Brian Lenihan Jnr (Dublin West, Fianna Fail)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"welcomes the largest ever expansion made by the Government in funding of services for older people by the provision of €110 million additional revenue funding in the Budget announcement for 2006 (€150 million full year cost);

supports the Government's commitment to introducing legislation in the near future which, inter alia, will establish the Social Services Inspectorate function on a statutory basis;

welcomes its commitment to extend the work of the Social Services Inspectorate to public and private nursing homes and to resource it accordingly;

notes the Government's commitment to ensuring that high quality care is made available to all patients in public, private and voluntary nursing homes, and in that context welcomes the preparation of standards for residential care settings for older people;

welcomes the HSE's provision of information to the general public on nursing homes and its policy decision to make nursing home inspection reports available on its website;

welcomes the HSE's provision of information to the general public on nursing homes and its policy decision that all completed inspections of nursing homes be made available to members of the public on request subject to Freedom of Information and Data Protection legislation;

welcomes the proposed implementation by the HSE of a common national approach to the inspection of nursing homes; and

commends its policy of supporting older people in their homes and communities in keeping with their stated wishes, and providing support to those who need residential care, and in that context, acknowledges the legal difficulties in the HSE publishing the Leas Cross Report".

I wish to share time with the Minister of State at the Department of Health and Children, Deputy Tim O'Malley.

I welcome this opportunity to address the House on these important issues. The Government has made a significant investment in the care of older persons and palliative care with the provision of €110 million in additional revenue funding in the budget announcement for 2006. The full year cost of that allocation is €150 million.

The Government is committed to maintaining older people in dignity and independence in their own homes, and in accordance with their wishes, for as long as possible and to provide a high quality of long-term residential care for older people when living at home is no longer possible.

It is internationally recognised that about 5% of the older population will eventually require long-term care. People are generally living longer these days, however, and even though most are leading healthy independent lives, the number of people in need of long-term care is increasing. There is a demand on long-stay places. It is imperative that the private nursing home places on offer are of a high enough and appropriate standard.

The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations 1993 set out the standards to which the private nursing home sector must adhere for the purpose of registration under the Health (Nursing Homes) Act 1990. These regulations apply only to the private nursing home sector and do not cover public long-stay facilities for older people.

There was a commitment in the health strategy, Quality and Fairness — A Health System for You, to extend the remit of the social services inspectorate to other social services, including residential services for older people. Legislation is therefore being prepared in the Department to provide for the establishment of the Health Information and Quality Authority and the establishment of the social services inspectorate function, as part of the authority, on a statutory basis.

Public consultation on the draft heads and general scheme of a Bill providing for the establishment of the Health Information and Quality Authority has been carried out. Included in the scheme is provision for the establishment of the office of the chief inspector of social services within the authority. The office of the chief inspector will be assigned responsibility for the inspection of residential services for older people, including public nursing homes. The Minister intends to seek Government approval as soon as possible to commence drafting the full Bill. The Minister intends to publish the Bill during the autumn session.

The Health Service Executive national care group manager for older persons services established a national nursing homes steering committee in July 2005. One of the priority tasks outlined for this committee was the standardisation of inspection documentation to make the information on inspections more transparent and more easily understood by nursing home proprietors and the general public. At the time, there were several different reporting templates in use across the country. The HSE nursing home inspection and registration teams use a standardised reporting template on an interim basis. The inspection report is based on the standards and criteria laid down in the Health (Nursing Homes) Act 1990 and the Nursing Homes (Care and Welfare) Regulations 1993. The HSE has commenced publishing these reports on its website.

The decision to publish nursing home inspection reports followed considerable consultation within the HSE and with representatives of nursing homes organisations. The nursing homes organisations have broadly welcomed this initiative. Nursing homes are required to be registered by the HSE. Registration certificates must be placed in a prominent position in nursing homes. If a registration has certain conditions attached to it, these will be displayed on the registration certificate.

When it is necessary for older people to move into long-term residential care, it is important that these older people have a choice of top quality nursing home care. For this reason, the Department has established a working group to develop the standards for residential care settings for older people. Membership of the group comprises officials from the Department, the HSE, the social services inspectorate and the Irish Health Service Accreditation Board. The group has commenced and developed draft standards for the inspection of public and private residential care for older people. It is intended that these draft standards will be the subject of a public consultation process in the coming months.

In addition, the Irish Health Service Accreditation Board has examined the development of accreditation standards for public and private residential care for older people. The Government's commitment to the development of a comprehensive range of services for older people and palliative care can be demonstrated clearly by outlining the considerable increase in resources made available in recent years for service developments. This has resulted in a major improvement in home and community-based support for older people. A comprehensive health and social care service is being developed, in a way that is reliable and that respects and values older people.

This is the largest ever increase in funding for services for older people. These initiatives set out the Government's continued commitment to older people and putting older people at the centre of health policy now and in the future. The investment package is focused on caring for people at home, in accordance with their expressed wishes. It is a major step in focusing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and reflects the growing independence of older people who want to stay living in their communities.

It is right that we should devote substantial additional resources to services for older people. They have made a great contribution to our society and to our current economic and social success. In this way, we are saying that the next generations value their contribution and will respect their needs and their continuing role in our society.

