John Dennehy (Cork South Central, Fianna Fail)

While making my contribution last night I made a few general points on the Bill, one being that health expenditure has increased fourfold over the past nine years. There is also a need to resolve the problems of vested interests in all disciplines, particularly in the orthodontic area. I indicated that the handling of the Neary inquiry by the peer group will probably be the catalyst for major changes in self-regulation by all professionals and that PPARS had failed to fully deliver primarily because of the existence of over 1,000 separate local agreements or arrangements relating to personnel etc.

These spell out a significant problem for any proposed reforms within the health service. Many other factors must change and are changing, including the behaviour towards consultants in the sector. The days of the God-like figure lording it over everyone, including junior staff, administrators and, most significantly, patients or clients, can no longer be tolerated. In the majority of cases, it is now possible to have a meaningful discussion with any consultant about one's case or that of a relative receiving attention.

Changes had to come about in that respect and, thankfully, that has happened. It should be said in passing that consultants will not be taken advantage of despite all these changes. They have an excellent trade union in place, although they are very shy about describing it as such. They have an excellent negotiating body and the outcome will be all right.

I have mentioned consultants several times during my contribution, primarily because I believe they are key players in the provision of services. It is important that they take part in these changes. Professor Drumm would tell us he is the holder of a common contract himself and knows the issues involved. Others at the coal face, be they nurses, general practitioners or pharmacists, will also need to be fully involved in any proposed changes. I know the head of the Labour Court made an appeal to people to be frank and agree to changes and the need for change.

I hope many of the issues, be they with the IMO, the consultants' body, or pharmacists, can be sorted out reasonably quickly. Some of the suggested agreements on the common contract, the medical card system, etc, have been going on for four or five years and this should not be happening in trade union matters. There should be a mechanism for dealing with it more quickly.

A rigorous inspection system for nursing homes will be introduced under the Bill and cover many types of residential care centres, forcing them to undergo a standard registration process. It will also establish parameters for their operation and registration details will be made public, an important point to ensure full transparency. We were reluctant to criticise some nursing homes on the basis that they were doing the job of the State in providing beds for elderly people. Such people should be cared for by the State where necessary.

Offences under the Bill will involve fines of up to €5,000 or imprisonment of up to 12 months and stronger sentences can be meted out. That is the extreme endgame and I hope there will be voluntary compliance with codes. As there will be a proper inspection regime in place, this will happen. People may forget that it was only in 1993 that the Health (Nursing Homes) Act came into effect and up until then there was no subsidy for anybody. People were in very distressing situations, particularly where only one person was able to contribute. In other cases, four or five family members could share the cost of a home.

Since the Act came into effect, much has happened and we have rightly become more critical of wrongdoings. A number of people who contributed to the debate last night indicated that the vast majority of people running nursing homes are doing so in a very capable and acceptable fashion. They are running a business and must make a profit to keep going, but they are doing a good job at the same time.

I have been involved with health boards for more than 20 years and one in particular — the former Southern Health Board. I have always been concerned about catch-all phrases such as care of the elderly which are used to cover a multitude of things. It is a lazy expression. We must break it down because it is handily used to lump a large proportion of the population into one group. We are afraid to get too personal about the people needing services for Alzheimer's disease or other geriatric conditions. A range of issues involve people who have exceeded 65 or 70 years of age or whatever is the target age with which we like to brand people. It is handy for administration to use a catch-all phrase.

Every Government of the past 30 years failed on this issue and I do not mind saying this. I stated here previously that as a long-serving Government Member, I felt guilty when a survey I requested from the Southern Health Board in 2001 indicated more than 200 extra beds were needed in the Cork area alone to care for the elderly. Despite all the arguing I did, people were let down and we must redress this failure.

A suggestion was made three or four years ago that four new homes would be provided in or near the city under public private partnership. It ran into difficulty with EUROSTAT, the control mechanism of spending by states. The Cork College of Music also ran into trouble with it. I believe it has now been resurrected. One site, located near County Hall, was bought from nuns and I expected work to begin four or five years ago. We need these centres and the State must be proactive in providing them.

Recent debate on this sector centred on the nursing home repayment scheme and the repayment of charges which the Supreme Court found to be illegally levied on elderly people. The debate should go well beyond this issue. Our primary objective should be to identify the form and level of care an elderly person should expect to receive when he or she requires it. The establishment of the information quality authority and the office of chief inspector should assist in this process. Approximately €105 million or €135 million was spent on nursing homes in 2005. It is a tiny element of the total expenditure of €23 billion. It is not a fair share of funding for elderly people. The rest is primarily spent on acute care.

We must always do more for older people in society, whether it is essential repairs to houses, home help packages or benefits for people living alone. The Government must continue to lead and show that older people remain a priority. Older people's groups have become more vocal and demanding and rightly so. They have become more organised and I welcome that; they should demand their fair share. Other groups have trade unions working for them and can negotiate. Members of both Houses of the Oireachtas represent these people and it is part of our job to continue to lobby for them whether it is within our parties, in the Chambers or elsewhere.

The new Health Information Quality Authority will be extremely important. People may take for granted the setting and monitoring of standards in the delivery of health and personal social services and assume a standard exists across the board. It does not. In two hours time at a meeting of the Committee of Public Accounts I will point out to Professor Drumm that when PPARS was first tried out, more than 1,000 agreements were in place throughout the eight health boards. This was a ludicrous situation. We need to have a standard throughout the country. Whether one lives in Cork, Dublin or Galway the standard applied should be equal. We must ensure this happens and it is hoped this is the start of that reform.

I mentioned the public orthodontic service and I make no excuse for returning to the matter. The sub-committee on orthodontics of the Joint Committee on Health and Children spent six months preparing a report on which we must act speedily. It is another area where vested interests have taken control.

Everyone involved in the supply of services must co-operate. We have turf wars in Dublin over the children's hospital. I am not qualified to comment on the correctness of the chosen location. The only hospital I have had involvement with is Crumlin children's hospital. We cannot afford to have turf wars on issues such as this. The parents of sick children are quite correct to state they do not care where the hospital is located and that it is urgently required.

It is not all bad news. A state-of-the-art maternity hospital was opened recently at Cork University Hospital. Progress can also be seen in the three other new units of various disciplines at the hospital. We must continue this throughout the country. I am concerned about rumours that cancer care services will not roll out as quickly as possible and I will also raise this with Professor Drumm.

Each week I see the site works at the South Infirmary-Victoria Hospital for the provision of BreastCheck. I am a member of the South Infirmary board. The information I received last week is that it is on cue. We must continue to co-operate to supply the services. Cork requires specialist paediatric equipment and diabetic services for young children, particularly if those children suffer from more than diabetes. The reform of the health package will help to deal with these issues.

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