Michael Ring (Mayo, Fine Gael)

The issues addressed in this Bill are creating many problems for the elderly and particularly for families who need to put one of their loved ones into either a private or public nursing home. I compliment Deputy Michael Higgins on his speech because what he says is correct.

Everyday I see very vulnerable people who are not well off and have no resources of their own. Vulnerable families are assessed by the HSE and told by it that their loved ones need a long-stay bed. They face very serious problems and I hate to say they are being forced by the State to put their loved ones into private nursing homes. They are given a list of such homes and a subvention form. This is not correct and I want the Government to write to the carers of the elderly to clarify the law, which it does not seem to know. The Ombudsman, however, made it quite clear some years ago. When I was deputy spokesman for health, I highlighted on many occasions the Ombudsman's view that if one is over 70 and has a medical card, one is entitled to a State bed. If that is not correct, I ask the Minister of State to refute it. Doctors, nurses and the Health Service Executive should be aware of the law of the land. They should not intimidate people and pressurise them to put their loved ones into private homes when they do not have the resources to fund it. People are being pressurised on a daily basis. The State may not have enough beds but it is not the job of the families to provide them. That is the job of the State.

The Sacred Heart Home in Mayo is an excellent, well-run home but in recent years all the Health Service Executive could do was reduce the number of beds in that home. A problem arose with the floor in the home and I understand, although I am open to correction, that it has not resolved that problem to this day yet it has no problem upsetting families when they are under pressure.

I could give many examples of people being pressurised who were unable to stand up for themselves. I am thinking of the woman who came to my clinic crying and saying she was being intimidated by a doctor. She said she was unable to put up with it any more. I had to write to that doctor, explain the law of the land to him and ask him to stop upsetting the woman who was in need of full-time care herself. She was trying to look after her sister but was unable to do it, yet she was told that she must fill in the subvention form and that her sister must go into a private home. That is not the law of the land and that must be spelled out to the doctors and to the Health Service Executive. If people want to or have to go into private homes the procedures should be explained to them in a simple way. The options should be outlined to them and they should not be forced out of hospital.

I made the point yesterday to Professor Drumm that the Health Service Executive cannot have it both ways. Some weeks ago it announced the home care package. I am sure the Minister of State heard about that because we had a big spin about it. All the spin doctors were out, and there are more spin doctors in the country than there are medical doctors. They were spinning as usual about the home care package, which is amazing because I have tried to get the home care package for some of my constituents or at least a copy of the guidelines, rules and regulations without success to date. I am waiting for many weeks for a reply to a Dáil question, and it is no longer easy to get a reply from the Health Service Executive on the number of home care packages produced in Mayo. I know how many — none. There is little point in announcing fancy schemes and ideas without having the scheme approved, publishing the rules and regulations and having applications dealt with quickly. We cannot have it both ways. We cannot expect people to bring their loved ones home from hospital without any back-up or help from the State.

I will give the Minister of State another example of what is going on with the Health Service Executive when there is a small cut-back. Belmullet is approximately 70 miles from Castlebar, more than 100 miles from Galway and more than 200 miles from Dublin. Elderly people living there want to remain at home. Every report and statistic shows that people want to stay at home, be looked after in their own homes and die at home. They do not want to take up a State bed. They want to stay in their own beds in their own homes in their own part of the country. The situation now, however, is that many elderly people on social welfare payments who have no resources, money or family back-up must travel to Dublin or Galway to keep a hospital appointment. That is not their fault, nor is it their fault that their appointment is for 9 a.m. We have very little infrastructure to allow them get a train or a plane to bring them to Dublin. We have no Luas in Belmullet, Castlebar or Mayo. Our people cannot hop on the Luas to keep hospital appointments. They must travel more than 200 miles.

The Health Service Executive in Mayo has new criteria. I raised this matter with Professor Brendan Drumm yesterday and I hope the Minister of State and his officials will raise it also. It has decided that it will provide transport to only three or four categories of patients. We now have a situation where many sick elderly people in need of hospital appointments will be unable to take up those appointments because they do not have the resources or the money. In the past the former health boards supported them and arranged for them to be brought to hospital appointments. When I raised that yesterday with Professor Drumm he told me that there was no cut-back. If there is no cut-back I want the Minister of State and his Department to write to the Health Service Executive today and tell it to go back to the old scheme and abolish the existing scheme. What is going on is not right. We cannot have it both ways.

I will outline what the former health board is doing in my county. They wonder about the reason State beds are taken up, accident and emergency units are over-crowded and the health service is in disarray. I will explain the reason. It is because we did not do our business in this House. Previous Ministers did not do their business. There are no step-down facilities available. There is no place for an elderly person to go when discharged from hospital needing a week or two in a nursing home to recuperate. There are no step-down facilities for those people. We cannot force people out of hospitals and into their own homes without back-up. We will not give them the necessary back-up at home and we will not give them the back-up in hospital.

