Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Deputy for raising this issue. I do not offer excuses as a cover for inaction but I am duty bound to point out the factual and policy considerations relating to this issue that must be discussed. Like the Deputy, I hope there are not more borders in place tomorrow on the island of Ireland and that the outcome of the referendum on Britain's place in the European Union does not pose additional difficulties. There have been many good developments in the cross-Border development of our health service in recent years and I am eager to continue that.

I am taking this debate on behalf of my colleague, the Minister of State with responsibility for older people, Deputy Helen McEntee, who is unavailable. Government policy is to support older people to remain in their own homes and communities for as long as possible. There will, however, always be a cohort of older people who require a quality long-term residential care option. The nursing homes support scheme, or fair deal as it is commonly known, is a system of financial support for those assessed as needing long-term nursing home care, regardless of their age. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.

The applicant is free to choose any public, voluntary or approved private nursing home in the State. Of course, the home must have availability and be able to cater for the applicant's particular needs. The scheme has a net budget in 2016 of €940 million. This represents an increase of €43.1 million on the 2015 outturn. It is expected that the scheme will provide financial support to 23,450 clients on average per week in 2016.

The scheme has a statutory basis and is governed by the Nursing Homes Support Scheme Act 2009. It replaced the nursing home subvention scheme which had been in existence since 1993, and the system of contract beds and long-stay charges in public nursing homes. To be eligible to apply for the scheme, an applicant must be ordinarily resident in the State. This means that they are living in the State for at least a year or intend to live in the State for at least a year. The nursing homes support scheme does not extend to homes in Northern Ireland and it would not be possible to include facilities outside of this jurisdiction in key elements of the scheme. For example, prices payable under the scheme are negotiated by the National Treatment Purchase Fund. Such facilities are also subject to regulation by the Health Information and Quality Authority, HIQA, which has no jurisdiction within Northern Ireland. This issue was given careful consideration before the scheme was introduced in 2009. The decision not to extend the scheme to Northern Ireland was taken by the Government of the day on the basis of legal advice received from the Office of the Attorney General.

While my response is somewhat negative, the rationale for it is based on the legal advice of the Attorney General to the Government of 2009. One of the issues is how one can ensure qualities and standards when HIQA does not have jurisdiction in Northern Ireland. There are also the other points I outlined. That said, I have had an excellent conversation with my counterpart in Northern Ireland, the Deputy's party colleague and new Minister for Health, Social Services and Public Safety, Michelle O'Neill. We had a constructive conversation last Monday about areas of cross-Border co-operation. There is a great deal being done for children with heart conditions and there are plans to do more regarding organ donation. I would welcome the opportunity to discuss a range of issues with the Minister, Ms O'Neill, and I look forward to meeting her in Dublin on 4 July. I will be happy to discuss this matter with her, but I must sound serious caution in terms of the difficulties that currently exist.

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