Jan O'Sullivan (Limerick East, Labour)

This legislation will be welcomed by people who have been struggling to pay nursing home bills they simply cannot afford. There are many families who have been looking forward to this legislation for a long time. However, the Labour Party has serious concerns about the legislation on a number of fronts and I propose to outline those concerns.

There is no doubt that the current situation cannot be sustained and in that regard we support the Government. However, there are aspects of the Bill that we cannot support. It is true that people who happen to live in different parts of the country or happen to be in a private rather than public nursing home are being treated differently in terms of the amount of money they must pay, even though they are in the same economic circumstances and have the same health needs. Clearly, that is unsustainable and wrong. In that regard, the Bill will improve their situation. It will alleviate the worry, concern and fear in many families.

However, this is not the legislation we were expecting after the fair deal was first announced. It still contains the elements the Labour Party signalled its concern about some time ago. Our concerns are based mainly on four aspects of the Bill. I will summarise them before discussing them in detail. The first is the removal of people's automatic right to universal health care under the Health Act 1970. Basically, people who need long-term residential care will be treated differently from the rest of the population, and most of those people will be senior citizens. The Irish Senior Citizens' Parliament and Age Action Ireland have strongly indicated their concerns in that regard. The Minister said today that this only represents one in 20 of the population. Why should that one person in 20 be treated differently from everybody else?

Age Action Ireland put the argument well when it stated that the legislation sounds the death knell of the public bed for those who need a residential nursing home bed, and that it also means the introduction, for the first time in the Irish health service, of a charge beyond the grave for essential health care services. The organisation went on to state that if this legislation is passed, it will mean that those who have conditions such as dementia and stroke will be treated differently from those who have heart attacks and cancer. We must be concerned when legislation such as this is introduced because we are, in effect, treating different elderly people differently, depending on the condition from which they suffer. The Labour Party is committed to a universal system of health care whereby everybody is treated the same irrespective of income and age. That is our first major concern about this legislation.

The second concern relates to the family home. We considered the original proposals unconstitutional because they involved the family home in the payment for long-term care. The Minister has been quite clever in this legislation in that people will be allowed to choose not to take the option of payment after the grave. However, if one does not take that option, one must come up with the money anyway. It is something of a Hobson's choice and it still means families will have to include up to 15% of the value of the family home in terms of how they are assessed for long-term care. Again, the Labour Party has a principled objection to this which I will discuss in more detail later. I will also raise questions similar to those raised by Deputy Reilly with regard to members of a family who do not fulfil the quite strict criteria outlined in page 25 of the Bill regarding the type of families that can have a deferred payment.

The third concern is the issue of the scheme being resource capped. This is a serious concern. It means, as the Minister said, that the person has an eligibility rather than an entitlement. In other words, if the money is not available, one does not get the service. This is a matter the Labour Party raised when the Disability Bill and the Education for Persons with Special Educational Needs Bill were going through the Oireachtas. It has been proved with both those legislative measures that if money is tight, the service need not be provided. That is not good enough for our senior citizens and future senior citizens.

In that context, I am particularly concerned for the future because it has been estimated that there will be more than 800,000 people over the age of 65 by 2025. Obviously, not all those people will require nursing home care; the percentages will probably be somewhat similar to the current ones. In fact, I hope they will be less because by that time I hope a great deal more money will have been put into providing care in the community and allowing people to stay in their homes. So far, however, there is no evidence of that when one sees the cutbacks in home help hours. There is no evidence that money is being put where the Minister's mouth is, if I may say so, in terms of transferring resources to community care.

According to an article in the Health Plus section of The Irish Times, there is an estimate from the Bank of Ireland, of all places, suggesting that 10,000 new nursing home beds will have to become available over the next ten years, at an average cost of €100,000 per bed. There is, therefore, a projected large increase in the population that is likely to need long-term residential care. If the scheme is resource capped, how will we fund this? I urge the Minister to address this issue. While people might think it a good idea that they will only have to pay 80% of their income and resources to have the security of long-term care, by providing for the scheme to be resource capped, that will not be the case and many families might be squeezed out simply because the HSE runs out of money. That is a serious concern for the Labour Party.

