Deirdre Clune (Cork South Central, Fine Gael)

Since publication of the Who Cares? report commentary has been dominated by the controversy and dispute between the Office of the Ombudsman and the Department of Health and Children and Health Service Executive. It is important we bear in mind that the Ombudsman has stated that this report is based on more than 1,000 complaints she has received since 1985. It is important we keep that to the fore in this debate. The complaints relate to care in nursing homes, care for elderly patients, complaints from families and patients and those dealing with their affairs in terms of who was providing their care, what were their entitlements and the level of confusion in this regard.

It is difficult to understand what these people were and are entitled to now. There is no clear statement from the Government on how the system will operate in terms of nursing home care. It is understandable, given the role of the Ombudsman, that complaints would be directed towards her from frustrated individuals and that these complaints would be acted upon. The Ombudsman's report is littered with stories from individuals in regard to their financial situation, the distress this has caused and the fact that they found it so difficult to get answers.

Having to find long-term care for one's elderly relatives is difficult for many families. As mentioned by a previous speaker, there are many families who must do this for relatives who are not so elderly but who are incapacitated and must be cared for in a long-term setting. The Ombudsman in her report outlines the difficulties she encountered in getting information from the State and the tardiness with which the State operated in addressing the concerns she raised. The Ombudsman's report, in terms of what followed when the report was published and the relationship between the Health Service Executive, the Department and the Office of the Ombudsman, outlines important issues in regard to the independent role of the Office of the Ombudsman and how the person holding that office should discharge his or her role.

I deal regularly with people facing these issues. Having read the report, it is not clear to what people are entitled. This issue needs to be addressed, particularly given that we are dealing with vulnerable people who rely on others for information. The Ombudsman raised the question of whether there is any enforceable entitlement to be provided when it comes to long-term care. We need clarity and certainty not legislation that is open to different interpretations. It now appears that one's statutory entitlement will not be provided if the resources required to do so are not available. While this is not clearly stated in the legislation, perhaps it should be. We have been promised time and again that the eligibility for health and personal social services Bill, which is at an early stage of drafting, will be published. We need clarity in regard to what people are entitled to in this State when it comes to services provided for them by the HSE, the Department of Health and Children or the State.

Whether one is speaking to someone in the HSE south, HSE south east, HSE national or the Department of Health and Children, the story surrounding the care of elderly people in our nursing homes or hospitals is littered with conflicts and contradictions. The position is not clear. A similar situation prevails with home care packages, in regard to which a completely different approach is taken in different areas. It appears that one's address is often an indication of the type of service or entitlements one can expect to get in one's area.

The nursing home support scheme was introduced 12 months ago. The Ombudsman states in her report that she is aware of much concern in regard to how the scheme is operating. Of particular concern is whether people under 65 years of age in need of long-term care have a right to avail of the service. This issue needs to be clarified. The future of nursing home care is of concern to us all. Will the State provide funding to support the needs of these homes? In 2010, €979 million was allocated for long-term residential care, of which €97 million was released to the fair deal scheme to cover all applicants this year. However, the Minister has stated that given the economic situation, of which we are all aware, she needs to take €1 billion next year from HSE services. Will this result in a reduction in funding to the nursing home support scheme? Are we likely to see a return to long waiting lists, a concern raised in a recent document published by Age Action Ireland? This issue must be addressed.

There are currently a number of legal actions outstanding before the courts. I understand that more than 300 actions have been taken on behalf of people who claim their right to long-term nursing care has not been honoured. What is surprising is that at this stage, none of these cases has gone to a hearing in the High Court despite many of them having been taken more than five years ago. I understand that settlements have been reached in at least a dozen of these cases, the details of which have not been disclosed. This sends out mixed messages and raises questions. Why were these cases settled out of court? Is it an acceptance by the State that these individuals should have been provided with nursing home care by the State and that the costs involved in providing that care should have been funded by the State? How much by way of compensation was paid to the individuals whose cases were settled out of court? What is the position in regard to the hundreds of outstanding cases? Will they be defended or settled out of court? We need answers to these questions. More important, we need clarity in regard to the provision and cost of nursing home care and where individuals stand in terms of their relationship with the State.

I heard part of the Minister's response to this matter last night. It is clear she is at odds with the Ombudsman on many issues. The Ombudsman provided a detailed response tonight to what the Minister had to say last night. While I have not yet had an opportunity to read it in detail I will do so. The Ombudsman is acting on behalf of individuals. The Office of the Ombudsman is an independent body to which people can make complaints and from whom they can seek redress when they believe the State is not providing them with the services to which they are entitled.

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