John McGuinness (Carlow-Kilkenny, Fianna Fail)

I welcome the Bill and I hope that it receives a speedy passage through this House. Much money, totalling approximately €1 billion, is pending on this Bill and the assessments must be made so that people who are out of pocket, or covered by this Bill, can receive their payments promptly. I am glad to see Deputy Perry here for the Opposition as it was during his chairmanship of the Committee of Public Accounts Committee that some of these questions were first asked. Since then the matter has been debated publicly throughout the country and identified as a serious problem.

It is no harm to reflect on prior events during the course of this debate. The issue was mentioned a number of times at health board meetings. While the procedure was questioned, the questions were never answered. They may not have been pursued strongly enough to obtain an answer and thereby uncover the process which was going on within the health boards. This shows the value of a committee system, where information is received from the public. I received some of that information as a member of the Committee of Public Accounts. This facilitates investigation and teasing out whether complaints are legitimate. In this case the complaints were found to be legitimate.

It is no harm to reflect on the fact that management of the former health boards proved to be wholly inadequate. It lacked the cutting edge which is required to administer a health system. As a result, these charges were administered willy-nilly, depending on the health board. This showed a lack of consistency throughout the country and there was very poor scrutiny or transparency in the system through the health boards.

It was for this reason and other associated issues within the old health board system that I fully supported the change from that health board structure to the current system, the Health Service Executive. Given the commitment expressed last night by Professor Brendan Drumm, supported by the Tánaiste and Minister for Health and Children, Deputy Harney, on "Questions and Answers", I commend both of them on the manner in which they proactively dealt with issues relating to accident and emergency departments, among others in health services.

I hope that in the context of their work within the HSE, the necessary reform, not only in accident and emergency departments but with many other issues relating to the delivery of services to those who need it within the health system, is delivered speedily, accurately and in a focused way for the benefit of the patient. That is what I saw from the debate last night and from exchanges with people like Professor Drumm at meetings of the Committee of Public Accounts.

My only difficulty is with the speed of that system. It is still very bureaucratic and it needs to be trimmed so that an appropriate management system is put in place and there are appropriately qualified people to manage the system. This takes time, which I acknowledge, but we need to see continued funding and commitment until a proper management structure is delivered within the Health Service Executive. We can then accurately point to where system failures continue to occur, from management level to the various hospitals in the country. Until that happens, we will not have the efficiency of service that is demanded by the public.

The proper approach is being taken with regard to this Bill and the patients covered by it. The Health Service Executive has established that up to 10,000 people must be repaid. I welcome the fact that a second company will oversee those repayments and that there has been some involvement on the part of Health Service Executive staff. The decision to outsource the process is correct because it enables the health service, as it undergoes restructuring, to focus exclusively on staff management and redeployment rather than be burdened with such a complex issue as these repayments. A system failure in the old health boards caused this problem.

I also welcome the fact that the Tánaiste is considering how patients' private property accounts are managed. I have had the opportunity to raise this issue at the Committee of Public Accounts and I do not believe there is adequate transparency in the system. In the old health boards there was little or no transparency and a number of whistleblowers employed by health boards have highlighted the inadequacies of the system. They have made complaints but in some cases have been identified and are being bullied and harassed in the workplace. That is not a position that can be tolerated by the HSE.

A national oversight committee has been appointed. It is representative of service users, including Age Action Ireland and the Irish Senior Citizen's Parliament, and provides an independent input into the design of the repayment scheme. I encourage that group to study not only what led to this scheme but also the patients' private property accounts, how they were administered by the health boards and whether money might need to be repaid to patients in that context. It might also examine the whereabouts of funds, property and other possessions of patients while they were under the care of the old health boards, as well as how they were transferred from the health boards to the HSE. A national audit should take place, overseen by the national oversight committee, so that we can create new books of accounts in which the balance of the affected patients' accounts, audited by an independent group or committee, is brought forward.

It is necessary to protect not only patients' rights but the integrity of employees. A protocol should be drawn up in every HSE area stating how the affected patients' accounts should be handled and accounted for and how the patients or their representatives should be informed of the balances and the activities on their accounts. There was a very poor accountancy system in the old health boards.

I have in my hand a patients' money book given to me by a psychiatric nurse who has made a complaint to the Department of Health and Children, a complaint which has not been responded to adequately. It raises serious questions. It dates back to 2003 and earlier and relates to the management of several patients' money. While that complaint awaits a response, it does no justice to the men and women who manage such accounts in the health system. It raises questions that have yet to be answered. It is a poor system that does not take such a complaint seriously and fails to respond. On more than one occasion the person to whom I refer was questioned by the Garda Síochána. I know of another complaint that has been under investigation by the Garda in Waterford for quite some time. The HSE and the Department owe it to staff and patients to investigate complaints vigorously and respond to them effectively to protect the system and those who work in it as well as those who are cared by it.

