Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

I hope it can be ensured that, as happened earlier, we will not in the future have to raise on the Order of Business the issue of the allocation of speaking time in order for us to be facilitated in that regard.

I will not be opposing the motion which is technical in nature and provides clarity on the two issues outlined by the Minister of State. However, in addressing the nursing homes support scheme it does not go far enough. There a couple of gaping holes, in respect of which I have tabled an amendment for discussion on Report Stage of the Bill.

Another issue that is causing huge problems within the health service is that of short-term nursing home support for persons in acute hospitals. I am aware that some hospitals are putting aside a dedicated fund in this regard. Under the old nursing home subvention scheme, a person being discharged from hospital who was too well to remain but too sick to be at home was facilitated by a short stay in a nursing home. Those involved are usually older people from isolated communities who have traditionally been branded bed-blockers. Sadly, I represent many such persons. Surely it makes financial sense to put in place a fund to meet the weekly cost of €850 or €900 of caring for such a person in a private nursing home for two or three weeks, rather than paying €1,200 a day to keep him or her in an acute hospital bed, resulting in congestion in hospital wards, delays in and the postponement of elective surgery, congestion in accident and emergency departments and ambulances being parked outside accident and emergency departments rather than being available to respond to meet community needs. I hope the Minister of State will be able to revisit this issue.

Under the nursing home supports scheme, it takes up to four weeks for an application to be processed. The person concerned is then placed on a national waiting list. Currently, it takes 12 weeks from the time a person is placed on the list for his or her payment to kick in. One particular individual whose sibling was discharged from Portiuncula hospital in Ballinasloe and is now in a nursing home is facing a bill of €5,000 which is accumulating by the week because an application under the nursing home support scheme has not yet been approved. The objective behind the scheme was to ensure financial liabilities would not be placed on older people or their next of kin. It now appears that the policy of the HSE is to wait for two beds to become vacant before releasing a patient under the nursing homes support scheme. This is resulting in chaos in the health system because families are not willing to have their next of kin discharged to a nursing home when they are facing such significant financial liabilities. I ask the Minister of State examine this issue.

Another issue that arises is at the other end of the age profile, which issue I raised with the Minister of State during the Second Stage debate on the Bill and have raised previously with him, namely, children with life limiting conditions. The Exchequer, through the HSE, is paying approximately €8.2 million per annum in supporting children with life limiting conditions in their communities. These are children who were born with profound disabilities, many of whom will not live to be five years of age, never mind ten or 15.

There is no co-ordinated approach being taken in regard to that and there is a piecemeal approach right across the country. By pooling resources into a national fund, there would be adequate resources to ensure provision would be made for the children in question. My proposal has been endorsed by LauraLynn and the Jack and Jill Foundation, which believe it represents a way of delivering better value for money within the existing budget.

Let me give the Minister of State an example of what I am talking about. At present, there are children trapped in hospital, costing approximately €147,000 per annum in a paediatric hospital bed. They could be put back into their own homes with their families, sometimes at a significantly lower cost. The Jack and Jill Foundation refers to a figure of approximately €24,000 per child. It refers to the PCCC community health figure of €47,000. It is still a small fraction of the money it costs to keep children in an acute paediatric bed in the three centres, but usually in Dublin.

There are families trying desperately to get beds in those hospitals; yet there are children therein who could be more appropriately accommodated in the community. Surely it is time to start joining the dots, particularly when we are not talking about additional funding but about spending existing money far more effectively.

My final point is on my amendment No. 3, that has been ruled out of order. This is the only opportunity I will have to raise the matter. During the Order of Business this morning, the Minister for Education and Skills said on behalf of the Government that new legislation would be introduced before the summer recess. It is to be rushed through so women who were in Magdalen laundries will actually get a medical card. If the Government had accepted my amendment today, it could have facilitated this process by statutory instrument.

My objective has been to ensure that, once the report on the review of medical need is published by the expert group at the end of September, the Government could introduce by statutory instrument an arrangement whereby children over the age of six would be automatically entitled to free general practitioner access based on medical need rather than having to wait for legislation to come through. We were told yesterday by the HSE that it will be at least 12 months before any additional provision will be made through the legislation process for medical cards for patients with chronic, long-term conditions.

As I stated on Second Stage, probably the most distressing thing public representatives have to do in their constituencies is battle through the bureaucratic system on behalf of distressed parents to obtain medical cards for children with terminal or serious chronic conditions. While the Minister of State has made some concessions in cases where discretionary medical cards issued prior to July 2011 were removed, the strict rules on discretionary medical cards that were in place last week, last month and last year are still in place for a child born today with a chronic, terminal or life-limiting condition. The family must still go through the same bureaucratic nightmare.

If the Minister of State accepted the amendment tabled by Deputy Shortall and me, he could, at the end of September when the expert group reports, introduce, at the very least, a doctor-only card for the families to give them some reassurance. It is disappointing that he has not been prepared to take on board the amendment. I ask him to reconsider that decision and table an amendment that would deal with the Magdalen laundry issue in the short-term and also with the very effective campaign by Our Children’s Health seeking a medical card for children under 18 with a chronic and serious condition. There is strong merit in this argument. Our amendment does not go that far, sadly, because we tried to draft it in such a way that it would be ruled in order. Disappointingly, it has been ruled out of order but the Minister of State has the power to table his own amendment along the lines we have proposed to reassure affected families that, when the expert group reports by the end of September, the sickest children will at least be granted free general practitioner access.

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