Séamus Healy (Tipperary South, Independent)

I welcome the debate and I welcome the Bill, which is long awaited and not before time. In recent times disturbing reports and details have emerged from private nursing homes and there is no doubt a robust inspection system is urgently needed. I believe the operators of private nursing homes and public hospitals will generally welcome the legislation and the regulations that will arise from it.

There is a sense in which both Government and Opposition want the legislation to pass through the House as quickly as possible but it must be considered in detail also. While the detailed forensic examination of the Bill is for Committee Stage, not for this debate where more general comment is appropriate, I welcome the Minister's intention to include a whistleblower section. There is no point in having world class high standards of legislation and regulation if we do not have the will and resources to implement the legislation and regulations. This has happened too often in the past. We have had good quality legislation and excellent regulations but little or no will or resources to implement them. I hope in this case the resources are provided and that the will is evident to implement the Bill when it becomes law.

A disturbing matter has come to my attention in recent weeks. Consequent on the Minister's indication that there would be an increase from 1 January in nursing home subvention, it appears nursing homes have routinely notified residents and their families of increased rates. This appears to be happening on a universal basis and one would wonder if the word "cartel" might be appropriate to what is taking place. The effect is that the increase in subvention will have little or no positive effect for most residents of nursing homes. I bring this to the attention of the Minister of State, Deputy Seán Power, who might consider the situation to find what might be done in this regard.

As I noted, this debate is for more general comment. We have repeatedly heard during the course of the debate the phrase "so much money has been put into the health service". Of course, if this is said often enough, it becomes a "fact", whereas the real facts are that we are not funding health services to even average EU levels and there is a major deficit due to under-funding in the past 20 years. We are not providing enough finance for the health services, even as we speak. We have much time and funding to make up due to the deficiencies of past years.

On the question of reform, repeated reference has been made to one of the Minister's reforms. I must record my concern and those of many Opposition Members at the establishment of the Health Service Executive. We were concerned that it would not help the situation and, unfortunately, those fears have been confirmed. The HSE is more bureaucratic, more centralised, less accountable, less responsive and less transparent than the previous system ever was. There is no accountability to the public, local public representatives or the House, although the Minister told us when she was putting through the legislation that we could ask any question we liked and we would get an answer. That has not happened and will not happen.

This had led to an unfortunate situation where local health staff, particularly at managerial level, have effectively become paper pushers and the bureaucracy is significantly worse than ever before. An example of this comes from my constituency town of Carrick-on-Suir, which has been seeking an emergency ambulance service for years. It has been accepted by the local people and their doctors and public representatives, as well as ambulance and health service personnel, that the service is necessary. However, it has been found necessary to go through another paper exercise to satisfy the HSE, which must have another investigation. I am sure that in the months to come it will think up another investigation to ensure the service is not provided. The Minister must examine this matter to find whether it can be progressed. An emergency ambulance station is vitally needed in Carrick-on-Suir.

With regard to the elderly, we have heard for years that nursing homes and long-stay institutions must be a last resort, which is the case. Much lip service has been paid to this issue but there has been no prioritisation of the facilities and services needed to keep elderly people comfortably and securely at home in their communities. I welcome the involvement of voluntary organisations, which are of vital importance to the effort to keep elderly people at home. However, far too much work is left to such organisations. We need more home helps, not less, as was the case last year. We need more meals on wheels services, day-care centres and chiropody services, which are now non-existent for elderly people at home. There is an 18-month waiting list for elderly people to be seen for a simple thing like a hearing aid. The position is similar with regard to eye-testing, for which there is a 12-month waiting list, and the absence of laundry services is a further example. Such problems do not help to keep an elderly person at home but make him or her more dependent. These services need to be put in place in the community.

If we are not just paying lip service and are real about wanting to keep elderly people at home — secure, comfortable and involved in their local communities — we must put these services in place and make the necessary resources available. We should not leave this work completely to local voluntary organisations, such as those which complain to me that their FÁS workers are being withdrawn. It is not good enough. I suggest that if the Government wants to treat the elderly fairly and equitably, it must establish the necessary services in local communities and in their homes. This would be a cheaper option than residential care and it should be done.

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