Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I wish to share time with Deputies Gormley, Catherine Murphy and Cowley.

I will put the Minister of State at ease by saying that I welcome the Bill which is designed to place the existing subvention scheme for private nursing home care on the basis of primary legislation. The Government has stated that this legislation will also assist the Health Service Executive to implement the scheme on a standardised basis throughout the State.

The Bill comes at a time when there is more debate and public concern than ever on the issue of pensions, long-term care for older people and all the social, cultural and economic implications of our ageing population. It comes in the wake of the Health (Repayment Scheme) Bill which seeks to rectify the unlawful charging of older people by the State for long-term residential care and which has yet to progress to finality. The shadow looming over all these matters is the experience of the Leas Cross scandal which exposed the neglect and abandonment of older people for which this State has been responsible. At the time of that scandal, the Taoiseach and the Tánaiste made commitments to establish an independent nursing home inspectorate. They soon rowed back on that promise and made another promise to extend the remit of the social services inspectorate.

While welcoming the purpose of this Bill which is to set an existing scheme on a sounder basis, it is also important to place it in the context of the many problems surrounding nursing home care. The regulatory regime has been found wanting with serious and sometimes tragic consequences for many older people. As I have stated before in this House and I emphasise the point once more, most of those providing private nursing home care do so efficiently and responsibly. It is important this statement is heard loud and clear. However, there are also many — in fact too many — such institutions where standards are poor, and I maintain that one would be too many. The State has still not invested the resources to regulate this sector properly. This essential action must be taken.

The 2006 budget allocated €160 million to the nursing home subvention scheme covered by this Bill. The Department of Finance review of property-based tax schemes estimated that nearly €55 million has been spent thus far on tax breaks for developers of private nursing homes. The question of how much of this really benefits older people needs to be answered. It is clear there are significant benefits and incentives for developers and proprietors of private nursing homes. They can bank on guaranteed income, a significant section of which is guaranteed by this legislation. I question whether older people receive the care they need and deserve in return for what they pay from their resources, supplemented by the subvention for which we are legislating and for which we taxpayers pay.

In many ways this is comparable to the situation of rent allowance. Sinn Féin has argued repeatedly over many years that rent allowance has subsidised substandard accommodation and rack-renting landlords. If resources were used instead to provide the local authority accommodation so desperately required, the outcome would be much better both for tenants and the economy.

The Department of Finance's review of tax reliefs stated that there is considerable variation across different regions in the number of nursing home beds per capita, the costs to the operator per bed, the rate charged per bed and the average occupancy rates. While the review claims that the tax breaks increased the number of nursing home places, it also states that it has been ineffective in reducing the cost of nursing home accommodation.

This Bill contains detailed provisions on how older people's means are to be assessed when they apply for subvention under the scheme. There is no such detail, however, in terms of accountability required from the proprietors of nursing homes. Are they providing the range and quality of care needed by the older people who will benefit from the Health Service Executive subvention? An ongoing assessment of that aspect also needs to be carried out.

I referred previously to the National Economic and Social Forum report, Care for Older People. I make no apology for referring again to this report which has not received the attention it deserves. At the outset it states:

There is strong evidence that older people want to remain living in their own homes and communities as independently as possible for as long as possible. This preference has been accepted by successive Governments as a key policy objective. Yet this objective is nowhere near achievement. This is reflected in our under-developed community care system, which is crisis driven, lacks sufficient co-ordination and resources and does not afford older people the choice, independence and autonomy they seek and deserve.

The report also states:

It is also clear that the funding of services for older people has not always been wholly consistent with the policy objective of encouraging community-based responses. Considerable resources have been invested in nursing home care responses, some of which was unnecessary, not wanted and inappropriate. For many older people, inappropriate or unnecessary admission to acute or long-stay residential care could have been avoided or delayed by greater development of community services and use of preventative and proactive approaches.

There are basic questions in what I cited about how public money is being utilised. The scheme for which we are legislating in this Bill must be subject to that test. We must reverse the excessive reliance on nursing homes and other institutions for the long-term care of older people.

That said, the NESF report also contains extensive findings and recommendations on care in nursing home settings. It points to the need for more systematic data to be collected to assess the range and quality of care. The report found that there are some very good care settings but others are in need of major and urgent improvement. While the report identifies initiatives at regional and local level being undertaken to improve standards of care, it points to the need identified in the Government's health strategy to prepare and implement national standards for community and long-term residential care. The NESF report states:

It is important, however, that the setting and measurement of standards are co-ordinated at a national level to ensure that there is consistency across different sites and to avoid duplication of effort and 're-inventing the wheel'. It is also important that advancement in the standards setting in residential sites is matched by quality initiatives in community services, for example: in relation to Day Care centres, the Home Help services and Meals on Wheels service, etc.

As I stated earlier, the Government does not propose to establish an independent nursing homes inspectorate, proposing instead to extend the remit of the social services inspectorate to include residential care for older people, as it committed to in its health strategy. What progress, if any, has been made on this matter? Will the Minister of State, Deputy Seán Power, address that point in his summation of this debate?

I again endorse the recommendations of the NESF report in this regard. It calls for the remit of the social services inspectorate to be extended on a statutory basis to include all care settings for older people, including residential settings with the necessary trained staff and financial resources; that inspection findings be published with sanctions for non-compliance with standards; and that the principles of autonomy and empowerment and person-centredness should inform the development and implementation of standards and standards should be developed in consultation with users. The latter point is crucial.

I support the Bill, but the Minister of State should take note of the various elements we highlighted that still remain to be addressed.

See this speech in context