Dan Boyle (Cork South Central, Green Party)

It is always difficult to speak in the House after Deputy Higgins. However, I will try to rise to the challenge. I agree with what he stated on the rapaciousness which exists in particular elements of the Government regarding the provision of extra facilities which should already exist but sadly are still lacking.

This legislation is badly needed. It has widespread support in the House as a legislative base for filling the gaps on an independent inspectorate for nursing homes. Unfortunately, a more embracing and holistic approach to legislation dealing with care of the elderly is necessary. This Government tends to make things up as it goes along, reacts to crises and introduces legislation to plug gaps which become apparent. It is unfortunate that given this is its ninth year in office, we have not had before us more embracing legislation to deal with the wider area of care of the elderly. Models and methods of looking after our ageing population exist and this Government should respond in innovative and better resourced ways. However, it chooses not to.

It is welcome that at least this Bill will replace the extremely ineffective 1993 Nursing Home (Subvention) Regulations under section 7 of the Health (Nursing Homes) Act 1990. We know to our cost it was particularly ineffective legislation. The inspection regime which followed from it was shown to be all too wanting, most notoriously in the case of Leas Cross. Many of us in this House suspect that Leas Cross is not an isolated example and many more such examples could exist in our system. We have not put in place a strengthened inspection system nor have we provided the resources to establish the extent to which these problems exist in our society.

Many aspects of this issue involve societal problems and the Government cannot and should not be expected to solve all of them in the first instance. However, the Government does have a right and a duty to ensure at least basic standards apply. As Deputy Higgins stated, the philosophical approach of the Government on this must be questioned. It has been found wanting. This Government considers a problem in terms of the easiest possible solution in the quickest possible time. These problems are endemic and should be sorted out from the first base.

In trying to introduce out of sight out of mind solutions, the Government's approach is to try to get as many elderly people as possible into nursing homes, provide as many nursing homes as possible by the private sector in locations far removed from family, community and wider society and then throw up its hands when we discover Leas Cross situations. The first source of possible solutions to these problems should be found within the community and family structures. The fact this Government fails to recognise that and fails to provide adequate resources means a band-aid approach exists among families and they find they are forced to use nursing homes. Social welfare rules restrict pensioners from receiving carer's benefit, and 50% of carers are over 60.

A facility exists in my constituency which is a model that should be replicated around the country. It takes a holistic approach to care of the elderly. The Westgate Foundation in Ballincollig has independent living units, day care facilities and bed and medical facilities for people who find themselves immobile and in need of medical attention on an ongoing basis. The Government's policy is to try to parcel it out, as is done with waste management. Perhaps that is a cruel analogy. The Government's approach to this problem, as with many other problems, is to see how the private sector with its profit motive can deal with and solve the problem. Neither I nor my party accepts that, nor do many other Members on this side of the House or the vast majority of people.

The Green Party recently issued its policy document, Citizenship, Equality, Respect: A Policy on Ageing and Older Persons. If this Bill were more embracing and holistic, it would include many of the principles we are trying to advocate. In circumstances where elderly people find themselves in nursing homes on a long-term basis, or even to the end of their lives, is it enough for us to refer to legally enforceable standards of care and sanitation? Surely they deserve more, such as the right to the maximum quality of life, the feeling they are in an institution which they consider a home and the right to participate in the decisions that affect the community in which they find themselves.

We have legislation that gives parents the right to be involved in their children's education and there is even a role for student councils in secondary schools so students can be more involved in decisions that affect those schools. The nursing homes legislation should therefore refer to the elderly themselves. What role do they have when living in nursing homes and how do they articulate their needs and enforce their rights? Unfortunately the Government is continuing to enforce standards from the outside. It only ensures that minimum standards are maintained and then walks away for a given period.

Inspections of nursing homes will be quite infrequent. Experience shows that inspections under the existing system very often occurred with the prior knowledge of the nursing home authorities. We need to know that this will not apply under the new inspectorate and that the spot-checks will be unannounced. The checks should ensure the standards that apply on the day on which they are carried out apply day in, day out.

Deputy Michael Higgins stated nursing homes are regarded as the first resort under Government policy although they should be the last resort. There seems to be no policy to deal with the intermediate circumstances in which people find themselves. Between the family home, the hospital and nursing home, there is an utter dearth of step-down facilities. With a bit of imagination and innovation we could prevent circumstances in which people effectively find themselves incarcerated in nursing homes throughout the country. Such people find themselves cut off without adequate support when their conditions could be dealt with a little more effectively on a short-term to medium-term basis.

The wider issue is that the Government's policy of continuing to depend on nursing homes as the main means of caring for the elderly, with which policy the inspectorate will have little to do, is very expensive, particularly when nursing homes are largely privately owned. Before the recess, we will have to deal with the short-term bill for nursing home charges, which will probably be in excess of €1 billion. Upon a nod, the House will be expected to decide on the first tranche of this, which will amount to €340 million, just to deal with the original payments. Ultimately, successive Governments, including the current one, made serious errors in this area. That the bill was allowed to accrue and that a wrong principle was put into practice does not escape the fact that the policy the Government wishes to pursue will result in a continuing added cost to society.

We believe the money could be used more effectively by resourcing family units, the carer sector and community structures. The Government needs to come out of its shell on this issue. Does it not believe there is a more effective approach than throwing money at the problem in such a way that it only benefits a small number and barely affects those in need of care who are meant to benefit therefrom?

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