John Cregan (Limerick West, Fianna Fail)

I welcome the amendment as proposed by the Minister, Deputy Harney, and I am glad of the opportunity to say a few words on this important issue.

At the outset we should remember that we are discussing health and the Department of Health and Children. We have to factor in the budget that is available and the pay bill required to pay the many people who provide their services. Then we are left with an amount of funding which must be quantified and controlled in good times and bad. The Department of Health and Children is in competition with other Departments for scarce finance, and we must start from that premise.

Given the huge demands on that Department it is very difficult to provide adequate resources for all the different disciplines and demands. If we are to be honest in this debate, we should not lose sight of that. Care of the elderly has always been a core value of my party and of Government. In recent years where the economy was in surplus we increased the budget enormously and that should be acknowledged. We must look at the enormous increases that have been put into all the different health disciplines in those years, all very welcome, but each one must have a definite amount of money allocated to it.

We are talking specifically about the care of the elderly, nursing homes etc., and HIQA has been mentioned etc. I welcome the fact that HIQA, as the regulatory body, is doing its rounds throughout the country and is responsible for the registration of nursing homes. If we did not have Leas Cross and its likes, we would not require HIQA, and this must be acknowledged as well. Unfortunately that is the type of world we live in, however. If people did not break the law, we would not need gardaí on the streets. They do, and we must accept that. People have broken the law blatantly in the nursing home sector and we have to acknowledge that the regulatory position had to be corrected. HIQA is now doing that job. One can talk about bureaucracy, red tape etc., but ultimately there has to be a satisfactory regulatory body to ensure that the best care is given to the elderly when they are obliged to finish their lives in nursing homes.

I have seen both sides, both personally and in my constituency work, as regards people doing their best to cater for the elderly in their own homes. We talk about the home care packages, home help hours, visits from the community health nurse and all the different back-up services that we try to have in place. Of course we do not live in an ideal world, and we all wish to enhance those services more, but by and large the vast majority of people living in their homes are well-supported. As regards institutional care, there are both public and private facilities to be considered. On many occasions in this Chamber I have made criticism to the effect that discrimination was being applied when decisions were being taken about where elderly people were being placed. Those fortunate enough to get places in public facilities - I am not sure what the selection criteria were, perhaps social and medical circumstances - paid a small price for their keep. On the other side of the coin, a next door neighbour, perhaps, might have been unfortunate enough to have had to go to a private facility. I am not referring to the level of care. When a person had to go to a private facility, the bill was anything from €500 to €1,000 or whatever. There was the person's pension, a subvention paid by the State and in many instances there was a shortfall which had to be made up by the family. In many instances, such families were at the pin of their collar to put their children through college perhaps, and have some degree of quality of life. I greatly welcome the fact, therefore, that we have taken out the discrimination and now have a system that is equal and fair to all, whereby people may apply for the fair deal, and be assessed.

There will always be delays in certain cases, where people make applications. My understanding is that the applications are straightforward and are being dealt with relatively quickly. I support the view expressed by the Minister when she referred to public officials in the Department of Health and Children and also the HSE. We are probably too inclined to be negative as regards the work they do. The vast majority of public officials I meet in the course of my duties as a public representative, whether in local authorities, the HSE or Departments of State, are good people and do a good job. As in any part of society, one will find people who work more efficiently and better than others, and those who are more responsible than others. This is a fact of life and we have to put up with it. When one is dealing with an organisation of more than 100,000 employees, one must be sensible and realise there will be difficulties. One must also acknowledge the vested interests that exist within the system, which can create further difficulties. It is time, however, that we are honest about the debate.

Like everyone else, I should love to see more home help hours and home care packages. However, I can recall as a member of Limerick County Council that if one suggested to the county manager or officials at budget time that one wanted to make changes in what was being proposed, one would be asked to find the necessary savings someplace else. We have to be sensible here. There is a limited amount of funding and there are enormous demands on it. There are many disciplines in health provision that are all seeking parity with each other, if not more funding. The situation is very difficult.

However, as regards the arguments being put forward tonight, I am proud of the fact we have supported and enhanced the facilities that have been provided, which have ensured a better quality of care for the elderly, whether in their homes or in institutions throughout the country. I acknowledge that HIQA has a job to do, and this can cause difficulty perhaps for some groups at times. I had occasion to speak to the Minister about a voluntary respite centre in my home town, Drumcollogher, probably unique in the country, with 20 beds. That is not long-stay care, and the difficulty it faced was that it could not tick the boxes, effectively, since the criterion as laid down by HIQA was basically the provision of long-stay care. I welcome the fact that this is now being looked at and I am sure it will help other places as well as Drumcollogher's respite centre. We must accept the facts of life. We have nursing homes, we have to have standards and registration and by and large they are all providing a good and worthwhile service. However, we must also acknowledge that we are working within a particular budget which this Government and Minister has increased year on year, and substantially so over the last ten years.

No matter what government is in power, we must acknowledge that we have to draw the line somewhere. We have to give the best possible service, but we must be realistic as well. We have to live within our means. I support the amendment and commend the Minister on her work.

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