 to €1,000 weekly, and the cost in Dublin could be up to €1,500 per week. There are not enough public nursing home beds, especially in the Dublin region, which has been made glaringly obvious during the accident and emergency service crisis. Even where such beds are available in Dublin, the cost is quite significant. While the Government has talked a great deal about solving the crisis, the number of contracted beds it has taken up in the private sector is pretty low, given the size of the problem.

When Second Stage concludes, the Minister of State should return to the House with better news for people who are seeking or are in receipt of subvention, and are not just getting the same amounts of money they got in 2001 — too far back.

The next section refers to the applicant's annual income or "prescribed amount" being not less than €9,000. The term "prescribed amount" litters this legislation. The non-contributory old age pension exceeds €9,000. This figure should be changed because this legislation has probably been lying around since 2001.

Section 7C(6) of the Bill states: "The Executive shall only determine the amounts of alternative subventions after taking into account the resources available to pay the alternative subventions". This is enhanced subvention and is paid in an inequitable fashion across the country. Enhanced subvention in two neighbouring areas can be very different. The former South Eastern Health Board was reluctant to pay enhanced subvention whereas the southern health board was more willing. The HSE was supposed to provide a more equitable service throughout the country but the only change from the old health board system is the name. Every parliamentary question is answered by the HSE regional area, similar to the old health board structure, rather than by the HSE headquarters on the Naas road. Will alternative subvention be equal throughout the country or will it be implemented in different ways at local level? It is important this is clarified on Second Stage.

Will patients over 70 be entitled to free nursing home care? If a public nursing home bed is not available, is the patient entitled to a bed in the private sector, paid for by the HSE? Legislation in 2001 provided a medical card to every person over 70. Prior to that, the CEO of the health board could use discretion to decide if enhanced subvention was payable. The 2001 legislation stated that inpatient care was a statutory entitlement. I have sought clarification on this question several times.

The Tánaiste should be able to answer this question. When the legislation was being passed by the Oireachtas the current Minister for Justice, Equality and Law Reform was the Attorney General. When legislation with such fundamental changes is proposed, with subvention no longer at the discretion of the health board CEO but a statutory entitlement, someone must have asked the opinion of the Attorney General.

The illegal nature of some nursing home charges came to the fore in 2003. The Travers report and the review of the Travers report were published in 2004 and 2005. No member of the Government has stated if every person over 70 is entitled to nursing home care, paid for by the taxpayer. The Minister of State has prevaricated over this on a number of occasions and must now make it clear.

Legislation dealing with the illegal nursing home charges is also being passed by the Oireachtas. The Government is stating that any person still alive will not have to pay income tax on the nursing home repayments. Does that refer to any person alive when this legislation was published in December 2005 or any person alive after this legislation has been passed by the Oireachtas and signed by the Minister? We have awaited this legislation throughout 2005 and, with the progress we are making this year, the Bill will not be passed until December 2006, two years later. The average stay in a nursing home is not ten or 15 years but between two and three years. At the current rate of progress, the vast majority of patients alive when this issue was first raised will have passed away by the time the legislation is passed. Very few people will benefit from the provision absolving them from paying income tax on the repayment. Faster progress should be made if the Government is genuine in seeking to repay this money.

Section 7F(3) of the legislation states: "The proprietor of a nursing home who, without reasonable excuse, contravenes subsection (1) or (2) is guilty of an offence and liable on summary conviction to a fine not exceeding €1,000". Do nursing home proprietors who receive nursing home subvention by direct debit fail to inform the HSE when patients pass away? Do they continue to claim money from the HSE? Are there checks and balances to ensure proprietors inform the HSE so payments can be stopped?

