Olivia Mitchell (Dublin South, Fine Gael)

I very much welcome the opportunity to speak on what I regard as probably one of the most important pieces of legislation to come before us for some time. I recognise that provision has been made for a long reading time which has been allowed and I hope that is for good reason and because the Minister will take on board some of the concerns and questions people have been raising.

When it comes to health generally, uncertainty causes great levels of distress and anxiety, especially for older people and their families. I accept there is uncertainty on almost all issues currently. We are beginning to see the fallout from the medical card issue. I am dealing at present with a constituent who lost her medical card at the age of 95 who is reapplying for it on means grounds. She can barely even see the form. I regret the distress that is being caused to her even if she gets the medical card.

As people get older uncertainty causes them much more stress than it does when they are young. Older people in particular like to plan for their financial liabilities, to provide for them and to know what their liabilities will be in the future. When people's circumstances change they have to deal with that but when the Government pulls the rug from under them it is difficult for them to cope. I accept that is not the intent of the Government's actions but it has been happening nevertheless.

In terms of private health insurance we have had the fiasco of risk equalisation, which was bound to be challenged and to fail. There have been repercussions and we have not seen them all yet. The resulting departure from the country by BUPA — a reputable company — was regrettable. The new Government proposal awaits the approval of the authorities in Europe but it may well fall foul of them also. That is adding to the uncertainty people face, especially the elderly, about whether they can afford to pay for private health insurance. The proposal is to add €60 to everybody's premium. I cannot think of any other sector or industry where the introduction of competition results in everybody paying more. That does not make sense. It appears that the subsidy will become a permanent one. I accept the Minister indicated the amount will not necessarily be passed on to customers but of course it will be. If the insurance companies do not pass it on that is an admission that they have been overcharging us all along by €60.

If those matters are causing uncertainty, the whole question of nursing home care and long-term care for the elderly will probably be even more traumatic for families in terms of expense and stress. Nursing home care and what will happen in the future in that regard is one of the sources of greatest concern to people calling my office.

I welcome the Bill in the sense that the area is hugely problematic for all families no matter where they live. There is no doubt that changes are needed in a range of areas. I refer to how free beds were allocated, the way they were subvented, the inconsistencies in allocation and the cost variations across the country. In Dublin, nursing home costs have become almost impossible for families to pay. No matter what the courts might say, that families and dependants are not responsible, if the State does not provide nursing home beds then somebody has to pay. In many cases families are put to the pin of their collar to make the payments that are required. I welcome the attempt to provide some kind of certainty and security for people but many questions remain unanswered.

One wonders whether the scheme will ever be introduced. Last year we were told it would be introduced during 2008. Originally the scheme was to be introduced in January, then June and now I hear it is September. Is there any danger the scheme will not be introduced at all? I accept money was allocated for it in the budget but many proposals included in the budget have changed in the meantime. Perhaps the Minister will provide certainty on the matter.

Other issues remain to be clarified regarding who will benefit. There is a perception that everybody will benefit from the measure, that one's assets will be protected and that all one will have to pay is the 80% charge, and 5% of one's family home. Many people do not realise that the family home is the only asset that is protected. While there may be some fairness attached to that, the reality is that many assets consist of the family business or the family farm and that has implications. We may only be talking about 5% a year but in the context of a husband and wife in long-term care, 5% or 10% each year adds up to a significant burden on any business, especially in this day and age. I seek clarification on who is covered and what exactly is protected.

Issues also arise about putting pressure on older people to dispose of assets. We should be aware that not all families are as selfless as we might like them to be. Once it becomes clear that assets are not protected pressure could be put on older people to dispose of assets ahead of when they might like to do so. There is also potential to manipulate young people who are in the category of long-term incapacitated perhaps as a result of brain injury. In some cases they may have large assets and they could be vulnerable to manipulation. Those are people who might have to be protected.

Another issue of concern is that the introduction of the new scheme fundamentally changes the relationship between the patient and the nursing home because the Government is the monopoly buyer of all nursing home services. Whether it is done directly or indirectly, in effect, it is the Government that is making the decisions and it will decide who can have nursing home care and when patients will be able to avail of nursing home services. Assessment is an issue of concern also. I understand that social considerations are included but the reality is that medical grounds will and must be paramount.

Choice is being taken away from patients who may decide, for example, that they want to go into a nursing home because they do not feel confident about looking after themselves. In those cases people will not be eligible for the scheme and they will have to pay the full amount in the absence of a subsidy. In effect, it will become an all or nothing system. Perhaps I am wrong and there will be a subsidy at some stage for people who do not qualify for this scheme but as far as we can see it is an all or nothing system.

Unfortunately, not everybody will benefit from the scheme because it is capped in terms of resources. That means, inevitably — it is happening already — that services will be rationed and if that is the case there will be a queue. If one exempts those who might have social priority and replaces them with those who have medical priority it still does not guarantee that everyone who needs admission on medical grounds to a nursing home will get it and avail of the scheme. That is happening at the moment, as long-term incapacitated people are being looked after by their parents at home. Families will still have to mortgage their homes to pay for the care of elderly family members.

The rationing of services undermines the rationale behind the scheme which is to give certainty, clarity and security about what will happen to older people in future. The Bill fails on that ground and the objective of the scheme is missed. The level of service is another issue. Will it extend to services currently available to patients in public beds? What will be the quality of the service? Will all the ancillary services and the good deal currently available to patients in public beds, which private patients have to pay for, be available to people who are subvented by the State in a private nursing home in the future?

Community care seems to be under huge pressure currently. The Minister must be aware of that. I tried to secure minor supports for a patient recently in order that she could be discharged from St. Vincent's Hospital and I was informed 50 patients were waiting to be discharged because the meagre services required to make it possible to send them home were not available. The provision of nursing home care is one part of this but people prefer to stay in their own homes and, without the necessary services, this legislation is only one leg of the stool.

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