I raised this problem with the Minister of State, and to be fair to him he wrote to me and did his best. He outlined all the extra money he provided for home help yet I am aware of elderly people in their 80s and 90s who previously got four hours home help a day but which has been reduced to two hours. The home help service has been taken from some of them. When I raised that with Professor Drumm yesterday I was told there were no cut-backs and that anybody who needs home help will get it. I know many people who need home help but they are not getting it. It is hypocritical of the State to say on the one hand that it cannot provide funding and does not have the beds yet the people who want to stay at home are not being supported or given the necessary back-up and resources.

In the Sacred Heart Home I mentioned earlier there are two beds for cancer patients. That hospice unit has been open for many years but the beds are vacant. The Health Service Executive placed a number of advertisements for a doctor post in a newspaper and I wondered why no doctor would take up that job. I put down a Dáil question on that matter, but it took a long time to get an answer. Eventually I had to threaten to make a freedom of information request. I am not sure whether I did that but eventually I got information on the advertisement, the salary the HSE was offering to pay the doctor who would take up the job. I now know the reason the job has not been taken up. It is because the pittance the HSE was offering was less than somebody would earn working on an island looking after ten medical card patients. We are not serious about dealing with health if that is the situation. People had to leave my county to go to other counties in their last days to be looked after. That is sad. If we were serious about health and if the HSE was serious about filling that position in the Sacred Heart Home, it would be filled.

I will give another example to the Minister of State. Since I became a Member of this Dáil 12 years ago, we have been talking about providing a nursing home for Ballinrobe. It was an issue in every election for the past 12 years yet 12 years on there is not a brick laid to start building that nursing home in Ballinrobe. We urgently need nursing homes. I am talking about a public nursing home on which a commitment was given that it would be built, but it has not happened. If the former Western Health Board did its job properly, that nursing home would be up and running now and patients discharged from the old general hospital who still need full-time care would be in it. We cannot have it both ways. The State cannot lecture people about keeping their loved ones at home if it is not making any effort to provide for them.

The time has come. People are depending on the private sector. We have an Alzheimer's unit in Ballindine provided by a man called John Grant. I take this opportunity to compliment John Grant and his staff on the efforts he has made over the years and the beds he has provided. He has done an excellent job for people who found themselves under pressure because the Health Service Executive was unable to meet their needs. They had to go to the private sector where people like John Grant operate, who through voluntary contributions raised money to provide an excellent unit in Ballindine. Compliment and say well done to people such as Mr. John Grant. We had no Ministers with the foresight he showed in erecting buildings and knowing that these additional Alzheimer beds were needed in Ballindine.

I will finish on the topic of the elderly and I want to again raise this issue as regards the Ombudsman. I want to ask the Minister of State and the Government to spell out the situation for a person over 70 years of age with a medical card. Is he or she entitled to a State bed? The Ombudsman says such people are entitled to a State bed. On the question of subvention, why are these forms being thrown at them when they find themselves in need of a State bed? It should be explained to these people first that they are entitled to a State bed, while they might have to wait a while. In the meantime the Health Service Executive should be paying if it wants to put them into private sector beds, not putting pressure on the people who cannot afford it. The HSE takes their pensions off them and that is fine — I have no problem with this and that is how it should be. However, it should not be putting pressure on family members at home on social welfare or low incomes to try and meet the shortfall.

As regards the Bill, I hope this will deal with what has been happening in recent years, particularly in the west where we get a lower subvention than people on the east coast. The time has come for this to be resolved. Whatever people get on the east coast should be replicated along the west coast. We cannot have two types of payment, one for the east coast and one for the west. In the west, of course, we are getting the lower and not the higher end of the payment. As regards people who are in private nursing homes, it is time for a stronger inspectorate, with more people on the ground visiting these homes on a daily basis to ensure, where the State is providing subvention, that we have an input into the level of care such people are receiving. These people are entitled to the assurance that there is somebody to protect their interests because, while sometimes the private sector homes do an excellent job, there will always be those willing to take short-cuts. We saw that in Dublin, in Leas Cross, and I am sure there are more nursing homes throughout the State where the care is not being given, even though they are being well paid to look after people. The inspectorate should be in place.

The elderly built this State. If one listened to the media last week one would think only one person built up the State. That is not the case. Both men and women, who are now elderly, worked very hard and paid their taxes to the State. They raised their families and presumed, on paying their taxes, that when they reached the end of their days if they needed health care, nursing home beds or to be protected and looked after, the State would do that for them. They expected this because they paid their dues to the State. They are the people who went without many necessities during difficult times. They did what was right and the Minister of State and the Government should ensure they are protected. Whatever they need at the end of their days, whether a nursing home bed, a home care package, home help, or a doctor calling to see them on a regular basis, we should ensure they are protected because they have paid their dues.

I want this to happen. We do not want lecturing any more. We do not want spin doctors. We want medical doctors and people to look after the elderly.

See this speech in context