Seán Power (Kildare South, Fianna Fail)

I thank Deputies for their participation in the debate over recent weeks. They covered many of the issues affecting elderly people and they are very much in touch with their constituents and the difficulties a number of them encounter. It is Government policy to help older people maintain themselves in their homes and communities for as long as possible, in line with their wishes, and to provide for appropriate residential care where this is no longer possible. The subvention scheme, which was introduced in 1993 on foot of the Nursing Homes (Subvention) Regulations, provides financial assistance to older people towards the cost of private nursing home care. It was never intended that the subvention payment would cover the full cost of care.

The Bill is designed to ensure that the existing subvention scheme for private nursing home care is firmly grounded in primary legislation. Once enacted, it will replace the 1993 regulations. The Bill will also go a long way towards helping the Health Service Executive to implement the scheme on a standardised basis across the country by ensuring increased clarity and reducing room for interpretation. Since it was established as a national body, the HSE has striven towards the implementation of common frameworks and processes throughout the State in regard to services for older people, including the subvention scheme, and the legislation contributes to that overall goal.

Significant changes are projected regarding older people, especially in the medium to long term, to which a number of Members referred. It is estimated that, this year, 463,000 people will be aged 65 years and over. Latest population projections suggest that this figure will increase to more than 1.1 million by 2036, with an increase in the old age dependency ratio from 18% to 39%. The number of people aged 85 and over is projected to increase from 46,700 to 155,500 during the same period, and this trend is expected to continue until 2056 when the old age dependency ratio is projected to reach 60%. These demographic trends clearly demonstrate there will be an increase in the pressure for services and a corresponding increase in the cost of care. Funding the long-term care needs of older people, both in residential and community facilities, is among the most difficult and complex areas in the health sector. It is for this reason that an interdepartmental group was set up last year to examine the long-term care of older people, and its report is being considered by Cabinet. It deals with a number of the issues raised by Members.

Significant progress has been made in increasing the funding available for services for older people in recent years and this increase, together with the investment package provided for in the 2006 budget, is indicative of the Government's commitment to the ongoing development of health funded services for older people. Our focus is on keeping people in their homes and communities for as long as possible with the appropriate supports in place. This is what the majority of older people want and this will contribute greatly to their quality of life in their later years. I do not say everything is fine because services for the elderly were underfunded for a long time. However, the funding announced in the budget will be the beginning of major investment in such services. There will always be those who require residential care, and following the enactment of this Bill and in light of the deliberations of the working group on long-term care, we must consider the future of care for older people, both in residential and community settings. We will try to achieve an equitable, balanced approach, both for residential and community care and for public and private provision.

I will respond to a number of issues raised by Deputies during the debate. Many of them referred to nursing home standards. Public consultation on the legislative proposals contained in the draft heads of the health Bill 2006 has concluded. Under the proposals in the draft heads, the health information and quality authority, HIQA, will set standards on safety and quality of services provided by, or on behalf of, the Health Service Executive and will monitor and advise the Minister and the executive on compliance with those standards. Provision is also being made to give the HIQA the power to investigate, at the request of the Minister or the HSE, the safety, quality and standards of such services and to make recommendations it deems necessary. The chief inspector of social services will be required to monitor against standards set by HIQA.

Standards for private nursing homes are set out in the Care and Welfare Regulations 1993 and private homes are also inspected under these regulations. The Department's focus is on protecting vulnerable older people and providing for the highest possible standards of care for older people in all long-stay facilities. In advance of the HIQA being fully established and functional, the Department set up a working group which is developing national standards that both private and public nursing homes will have to meet. This group is chaired by the Department and members include representatives of the Department, the HSE, the social services inspectorate and the Irish Health Service Accreditation Board, IHSAB. These standards are being developed in line with best international practice and will put the resident at the centre of care. It is intended that these standards will be ready in draft form in July and a consultation process will follow, thus enabling all interested parties to give their views. The IHSAB has developed accreditation standards which, when introduced, will be voluntary. There will not be a statutory obligation on a nursing home to comply with them. The accreditation standards are the very highest level quality of care which can be achieved in the setting and which all service providers should work towards. Thus, the standards being developed by the interdepartmental working group will provide a foundation that must be achieved and that enables organisations to aim for and work towards accreditation under the IHSAB scheme.

The issue of standardising enhanced subventions was raised. The HSE continues to have discretion on enhanced subvention. Where a person cannot meet the costs of care without undue hardship, the HSE can pay enhanced subvention and is given discretion so that the granting of it can be flexible. Amounts of enhanced subvention vary from case to case and depend on the particulars of the case in question, the cost of nursing home care in the area and the resources available to the HSE. An additional €20 million has been allocated to the nursing home subvention scheme in 2006 and the aim is to standardise means tests and bring greater consistency to the different levels of enhanced subvention support throughout the country.

