Frank Fahey (Galway West, Fianna Fail)

I welcome the Bill and congratulate the Minister for Health and Children, Deputy Harney, and the Minister of State, Deputy Hoctor, on bringing it forward. It has taken a long time to get to the House and is a result of long and complex negotiation and discussion in which many were involved. It was worth waiting for as it puts right an anomaly that existed in this country for years. We will now have a situation that is fair to all citizens and this is long overdue. I pay tribute to the Minister and Minister of State for the amount of work they have done to bring forward the legislation and to change the old unfair system that caused so much concern and anxiety to people, particularly older people.

It is important to note that only one in 20 people over 65 years of age is a high dependency patient who will need long-term residential care. This amounts to 25,000 people currently. This low figure demonstrates that we continue to ensure that the majority of people are looked after by their families in their homes. Efforts made by primary health care workers and families to ensure older people are cared for in the community are worthy of mention. We should strive to ensure that it is only people in need of high-dependency care who will have to spend the rest of their days in a nursing home.

This legislation will guarantee security to people who will need high dependency care on a long-term basis. A more significant aspect of the Bill is that it will cater for people under 65 who need long-term care, for example, people with high-dependency needs as a result of debilitating conditions. We are aware of many young people in society in this situation who will require high dependency care for the rest of their lives.

The system which existed up to now was deeply unfair. It was unfair that people of the same means faced radically different costs for nursing home care. It was unfair because many people and their families had no option other than to sell the family home to pay for care. This particular issue was most unreasonable and caused much anxiety to people throughout the country, in particular when other people were in public nursing homes and were given a very good package in terms of care for the rest of their lives. This unfairness is dealt with in the legislation and from hereon no one will have to sell his or her home to provide for care in their later years.

Many families face serious situations where there is some doubt as to the mental capacity of their loved one who needs care and complex family and legal situations and financial arrangements exist which must be addressed. The legislation will deal with this problem for quite a number of families throughout the country and will provide the reassurance and legal protection to help the individual concerned and his or her carers.

I understand the State will continue to meet up to 70% of the total cost of long-term care for the population. If I have any concern about this legislation, it is as to what its overall cost will be. I would like to hear from the Minister of State or the Minister on what are the projected costs. As we have an ageing population there is no doubt that this will be a very costly scheme. This is an issue for which we must address if we are to provide a comprehensive care scheme as the Bill will do. I compliment this very good legislation which is rightly described as a fair deal.

I want to dwell on the question of the high-dependency requirements of younger people afflicted with brain injuries or who have developed Alzheimer's disease or suffered strokes. We have neglected these people in a serious way in the past and this neglect has cost us and is costing us a huge amount of money. Will the Minister tell us how many people in need of continuing care are holding down acute beds in acute hospitals? There is a term used for people in this situation. It is important to establish this number. I understand that at any one time there could be up to 600 people in this situation. Today, I checked with the Department and I was informed that an acute hospital bed costs €1,000 per day or €7,000 per week. I suggest there must be an alternative to this cost for patients who require high-dependency care.

I came across an example in Galway which is worth relating to the House and to the Minister. Great credit is due to the HSE staff in Galway and the nursing homes in the Galway area for their ability to address this issue. The HSE decided because of the number of acute beds being occupied in University College Hospital Galway and other places that it would look for the private nursing home sector to provide a service for these people. It went out to tender among nursing homes in Galway. The Village Care Centre in Craughwell, County Galway, which is not in my constituency, won the tender process and established a high-dependency unit with 12 beds. This unit has been hugely successful and I have visited it myself. The cost to the HSE of a bed in this unit is approximately €2,000 per week as opposed to a minimum of €7,000 if the people remained in an acute bed.

It is a specialist unit in a new facility and a range of services are provided and included in the cost such as physiotherapy, occupational therapy, access to speech and language therapy and other very innovative activity-type services and supports for patients who need them. It was a revelation to me to see the private sector work in co-operation with the HSE in the public sector. The care centre is located in Deputy Ulick Burke's constituency and if he has not seen it he should visit it. It is run by Dr. Bhatti who is a pioneer in this area of health care.

This is a good example of the way in which proper services of a high quality can be provided while we can save a significant amount of money. If 600 people are holding down acute beds at €7,000 a week and these 600 people could be transferred out to the private sector for €2,000 a week then I recommend to the Minister and the Minister of State that it should be done immediately. It is one way to free up the acute beds we so desperately need to deal with waiting lists in our accident and emergency departments.

In recent times I have noticed much disquiet in the private nursing home sector about the system of referral from the HSE. While the first prerogative of the HSE is to ensure it gets value for money and the highest quality services, and this should be the bedrock of the system, there appears to be a problem. Many nursing home managers have contacted me in recent weeks on this issue. Whatever the problem, it should be dealt with and we will attend a meeting soon to discuss it.

In Galway, we have very high-quality nursing home provision throughout the county and in the city. I wish to take this opportunity to pay tribute to those in the private sector who provide these facilities. If anybody has the idea that it is a money-making exercise, it is not. From the knowledge I have of the people who run nursing homes, they put in a huge amount of effort to ensure that they provide a high-quality service and that they do so at the lowest possible cost. There is sufficient competition to ensure that costs are kept to a minimum and this is equally as important as the level of service provided, which is the most important requirement.

I thank the Minister of State and the Minister and I welcome the legislation. It is a fair deal which will allow many old people to be assured of high-dependency care in their later years. It is innovative and everybody involved should be thanked and complimented.

See this speech in context