Thomas Byrne (Meath East, Fianna Fail)

I thought I would never see the day when I would come here to support this legislation in the House. My first encounter with the fair deal was at a meeting before the election at which I got a lot of flak from people about the scheme. At the time I defended it because, having examined it, I felt instinctively that it was a great scheme. My view has been confirmed by my experience as a Deputy since the election. Constituents seeking subventions or subvention increases are anxiously awaiting the introduction of this scheme. The assets and savings of most of them have been almost completely depleted at this stage, whereas they will now qualify for subvention as they have no money left. They want this fair deal to come in as a result of this Bill being passed into law. I am sure members of the public are telling other parties that also, which is why, although they may not be totally in favour of the legislation, the level of opposition is not the same as before.

The Bill presents an opportunity to greatly improve the nursing home system. By adopting a new scheme we can help to fix many of the problems we see daily, as elected representatives. It is great to talk about free public nursing homes but they cannot cater for everybody. In my constituency, St. Joseph's in Trim serves County Meath very well. In addition, St. Mary's in Drogheda, which used to serve part of Meath, now does a good job in serving County Louth. There are plenty of Meath people in it. The reality, however, is that such homes are not available to everyone who wishes to avail of their services and that is where the private sector comes in, although there have been difficulties with it. Some Deputies have done a good job in exposing the problems associated with certain nursing homes. By and large, however, private nursing homes I have visited are of a high standard and provide much needed employment in my constituency. The Minister visited one such extended care facility in Stamullen, County Meath, and was welcomed to the constituency on that occasion. It is a great facility and I know many of those who operate it as well as those who live there.

Our current nursing home system is broken and inconsistent. One cannot advise people with any degree of certainty what subvention they might get. There seems to be a huge discretion among the various HSE areas. I do not accept the contention that this is the first time the family home has been taken into account. Why would we be looking for valuations of family homes as things currently stand, which we regularly have to do? Why do people feel they must sell or transfer the family home, worry about their savings or throw their assets away? Nonetheless, it is happening all the time and causes much stress and strain. At my first clinic this evening after leaving the Dáil, the first person I am due to see is someone whose husband is going into a nursing home. Such homes are very important and have a major impact on the general health service.

Currently, there are 25 patients in Our Lady of Lourdes Hospital in Drogheda who should be in nursing homes. Their families do not want them to stay in hospital, but the cost of private nursing homes coupled with the lack of beds in the public sector — even though we do our best — and the uncertainty over applications are all causes for concern. When people hear the term "nursing home subvention" a lot of fear generated, which can cause delays. If the people in Our Lady of Lourdes Hospital who should be in nursing homes, many of whom I know, can get the financial certainty they need to move into the nursing home system, it would have a dramatic effect on the hospital system in the north east. That system is under pressure at the moment, although the bed managers are doing great work. However, people are there who should be in nursing homes because the hospital cannot do anything more for them. The fair deal will not only have a positive financial impact on families but also on the general health system.

Older people in need of nursing home care face vastly different costs depending on whether they are in the private or public sector. This also applies to their families. In public nursing homes they pay a flat-rate contribution regardless of affordability. In fairness, however, I would have thought most people who could afford private nursing home care are probably not in the public sector. That is my understanding, although I am open to correction. Many older people who choose to go into private nursing homes receive minimal or no financial support from the State, even though prices are rising all the time. Even those who do get help from the State often cannot afford to pay the rest because the subvention only goes so far.

There is also the question of the HSE staff's discretion in this matter. Certain people often give out about HSE staff but I do not. The HSE staff in my constituency who deal with the administration of nursing home subventions are run off their feet, so they deserve credit. The HSE is always slammed for being too fat and perhaps there are people there who, as Professor Drumm said, have nothing to do. However, the ones with whom I deal daily, whether for subvention or home help, are working hard and effectively. They are working within the resources the Government is making available to them, which are not unlimited. I am grateful to the HSE's administrative staff in my area who do great work.

No families want the stress of dealing with subvention, which is an unfair and complicated system. If we can fix the system with this legislation we can make life easier and fairer for nursing home residents and their families. People really require clarity in this regard. By now, we know that the system has to be changed and made fair and understandable. There are approximately 21,200 people in nursing homes and this figure will grow. It may be as a result of the property downturn, but there are quite a number of planning applications for nursing homes in my constituency. One of them was granted recently beside where I live and I welcome that because it will provide good quality employment for nurses, care assistants and administrative staff.

Many people moved to east Meath in their 50s when their families were reared and some of them will require nursing home care, so we must have such facilities for them. I welcome the investment that has been made in that area. In 2036, it is estimated that there will be about 44,000 patients in long-term care. It is often forgotten in the debate on our health services that people are living longer than ever before. The health service must be doing something right therefore although that is never acknowledged.