I urge the Minister of State to pursue those aspects of the Bill that seek to ensure that complaints awaiting response in the Department are dealt with and to ensure that those being investigated by gardaí are also made the subject of internal investigations. The protocol to which I referred should then be put in place to be followed by everyone concerned. It should be transparent and acceptable to all. Until that happens there will continue to be doubts over the system. We have the opportunity in this Bill to ensure that an audit takes place under the scrutiny of the oversight committee. A balance needs to be brought forward and the amount calculated as owed repaid.

I defend any whistleblower who raised a complaint and call on the HSE to offer appropriate protection to people in their employment who express their view on what is happening in the interests of better service. Any complaint should be investigated and both patient and employee be protected.

Deputy Seán Ryan dealt with subventions and issues arising from the television programme last night. I was impressed by the contribution of Dr. Gary Courtney on the subject of St. Luke's Hospital in Kilkenny. That hospital represents an example of best practice. It showed how a patient could be brought into a medical assessment unit and looked after properly. The patient could then be sent to the appropriate section of the hospital and thereafter cared for in the appropriate bed. If necessary, he or she would be discharged to the pre-discharge unit. I know from my work with that unit that a home liaison officer then ensures the appropriate care and support is made available in a patient's home within the community so that he or she receives the best quality care according to his or her needs.

St. Luke's Hospital is a model that can easily be replicated. There may be different emphases in terms of the type of beds needed. They may be needed in a medical assessment unit, in the hospital itself or in the pre-discharge unit, but that is the job of a bed manager. The Minister of State visited St. Luke's and will know that everybody, from the consultants to the person who sweeps the floor, participates in the management and delivery of the service in that hospital. The hospital also maintains strong links with general practitioners in Carlow and Kilkenny to ensure the best possible delivery of health care to the patient.

I encourage the Tánaiste to adopt a suggestion on "Questions and Answers". Hospitals such as St. Luke's which have recently been funded to the tune of €6.2 million for one particular service and €1.5 million for another but which set an example to others by innovating should be rewarded by the Department of Health and Children, through the HSE. As best practice replicated and rolled out in other hospitals, the hospital in which an initiative originated should be financially rewarded for its achievement. Such awards should be directed towards delivering frontline patient care, improving the image of the hospital, developing innovative approaches in other areas or providing care for the elderly.

Elderly people assessed in pre-discharge units are directed towards the appropriate care facility, either in the community or at home. There is no reason, therefore, that subvention payments made to private nursing homes should not be relabelled and paid directly to those caring for patients in their homes. The Department, with the support of the Health Service Executive, should introduce this innovation which would support families who wish to care for elderly family members at home.

On the issue of subvention payments, with so few public beds available in Kilkenny city, I encourage the Tánaiste to expedite plans to provide a 30-bed unit on the campus of St. Luke's Hospital in order that public beds become available for the care of the elderly and some balance is introduced in a market in which the cost of private beds is spiralling. When the nursing home subvention scheme commenced, a private nursing home bed cost approximately €300 per week but the figure has since increased to €700 to €800 per week, with additional payment required for every extra service needed by those in care. Given the gap between charges and the value of the subvention and the person in care's pension, families must make a substantial contribution towards the costs of care. The State has an obligation to bridge this gap.

The provision of public beds for care of the elderly would also create competition with the private sector. Allowing this market to be run exclusively by the private sector will result in the State being scourged in terms of price. As the population grows older, this issue will become more urgent and will need to be addressed through a mix of public and private beds.

Home care packages, a welcome, new initiative providing for an assessment and costing of people's care needs in the home, need to be promoted much more. The Health Service Executive should identify families which would benefit from home care packages and encourage them to support family members at home. The lack of public beds for providing care for the elderly is the reason for current problems with subventions and charges. Active retired groups in every constituency are campaigning to ensure that appropriate funding is made available for nursing home care in order that the accumulated assets of families, especially family homes, are not placed in jeopardy. Efforts should also be made to have people who normally live alone but are currently accommodated in public hospital beds cared for at home.

I note the company responsible for making the repayments under the new scheme was to have been appointed at the end of April with payments likely to commence in June. Clearly a decision is close on which entity will oversee the process. I hope the work the Health Service Executive has done in identifying patients who were wrongly charged and are still alive — I understand from the Tánaiste's note that almost 10,000 payments have been calculated — will be verified by the company and made immediately thereafter.

Where the person in care has passed away, I encourage the potential beneficiaries to consider donating the reimbursed moneys for use in frontline services. This is a wealthy country and some potential beneficiaries could be encouraged to donate repayments owing to them. They should, therefore, be informed of this provision and the areas on which their moneys would be spent. For example, people could be encouraged to donate money if it is earmarked for use in the region in which they live. While many people are decent enough to consider such an appeal, it is essential that they are informed about the provision. I commend the Bill to the House.

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