Seymour Crawford (Cavan-Monaghan, Fine Gael)

I welcome the opportunity to speak on this Bill. No issue could cause more anxiety in my office and the homes of Cavan-Monaghan than that of nursing homes and subventions. It is obviously linked with the delays in accident and emergency departments. I welcome this debate.

I will give one example. Only yesterday I received a telephone call from St. Davnet's Hospital where one of my constituents was waiting to see a doctor. She simply could not believe the situation. There was a marvellous building with many beds that were simply not being utilised. They are owned by the HSE, although they may be in the St. Davnet's complex. There must be more forward thinking to ensure that beds do not lie idle while people lie on trolleys or even worse in Cavan, Beaumont or elsewhere. There must be a degree of planning regarding use of the resources that we have but are not using, even as we allow people to suffer such discomfort.

The history behind this lady being in hospital is even more frightening. My constituent had been receiving one and a half hours' home help per day in her home. Suddenly that was cut from seven and a half hours per week to five because some inspector identified an anomaly. The woman could not feed herself, being dependent on the home help seven days a week. She is now in her fifth week in Monaghan General Hospital. Her daughter, who now lives in Northern Ireland, had been in to speak to the consultant and find out what the future held. Trying to save pennies on the one hand costs the HSE thousands on the other. There is no planning.

Regarding subventions, we in Cavan-Monaghan have one of the more serious problems. In the early 1990s, as many patients as possible were sent to the United Kingdom under the free scheme. We obviously had a low level of involvement in subvention as a result. The numbers receiving subvention before the previous general election and for a few days after went up to approximately 270. However, immediately after, an effort was made to bring it back down to 150. At the time, we had people almost 100 years of age on a waiting list to receive a subvention. That was and is unacceptable and must be changed.

The staff in the subvention office in Cavan are excellent. They are more than pleasant and helpful, but they must tell us the facts, which are that they must ensure they stick to the letter of the law so that as few people as possible receive subvention because funds are limited. Is that the treatment the elderly should receive after having given a lifetime's service to the nation? Is it right that someone should lie in Cavan General Hospital, Drogheda Hospital or elsewhere waiting on a subvention bed while others wait on trolleys? Those are facts rather than stories. People contact me every day on this subject.

This is another example of the misuse of property. There are 25 beds in a psychiatric ward in Cavan. The unit is reasonably new with approximately seven to ten patients at any given time. It is locked up but surely it could be divided so that some of those beds might be made available for the elderly who so badly need proper care. It is not happening, however. That has been suggested to me by personnel in Cavan who know the scene very well. At the other end of that hospital building is a step-down unit which is forced to provide long-term care. Surely some of those people should be in private nursing homes with the help of subventions to allow more step-down beds for the hospital. If those two units were utilised, we would not have 25 to 30 people on trolleys. I have passed on letters from some clients who spent time on trolleys there detailing how they felt.

This is an example of where the Government must wake up. There is no point in my tabling questions to the Tánaiste and Minister for Health and Children as I did this week, last week and on previous occasions. My colleagues and all the others do the same. All that we receive is a letter stating that the Tánaiste has no interest, since she is not involved, and the HSE answers such queries.

The Tánaiste was appointed by the Taoiseach after a general election that produced a coalition Government between Fianna Fáil and the Progressive Democrats. The only way we can get answers is for the Tánaiste to accept responsibility for her position rather than running away from it. It is very difficult for us to tell constituents that we have tabled a written question to the Tánaiste but cannot receive a simple written reply. Surely, with all the extra staff in her office and elsewhere, that should not be difficult. Will the Minister of State relay that message because it is so seldom we get a chance to see the Tánaiste and Minister for Health and Children herself? There is a need to recognise this House and its relevance to policy at least. Who decides the policy on whether beds lie empty, while people lie on trolleys? It is totally wrong that that should happen. We all want to see our people getting proper services. I will not indefinitely abide by a situation whereby facilities that could be used are available, but are being ignored or red tape is being allowed to get in the way.

The regulations for getting subvention are very difficult. A pensioner might live with an elderly parent but the house is still in his parent's name. While the person on pension is not dependent on his or her parent, the house is the only home he or she will have in the future, but because the house is in his or her parent's name the house must be taken into account. Is this fair? If that issue is not addressed in the Bill, I ask that it be rectified. Someone who is dependent, perhaps through disability, may be included. I had such a case in my home town, Clones, where an elderly person in her 90s lives in the family home with two daughters who have pensions earned in their own right through their taxes. The family home needed to be used for subvention purposes.