A number of Members also sought clarification on the operation of the subvention scheme. The Bill provides the framework for the subvention scheme and provides that the HSE must issue guidelines on how the scheme will work. For example, it must outline the process to be followed to decide the amount of subvention to be paid to an applicant. The Bill also provides that these guidelines must be issued on the Internet. This will ensure the guidelines are easily accessible to those requiring information on how the scheme works.

Members raised a number of other issues and I will try to deal with them as quickly as possible. When the scheme was first introduced in 1993, £5 million was provided for its operation. The following year, that sum was increased to £15 million and this year, €160 million will be spent on the scheme. I am aware the scheme is far from perfect and major changes must be made to it.

In particular, I wish to raise the issue of the tenders sought from nursing homes in 2005. At the time, the Eastern Regional Health Authority sought tenders for high dependency and intermediate care. In that instance, nursing homes were being asked to provide for the needs of patients who had been inappropriately accommodated in acute hospitals. Such patients required specific care of a type that would not normally be found in most private nursing homes. Given the specific nature of the requirements, some applicants were not in a position to meet them and consequently, they were not granted a contract.

However, that does not mean that such nursing homes are not in a position to provide traditional nursing home care. The inference that a large number of nursing homes are not in a position to provide care only serves to create undue worry for people. An inspection system is in place and, as I noted earlier, it will be improved. On its introduction, the new system will apply to both public and private nursing homes. However, it is unfair to create the impression that many nursing homes do not provide proper care.

Members again mentioned home care packages today. It is completely incorrect to assert that the Government is doing nothing for the elderly as nothing could be further from the truth. In the last budget, it provided major resources to try to improve the lot of older people in respect of areas such as home help and home care packages. A total of 1,100 home care packages were allocated last year and the Government has provided sufficient money to allow for 2,000 additional home care packages, which will be spread nationwide.

Deputy Ring questioned whether any packages had been allocated to County Mayo. As I cannot confirm this, I will investigate the matter and report back to him. However, I would be surprised if they have not been so allocated, certainly by the end of the year. It is intended to spread them throughout the country as they are of major benefit and can keep people out of nursing homes or hospitals. Moreover, having the proper home care packages in place can help those who wish for an early discharge from hospital. The packages have been tested on a pilot basis and as they worked exceptionally well, the Government will continue to invest in them. Deputy Ring also mentioned Ballindine and the great work carried out by John Grant and his staff there. I had the pleasure of visiting that facility quite recently and I agree with the Deputy's statements in this regard.

The issue of the differing subvention rates paid around the country was raised, as was the issue of enhanced subvention. As I noted earlier, the HSE has discretion to pay a higher rate of subvention in cases in which a person would suffer undue hardship. The level of enhanced subvention is at the discretion of the HSE and depends on individual circumstances.

Deputy Timmins's contribution mentioned the wonderful facilities to be found in the Carnew community care village and I will have the pleasure of visiting it within the next two weeks. I am sure the Deputy is correct and I look forward to the visit.

Last year, the Government provided approximately €120 million for home help. This year, that sum has been increased by €30 million. While I am aware that Members have cited cases in which home help hours have been reduced, this can depend on a person's individual circumstances. It can be difficult to try to explain this and I hope it will not happen this year. The Government has provided a significant increase in this regard. It is a facility that can mean much to people, can give them great comfort and can allow them to live in their own communities.

A number of Members asked about the cases pertaining to people who were eligible for public nursing home care but could not access one and were forced to enter a private nursing home and to pay for it. A number of legal cases are pending in this regard, which the State will defend. However, as we must await their outcome, it would not be appropriate for me to make any further comment in this regard.

Deputy Wall laid a heavy emphasis on the inclusion of the family home in the Bill. While I appreciate this is a sensitive issue for families, this is not a new provision. It existed in the regulations for the subvention scheme when it was first introduced in 1993. Nevertheless, I realise this is a sensitive issue. One must consider whether a person who occupies a house worth several million euro should be in a position to make some contribution. A group has been studying the financing of the long-term care of older people. This matter is under serious discussion by the Government and announcements will be made in this regard in the near future. Hopefully, the issues raised by Deputy Wall and other Members will be addressed.

I thank Members again for their contributions, most of which were extremely constructive. I look forward to the further Stages, at which time the views put forward by Members will be considered in detail. I commend the Bill to the House and thank Members for their participation.

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