Paudge Connolly (Cavan-Monaghan, Independent)

I welcome the opportunity to speak on this issue. The nursing home charges fiasco has turned into a major issue but it would have been a non-issue if there had been some honesty in high places. That is one of the tragedies of the whole process because there were people who knew that what was happening was a con or a deceit. While people do not mind paying for a bed, they do not like being conned. People I have met recognise that they do not get anything without paying for it. To add insult to injury, the instruction to the health boards was not to charge those creating a sufficiently big fuss, which was a serious deception and a very shabby way to treat a very vulnerable group of people at the end of their lives.

Last week the Minister of State, Deputy Seán Power, made a presentation to the Oireachtas Joint Committee on Health and Children during which he referred to different levels of return to people. I detected that this might refer to people who had been in mental health institutions or people of intellectual disability. I would like that issue clarified in the House today. I could not support such differences in repayment.

Deputy Ó Caoláin spoke about outsourcing, with which I also have major difficulties. When the contract was agreed with the Health Service Executive I have no doubt that no reference was made to the fact that part of the work would be sent to India. We have no way of knowing whether these people are paid 50 cent an hour. Is this another Gama? It sets a precedent which should be addressed. The work is not highly technical. Many students here could do this type of work during the summer and we would keep the money in the country. We cannot let this happen again.

Some people who had worked for health boards left and got their superannuation. When they had to return to work and repay their superannuation, the health board charged them a compound rate of interest, which was a severe penalty to those wanting to get back into the workforce and wanted to buy back their pension rights. People whose money was taken illegally are getting repayment which only reflects the consumer price index increase. There is a significant difference between these two cases. I would like some consistency with the Health Service Executive in terms of returning money.

The issue for most people is getting a nursing home or acute hospital bed when they are sick. If their lives are in danger, they need to be able to get a bed in an acute hospital. Upwards of 2,000 beds can be occupied by elderly people who are inappropriately left in general hospitals. A general hospital costs approximately €700 per day. However, if the patient is transferred to a nursing home, €700 would pay for a bed for a week. Despite this, we have difficulties with discharge. Nursing staff know that a significant issue when elderly patients are clinically fit for discharge is where to send them. Should they be sent home? Does the home need repair work? Do the patients need care hours which will cost? Obviously it would be much cheaper and more satisfactory for patients if that were delivered in their own homes. The major issue is that of subvention, which comes from a separate budget to that for hospitals. In-house fighting takes place in the health services. If those responsible for community-based services are not prepared to pay, the patient will be left in hospital occupying a bed.

Too often we hear of the negative aspects, which reflect badly on those working in nursing homes. We should acknowledge the brilliant work done by a large number of people in nursing homes. People feel that what happened in Leas Cross has reflected badly on staff in all nursing homes, which is not the case. Many very happy people are in nursing homes. When the Inspector of Mental Hospitals was due to visit a psychiatric hospital, it was notified approximately three months in advance which gave it the opportunity to put its best foot forward. Nursing home inspections should be unannounced and regular.

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