Brendan Kenneally (Waterford, Fianna Fail)

I welcome the legislation. It was hoped it would come into effect from 1 January last, but that was not to be. I can well understand that, because it must be difficult to put together a ground-breaking Bill such as this. It is a novel way of doing things because it involves recouping in retrospect a portion of people's assets to pay for their nursing home care when they have passed on. This is a very reasonable and forward-thinking measure and should give our elderly peace of mind, because it allows them to delve into the value of their asset to ensure they will be properly cared for and looked after in their old age. This will be of great benefit and consolation to them and their families and while they will ultimately contribute financially to their years in a nursing home, it will not reduce in any way their standard of living or their feeling of security that they always have their family home to fall back on. It is a means by which people can have their cake and eat it.

I have no doubt there will be objections to the principle of this measure, but for the elderly themselves and for their families who otherwise would have to dig deep in their pockets, it allows the best of both worlds. True, the eventual inheritance may not be as large or as valuable as had been anticipated when the 5% levy for nursing home charges has been collected, but it gives the elderly a sense of security and independence they did not have before. In this instance, it is the elderly who are the priority.

The current situation is less than satisfactory and is not operating very well, with the result that there is a great deal of disquiet about it. It can be inequitable, selective and hit-and-miss. This is no way to treat a section of our society who have a right to a better outlook in life than this. I am unsure of the exact number of older people in private and public nursing homes, but based on earlier figures I saw, an estimate of 25,000 would be quite reasonable. This is a section of our population whose numbers will only increase in the future, so it is very important we get this legislation right and ensure that proper funding is available to look after these people in their twilight years.

The current level of subvention in my area has been quite low, and most applicants are seeking top-up payments and appealing the amount which has been granted to them. Invariably, these have failed. I have come across many families who are in genuine hardship trying to find the necessary funding to keep a parent in a private nursing home. There are many instances in which they do not have the money, and the HSE is just not providing sufficient funding for them to meet the associated costs. I have no doubt there are few in the House who do not consider this measure a priority, or who do not think the Bill should be given as much precedence as possible along its passage towards enactment.

In this country, we pride ourselves on cherishing the older generation and looking after older people in their declining years. I am not sure the reality matches our aspirations. We must be seen to look after the oldest and most vulnerable people in our society. We should be perceived to have the sensitivity and decency to give them the support, reassurance and stability they deserve after a lifetime of service to our society. I cannot over-emphasise how necessary it is for us to deal with this growing problem. This administrative dilemma can be resolved over time, with some discussion and a little ingenuity. It involves elderly people who may be suffering hardship, indignity and insecurity. It also involves concerned relatives who see no avenue open to them because they do not have the personal resources to fund care privately and cannot rely on the HSE. No proper policy is in place to resolve the dilemma they face.

This legislation has been due since the start of the year. The Bill will hardly be passed the end of the year. As hardship and indecisiveness persist in the meantime, the elderly will continue to suffer. Many children can do little to relieve their parents' distress or their own sense of helplessness. We must treat this as a greater priority. We all have the aspiration to live to old age. We look forward to the care and attention our families will give us personally, or arrange for us through professionals. We must understand that such care is being denied to many people at the moment. As legislators and as a Government, it behoves us to deal promptly with this problem. An adequate framework and sufficient resources are needed if elderly people and their families are to sleep easy in their beds at night without wondering where the necessary care will come from.

I know of many genuine cases of people who do not have sufficient funds to look after themselves or their parents in a proper and dignified manner. The HSE is not allocating sufficient funds to meet the growing crisis. I understand that the present financial climate is not helping the situation. I compliment the Taoiseach and the Cabinet for safely steering us, so far, through what has been a difficult situation, to say the least. It has been a nightmare for everyone. I realise that this uncertainty and instability will not help us to secure more resources. Equally, it is causing more problems and greater anxiety among the older and dependent population.

I heard a lady on the radio last week who used to have a modest income from some bank shares she inherited. This income gave her a financial cushion against hardship and the capacity to get a few additional necessities. Now that bank shares are on the floor, her cushion is gone. Not only has she lost the purchasing power that went with her small income, but she is more anxious about how she will cope in the future. As she is well into retirement, she wonders what her final years will bring. Who will provide for her care and needs in that insecure period of her life? As a taxpayer who spent her life making an investment in the State, she naturally feels she should be looked after now, at a time when she is unable to provide such care herself.

I am less than happy with the service our elderly are getting in this country. This is not the fault of the individuals who deliver the care. It does not result from any deliberate policy of neglect on the part of the State. Those who work in hospitals and nursing homes are excellent people. They are committed to their professions and living out their vocations. They would not be able to do their work, to the level they achieve, without a vocational interest and approach to it. The "county home" mentality has long gone, thankfully, and standards have improved immeasurably. However, we are unable to care for the number of people who require these services. This must be dealt with in an effective manner. We have not got it together in regard to our retired population. Successive Administrations have shied away from the problem. They have preferred to gloss over the situation and hope a solution would present itself. That has now happened, in the form of this progressive measure.

I thank and congratulate the Minister, Deputy Harney, for placing this issue firmly on the agenda. She has opened up debate, given the issue greater prominence and provided clarity. Those at the coal face can only go so far. The planning and provision of resources dictates a great deal of what happens. This Legislature and successive Governments have paid lip service to the problem without tackling it head-on or in depth. This must change. The introduction of this Bill gives us another opportunity to do so. In the third millennium and with the benefit of modern and progressive thinking, we can provide the resources and reassurance needed by our older generation. We need to take that element of worry from them, for once and for all. We all have our aspirations and principles with regard to the care of the older generation. It is not happening on the ground, however. We must make it happen now.

