Seán Sherlock (Cork East, Labour)

Will the Minister tell us whether it is envisaged that the Health Act 1970, which guaranteed the right to a bed, will be revoked and whether that right will be enshrined in the new legislation? If that right is not to be revoked and in the event of somebody deciding not to sign up to and be a willing stakeholder in this scheme but it is decided medically that the person requires a bed, will he or she have an automatic right to a bed in a public or private facility?

On the resourcing of the scheme, if somebody goes into a private facility, will the charges accruing for the provision of that bed be capped by the State? Will the State legislate for or regulate the charges of nursing homes for the provision of that bed? I can envisage a situation where the private sphere, because of the economies of scale in that sector and the dramatic reduction in the provision of public beds for elderly people, will see an opportunity, when the budget is outlined each year in the annual Estimates passed by this House, to get together, pool their resources and calculate what the charging regime could be for a bed. That will present untold problems for many families. Can the Minister comment specifically on this issue?

If a person has a property and a son or daughter has been bequeathed that property or if a son or daughter who is not married has been given that property legally and if there is a legal arrangement whereby the person has an automatic right to residence in the home, what is the legal provision in the event of that person going into a nursing home? The regime at present is such that even though the son or daughter is residing within the family home and there is a legal arrangement to that effect, there is still a calculation of 15% rental income in arriving at the nursing home subvention. That is unfair. I consider it so unfair that I have referred the specific case to the Ombudsman, as an independent source, to ascertain her determination on such a provision. What will the legal provision be in the new arrangement, after the legislation is passed?

We are shoring up many problems but in seeking to deal with one set of problems the House and the Government will create a new set. I still cannot get my head around the proposals in the legislation regarding ancillary State support. I refer Members to the Citizens Information Board which produced a paper in December 2008 that referred specifically to ancillary State support in the context of this Bill. The paper says the Bill distinguishes between State support and ancillary State support. We are aware of the provisions relating to State support but, according to the paper one must apply separately for ancillary State support; one can apply even if one does not qualify for State support; ancillary State support can be based on relevant assets only, not cash assets; and there must be a property over which a charge can be taken.

If somebody applies for ancillary State support, a charge is levelled against the property. What is the repayment schedule on that? If I need to go to a nursing home tomorrow, for example, and I apply for ancillary State support, what agency will pay the money to the nursing home in terms of the support that is given? Will it be the HSE or another such agency as determined by the Minister for Health and Children? If this will be a resource-based scheme and if we are now living in times of economic turmoil, I can see a situation where there will be hundreds of people queuing up for nursing home beds who will not be able to get one as they will not be able to benefit from the ancillary State support because there will not be such funding. How that will work its way out through the system needs to be teased out.

We are reaching a stage in this country where the community beds that once provided wonderful nursing home care are being whittled away by a process of stealth. We are moving so far into the private sector that by the time it comes for me to be cared for in a nursing home, the costs accruing will be so astronomical it will place such a burden on the State as to be untenable. At this stage of the process I would put forward a theory that there needs to be a greater degree of analysis about how we can provide beds within the public sector. For example, there is a 42-bed facility in north Cork which is about to be closed. It is neither a geriatric nor a psychiatric unit; it has no designation. It is a wonderful facility in a wonderful setting. If, instead of being closed, it received the right amount of investment, it could provide a wonderful facility for the provision of care for the elderly within its catchment area as a community facility. Those same people would happily pay their pension or a proportion of the cost of getting their bed within that facility and they would gladly welcome whatever subvention or State support that would arise.

However, there is no foresight and no planning. I see nothing in this legislation that would give me any grounds for hope — I must be honest about it — that the Minister will ensure we will move seamlessly from the current regime into a new regime and that this will be a panacea for the elderly. I can see a situation where the number of people, family members of persons who are in nursing homes, who come to my clinics will increase as a result of this ill thought-out legislation.

I heard the Taoiseach describe himself here as an egalitarian republican. If we are speaking of egalitarianism, older people should be able to come to their autumn or winter years with a certain peace of mind knowing that they or their families will not be left with an undue financial burden when it comes to caring for them. I cannot see anything in this legislation that will give solace to those people.

I reiterate the point that if we are to have a proper system in this country, it must be with the proviso that the cost of care in nursing homes must be capped. Deputy O'Dowd made the point earlier. There is the bare cost of provision for the bed for the week but there are also the extra costs that now seem to be accruing, which are not accounted for. I refer to chiropody, hairdressing and other such services which seem to be added on week in, week out.

I am not against the private sector because I visit nursing homes on a regular basis and I see the good work that is being done there, but there must be a good mix. This comes back to the point I made about the 1970 Act. I am asking that the 1970 Act not be rescinded and that everybody would have a right to a bed, whether in the public or private sector.

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