John Browne (Wexford, Fianna Fail)

I will be reasonably brief. I compliment the Minister of State, Deputy Hoctor, on her contribution to this Bill and her very deep interest in supporting such a worthwhile Government initiative. The new fair deal legislation is very welcome, as it stems from the time of the illegal charges in our nursing homes up and down the country. Much time, effort and work has gone into developing the legislation.

I am sure many different Departments were involved in the development of the legislation, which I understand took four years to produce. Those involved included the Departments of Social and Family Affairs, Health and Children and Justice, Equality and Law Reform. Other bodies, such as local authorities, were also involved in providing information during the preparation of the Bill, which I sincerely welcome.

All of us have been touched by the need for change in the nursing home subvention area. From county to county and even within counties, people were not paid a uniform amount of subvention. This was not fair or equitable. As politicians we came across many cases where one person up the road was getting one amount in a bed subvention while a neighbour may have been getting a different amount. The amount of money depended on who the person was dealing with in the HSE. This placed some very severe financial difficulties on the children of older people who had to go into nursing homes.

I am not so sure the term "nursing home" is the best one to describe where senior citizens go. In many cases, such people go to places which extend their living facilities — perhaps they should be called senior citizen living centres rather than nursing homes. Many people who go to nursing homes are in very good health but for different reasons they may decide to leave their homes. They may live in rural areas, there may be nobody to look after them or the local shop or post office may have closed down. Many people who go to nursing homes are very active and full of life. These people, or their families, would have paid large amounts of money for this up to now. In some cases older people sold their houses or other property and moved into nursing homes.

It is important that nursing homes are not just nursing homes. They should provide recreational facilities for many of the people living there who want to be very much part and parcel of the community. Such people do not want to be confined to nursing homes — they want to go to bingo, senior citizen outings, the Christmas parties and all of that. It is important that the owners of nursing homes provide such facilities for people living in them.

Most older people want to remain in the community and we should consider this seriously. It is very traumatic for older people, who have lived in a community all their lives up to the age of 70, 75 or 80, to go into a nursing home for reasons they have no control over. It is very important that we consider how to facilitate people through home care and other initiatives to allow them stay in their community. It is very important that the post office network, the rural transport initiative and other areas are continually considered to see how we can ensure facilities remain available for people if they want to stay in their own home or community. In this way they would retain access to the shops or be able to travel to the nearest town under the rural transport initiative scheme. It is important that while, on the one hand, we are catering for people who want to go into nursing homes, on the other we should also cater for older people who want to continue living in their community.

I see Deputy D'Arcy is present. We are very lucky in Wexford in that we have the new St. John's Hospital for older people, constructed over the last two years. The first phase has been completed and is open while the second phase of 54 beds has been completed and will open shortly. That will give over 100 new bed units in Enniscorthy. We also have Ely nursing home in Wexford, the two senior citizen hospitals in New Ross and the Gorey hospital.

Deputy D'Arcy has been very critical of the HSE because it has not upgraded that hospital. We hope the Minister of State, Deputy Hoctor, and the Minister, along with the HSE, will extend and develop the Gorey facility. Gorey and its surroundings have expanded greatly over the past number of years with people coming from Dublin to live there and commute to work. In many cases people do not have work but they still live in the community. It is important we continue to provide the infrastructure, as well as the funds, for the fair deal nursing home scheme. I put on record my compliments to the people involved in the running of the facilities in the Wexford centres.

We also have the valuable and important day care centres, which are important to older people. I am very annoyed that the HSE has decided to introduce a charge for people going into day care centres. In many cases the day care centres allow people to stay in the community. They come to the centre during the day to meet their friends and neighbours, have a meal and play bingo, pool, darts or whatever they want. It is a very important facility and the HSE should think again about putting a charge on those who use it. It is not the right way to go.

I do not have a major problem with clawback. During what was perceived as the illegal nursing home charges issue, many people claimed money because their elderly relative was in St. John's Hospital in Wexford or different hospitals around the country. The administration told me such people did not come to see their relatives very often but when the money was there to be claimed, it was claimed. I have no problem with clawback. I understand in the UK there is a clawback system but this system must be fair and equitable. If the house is to be sold on we will get a clawback but if the family in question continues to reside in the house, that is different. I do not have a major problem with the process.

There is an issue with hospital beds. At any given time in Wexford hospital there are between ten and 20 elderly patients ready to go home but they have nowhere to go. These people take up hospital beds through no fault of their own. There should be a greater participation between the HSE and the private nursing homes in that sense. Surely it is cheaper to keep people in a nursing home than in a hospital. There is the cost of the hospital accommodation to consider but other people are also being deprived of the chance to come to hospital for operations or other treatment. Far greater co-operation is needed between the HSE and the private nursing homes in dealing with the matter.

The provisions of the Bill should be administered promptly, fairly and without too much bureaucratic nonsense. With the old scheme of bed subvention, I have had cases where it has taken three, four or five months to get approval for such subvention. I hope that will not be the system here and we will not have all kinds of bureaucratic delays. We need dedicated people in the HSE to deal with the applicants and people involved. It is very traumatic for older people to have to move out of their home and into a nursing home, only then to find it is taking ages to have their application dealt with. It adds to the trauma and difficulty. It is very important, when the Minister is designating the scheme, that there should be little bureaucracy and prompt action.

I welcome the Bill and the fact that the Minister of State, Deputy Hoctor, is taking a keen interest in ensuring all aspects of it are approved as quickly as possible. Inspections of nursing homes, as provided for in the Bill, are very important. We have some excellent nursing homes, some good nursing homes and some not so good nursing homes. Some of them simply want to fill the home and get the money while providing little by the way of facilities. Many of those in nursing homes are still active and it is important that homeowners recognise that and provide such facilities. From visiting homes in Wexford, I know that many of them provide recreational facilities and parties but it is important that we keep the pressure up through inspections and ensure our nursing homes are run properly and kept clean, with the right numbers of staff and proper procedures in place to look after people, without decisions that will affect patients being made behind closed doors.

I welcome this Bill and hope its provisions will be implemented as soon as possible rather than our having to endure a load of bureaucracy.

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