Seán Ó Fearghaíl (Kildare South, Fianna Fail)

I thank Deputy Michael Fitzpatrick for sharing time.

I am pleased to have this opportunity to speak on this important and long-awaited Bill. The Minister and the Government have been correct in taking their time to ensure that any legal or other impediments have been dealt with.

This debate may highlight other issues that might require changes to the legislation. I trust that the Minister and her colleague, the Minister of State, Deputy Máire Hoctor, will closely follow the debate and take on board positive proposals from all sides of the House. There is great interest in this measure among Members of all parties who all have, as public representatives, dealt with the various issues raised in the legislation, and in many cases have had to confront them within their family circumstances.

The care of our ageing population is one of the most important issues that we will face in this century and is a political and societal challenge. The issues involved vary from pension provision to medical care and residential care. The residential care element is probably the most important because it has such a significant impact on the person as well as on his or her partner and on their extended family. The system of nursing home subvention clearly needs reforming. A scheme that covers only 40% of the cost of private nursing home care is not sustainable and is thankfully being replaced by this much more workable and supportive alternative.

We can all list examples in our own constituencies of families who have had to borrow heavily or sell the family home to offset the cost of care for an elderly relative. This Bill will negate the need to do this and I warmly welcome this initiative by the Government.

In assessing the need for this legislative change, we must reflect on the numbers of elderly people being cared for within the system. There are approximately 7,700 people in public long-term residential care and just over 15,000 people in private nursing homes. To cater for them, the HSE has over 10,000 public beds in residential care centres for older people across the country. In addition, the HSE partially finances 9,000 beds, "subvented beds", 3,000 of which are fully financed contract beds. These were secured between 2005 and 2008. Last year, the HSE indicated a strong commitment to providing over 800 public fast-track beds before the end of this year — more than half of which were to be in place at or before the end of 2008. This six-fold increase in Government spending clearly signifies its strong commitment to providing for the care of elderly people in society.

The provision of funding is not in itself an adequate response to the needs of the aged, and it has been clear for some considerable time that the State needs to reorganise the way in which it supports long-term residential elder care. It is deeply unfair that people were faced with hugely varying costs for nursing home care, depending on where they lived, or whether the nursing home was in public or private ownership. Under this new measure, families will have a certainty and consistency, something that is definitely not available to them under the current arrangement. This security is something which older people and their families require. The enactment of this Bill will bring with it a new peace of mind to many elderly people up and down the country, a peace of mind which will ultimately be beneficial for their personal health and well being. At the moment, nobody is charged more than 80% of the non-contributory pension for care in a public nursing home, regardless of income. However, the costs were quite substantial in the private nursing home sector, even allowing for subvention. This anomaly had to be put right and the Government will thankfully bring equity to the situation with this Bill. The pressures placed on family members to provide care for a dependent relative were extremely difficult and at times overwhelming, leading to financial hardship in many cases.

I commend the Minister on bringing forward this Bill, the benefits of which will be felt for decades to come. There was a clear need to address the situation and we are now in a position to deal with the matter effectively and decisively. The requirement to reform the manner in which nursing home provision is subvented has been apparent for a considerable time, but the manner in which nursing homes are managed and regulated was highlighted by the RTE exposé on the Leas Cross nursing home in north county Dublin. I pay tribute to Deputy Fergus O'Dowd for the work he has done in highlighting the inadequacy of the service in many nursing homes around the country.

This Bill requires all nursing homes to be registered. The Health Information and Quality Authority will be responsible for the monitoring and inspection of nursing homes, based on the provisions of the Health Act 2007, and taking into account the recent draft report on quality standards presented to the Minister. The combined objective of all those involved in this process must be to ensure that we provide residential conditions that are nurturing and supportive, and where the care available to elderly and dependent people is verifiably of the highest possible standards. These standards will apply to both public and private nursing homes and will address the safety and financial concerns of many families in caring for their loved ones in long-term dependency situations.

In the period since the Leas Cross revelations, significant progress has been made by the HSE in the development of its elder abuse programme. The initiatives rolled out include the appointment of 29 senior case workers nationwide; the establishment of a national steering committee to oversee the provision of HSE elder abuse services in detection, reporting and response; improved training for staff; and the development of a public awareness campaign aimed at informing people on the risks and realties of elder abuse. These initiatives will ensure the prevention of elder abuse in public and private care facilities, but the care and attention of families and the wider community must also be a factor in tackling such horrendous abuse.

One of the key decisions we have to make in the provision of long-term care facilities is on their location, to which Deputy Fitzpatrick referred. A number of homes have been built or are proposed to be built in rural locations around County Kildare. This has led to some controversy as to the merits of such proposals. In its recently published annual report, An Bord Pleanála stated:

A number of large scale nursing homes have been proposed in isolated greenfield sites remote from towns or villages, shops or services of any description. Invariably, these have been refused by the board, as it is considered that such facilities are best located within existing settlements where public services are available and where the occupants have some degree of access to shops and other amenities, or can walk up the street and encounter members of the local community.

Like Deputy Fitzpatrick, I do not entirely share the board's views on this matter. We should not be too prescriptive in this area. I feel that, as in many areas of life, variety is key. Many people who have lived in the countryside all their lives would much prefer to look out onto a green field than on an urban scene. Alternatively, many people would still like to be able to access the local shops, post office, pub or betting shop if they are fortunate enough to enjoy relatively good health in later life.

Therefore, quality and variety of location are very important. Placing someone who has lived in Dublin, or in any of the other large urban centres, in a nursing home in a rural location can cause huge difficulties for the person and his or her family, who may find it difficult to access such a location. Planners, developers, advocates for older people and the HSE need to work more closely to ensure that a full range of facilities are available to our aging population.

Much more needs to be done by those working in the planning system to provide trading down opportunities for older people and in particular, to encourage the provision of retirement complexes in which independent or supported living conditions are available. Kildare County Council has undertaken a study, through its strategic policy committee on economic planning and development, on the provision and location of elderly care facilities within the county. The Minister should conduct a national review on the same issues.

This Bill will have wide ranging effects on so many people in the coming years that it is one of the most important Bills to come before this Dáil. Therefore, it is vitally important that we frame it by taking as many points of view on board as possible. The title "fair deal" indicates this will be fair to the elderly, fair to their families and fair to the taxpayer.

I thank the Minister, the Minister of State and their officials for the work they have done in bringing the Bill before us, and I commend it to the House.

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