Jerry Buttimer (Cork South Central, Fine Gael) | Oireachtas source

One of the main benefits of the nursing home support scheme for individuals and families is that it gives them certainty about how much nursing home care will cost. Without this scheme many families would not know how much caring for their loved one will cost and they would not know how much they would have to put aside each week so that their elderly parent, as Deputy Mitchell O'Connor alluded to, gets the care he or she needs.

Given that Fianna Fáil, when in Government, has not been prepared to develop a policy regarding the care of the elderly and allowing for the fact that the Minister, Deputy Varadkar, in the recent budget achieved an increase in the health budget where we are now spending €13 billion, an increase of €635 million on last year, it is extraordinary that Fianna Fáil put this motion before us. It behoves the Members opposite, rather than coming in here with a condemnatory motion, to put forward a motion regarding their own health policy on care of the elderly.

Notwithstanding that, there are problems with the fair deal scheme. The waiting period between application to the scheme when a person takes up residence in a nursing home and the time of the first payment needs to be address. During this time the person or his or her family end up carrying the full cost of the nursing home which can prove difficult, both emotionally and financially.

I very much welcome the remarks of the Minister of State, Deputy Kathleen Lynch, last night that the scheme is being reviewed and I would ask that the Ministers in the Department provide a clear timeframe for when this review will be completed. It would also be useful that the terms of reference for the review take account of demographic changes. We all understand that the population is living longer and the age cohort concerned is increasing. The Department of Health estimates that an additional 1,000 long-term residential care beds each year will be required over the next seven years. This places additional pressures on the funding requirements but it is something that must be planned for as soon as possible. Something Fianna Fáil did not do in Government was plan for the future. The Minister of State, Deputy Kathleen Lynch, was correct to draw attention to this.

The review will also consider the effectiveness of current methods of negotiating and setting prices, which must be up for discussion. It has been described to me as a "cost plus system", a system that encourages a high cost base and does not incentivise efficiencies. I say that as somebody who visited a number of nursing homes in my constituency recently. We must ensure that this process is a real negotiation that enables nursing homes to have the financial capacity to re-invest so that they can maintain and improve their facilities for those who live in them as their new homes. We should also look at enabling a third-party review or arbitration of the negotiation process which will help to ensure fairness.

One issue that we need to be conscious of is the recruitment and retention of qualified staff, particularly nurses. From speaking to the nursing home owners, I note that as soon as the HSE advertises and recruits nurses, they draw from the private nursing home sector. As the Members know quite well, the private nursing home sector cannot offer the same package of remuneration and terms and conditions, and I would hope that the review process would also examine whether this should be a factor for consideration when negotiating and setting prices.

I hope that the review process will help to develop a comprehensive approach to the care of elderly citizens. I note that one aspect of the review is looking at extending the scheme to community-based services and other sectors, such as disability and mental health. It is helpful that this is being considered, as these services are every bit as important as nursing home care. I would share some of the concerns of Nursing Homes Ireland about this proposal. Given the forecasted increase in demand, we must ensure that funding for nursing home care is not diluted. Perhaps the review should also consider whether it would be better to establish a similar but separate scheme for community-based services.

Earlier this year the Joint Committee on Health and Children, which I chair, published a report on end-of-life care. Some of our recommendations related to access to long-stay care facilities. I ask the Minister for Health to consider these proposals in the context of the review of the nursing home support scheme. The current scheme deals with everyone on a chronological basis but it might be appropriate to prioritise some patients based on medical condition. The committee suggested that this should be done for palliative care patients, enabling them to access residential care in a timely manner and thereby facilitate their final medical care in a more appropriate setting.

The committee also suggested that consideration could be given to extending the definition of long-term residential care services and the range of services covered by the scheme.

I have already referred to the matter and it is something that is being examined. In reviewing the current fair deal scheme, an evidence-based cost of care model could also be used.

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