There are excellent carers in our hospitals and other caring institutions. There is no deficiency in that respect. We do not have a coherent policy or an integrated approach, however. To use a dreadful modern phrase, we do not have "joined-up thinking" in this area. We are not delivering the kind of service we would like or the level of care the elderly have a right to expect. Before the passage of this Bill is complete, we must have a clear pathway ahead. The blueprint the Bill provides for will be with us for years or decades to come. The legislation currently governing this area derives from the Health Act 1970, the Health (Nursing Homes) Act 1990 and the Health (Nursing Homes) (Amendment) Act 2007. We have visited the subject three times, never comprehensively or substantially, over the last 38 years. The Ireland of today is vastly different to the Ireland of the pre-EU days of 1970. We must sufficiently provide for whatever it takes to tidy up the situation as it stands.

It has been frequently acknowledged that there is a lack of clarity in respect of eligibility for nursing home care. I accept that everybody is entitled to such care in a public nursing home, regardless of their means. Not enough beds are available to cater for everyone, however. Where possible, people of advanced years or anyone else who needs care should be cared for in their own homes, regardless of their age. This can be facilitated by means of the provision of home help or regular visits from those who provide skilled nursing care. There does not appear to be as much emphasis on this point as there might be. I accept that efforts are being made in this respect, but implementation seems to be slow.

Health professionals have made it clear that our hospitals are not functioning near full capacity because beds are not being managed properly on a national basis. Patients who have undergone surgery should not be allowed to occupy a surgical bed beyond the number of days or hours professionally deemed necessary. Such a bed should be made available at the first opportunity for the next person who requires a procedure. That person should, in turn, vacate it quickly when the time comes. There are not enough beds lower down the scale of nursing care. As a result, there are people in high-care beds who should not be there. We learned a couple of weeks ago that a young girl is being housed in a hospital on a long-term basis, even though there is nothing wrong with her, because there is nowhere else for her to go. This is a scandal.

Systems need to be devised and implemented to ensure people do not occupy a bed above the level of priority they need. If greater use were made of home help and home nursing programmes, better use could be made of valuable, scarce and expensive hospital beds and waiting lists could be reduced. I do not doubt that health professionals would get a better sense of achievement from their work in circumstances of greater productivity. More importantly, people with painful, debilitating and dangerous conditions would receive care much earlier. Many people would have a higher chance of being cured and returning to normal life.

Everybody knows that the health service in this country is not working to full capacity, or with the level of competence of which it is capable. However, it would be facile to blame all our ills on the Minister, Deputy Harney, or the chief executive of the HSE. They have both worked diligently to reverse the trend, but have endured an uphill struggle against vested interests and entrenched positions. In volunteering for what must be the most difficult and politically suicidal portfolio in the Cabinet, the Minister did something that had never before been heard of in this country, or in many other countries for that matter. The chief executive officer, likewise, left a lucrative private medical practice, where he lived in relative obscurity and anonymity, to drink from the other side of the poisoned chalice that is the health service. In his budget address, the Minister for Finance made a call to patriotic action on the part of everyone. The two people at the forefront of the health service have already made that commitment publicly and at some personal sacrifice. We should all acknowledge that.

Many of the ills of our health service are deeply ingrained and were inherited from a previous generation. While a great deal of progress has been made in treating with different professions, there is still a distance to go. Moreover, there is a lack of consistency throughout the various regions in the application of criteria. While our health service operates on a nationwide basis, there are different approaches and practices in different areas. I am unsure what is happening in other community care areas throughout the State, for example, but I am certain there are many different interpretations of what the level of funding should be. I am sure the data would show that people elsewhere are receiving substantially more than those in the Waterford community care area.

The Bill provides for the care of the elderly at a cost of 5%, based on the value of the person's assets, usually the family home, to a maximum of 15% deferred until after the death of the patient. This addresses the main concern of people who are in and out of hospital or nursing home care, namely, whether their home will be there when they are ready to return to it. The Bill offers a vital guarantee for people who are already suffering deep anxiety and is, as I said earlier, the best of both worlds. However, some clarifications are required. For example, if three bachelor brothers living together in what was the family home all find themselves in need of nursing home care, will the maximum of 15% still apply in regard to their asset? It would seem excessive if it were to be otherwise. I am sure the Minister will clarify this point in her reply.

A detailed care needs assessment is provided for in section 7(6). This will standardise the criteria by which people are deemed eligible for the scheme. I am not generally in favour of means testing, but this particular scheme has no relation to money. There is a lengthy list of criteria which applicants must satisfy if they are to qualify for nursing home care, all of which seem reasonable. Perhaps because of our history, or as a result of previous experience, any type of assessment is generally looked upon with suspicion and resentment. There may have been good cause for such caution in the past. In the case of this scheme, it is to be expected that the assessment process may be looked at with a degree of suspicion by those who must undergo it.

I ask the Minister to ensure that the assessment process is implemented with the maximum of sensitivity and the minimum of interference in people's private lives and with due regard for the dignity of the person. Bearing in mind the possible incapacities already being borne by potential patients, the process must not be made any more difficult or intrusive than is absolutely necessary. There must be a standard methodology to apply right across the regions and it should be ensured that it is strictly adhered to in the interests of patients.

In conclusion, I am pleased that this long-standing area of difficulty is being tackled in a comprehensive and a sensible manner. It is essential that by the time this Bill is passed, we will have a system of nursing home care which provides adequately for some of the weakest members of society. This Bill, with some amendment and clarification, is adequate to the task and I commend it to the House.

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