Liz McManus (Wicklow, Labour)

It is important to acknowledge what happened and why €1 billion of the health budget is being set aside to make reparation to elderly vulnerable people and their families who were robbed by the State. This is a lamentable record, although I appreciate a number of Administrations are to blame. However, €1 billion is being taken out of the health budget, which could have been spent elsewhere. For example, an additional 350 hospital beds could have been provided and many other services could have used this money. However, the State must repay money it took illegally from people who were extremely vulnerable.

The bill should not be as high and that is the Government's responsibility. If the then Minister for Health and Children, Deputy Martin, had undertaken the simple task of reading his brief, as a Minister should, the cost would have been less. If his well-paid political advisers had done what they were supposed to, the bill would be less. The most disturbing aspect of the increased bill, which resulted from the Minister's failure to do his job, is that the Government, composed of the Progressive Democrats, which is supposed be the watchdog, and Fianna Fáil, has exonerated the Minister and rewarded him with a transfer to a more tranquil Department, where it is all good news for a change. The then Secretary General of the Department of Health and Children took the hit and that is no way for a Government to operate. It highlights a paucity of leadership, which is both revealing and disturbing, not only in the Department of Health and Children but throughout the Government. At the very least, we need to ensure those who are in positions of responsibility accept it and do not only accept the trappings of office such as the large salary, the minders, the driver, the advisers and all the praise and flattery that goes with the position. When they do not live up to their duties, the buck should stop with them.

That attitude has pervaded the entire Government. For a long time the Taoiseach managed to deflect criticism but that is no longer the case. He became known as the Teflon Taoiseach but this culture has pervaded the Government in a corrosive way. The Taoiseach's attitude is not working any longer and, generally, the Government is feeling the heat. The Minister for Justice, Equality and Law Reform, about whom there is a touch of a school boy, uses a silly phrase in this regard. However, support for both Government parties has slumped but that was inevitable given their record. If there were ministerial accountability — I do not only refer to the former Minister for Health and Children, Deputy Martin — the public at least would feel a sense of security that some principle remained within politics and the Government.

The costs that have been added unnecessarily by privatising the process are questionable. Why was a process embarked on to employ a private company to manage a simple set of procedures? What is the big deal? Not only did the Government hire a private company, the company tendered late and the process was repeated so the company could win the contract worth €15 million. The appeals process cost €33 million and, therefore, a total of €48 million will be paid for administration alone. We do not need to spend money like that. The Civil Service has spare capacity. As Deputy Twomey pointed out, 400 officials in the Department of Agriculture and Food processed very complex payments, which were abolished following the introduction of the single payment scheme. The Department of Social and Family Affairs made repayments when the European Union decided that married women were being discriminated against. The then Minister for Social Welfare, Proinsias De Rossa, did not need to hire a private company as a crutch on which to lean. Payments of much greater amounts are made by the Department of Social and Family Affairs as a matter of course. To be fair to that Department, the improvements made during the past ten years in terms of efficiency and better service are quite remarkable. It seems the Tánaiste and Minister for Health and Children is obsessed by some type of old fashioned or ideological thinking whereby she has no faith in anything the public sector does. It must be private, otherwise it is no good.

We are paying a price for an extremely blinkered Minister who does not understand the public service or the health service terribly well, and at every stage seizes the private solution whether it is private hospitals or private companies managing relatively simple processes or running GP services. It is an easy solution, but it is not the right solution. To every difficult question, as HL Mencken stated, there is a quick, easy and wrong solution. The Minister has found the wrong solution yet again in this instance.

The Labour Party carried out a study of Deputy Harney's first year in office and I noted what she stated regarding these payments. On 14 April 2005 she stated, "I hope we will start to make repayments towards the end of the year, beginning in autumn. . .". That referred to autumn 2005. We now hear it will be July and into the autumn of this year before these repayments are made. It shows more lethargy, delay and prevarication.

Even when the Minister acts quickly, she does not get it right. When she introduced legislation after this scandal was unearthed, she refused to accept that constitutional issues were raised. It was as if a pigheadedness drove her and she continued regardless of the best advice given by this side of the House. Fortunately, the President referred the legislation to the Supreme Court where it was struck down quickly and new legislation had to be introduced. Even when she speeds up, the Minister does not seem to be successful or productive.

On a number of occasions, Deputy Twomey raised the issue of the rights of elderly people in private nursing homes. I agree with him that it is important to hear the Government's view on this issue. The previous Ombudsman, Kevin Murphy, produced a report in which he clearly stated that in his view a sizeable cohort of people are entitled to free care. Kevin Murphy came before the Oireachtas Committee on Health and Children and I remember asking about this matter. It was clearly flagged and that was quite a number of years ago. Mr. Murphy left office clear in his own mind that this was the case.

Since then, we have not heard from the Government what is its position or what is the advice of the Attorney General. What we do know is that cases are going through the courts and eventually the courts will make a decision and the Government will react. At that stage, another bill must be paid which, because of prolonged inaction, will be higher than it should be.

Debating an Estimate such as this also raises other issues regarding the care of the elderly. Many people were shocked by the extremely revealing RTE programme on Leas Cross. We tend not to think too much about what happens within nursing homes. Many nursing homes are excellent. My mother lived in a nursing home for a number of years and I pay tribute to all those who looked after her. They did a wonderful job.

However, without proper scrutiny we do not have the confidence to state in all cases our elderly are well looked after in nursing homes. I will quote the Tánaiste and Minister for Health and Children again. On 31 May 2005 she stated, "The relevant Bill to establish the social services inspectorate on a statutory basis to deal with both private and public nursing homes will be published later this year". The reality is this has been subsumed into another Bill and we have yet to see it. Inspections with prior notice to nursing home owners are not good enough. Inspections of public nursing homes are in-house in the sense they are not examined by an independent body. That is not good enough.

I do not want to pre-empt any investigation but in a recent case, Hannah Comber regrettably slipped in a chair and died from being choked by a restraining belt. A group has been established to investigate that case and I welcome that investigation. However, it seems indicative that all is not right in terms of ensuring the elderly are protected. I note a social worker is not in the group.

The point was made to me that clear guidelines are required on the use of restraining belts and restraints in psychiatric institutions or nursing homes. That point has certain validity. The Irish Association of Social Workers produced an ethical statement on the use of restraints in residential hospital and institutional care settings. The statement sets out clearly a framework whereby the use of restraints can be permitted in an ethical way which is protective of the patient. Will the Minister examine that short document to see whether these measures, which I imagine are commonplace when dealing with frail people or within the psychiatric services, are appropriate?

Reference must be made to another issue when discussing care for the elderly, which is community care and home care packages. This Government promotes itself as one which cares about the elderly. However, currently we have 41 public health nurse vacancies and 100 vacancies out of 280 public health doctor posts. We have fewer community nursing beds than we had in 1997 and Limerick has seen a reduction of approximately 60 beds. The reality is that community services for the elderly are shrinking.

Compared with Northern Ireland, we are a disgrace. Chiropody services are unavailable because chiropodists are effectively on strike regarding public patients. Chiropodists will not visit nursing homes and I fully understand why. What they are paid is pathetic. These are the type of quality of life services which elderly people require. One may wait eight or nine months for a visit from an occupational therapist to approve a disabled person's grant. That is the reality at community level and it must be addressed. Meanwhile, we put this money aside to pay our debts.

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