Seán Ryan (Dublin North, Labour)

We have been waiting for the Bill for nearly a year and six months and it is still on Second Stage in this House. We have not seen the promised legislation on the health information and quality authority, despite its being considered an essential element of the reorganisation of health services. We have heard reference to it today but the heads have not yet been agreed. The delay in introducing the legislation on the independent inspectorate for nursing homes is even greater. The Health Strategy 2001, which was launched with such aplomb, now lies in shreds with virtually none of its promises fulfilled. This failure is greatest in the case of older people. We do not have any new public nursing home places despite a commitment made by the Government that it would provide 2,000 new places. We heard the public private partnership arrangements would resolve all the issues and yet not one place has been provided.

We have no new strategy for the care of older people and we have no independent inspectorate. This is a clear indication, if one was necessary, of the Government's lack of concern for one of the most vulnerable groups in society, those who are no longer able to continue to live in their own homes because of age and infirmity. The bottom line in respect of this issue is that the State broke the law over a period during which Ministers and Ministers of State were aware of the problem but kept quiet or forgot about the issue. Arising from this error, the Tánaiste and Minister for Health and Children, Deputy Harney, introduced legislation with the purpose of denying the most frail people in society the money due to them in retrospective payments. During the debate on that Bill, Opposition Deputies and even some Government backbenchers warned the Tánaiste that she was running a risk introducing such legislation and that in all probability it would be found unconstitutional, as was the case. The rights of the elderly have been vindicated in the Supreme Court because the Government has failed to vindicate them.

On a number of occasions I had reason to raise in this Chamber the scandalous problem experienced by elderly people in need of long-term care in a public nursing home particularly in Dublin and including the rural areas in my constituency of Dublin North. These people are now waiting for up to 12 years, provided they live that long, to get into a public nursing home. Given the issues in accident and emergency units, priority is given to older people who need long-term care and are in acute hospitals. Where does this leave people living in the community who want to live in the community? Most older people want to continue to live in their own homes, but for particular reasons they are unable to do so. While some home care packages are coming on stream, many more are not available and the only option for people is to try to get long-term care in public nursing homes.

This Bill is a cop-out in many ways. How are people on social welfare to pay for a private nursing home when no public nursing homes are available to which they are entitled under legislation? The Minister of State referred to subventions I, II and III. In my area the average weekly rate in nursing homes within the Fingal area is €800 to €900 per week. Where more acute care is required, nursing homes could cost as much as €1,200 per week. The Minister of State agrees these people are entitled to a public nursing home, but all he will do is give them subvention of €114.30 for a person of medium dependency, €150.40 per week for a person classified as high dependency and he will even go a little further to give €190.50 per week for a person with maximum dependency. How can a person with maximum dependency on social welfare payment afford to get into a private nursing home with a subvention of €190.50?

The Minister of State goes further by providing enhanced subventions, which he claims will resolve the problems. In each health area only a limited number of enhanced subventions is available. There is a huge waiting list. Last week I spoke to a very helpful person in the Health Service Executive who told me that a constituent of mine was being given priority for enhanced subvention, but that she would need to wait until somebody dies in one of the nursing homes in my area who happens to be on an enhanced subvention so she could get one. That is the way we treat our elderly people who made such a contribution to the country. The promised substantial legislation ends up merely giving legal effect to what exists at present and is totally inadequate. Nothing in this legislation will make it easier or more accessible for older people who are entitled to public nursing homes to get into private nursing homes at the going rates in the greater Dublin area or elsewhere in the country.

With all the resources available to the Government and all the wastage that has taken place including in the Department of Health and Children, it has reneged on its commitment to provide 2,000 long-term public nursing beds. Other fundamental issues need to be addressed in legislation, which could have been included even in this Bill. What happens to older people who need care and cannot get the appropriate care in their home setting and for whom a Health Service Executive place is not available? This links in with what I said earlier. They are entitled to a service, which they cannot get from the HSE. Nothing in this legislation will improve their situation especially when they cannot afford a private nursing home.

I have received representations and have spoken in the homes of many older people who could not get into a public nursing home and cared for 24 hours per day for their loving spouse feeling they could not do anything else. When it became necessary they had no alternative but to borrow money from the credit union to pay for a private nursing home. Imagine having to do that in one's 70s. The Government does not support or respond to such people. There is nothing in this legislation to help them, or the thousands of others in the same situation throughout the country. They look to us as legislators to help them in a time of plenty.

In theory our law provides universal entitlement to long-stay care. The Minister of State and the Tánaiste know this but are not prepared to deal with it by bringing in substantive legislation. The reality is that long-stay places are not available to those who need them. People are pushed out of acute hospitals and into private nursing homes, which we and the Government know are not adequately monitored.

