Dáil debates

Tuesday, 5 December 2006

Health (Nursing Homes) (Amendment) Bill 2006: Report Stage (Resumed)

 

7:00 pm

Seán Ryan (Dublin North, Labour)

I move amendment No. 17:

In page 12, lines 22 and 23, to delete all words from and including "a" in line 22 down to and including "Executive)" in line 23 and substitute "an independent person".

This is an important amendment, and at the outset I hope the Minister will take its principle on board. An appeal against a decision of the executive is to be heard by someone who could be an employee of the executive and who must comply with the guidelines set out by the executive, as relating to sections 7E(3) and 7E(4). It is important to make reference to these.

Section 7E(3) states "Where the Executive receives an appeal under subsection (1), it shall appoint a person (who may be an employee of the Executive) to consider the appeal." Section 7E(4) states,

The person appointed pursuant to subsection (2) to consider an appeal under subsection (1) shall—

(a) comply with guidelines issued by the Executive in respect of the procedure to be followed with respect to the consideration of any appeal,

(b) consider any written or oral objections made by the appellant in support of the appeal,

(c) make a decision ("relevant decision") in writing determining the appeal as soon as is practicable in all the circumstances of the case, and

(d) send a copy of the relevant decision to the relevant person and the Executive together with the person's reasons for the decision.

Comprehensive guidelines are set out within which the person will work. It should be noted that no independent appeals mechanism is in place. Since I entered this House, Bill after Bill has made reference to an appeals mechanism. Here we have a Bill which refers to the most vulnerable in our society, namely, elderly people who for the last two or three years of their lives will be confined to a nursing home because they do not have the provision or means to remain in their home environments where most would prefer to be. Through necessity they must enter either a public or private nursing home. A decision is then taken by the HSE for a particular reason that the person is not eligible for a miserly subvention of €114.30 for medium dependency, €152.40 for high dependency or €190.50 for maximum dependency. They are the levels of subvention.

Families of parents who over the years made huge sacrifices to educate them are told a public nursing home place is not available. This Government, notwithstanding its commitments in its manifesto and programme for Government that another 800 public nursing home beds would be provided, has not provided one. It is a shame on the Minister for State that this is the case.

Under this Bill, people will be told they will not be eligible for a miserly subvention. What is the situation throughout the country? I can tell the House what is the position in my constituency and in the greater Dublin area. The average rate for a nursing home bed in the Fingal area is between €800 and €900 per week. Where a high level of dependency is involved, the average weekly rate can be as much as €1,200 per week. This Bill states one can go through an appeals mechanism but no independent adjudicator will be involved. The executive or a nominated person from it will adjudicate on the appeal. This is a scandal. Show me another Bill which does not include an independent adjudicator. As far as I and the Labour Party are concerned, it is not acceptable that the most vulnerable in society and their families can be dealt with in this way.

Let us envisage an employee of the HSE designated by the chief executive to make an adjudication. Many people are of good standing. However, it is unfair to ask them to adjudicate in the first instance. Certain people, hopefully in a minority, could consider such a situation in light of the best way of climbing a career ladder. Will they adhere to the advice, recommendations and guidelines handed down by the executive to the letter of the law? They will be asked to make a judgment.

As I stated, an independent appeals mechanism is not in place nor is there an advocacy service for an appellant. Both services are proposed in other Bills. It would be better if they were in place before the Bill is enacted. This Bill is all the poorer without this amendment. This is about people having confidence that when they make an appeal it will be considered by someone in an objective manner and not as an employee of the chief executive. Such a person may be viewed as being there to implement the diktat of the executive.

It should be stated in the Bill that decisions of an appeals officer should be subject to a review by the Ombudsman. Why is the Ombudsman not referred to in this Bill? Perhaps the Department and Minister are afraid of the Ombudsman and have taken exception to decisions made by her over the years. The Ombudsman consistently stated with regard to issues relevant to older people that the Department broke the law. The Ombudsman is the one person who stood up for older people and the treatment they were afforded by the health boards in the past, and now the HSE. Why can we not have reference to the Ombudsman for further adjudication?

When we consider the situation of older people in its entirety and their rights and entitlements, it is obvious this Bill is not necessary. The guidelines in the Bill for an appeals officer state the financial assessment of an applicant's means will include all income and investments including life policies and any assets transferred within the previous five years for nominal consideration and up to 5% of the market value of one's house. I know the Minister of State does not like us getting back to this, but it is taken into consideration in the assessment of means.

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