Last year, the State spent approximately €648 million on long-term care. This year alone it is projected that the Government will spend €1 billion on nursing homes. In 20 years the cost of nursing homes will treble. With this amount of money at stake, it is important to ensure it is spent wisely and goes to help those who need it. We would like to see everyone being entitled to such facilities but there is only so much money in the kitty. The Government's role is to ensure it is spent as wisely and fairly as possible. I welcome the provision in the Estimates for this nursing homes support scheme.

I understand there have been no major changes to the nursing home system in the past 40 years. The Health Act 1970 introduced serious reforms, including the right to free health care, but that is not the reality in the nursing home sector given the available resources. Public nursing homes are doing a great job but they must be supplemented by the private sector. It is more efficient for the State to do that. The public and private sectors will be treated equally under the terms of this legislation, so it is as good a deal as one could imagine without significantly increasing the tax burden to pay for it.

When passed, the Bill will ensure that all nursing home patients and their families are given a fair deal. The system will ensure that everyone's contribution will be fair, because it can be unaffordable at present. I have seen cases where, in addition to the subvention, people have to make up €300 or €400 per week on top of their parent's income, which is usually a State pension and savings. It is a difficult burden for families to bear. It involves a lot of money every week when such families are already under severe financial pressure, which is getting worse due to the downturn nationally and internationally. Under the new scheme people will only have to pay what they can afford and this is very important. People I have spoken to about the 5% to 15% annual claw-back, I do not know the official term for it, seem to be quite happy about it. I explain to people that 15% is the maximum. There are variations, such as when both members of a couple go into care. Deputy Jan O'Sullivan's query raises what appears to be a difficult situation but it seems to be covered by section 20 of the Bill, as the Minister said in her speech. We all know cases like this and they can be discussed on Committee Stage; I am sure the Minister will be open to suggested improvements to the legislation.

People will not be forced to sell their homes to pay for care under this Bill, contrary to what has been said during this debate. People are stressed and worried at the moment and many are having their family homes valued. Many old people are currently forced to sell their homes to pay for care because they only receive a certain amount of subvention. I know a constituent whose savings are running out and who is considering this option but I told him to hang on until this deal comes in. The sooner it does, the better for all. The new Bill will ensure people will not be forced to sell their homes.

Moving into a nursing home is a difficult transition for old people and they do not need the extra stress of selling their houses. Their families do not need this stress either, as it is they who usually bear the burden. This matter affects not only old people but young people too. The Minister visited the Redwood care facility in Stamullen during the summer and there is a mixture of young and old people staying there as people need long-term care for various reasons; they are covered by this Bill and that is important. St. Clare's Nursing Home is also in that area.

It is understandable that concerns about this scheme have been expressed by patients, families and Age Action Ireland. I would have expected Age Action Ireland to suggest areas for improvement. However, some of the reaction to the Bill when it was first announced was over the top and it was not given a fair hearing. It was suggested that people's houses would be taken when the reality for many residents of nursing homes was that day had already passed. It is important we ensure that people understand how the new scheme will affect them. In fairness to the Department of Health and Children, much of the documentation that was issued was very clear and self-explanatory. People understood this documentation and the concepts of 80% and 5% per annum. Technical areas cover all of the individual cases and can explain them.

Costs will go down significantly for patients and, more importantly, for families. Nobody will ever be asked to pay more than the actual cost of the care received and, for those currently receiving subventions, in most cases they will go up under the new plan. It is extremely important that the State gives all nursing home patients a fair deal and the new scheme is fair and consistent. The Nursing Homes Support Scheme Bill will ensure no pensioners in need of nursing home care will be forced to sell their homes. Passing this law will ensure that nursing home patients in Ireland are given the best care and a fair deal. The HSE has concerns about standards in some of its centres and much work must be done in this regard.

It should be noted that various studies over many years have examined how we pay for nursing home care. This issue has been debated for many years and the Library and Research Service has produced a fantastic digest for the Nursing Homes Support Scheme Bill. This has been of use to me and could be of use to Deputies across the House. There is an interesting discussion in that paper of the various approaches that have been looked at over the years and could be adopted to fund nursing home care. Various reports, including the Mercer report and that of the inter-departmental group, looked at taxation, higher pay related social insurance, PRSI, and earmark taxation, like another health levy. Estate taxes seem logical but it was felt they would not attract sufficient broad support. The scheme we have today is the equivalent of an estate tax, but it is fair and not simply a charge of the full costs of nursing home care. In many cases the charge will be a significant fraction of the full cost and I think we have achieved a good balance.

I welcome the Bill and the opportunity to speak on it. I look forward to the Minister and Ministers of State, including the Minister of State at the Department of Health and Children, Deputy Barry Andrews, working hard to pass it as soon as possible, get the scheme up and running and give security to patients and families alike.

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