Ciarán Lynch (Cork South Central, Labour)

This Bill marks a significant change in how health care is delivered in Ireland, as it removes the right to free health care enshrined in the Health Act 1970 and singles out a particular sector of society — the elderly — as a group requiring institutional care and paying institutional costs. No other section of our society will be hit by this Bill. Children are born in maternity hospitals provided by the State. When they cut their knees in the schoolyard they go to the emergency unit of a public hospital. Those of us who do not have private health insurance will live our lives in the public health care sector until we get old. The Minister has not discriminated between private and public sector by specifying in which sector this care will take place. Is there a preference as to where the Minister sees this care being delivered? Or will we see with the roll-out of this scheme something similar to collocated hospitals, with collocated long term nursing beds?

If we are to take the fair deal scheme as a good idea, we must admit there is a world of difference between a good idea and good implementation. This scheme was launched in 2006 with an expectation that it would be in place on 1 January 2008. After two years in the making, it was not launched. Deputy White stated earlier that the Government needed to take its time thinking it over. There were two years to think it over. In the absence of thinking it over, when 1 January 2008 came there was no contingency plan. Nothing was in place for subvention that year, and chaos was created. People were left in limbo.

In 2008, Age Action Ireland pointed out that €110 million was set aside for the roll-out of this programme, and €85 million returned as savings to the HSE during that time. There are approximately 30,000 people in long-term care at this time, whether in the public or the private sector, and the cost of the delay for the extended families of those people ran into thousands upon thousands of euro. The Minister, Deputy Harney, when speaking about the fair deal scheme in one interview, mentioned a cost of €40,000, which is €6,000 more than the average industrial wage, to keep a person in care because of the failure to implement the scheme, which was on the shelf for two years.

One could make a study of the Government's version of chaos theory. The principle underpinning this theory is that one creates so much chaos that people will accept anything. There has been so much chaos out there, and people have been paying so much, that they will accept any deal except what they have at the moment. They cannot get subvention as it is not available or it is capped at whatever it was before 2008. In the absence of this legislation, they are being bled on a week-to-week basis of massive sums of money. I will give just one example of a case I dealt with in my own constituency of Cork South-Central. The family of an elderly woman was paying her nursing home fees, which were recently increased by €50 per week to more than €2,600 per month. At the same time the subvention from the HSE towards the woman's nursing home costs was dramatically cut, leaving her family to shoulder costs of more than €400 per week. This happened in June of last year. At first she was receiving a weekly subvention of €472.70, but when her house was taken into consideration these payments were reduced to €182 per week, leaving the family to shoulder the remaining charges of €400 per week. There is a great deal of nonsense in this. How, in the name of God, could the HSE give a notional value for an income based on the value of a house when the fair deal scheme was not even in place? I cannot get my head around it. How was this elderly women concluded to be earning an income from this property when the fair deal scheme was not in place, she had family still living in the house and it was generating no income? The calculations do not add up.

The numbers in nursing homes and nursing costs will increase. Deputy O'Dowd referred to the current number of 30,000 people in nursing homes. That number will rise significantly in forthcoming decades. The reason this will happen is that the demography of the Irish population has changed significantly. When I was a child, and I am not that old, there were six to eight children in the average household on Connolly Road, Ballyphehane. That was an extended family that could provide care for their parents when they got elderly. Thankfully, in my case my parents live at home. However, we have now moved to a position where the normal size of a family in this country is two children. The extended family support, and one should bear in mind the age profile of the people currently in nursing home care, will not be available in the future. That support cannot be sustained in the way it has been to date with smaller family sizes.

One issue that has arisen, between the cock-up on the subvention scheme and the two year delay, is the overall sum of money that is to be calculated. I do not believe this issue has been raised in any of the earlier debates. Property values have dropped significantly in the past 12 months. A 15% calculation has been made to pay for these costs. Given that the value of property is to drop further in the next three or four years according to all expert opinion, there will be a falling income under the fair deal scheme for the system as it is currently presented. In fact, it would make sense for somebody to opt into the fair deal scheme in the next year and a half when property values are at their lowest. Will the Minister clarify when the property value is set? Is it at the time the contract is signed, the time of the person's death or at some point between the two? After all, the value of property in Cork South-Central two years ago is quite different from its current value. This matter must be clarified.

I wish to mention a situation, one of many, I have encountered in my constituency. Every Member of this House has heard their constituents discussing this situation. Where an elderly person bequeaths a house to a child, who subsequently marries, but the elderly person retains a proportion of the house — perhaps one third and the husband and wife would have two thirds, how will that be calculated in the future?

How will the nursing home beds be provided? Does the Government envisage the State being the main provider of the beds or will it be the private sector, where costs and standards may vary from one location to another? Another critical point is that if the calculation will be based on a falling property market, I cannot see how daily costs will be met. I would be grateful if the Minister would respond on these issues.

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