Wednesday, 5 October 2005
I raise this issue after the family involved has exhausted every avenue in trying to seek a resolution to it. The background to the case, with which I believe the Tánaiste if not the Minister of State, Deputy Tim O'Malley, is familiar, is that Mr. Keeshan has suffered from Alzheimer's disease for the last 15 years. He does not recognise his family and needs full-time care and attention. He is still physically mobile and requires increased care as a result. He is in St. Conlon's Hospital in Nenagh and his family are anxious that he be allocated a bed at the community nursing unit in Birr.
Nenagh is 23 miles from their home whereas Birr is less than two miles away. The man's children live either at the family home or in Birr and they pass through Birr each day as they travel to and from work. The family is very much from Birr. They all went to primary and post primary school in Birr, go to mass and shop there and are part of Birr parish. It is very much their home.
I do not know whether the Minister of State, Deputy Tim O'Malley is familiar with hurling.
If this man was to hurl, he would have to hurl for Offaly and not for his own county. His address is Riverstown, Birr, County Offaly, but this is actually physically in County Tipperary. This is where his problem lies.
The Health Service Executive for the midland area will not consider him for a bed in Birr as he is outside their area. However, even this is not clear cut. The former chief officer of the HSE midland area in a letter in regard to this case stated:
There is a need at all times to adopt a flexible approach to matters of this nature. In the past it was the policy of all health boards that where boundaries cut through natural catchment areas or indeed where individuals were disadvantaged by particular boundaries a flexible approach would be adopted.
I ask the Minister of State whether this was or is the case, which is the first point that needs to be clarified.
The chief officer then goes on to state that Birr was Mr. Keeshan's community focal point. The letter states: "With the Government decision to abolish health boards and health board boundaries there is an even greater emphasis on adopting a flexible approach to such matters into the future." Is this an accurate statement? His letter goes on to make it clear that these points form part of the general policy framework of the HSE. Like him, I thought the abolition of health boards would at least mean that decisions I can only describe as cold, heartless bureaucracy would no longer form part of our health service. Unfortunately, this has not been the case for this family.
I am aware the HSE has offered subvention for Mr. Keeshan to attend a private nursing home in County Offaly but the family have already tried this and found it totally unsuited to his needs. He is at his most content when he can be outside in a garden. He requires little care at these times but he does require to be in a place that he cannot leave. I do not want to use the word "escape", which would be accurate. Birr community nursing unit offers such a place. His family naturally want to see their father as often as possible and take a very active role in his care but they cannot do this while he remains where he is.
We were promised a people-centred health service but this case does not meet that standard. This is a decision based on nothing more than a line on a map showing a boundary when we supposedly have one Health Service Executive and boundaries were thought to be a thing of the past. Even if they still exist, where is the flexibility that we need to ensure a proper caring health service?
I raise this matter in the hope that the Minister of State and the Tánaiste can understand the sense of the argument I make. I am not asking for interference but for common sense to be adopted. If the line exists, at the least arrangements should be put in place for people living in boundary areas, as described by the former chief officer. This matter has been allowed to drag on for a considerable time and needs to be resolved for the sake of the patient concerned and his family. I ask the Minister to intervene.
I take this Adjournment matter of behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising the question as it provides me with an opportunity to outline to the House the current situation.
The Department made inquiries of the Health Service Executive regarding the issue raised by the Deputy. The HSE informed the Department that there are no vacant beds in the nursing unit to which the Deputy refers and that the facility in question has a waiting list of 25 people at present. I have been further informed that the patient is receiving care in another HSE community nursing unit which is approximately 28 miles from the patient's home. The HSE recognises that the patient's family has difficulty in visiting him at that facility and has offered to provide a private nursing home bed in a facility approximately ten miles from the patient's family home. To date the patient's family have not accepted this offer. The HSE has met the patient's family in the past and is happy to do so again to review the matter.
It is worthwhile to point out that a working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established following on from the publication of the Mercer report on the future financing of long-term care in Ireland. The objective of this group is to identify the policy options for a financially sustainable system of long-term care, taking account of the Mercer report, the views of the consultation that was undertaken for that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea. This group has been requested to report to both the Tánaiste and the Minister for Social and Family Affairs. I understand this report is due shortly. Following this process it is the intention that there will be discussions with relevant interest groups in regard to the proposals for the future financing of long-term care.
The Department of Health and Children is reviewing the operation of the nursing home subvention scheme and the legislation and regulations underpinning it. It is intended to bring legislation to Government in this regard later this year. Part of reviewing the subvention system will be to update the thresholds contained in the 1993 nursing home regulations, which have not been updated since being set in 1993 and which warrant updating given the rising cost of living and property in the past 12 years.
The Department is also undertaking a comprehensive review of eligibility for services generally, including services for older persons and related legislation. This is the first major review in this area since the passing of the 1970 Health Act.