Paudge Connolly (Cavan-Monaghan, Independent)

I welcome the opportunity to speak on this Bill, which will standardise subvention rates throughout the country. The inconsistencies in the various health board areas have been a source of major concern over the years. No uniform system has been in place. The introduction of such a system will be helpful. Too many beds are occupied by elderly people who have been medically discharged but have nowhere to go. It is a real tragedy that this phenomenon is increasingly common in our hospitals. We cannot make progress in this regard because not enough resources are being invested in step-down resources. We heard a great deal of discussion of this aspect of the matter some years ago, but it has disappeared from the radar to some extent.

I contacted Monaghan General Hospital this morning to make representations on behalf of a patient who had spent three nights on a trolley in that hospital. When a consultant did his rounds last night, he dealt with some people who were medically fit to be discharged but had nowhere to go. That is not acceptable. The same happened again today. Another consultant visited the ward but found there was nowhere to send the patients because the special care unit was full. There are many difficulties in this regard. We used to associate this problem with winter, but similar problems are developing at present even though we are approaching summer.

A number of issues arise on foot of this legislation. If one compares the cost of care in a general hospital with the cost of care in a nursing home, one will find in most cases that the cost of a week's nursing home care equates to the cost of a day charge in a general hospital. I sometimes wonder whether economists think savings can be made by locking beds in large general hospitals because that means treatment does not have to be provided. Perhaps there is a hidden agenda in that regard. The availability of step-down facilities depends on the hospital one is in. People in hospitals in Dublin seem to be able to get step-down beds much more quickly than people coming from local general hospitals because the pressure is not the same. They are inclined to block up the system. It appears to me that approximately 2,000 people are in beds inappropriately — I will not call them bed blockers — and that approximately 2,000 beds should be available. We should look at this. We are talking about building private hospitals to take pressure off general hospitals, but we should also examine this issue because it is more critical and needs to be considered further.

I would like to speak about the distress that is sometimes caused when people are being evaluated for subvention. I am familiar with cases in which things were done which were wrong, in effect. Take the example of four elderly people, two of whom are in their late 70s and two in their 80s. Of the two in their seventies, attempts are being made to keep one of them in a nursing home. The family farm was initially ten acres, then an adjoining ten acres were bought in name of one of the family. The health board took the view that he should pay his own way, despite the fact that one could not rear snipe on that farm. Effectively, he was asked to pay his own way through a nursing home scheme. Alternatively, the health board wanted the family to split the farm and have costs incurred against it. That type of situation is not helpful.

I also encountered a situation where a 90 year old woman was being looked after by her pensioner daughters. Again, the health board wanted to put a charge on that home because the daughters had worked for a period of years. They were back, caring for their mother, but they did not want to put their mother through the trauma of signing the place over to one of them. Therefore, the health board was going to take first crack at having a charge against the home. I doubt whether that is what we should do at this time. We should not put people through the trauma of having to have a home signed over for a five year period. A major issue is involved as regards people wanting to hold on to their property and families respecting that right until the day they die. It is little more than opportunism on the part of the HSE to levy a charge against them.

On the notion of inspectors and their reports, the only area on which there used to be inspectors' reports was the psychiatric services. Regrettably, people were always told when the inspector was coming, and naturally they put the best foot forward on the day. That was wrong, because the inspectors in some cases got an entirely false impression. In other cases they did not, since they could see through a good deal of camouflage. However, as regards nursing homes, inspectors should be appointed and make visits on a regular basis, not just annually. If there is concern about a particular facility, there should be unannounced visits by the inspector. That is the key. We all can recall the Leas Cross scandal and what happened there. It made frightening television viewing.

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