The fourth concern is about the assessments. It is not clear from the Bill who will qualify and who will not. Age Action Ireland has also raised this point. The section on assessment is quite woolly as to how one does or does not qualify. At present, a large percentage of people in nursing homes are assessed as being medium or low dependency. I do not know if people in that category will qualify under the proposed assessment provisions. If they do qualify, will there be places for them? If they do not qualify and cannot afford to pay for care and if they do not have the supports they require in the community, what will happen to them? It seems from reading the legislation that one would have to be deemed very dependent in any assessment to qualify. There are issues with the assessment, such as the way the money is calculated, on which I will elaborate later. I wish to make clear at this stage that the Labour Party is not disposed to support the legislation on these grounds. If we can substantially amend the legislation and address these other issues our position may change, but we are not in a position to support it as it stands. I am aware the Minister will have an opportunity to reply at the end of Second Stage and I will listen carefully to her comments.

There are several other issues I wish to raise including the matter of consultation. I referred to Age Action Ireland and the Irish Senior Citizens Parliament, but there are several other bodies with concerns about the legislation. When the legislation was delayed last January, we were told the reason was to allow for consultation. However these groups told us they were not consulted. It was then further delayed for a variety of legal reasons and it is finally before the House today. The Bill is not long published. We received a very detailed submission from Age Action Ireland with which we will inform ourselves. It is important that these bodies, especially the two national organisations which represent several other affiliated organisations, have their voices heard before any final decision is made on the legislation. I presume these groups can attend on Committee Stage and I will raise this matter at the Joint Committee on Health and Children, but it is very important these organisations are heard.

The Health Information and Quality Authority, HIQA, is working on the matter of standards and I assume these will be published before the end of this year. It is important they are in place alongside the legislation to ensure a level playing field for all nursing homes. If a family is deciding on a nursing home for a loved one, they must be satisfied that it fulfils all standards including quality of care, cleanliness, and other issues of concern. Will the Minister clarify that the standards will be in place? Deputy Reilly remarked on the need for the body charged with the implementation of the standards to have teeth, given the history at Leas Cross Nursing Home and concerns raised about several other nursing homes throughout the country. I recognise the vast majority of nursing homes do a very good job. However, we must ensure those which do not are not permitted to take patients under this legislation. We must ensure the standards are in place.

I raise a concern about patients in acute beds, as it is not clear how this matter will be addressed in the legislation. There are many patients in acute hospitals in the country ready for discharge, but who cannot be discharged because there is no place for them. This is because there are no supports in place in the community or there are no places available in either a public or a private nursing home. The legislation seems to indicate that if these people are not moved out of the acute beds within a certain period of time, a charge will apply. It seems such people are treated as if they are in a private nursing home under the legislation. What happens in the case of a person who, through no fault of his or her own, cannot move from an acute bed? Such a person may be there because of a capping of the resources or because he or she cannot afford to pay for private care, but he or she is not there by choice. We all understand it would be a better use of resources if such a person is cared for at the appropriate level. However, if there is no other option to an acute bed, I wish to ensure a charge will not apply under the legislation.

It is not clear from the legislation how palliative care is catered for, and whether it is deemed different from other types of care. There are hospices throughout the country which do a wonderful job. Will the Minister ensure people in palliative care will not be subject to any additional charges, especially in the case of someone in care for an extended period of time?

I return to the four main points of my contribution, including the removal of rights under the Health Act 1970. Age Action Ireland referred to this and I expressed the concern of the Labour Party and its wish to ensure the protection of the right to health care under the Act. The withdrawal of this right amounts to treating senior citizens and others in need of long-term residential care differently from other members of the community, which is wrong. I wish to put down a marker as there is a principle involved and if it is broken with this legislation, it could be broken in other ways also.

