Liz McManus (Wicklow, Labour)

I agree with Deputy Twomey. The Minister and the Department have not worked out a fair position on residential care for elderly people. There is a perception of action while the reality is that restrictive arrangements are in place on how people are assessed and unfair methods of assessment in terms of the family home.

The Minister for Health and Children is also promoting the idea that somehow all the issues raised by the Leas Cross nursing home have been resolved and a bright new day has arrived. If we look at the published standards, they are just photocopies of the British standards and there is no clear determination of staffing levels. I would expect that accommodation in the private nursing home sector will be improved — there are many excellent nursing homes — but in certain nursing homes, standards are not high enough and anything that is being done to improve accommodation is, of course, welcome. The sector, to be fair, has sought standards but when there are no staffing regulations to set baselines, it raises concerns about the protection of elderly people that have not been addressed by the Minister. In public nursing homes, the level and qualifications of staff are generally higher and probably more expensive than the private sector but the Minister and the HSE are relying to an ever greater degree on the private nursing home sector. The onus is on the Minister to set certain standards and she has ducked it, as did her predecessors.

We have already expressed our opposition to the family home being taken into account when assessing eligibility. This is unprecedented. The policy pursued by the Government of over-dependence on the private nursing home sector leads to severe anomalies in the acute hospital sector. Beaumont Hospital has more than 100 people inappropriately in hospital beds because they simply cannot move out of the acute hospital sector into step-down or nursing home care. That places extraordinary pressure on that hospital and it is not the only one in that situation. Patients are in hospital when they do not need to be but cannot move on because the nursing home beds do not exist in the local area. It is extraordinary that Government policy has been so remiss that in a part of the city with an older population there is far less capacity in private or public nursing homes than in other areas. In Bray there is good private nursing home capacity but our elderly population is not sizeable, it certainly does not compare with the north inner city.

There is a mismatch and the lack of Government planning to ensure proper provision of step-down and nursing home beds leads to problems in the acute hospital sector. I was shocked today to find that St. James's Hospital is cancelling operations for cardiac patients. This is a chronic crisis at St. James's Hospital and it demonstrates the Government's failure to provide capacity at acute hospital level and in the community.

The private nursing home sector has a role to play but that there is an over-reliance and a lack of planning to ensure that provision meets need. Ultimately that is not the fault of private nursing home owners because they have their own considerations; they are not charities, they are providing a service and people are paying for it. The HSE and the Minister must bear responsibility.

Looking at the inspectorate, which relates to the charges being levied by nursing homes, we can see complete inconsistency across the country. There are nursing homes where residents who have been living there for some time suddenly found the fees had rocketed because the inspectorate from the HSE determined that increased staffing levels are required. Extra costs must be borne by the owner who passes them on to the residents and their families. Many people are genuinely shocked by the increases which are as a direct result of the HSE inspectors determining that certain changes must be made in a nursing home. It may well be that those changes are necessary — I am not arguing that point. However, down the road in another county or region a completely different approach may be taken and private nursing homes may be protected from such pressure on costs. It is a bit of a mess.

I believe the Minister of State promised the interdepartmental review would be published in 2005 and yet we are still waiting for it. It is hard to have confidence in any proposals of the Minister of State to resolve the issue of care for the elderly. Most important is to determine the cost of such care in a fair way that does not attack the family home. We need to ensure that people are cared for in a way that recognises their dignity, with respect, and that recognises that they in their time paid taxes. Those rights are recognised when patients attend for acute care. Nobody assesses the value their family home before they access hospital care or if they qualify for a medical card. It is a unique arrangement that is causing great fear and trepidation. The Government's record is inadequate and I do not believe this legislation will ease the pain in any way.

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