Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

Ba mhaith liom mo bhuíochas a ghabháil leis an Teachta Ó Súilleabháin.

If this State were not in the depths of the present economic crisis, I have no doubt that the issue dominating politics and the news media would be the major clash between the Office of the Ombudsman and the Government on the Ombudsman's report, Who Cares? - An Investigation into the Right to Nursing Home Care in Ireland. I have seldom seen a report by any statutory body so strongly critical of a Department and I have seldom seen such hostility to a statutory body as that shown by the Government to the Ombudsman.

The matter in question - the care of our older citizens - is extremely important for each and every one of us and the issue at stake - the role and future of the Office of the Ombudsman - is very serious for democratic accountability and civil rights in this country. The Minister for Health and Children and her Department, as well as the HSE, should have co-operated fully with the Ombudsman in her investigation. Instead, both the Department and the HSE refused to co-operate and the Ombudsman states in her report that it is her view that the Department and the HSE are in breach of their statutory requirements under the Ombudsman Act 1980.

This is a very serious charge on the part of the Ombudsman and I have no doubt that she is correct.

To make the matter even more serious, the Government, on 10 September 2010, informed the Ombudsman that it supports the position of the Department. The Government says the Ombudsman is acting outside her powers and that her actions constitute interference in the State's defence of several hundred legal actions. "An unprecedented intervention by Government" is how the Ombudsman has described the Government's treatment of her investigation and report. The Ombudsman states:

The HSE and the Department, with the support of the Government, have opposed this Ombudsman investigation and have made very serious charges against the Ombudsman's Office. In effect, the charge is that the Ombudsman has acted in bad faith in the conduct of this investigation. The Ombudsman rejects these charges totally.

It is unprecedented that any Government in this State should have deliberately caused such a serious confrontation with one of the principal watchdogs for the rights of citizens. The Government's approach represents an attack on the Office of the Ombudsman and, by extension, on the rights of citizens.

Why is this being done by Government? Clearly, it is being done to undermine a report that exposes attacks on the rights of citizens by successive Governments. The conclusions of the Ombudsman could not be clearer or more damning. The Ombudsman concludes that the State, through the Department of Health and Children, the former health boards and the HSE has failed over many years to provide people with their legal entitlement to nursing home care. She says that this failure has inevitably caused confusion, suffering and hardship. She finds that the health boards and HSE failed to fulfil their obligations to older people under the Health Act 1970 and that this failure came about with the full knowledge and agreement of the Department.

The key finding of the Ombudsman's report is that the obligations of the Health Act 1970 relating to nursing home care continue to have effect and have not been set aside by the Nursing Homes Support Scheme Act 2009. The latter Act legislated for the so-called fair deal scheme. That Act introduced a complex new system regarding support for nursing home care that is hugely problematic. I said on Second Stage of the Bill that I believed, as did organisations representing older people, that the Bill effectively removed the universal eligibility for a place in a public nursing home as provided for under the Health Act 1970. The Ombudsman's report clarifies the matter now. It exposes as false the Government's argument that universal eligibility never existed under the 1970 Act and it asserts that this eligibility still exists under the 1970 Act, notwithstanding the 2009 Act. I welcome that clarification.

The statutory eligibility to a bed in a public nursing home has never been vindicated in terms of the provision of the resources to make those beds available. This led to a huge reliance on the private nursing home sector and a complex and inequitable system of State subsidy for nursing home care. Undoubtedly, this had to change but I believe the Government, in doing so, went in the wrong direction. How wrong is now exposed in the Ombudsman's report. Of course, this is not the first such report. The previous Ombudsman published one in 2001.

We also had the report, Care for Older People, published by the National Economic and Social Forum in 2006. That report exposed how our system of care for our senior citizens is skewed towards residential options and how there is a funding bias towards nursing home subventions. It pointed to the lack of a general model of assessment and rehabilitation. The figures in the 2006 report - and I doubt they have changed much - show that the 5% of older people in long-stay care account for 55% of the overall budget for care of older people. Describing the barriers to the development of community services for older people, the report referred to "perverse investment incentives" and stated: "The present official funding of services is not consistent with the policy objective of encouraging community-based responses; considerable resources are invested in nursing home care responses, some of which are unnecessary and inappropriate."

The worst nightmare for the vast majority of older people is to have to leave their homes and enter long-term residential care. The best option is for people to be cared for in their homes with the help of their family, friends, neighbours and the health and social services provided by the State. The Minister claims that the Government is providing for improved support for older people in their homes but the reality is that current provision is totally inadequate. Under the disastrous regime of this Government, the cuts of recent years to home helps and other supports will be far exceeded in the forthcoming budget. Comprehensive rights-based legislation setting out the entitlements of older people to all forms of care in the home, in other community-based settings and in nursing homes is needed.

The sad reality is that the inadequacy of support for older people to spend their twilight years in their own homes means that more of them end up having to avail of expensive nursing home care. It means that more of them become ill and lose their independence. This short-sighted failure of successive Governments to provide the essential resources for community care has cost the State hugely in providing for long-term residential care. When it comes to residential care the Government, blind as usual to fairness and to real efficiency, downgrades public provision and gives preference to the more expensive private sector. It took years for proper standards to be applied to nursing homes by a Government more concerned with fostering the private nursing home sector as a lucrative business than with ensuring the best care for our older citizens. For example, we had the recent closure order on the private Upton House nursing home in Clara, County Offaly, which failed to meet HIQA standards. I had raised concerns about that facility in a parliamentary question only last year. At the same time, the HSE, because of the Government's privatisation policy, is attempting to close a public nursing home, Loughloe House, in Athlone, which it did not recommend to close. There is a clear pattern. It is not only a recommendation or the absence of one, but the privatisation agenda that is driving the Government and the HSE in carrying out their policies. The Sinn Féin Deputies fully support the motion before the House this evening and tomorrow and I urge all Deputies, on both sides of the House, to support it.

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