It seems the provision of public beds will be overtaken by the provision of private beds under the legislation. There is an increasing number of private nursing homes fulfilling the demand, but there is a very good service in public institutions. Most people, including those in my area, say the level of care in public institutions is very high. There is a more intensive nursing presence in such institutions than in private nursing homes and I do not wish to see this thrown away.

There is an incentive in the legislation to reduce the number of public beds, to make fewer available in future and to depend on the private sector. I am conscious of the Minister's general position in depending on the private sector. The Labour Party fundamentally disagrees with this view, whether in respect of co-located hospitals, home care packages or whatever. The Labour Party is very concerned at the growing use of the private sector in health care. I referred to this yesterday in the debate on the cervical cancer vaccination programme. A sum of €15 million was given to a private company as part of the health repayment scheme. The work involved in sending letters to in excess of 5,000 patients who had X-rays reviewed in the north east was farmed out to a private company. Throughout the health sector there is more and more of a move from public to private service provision, to which the Labour Party fundamentally objects. We wish to ensure that in the nursing home sector public beds of a high quality will continue to be provided for senior citizens.

The matter of assessment is referred to in the document we received from the Library. I thank the library staff for the detailed research done and for the document circulated to all Deputies, which is very useful. Outlining the position on assessment and dependency, the document states that "the Interdepartmental Working Group in 2006, for instance, reported that approximately 30% of residents in long-term care were classified as medium to low dependency". What happens to such people? The document also refers to enhancing tailor-made home and community services. It quotes from a study carried out in 2006, comparing Ireland to the United Kingdom, Finland and the Netherlands. It indicates Ireland has a relatively underdeveloped and poorly co-ordinated community care service, of which we are all aware from dealing with patients in the community. My two Labour Party colleagues from County Kildare, namely, Deputies Jack Wall and Emmet Stagg, have brought to my attention on several occasions the cutbacks in the home help service in that county. The necessary level of resources are not available in the community. I acknowledge that home care packages have helped in some areas, but not others. Serious problems have been caused for patients where home care packages have taken funding from traditional home help services.

Will the Minister ensure there will be services for those who are considered of a low enough dependency that they can be catered for in the community? Otherwise, those people will be caught in the middle of this. They will not be dependent enough to qualify under this Bill, and there may not be the full service in the community that they need. The Minister has often had good ideas for the health sector, and I have supported some of them, including her wish to transfer patients from acute care to community care where possible. The reality is that the resources are not always there. When people are in the community and are assessed to be suitable for care in the community, the resources should be there for them.

I had a query about the way in which the family home is treated in the Bill. The Labour Party made clear its serious concern about including the family home in obtaining payment for this. The Minister has cleverly got around the legal issue by making it voluntary, but in effect, it is not voluntary because if a person does not have the money, then he or she will have to take this option. For up to 15% of the cost of the family home, payment can be deferred until after the death of the person concerned. It can be deferred further if the person is in a certain category outlined clearly in the Bill. The Bill lists the following people who qualify — a child of the person in respect of whom payment of ancillary State support was made, when such a child is less than 21 years; a relative of a person in respect of whom the payment of ancillary State support was made, and who is in receipt of different types of pensions and so on, and whose total income is not more than the maximum income of State pension; and other similar cases.

The query I received was from a man who lives with his elderly mother, and the letter states:

I really do not know my position vis-À-vis my elderly mother of 93 years, and would be grateful if you could enlighten me. I noted your name and comments recently concerning the fair deal nursing homes. I am a man of 59 years, living with my mother, having a joint ownership in the family home, my only home and property. Could you please inform me in simple terms my position, should my mother require nursing home care? She is in receipt of a State pension. Must the levy of 5% be incurred? I really do not know. I am a divorced man, having no interest in any other property. Any assistance or direction welcome.

That man does not have any protection under this Bill as I read it. When his mother dies — I assume she will die before him, as she is 93 and he is 59 — what happens to this man and his home?

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