Michael McNamara (Clare, Labour) | Oireachtas source

The Minister will be aware that the fair deal scheme is a source of concern to me. I raised the matter with him in correspondence and he replied to the effect that when the nursing homes support scheme commenced, a commitment was made that it would be reviewed after three years. That review is currently under way. There are certain aspects of the scheme which require urgent consideration. Obviously, the level of funding is unlikely to change dramatically just because a review into how the scheme operates is under way. Every funding line is dependent on available resources and the resources available in the State for many, if not all, services are still constrained and are likely to remain so for at least the lifetime of this Government, however long that might be. Obviously, the maximum length of that lifetime is known but the minimum is not.

Delay is an inevitable aspect of administration. However, the way in which the nursing homes support scheme operates almost incentivises delay on the part of the HSE and those who administer the scheme. Applications are made and all applicants are put on a placement in chronological order to ensure equity nationally. The current delay is approximately 15 weeks. If one does not have moneys available to cater for the number of applicants - effectively, that is the current position - the best thing to do is delay making any adjudication on applications. This avoids people who have been approved being left on the waiting list.

It seems to be a slightly bizarre use of State resources, particularly because the cheapest place to look after people in need of care is their home, as Deputy Mulherin said. Obviously, the next cheapest place is a nursing home. The most expensive place is a hospital. Beds in the category-four hospitals are obviously at a greater premium than the step-down hospital beds.

While I appreciate that funding is constrained, it appears to be increasingly the case that a number of people in community hospitals could be accommodated elsewhere if their applications were properly dealt with under the fair deal scheme. There are those in category-two hospitals, such as those in Ennis and Nenagh, whose medical care might be equally well provided in community hospitals. It is not provided in the latter because there are people in community hospitals whose fair deal applications have not been dealt with. While there is an incentive to delay dealing with applicants under the fair deal scheme, this is clogging up other beds that are much more expensive for the State to provide. This seems to be symptomatic of some of the difficulties that exist within the HSE and the fact that there is not really an incentive not to exceed any particular budget because budget lines are not desegregated sufficiently in the HSE. That is a broader issue.

I welcome the spotlight being shone on this issue. I hope that, notwithstanding funding shortfalls, the scheme can be run in a more efficient manner. Perhaps other budget lines could be examined to determine whether, if by providing more funding for the fair deal scheme, savings could be achieved elsewhere through freeing up much-needed beds in acute hospitals.

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