In 2004 I raised in this House the lack of an independent inspectorate for our public nursing homes. We all knew about this and many say nothing was done about it because an inspectorate might identify the problems that exist, not in the nursing but in the physical accommodation. We have seen the Leas Cross scandal and other problems arising in respect of nursing homes.

The Tánaiste replied to my question in January 2005, saying that inspectors of private nursing homes identified a range of problems, including staffing levels; nursing policy issues; maintenance of accommodation standards; hygiene problems; lack of activity for residents — elderly people are taken out of bed at 8 a.m. and left sitting in a chair beside the bed with no occupation for the rest of the day; lack of record-keeping; insufficient, or no, active involvement by the local authority in fire safety; lack of equipment appropriate to clinical practices, for example, pressure mattresses, surely a basic requirement; and discrepancies in the contract of care.

We know about this, and the Department of Health and Children and the Minister of State's two predecessors knew about it but did nothing until the Leas Cross scandal emerged. If we are to believe Deputy Twomey's contribution about the number of Bills outstanding at the Department of Health and Children I doubt the legislation we await will be enacted before the end of this Dáil session.

Long-term care arrangements for older people are unplanned, inadequate, inequitable and under-funded. It gives me no joy to say that. Older people want only to continue to live in their own homes. Fortunately, the majority succeed in doing so, maintaining active healthy lives, with some support from GPs, community care services, their families and communities. They are able to make and implement decisions about their lives and do not need constant or sustained care. People in need of care who must go into long-stay institutions are among the most vulnerable members of society.

A civilised society that respects human rights and promotes human dignity should be judged on how it provides care, and the quality of that care. A recent report reiterated this point in detail. Any objective judgment on our care system would be harsh because we have a stated policy which favours community or home care but in practice makes it extraordinarily difficult, and effectively gives more support to institutional care.

That has been the reality until recently. I acknowledge that the Minister of State and the Tánaiste have tried to divert more money into community care but the ratio of funding for this has been negligible. We do not have a fair and equitable system for financing care or a transparent set of rights and entitlements. Does the Minister of State not think that establishing such rights is paramount? It is time older people received the same rights and entitlements in law as any other group in society. Our system does not ensure the delivery of quality care. Care facilities have developed in response to the tax laws, rather than in response to the real needs of older people. The tax laws enable people to make millions of euro through offsets from providing facilities. The Government has reneged on its commitment to provide public nursing homes. There are not enough specialists working within the system. Many of the people who work within the system are not properly trained or paid. We do not facilitate the involvement of older people in decisions about their care. We do not have a suitable system of substitute decision-making for people who are no longer able to make decisions. This is a very important point in the context of the Health (Repayment Scheme) Bill 2006. We do not have a clear policy and appropriate services for combating elder abuse which is happening throughout the country. Thousands of elderly people are affected by elder abuse and they are afraid to come forward and bring it to official attention.

Perhaps the harshest judgment on our system arises from the fact that the problems are officially recognised, plans have been made to put things right, but virtually nothing has been done. The Government has stated that the care of older people will be given the priority it requires but it is a case of waiting and seeing if this happens. At present there is no clear entitlement to community care services other than to general practitioner services. There are severe shortages of home helps, occupational therapists and chiropodists. The Government acknowledged the shortage in the health strategy in 2001 but it has done nothing about it and the situation is now worse.

The Health Service Executive south western area saw a 16% reduction in home help hours between 2002 and 2003 and a further 3% reduction in 2004. I agree with the views expressed by organisations such as the National Council on Ageing and Older People that the absence of a right to a service is a factor in the failure of the Government to provide adequate facilities. In areas of County Dublin, including rural areas, older people living at home who are in need of long-term care in a public nursing home now wait for a period of 12 years.

Notwithstanding the Government commitment to provide 2,000 extra beds, I remind the Minister of State that the health strategy included a commitment to build 850 community nursing units. It seems this commitment has been effectively abandoned because of difficulties with the public private partnership. This is another example where it was envisaged the so-called public private partnership arrangement would solve all our problems. The Tánaiste stated that the public private partnership arrangement would sort out everything but it has failed. These beds should be provided directly by the public sector.

The House will have an opportunity to deal with this Bill in greater detail on Committee Stage. The issues of basic payments and enhanced subventions will need to be dealt with in greater detail. There is a perception that under the existing legislation and regulations the State can take away an elderly person's home to fund their long-term care in a private nursing home, care to which they may be entitled to in a public nursing home. The Bill is not clear on this point.

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