Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

I wish to share time with Deputy Joanna Tuffy.

This Bill has been long promised and long awaited. It has major implications not only for the care of older people but also, I believe, for our entire system of health and personal social services. While the Bill clarifies much that is very unclear in terms of the care entitlements of older people at present it also introduces a complex new system that is extremely problematic. My strong objection is that I believe it effectively removes the universal eligibility for a place in a public nursing home as provided for under the Health Act 1970.

The delay in publishing this legislation has caused great concern to older people and their families and left many thousands of people in doubt about how nursing home care will be provided and paid for. I regret to say that the system put in place by the Bill is certain to give rise to new concerns and will create new forms of inequity.

We know the statutory eligibility to a bed in a public nursing home has never been vindicated in terms of the provision of the resources to make those beds available. This has led to a huge reliance on the private nursing home sector and the current complex and inequitable system of State subsidy for nursing home care. Undoubtedly this had to change but I believe that the Government, in doing so, has gone in the wrong direction.

Simply put, if a person suffers a heart attack he or she is entitled to a bed free of charge in a public hospital. However, under this Bill if a person becomes so dependent — say from the effects of a stroke — that he or she needs constant care in a nursing home, his or her entitlement to a public bed free of charge is effectively gone and he or she must pay. The Minister will argue that the places have never been there and will not be there to provide full provision for universal entitlement but I emphasise that this is not the point. A fundamental shift is taking place and the implications for the entire health service are profound.

I was alarmed to find that the Bill as published was framed without consultation with older people and older people's organisations, including Age Action Ireland. I urge the Minister to study closely Age Action Ireland's detailed submission which all Deputies and Senators have now received. This submission and the many concerns about the Bill raised by others should cause the Minister to pause and reconsider before the legislation goes to Committee Stage and I urge her to do so.

To put this debate in context I refer to the report "Care for Older People" published by the National Economic and Social Forum in 2006. This report exposed how our system of care for our senior citizens is skewed towards residential options and how there is a funding bias towards nursing home subventions. It pointed to the lack of a general model of assessment and rehabilitation.

The figures in the 2006 report, which I doubt have changed much, make stark reading. The 5% of older people who are in long-stay care account for 55% of the overall budget for care of older people of approximately €1 billion. This State ranks lowest of the EU 15, the pre-enlargement grouping, in terms of social spending per older person. We spend one third of what Denmark spends per person aged over 65.

Describing the barriers to the development of community services for older people the NESF report referred to perverse investment incentives. The report stated:

The present official funding of services is not consistent with the policy objective of encouraging community-based responses; considerable resources are invested in nursing home care responses, some of which are unnecessary and inappropriate.

To speak plainly, we all know that the worst nightmare for the vast majority of older people, and any number of us may have to face this ourselves, is to have to leave their homes and enter long-term residential care. The best option is for people to be cared for in their homes with the help of their family, friends, neighbours and the health and social services provided by the State.

The Minister claims that the Government is providing for improved support for older people in their homes but the reality is that current provision is totally inadequate. Despite the claims of the Minister and the HSE the experience on the ground is that home help hours have remained static since 2007. Frequently, we receive reports of older people's home help hours being reduced or cut off entirely. Research carried out by the Irish Association of Social Workers this year exposed the lack of adequate provision of home help across the State as well as the cutting of hours. Every Deputy can attest to cases which fit this experience within their constituencies.

The NESF report identified the weakness of community care, the poor integration between systems and between sectors, under-resourcing, lack of responsiveness to the needs of older people, poor co-ordination and the fact that care is not embedded in local communities.

Community-based care requires resources and legislation. The Bill should have been a much more comprehensive piece of rights-based legislation setting out the entitlements of older people to all forms of care, in the home, in other community-based settings and in nursing homes. At the very least, there should be parallel legislation covering the range of care other than nursing home care.

The sad reality is that the inadequacy of support for older people to spend their twilight years in their own homes means more of them must avail of expensive nursing home care. It means more of them become ill and lose their independence. This short-sighted failure of successive Governments to provide the essential resources for community care ends up costing the State enormously in providing for long-term residential care.

Cost is a major issue with this Bill. Government policy has led to a catastrophic fall in revenue. How will the provisions in the Bill be funded in 2009 and subsequently? Will we face a long delay in its commencement? Most crucially, will we see the creation of a massive waiting list for nursing home care as people are assessed as being in need of such care and then find the places are not yet available?

Age Action Ireland asked a pertinent question, namely, how would such a list work? Would it be on the basis of first come first served or on the basis of need with those most urgently requiring care being accommodated first? Has this been worked out?

See this speech in context