James Reilly (Dublin North, Fine Gael)

While some of these amendments may appear innocuous, issues arise in respect of some of them, certainly amendment No. 4 on the mortgage issue. If a mortgage pre-exists the mortgage holder's entry into a nursing home and there are payments still due, will it be the first debt to be paid? This is not clear. One could be left with a property whose mortgage value exceeds the equity value, particularly in the current climate. If a patient who enters a nursing home passes away three years later and 15% of the fee has been paid up front, what will occur if that patient's property was worth €450,000 on his or her entering the nursing home but is only worth €250,000 at the time of his or her death? How will the bill be calculated in this case?

With the Acting Chairman's permission, may I make a few broader points? I am deeply unhappy with the Bill. Many of the issues we raised have not been addressed, particularly that of independent financial assessment. Issues arise over the valuation of patients' houses and assets. A person's bank shares, stock or dividends could be assessed as valueless at the time he or she enters a nursing home.

The issue concerning the rights of siblings at the time of application has not been addressed. I refer to siblings who may have been living together all their lives. A sister in such circumstances may have decided to stay at home to mind the house. Such arrangements are not uncommon in Irish society.

Two issues arise over capping, one of which pertains to capping in respect of the scheme itself. If money runs out, what happens to the assessments? The medical assessment is not independent and this has not been addressed. The HSE is to provide care and assess people for care. Will the threshold move up and down? Although we discussed this before, it is important to highlight the matter.

Age Action Ireland is distinctly unhappy about this Bill and the manner in which it is less than clear on the position of those who are charged for being placed in a hospital bed for a long period because there is not a more suitable place for them in the community. The issues associated with geography and the National Treatment Purchase Fund have not been addressed, including the National Treatment Purchase Fund's absolute right to omit or admit a particular nursing home from or to the scheme, depending on whether the home can arrange a reasonable fee. Far too much power is being given to the HSE.

I received an e-mail only yesterday from a lady who has been living all her life with her cousin. They live as sisters but a cousin is not regarded by the legislation as a connected person. The lady, to whom the house is left, believes she may well end up in a nursing home and precede her cousin in death, thereby leaving the cousin seriously discommoded and disadvantaged.

There is still no cap pertaining to assets. The sop that the Minister made in an amendment on an earlier Stage, referring to circumstances in the event of sudden illness, was totally turned over by the caveats in section 8, which bound a person to his or her business in that he or she must have been involved, for the greater part of his or her working days, in that business before taking ill. He or she must continue to be bound to the business for the foreseeable future. As I stated on Report Stage, the requirement that one be bonded to the land or a business smacks of feudalism.

The definitions are characterised by laxity. "Sudden illness" is not defined. Is it a stroke or cancer? How is it defined? Is it of sudden onset and, if so, what does this mean? Is it the last element of a well-known illness, multi-infarct dementia? In this case a patient may be managing the illness but finally receives the small insult to the brain that changes his or her circumstances. I am deeply unhappy about all these issues and am of the view the Bill must be opposed. If this is only opportunity afforded me to do so I will vehemently oppose amendment No. 4 and unless some concessions are given on it amendment I will press to a vote.

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