In another case a solicitor stopped an elderly man handing over the last 20 acres of his farm to his son. Those 20 acres were reckoned against him for subvention purposes and he needed to use nearly all the cash that was left behind for his widow. In such cases the Government is seen to be uncaring and unthinking. People over 70 now qualify for free medical cards and should qualify for free health service also.

We in the north east and particularly in Cavan and Monaghan are victims of circumstances. Sizeable numbers were sent across the Border in the 1990s and our subvention figures seem to be based on those earlier numbers. More seriously, the four counties of Cavan, Monaghan, Louth and Meath have the highest increase in population in the country. Admittedly Louth and Meath are the two counties that caused the increase. Two years ago the submission by the then North Eastern Health Board to the Government stated it would take an additional €40 million to cover the needs resulting from that population increase. However, the budget gave us the same 9.5% increase. Unless this changes dramatically we will have very serious problems.

The process for applying for subvention must be greatly simplified. Many of the people involved are elderly and some are not very well educated, which is placing enormous pressure on families. Help should be given directly by the HSE to help these people complete the forms. Some individuals are good at doing this and some district nurses and others are very helpful. However, the crisis arises when they need to meet the social welfare officials and they do not know what they should and should not do. The last budget gave figures purporting to show how the situation had improved and I genuinely believed it showed a major change. However, when the increase in house valuations and the increase in the amount a person was allowed to own are included, the changes were not that great. A person with €27,000 in the bank can now get an old age pension. However, the maximum allowable bank balance for subvention purposes is €11,000. In many cases the value of the house is immaterial because of how the means test operates.

Another issue arises with how the degree of dependency of an applicant is assessed. Surely the best person to make that assessment is the district nurse and the applicant's doctor. However, sometimes others are brought in to make the assessment. As the Minister of State knows, if his mother or mine were examined, the inspector would not know what was happening and for five or ten minutes would try to ascertain how well she is able to cope. In some cases an elderly person will go to the trouble — which is the norm if he or she is in any way fit — to provide a cup of tea for the inspector. Someone supplying a cup of tea to an inspector can surely expect the worst as this would indicate he or she is well able to look after himself or herself and there is no need to be in a nursing home. An inspector calling half an hour later or in the middle of the night might realise that things were totally different.

This all comes down to how the HSE determines an application for subvention. I hope the Bill will ensure that HSE officers in different areas deal with the issue consistently. Previously in the House I mentioned a particular case and it is worth repeating. A family whose mother was in a nursing home in Sligo needed to come back to the north eastern area in order to get subvention. The manager of the home spoke to me several times on the phone. He could not believe the difference between what I had to deal with and what he had to deal with. There were differences in the means test and the mechanisms for paying back until the person went into the home. We eventually reached a compromise and the family only needed to borrow for one month. It is vital that this situation be rectified.

I welcome the discussion on the issue of subvention. It is vital that it is sufficiently funded and that nobody needs to be on a waiting list, regardless of where they live. Private nursing homes are not getting any cheaper. I recently spoke to a person who is waiting to get into St. Mary's nursing home in Castleblaney. I make no apologies for saying it is one of the best in the country. It has a high-care unit for people with various problems. The unit was funded and opened by the then Minister, Deputy Noonan, prior to which it was a locked-up ward. It gives tremendous service. The person waiting to get into St. Mary's is paying €825 to stay in a nearby nursing home. Because he had some money and five acres of land he does not qualify for subvention. When he burns out the few pounds he has, I hope he will be allowed into St. Mary's. However, this is not acceptable. This person deserves to deal with his difficulties in some dignity. I hope that by the time this Bill is passed the Government will provide the necessary funding to give a subvention to all who need one. If the Health Service Executive was allowed to give proper home care much of the subvention would not be necessary, in cases such as that I mentioned of the woman who spent four weeks in hospital. There are many other cases of people who could be let go home from hospital if care was available. Home care funding in the north east was halved a few years ago. There have been small increases but it is unacceptable and unfair that a woman, an amputee, when living in Donegal received 12 hours home help a week but receives two hours since moving to Carrickmacross following her husband's change of job.

We are supposed to treat all children of our island equally but that is not happening. I urge the Minister of State to rectify the home help service. There are people prepared to deliver the service but they need flexibility. Their income is somewhat better than in the past but if home help can allow somebody remain at home the allowance should be improved. The Joint Committee on Social and Family Affairs, of which I am a member, agreed unanimously that a person receiving social welfare, such as an old age pension or widow's pension, should be entitled as a minimum to half the carer's allowance. That would dramatically change the situation.

See this speech in context