This is important legislation, serving to clarify matters, but we need a number of answers. The Minister of State referred to other Bills he hopes to pass before the next general election. If legislation has not been enacted before the next general election, all Bills on Second Stage or Committee Stage collapse. It will be similar to a cattle crush, where a number of large farm animals try to squeeze through a small space as quickly as possible. It is like the publication of health legislation, where the situation is out of control and nobody knows what is going on. As the House approaches the end of its five-year term, the Department of Health and Children has published only one or two primary legislation Bills per year, the remaining legislation being amendments. The programme for the next 12 months includes the health repayments Bill, the Health Information and Quality Authority legislation, the pharmacy Bill, the nursing Bill, the medical practitioners Bill and standards in residential care, which may not require legislation. The matter of eligibility has been discussed since the 2001 health strategy was published. At least six Bills of major significance are expected to be passed in the next 12 months yet only one Bill has been passed in the past two years. It will not be possible to complete the legislative programme and my great fear is that the Tánaiste realises this. She has done very little but perhaps her predecessor, Deputy Micheál Martin, is more to blame for the problems in the health service than anyone else. I fear this may result in bad legislation being passed and the Tánaiste making a dolly mix of legislation from different Bills to create the impression she is making progress. I hope this does not happen.

More important is that the Tánaiste and Minister for Health and Children, Deputy Harney, be honest and state clearly what legislation she thinks might realistically get through the Oireachtas in the next 12 months. The legislation to establish the health information and quality authority looks like it will be ready to be put before the House by the end of the summer, which is reasonable. However, we should be realistic about what else might get through the House before the next general election. The eligibility legislation, which has been promised since November 2001, is highly unlikely to make it despite having been discussed by every Minister in recent years. We must decide what legislation has a realistic chance.

Regarding the HIQA legislation, the Tánaiste made it quite clear that whistleblowers' legislation will be incorporated in it when it comes before the House. Perhaps the Minister of State might inform the House whether that is true because I see nothing that stands out as being whistleblowers' legislation in the document put out for public consultation. It is typical of the Government in some respects.

There is a major problem with Our Lady of Lourdes Hospital, and Judge Harding Clark drew up a report on it pointing out a large number of difficulties regarding competence assurance, clinical audit and continuing medical education. The Tánaiste came to the Chamber bullish about how she would take on the consultants and change things. The Labour Party withdrew its whistleblowers' legislation when she stated that it would be easier to enact sectorally rather than taking all Departments together. She said that whistleblowers' provisions would be in the next major related legislation to come before the House, which is the HIQA legislation.

The Tánaiste should make it quite clear whether she has now dropped that proposal. She also threatened consultants that unless they had renegotiated their new contract by the end of the spring, she would unilaterally introduce her own public-only consultant's contract. When the time came, she went to the US to lecture the Americans on how to run their health service, which is as rich as anything ever was.

People expect the Government to act and to be honest with them, and those are the sorts of answers we want. The Minister of State should tell us what is going on. It makes me laugh when I think how the Cabinet must operate. Five years ago, as part of the health strategy, the Government stated that there would be a policy on care of the elderly. At least three reports were written thereafter, including the Mercer and O'Shea reports. Nothing happened. Afterwards we heard that it had gone to a Cabinet sub-committee, on which I believe the Taoiseach and the Tánaiste sat, together with the Minister for Social and Family Affairs, Deputy Brennan. It is to make proposals on how we take care of the elderly in future. That Cabinet sub-committee was established last October. The Government has all the information and has been aware of the problem since at least 2001. How we pay for care of the elderly is an important issue, but there is no movement and no policy.

The Progressive Democrats Members — the rancid meat between two slices of bread — were jumping up and down during and after my party's Ard-Fheis at the weekend claiming that we had no policies. The Minister of State, Deputy Seán Power, seems not to understand his own legislation. This is a very important matter regarding how we legislators run the country, but it has been treated in a cavalier fashion. When the Minister of State returns to the House, perhaps he might indicate when he expects a policy on care of the elderly to be put to the people. Will it simply become another promise like the health strategy, which was used by his party in its 2002 election manifesto? They claimed to stand by it, and it also went into the programme for Government. He should not think that, simply because it was published in 2001, he can now forget about it and start referring to the other 180 reports published since. I have left more than enough questions for the Minister of State to answer.

See this speech in context