This new investment involves additional resources of €150 million in a full year with €110 million in 2006 and €40 million more the following year. Reflecting the new emphasis on home and day care, almost three quarters of the full year costs are being committed to community care supports. This investment is a response by the Government to older peoples' preference for being cared for at home rather than going into residential care. That may often require some additional home help or more developed home support, including various therapy services. All the evidence shows that families caring for elderly relatives continue to provide care in partnership with the support services put in place for those that require it. It is estimated that 28% of nursing home residents have a low to moderate dependency level and many of these residents might well have continued to live at home if the right supports had been made available to them at the appropriate time.

The budget day package provided for a number of initiatives including home care support packages which deliver a wide range of services and have been piloted successfully in several regions in recent years. They include the services of nurses, home care attendants, home helps and various therapists including physiotherapists and occupational therapists. A home care package will vary according to the care needs of the person so that, for example, there might be a greater emphasis in some packages on home care assistants while other packages may require a greater level of therapy and nursing.

The priority is older people living in the community or who are inpatients in an acute hospital and who without this support would need to be admitted to long-term care. The home care packages are also available to older people who have been admitted to long-term care and wish to return to the community. In addition, the packages will be offered to people who are already using existing core services, such as home help, but need more assistance to continue to live in their community.

The packages are delivered through the HSE, by a range of providers including the executive, voluntary groups and the private sector. The scheme is intended to be as flexible as possible and highly responsive to the real needs of the individual so that where a family or friends of an older person wish to provide these services, they will be encouraged to do so, with support, and linking in with the HSE, voluntary or private sectors.

Approximately 1,100 home care packages were provided to people at the end of 2005. By the end of this year a total of 2,000 additional home care packages will have been provided. The 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a temporary care package. The major thrust of this initiative is to be directed at older people.

Home helps are an essential part of supporting older people at home and thereby delaying or preventing admission to long-stay residential care. They also help to keep people out of acute hospitals or help their early discharge from hospitals. There is a continuing demand for home helps because of the increased number of older people. An additional €33 million full year cost has now been allocated for this programme, €30 million of which is for 2006. This represents a significant increase over the Estimates provision of €112 million for 2005 and is used to provide 1.75 million more home help hours.

Day care and respite care centres are an integral part of delivering a comprehensive community service for older people. The service provided may include a mid-day meal, bath, physiotherapy, occupational therapy, chiropody, laundry, hairdressing, social contact among older people, respite for family members and carers and social stimulation in a safe environment for older people with mild forms of dementia.

The provision of €9 million in a full year allows for an additional 1,325 places per week in such centres. The number of older people who will benefit from these new places will be substantially more than 1,325 since, over the whole year, one place can provide a service for more than one person. The investment of €9 million allows for additional programmes for specific needs such as activity therapy. It will also mean that many day care centres can open for five or seven days a week, rather than two or three days as was often the case. There is an investment of €7 million in 2006 with the balance of €2 million being provided the following year.

There is a significant increase in the resources available to the meals on wheels service. An additional €2.5 million has been provided in 2006 together with a further €2.5 million in 2007. This is part of the range of services which help support older people to continue living in their own homes.

The Government strongly supports the development of sheltered housing accommodation for older people, as it provides a real alternative to residential care and reflects the desire of older people to live with as much independence as possible. Some €1 million will be allocated in support of the development of sheltered housing, split evenly between 2006 and 2007, to provide frontline health service support for sheltered housing, such as therapists and public health nurses.

I would like to speak about the development of the nursing home subvention scheme and the provision of additional long-stay bed capacity. Some €20 million is being allocated under the scheme for residents of private nursing homes. This represents an increase of 14% on 2005, when there was an estimated spend of €140 million. The €20 million to which I referred will be used to support the increasing numbers of people who are entitled to basic nursing home subvention, to reduce the waiting lists for enhanced subventions and to bring greater consistency to the different levels of enhanced subvention support throughout the country. Some €8 million is being provided to cover the cost of 250 additional nursing home beds which the HSE has sourced from private nursing homes. Some €9 million was provided in this year's budget for specialist palliative care, including home care and community initiatives. This allocation includes funding for 24 additional extended care beds in Our Lady's Hospice in Harold's Cross. A further €4 million is being allocated in 2007 to develop palliative care services, which amounts to a full-year cost of €13 million.

It is clear from the budget day package that the Government is firmly committed to developing services for older people. The emphasis on developing home care packages and the increases in the home help and meals on wheels schemes and other community-based supports are assisting older people to remain in their homes and communities for longer, in accordance with their wishes. As I have said, additional funding has been provided under the nursing home subvention scheme to support the increasing numbers of people who are entitled to subvention and to reduce waiting lists for enhanced subvention. The issue of the staffing resources needed by the statutory inspectorate is being explored by the stakeholders in the overall context of ensuring that standards are met and health service staff are utilised in the most effective way.

The motion before the House deals with Professor O'Neill's report into the deaths at Leas Cross nursing home and refers to the question of an independent inspection regime. It highlights a lack of information and transparency in respect of the standards which apply to nursing homes. I spoke earlier about the Government's commitment to introduce legislation establishing a social services inspectorate that will inspect all residential centres for older people, including public centres. The failure to publish Professor O'Neill's report cannot be attributed to the Government as it is not a function of the Government to publish such a report.

See this speech in context