Wednesday, 31 May 2006
Health (Repayment Scheme) Bill 2006: Report Stage.
I move amendment No. 1:
In page 4, between lines 39 and 40, to insert the following:
""Fund" has the meaning assigned to it by section 11(1);".
This amendment will define in the legislation what constitutes the donation fund.
Is the Minister facilitating amendment No. 10 in this raft of amendments? We want to ensure the money that comes into the Government's possession as a result of a decision of residents of nursing homes or their families not to take up the refund due to them is earmarked for specific projects and not lost in the general finances of the Department of Health and Children. We are asking that under no circumstances shall funds or any money donated be used in lieu of expenditure that would otherwise have been allocated by the Minister in his normal function and that such money be ring-fenced for projects of benefit to the elderly involved, such as community care units and other necessary facilities that are currently lacking. Such projects would lengthen the time some elderly people would remain outside nursing homes, private or public.
Deputy Twomey raised this on Committee Stage and amendment No. 9 will deal with a number of the issues raised about the donations fund.
This amendment will allow for the fund to be established and managed by the Health Service Executive. The fund will be also be able to receive donations of property and the proceeds of any dispersal shall be placed in it. The HSE will be able to invest the money in the fund but only in institutions that have been authorised by the Irish Financial Services Regulatory Authority. The fund will be monitored and audited to ensure the money in the account will be used appropriately and for what it was intended. Reports on the operation of the fund will be made to the Minister and these reports will be laid before each House of the Oireachtas.
Any money that is donated to this fund will not be subject to capital acquisitions tax liability and the individual making a donation to the fund can specify how he would like that money to be applied within the health services. The HSE will have regard to the wishes of the person making the donation to the fund but, due to practical and administrative difficulties, it cannot provide assurances that the money will be used for the specific institution requested. It can, however, provide assurances that the money will only be used for service improvements in the area of older people or the disability sector.
The HSE has provided initial indications of how it is proposed to administer the fund and any fund allocation decision by the HSE will, as far as possible, assign funds as close as possible to the service and unit that was the source of the funds and it is intended to specify this on the application form.
It is envisaged that the fund will be administered by the HSE, which will include managing and assigning money and accounting for and reporting on the fund. If it is not practical to assign funds to a specific unit, funding should be ring-fenced for the same service in the same area. The HSE intends as soon as possible to establish a working group incorporating representatives of the service areas and the finance unit to agree the criteria for selecting the service improvements that will benefit from the disbursement of the fund.
Any further issues around the administration of the donation fund can be addressed by way of secondary legislation. Section 21 of the Bill also allows the Minister to deal with any emerging difficulties in the scheme.
The fund will be separate from money from the Department of Finance and from the annual expenditure in the Department of Health and Children. It will be used specifically for services for older people or those with disabilities.
The thrust of the Minister's reply covers the objectives of amendment No. 10. Under those circumstances I will not move the amendment. We are pleased there will be an opportunity to discuss this when it is laid before the Dáil each year. It introduces a level of transparency that will meet our concerns about the transfer of funds being used to meet the normal expenditure accruing from the Department of Finance to the Department of Health and Children.
I move amendment No. 2:
In page 6, line 2, to delete "including" and substitute "being".
This bone of contention for the Labour Party was raised on Second and Committee Stages. Bringing in outside consultants to operate this system cannot be justified. Why is this being proposed? It will lead to additional costs with no guarantee that the system will be better or more efficient. We have some of the best personnel in the public sector. They are very competent and have proved in the past that they can deal with emergency payments. In the Department of Social and Family Affairs, for example, personnel organise the making of payments on a weekly basis. One of the great cries from the general public, who are weary of this Government, concerns the number of consultants and outside bodies every Minister and Department engages to produce reports and get work done which can be done by people in the Departments. We have confidence that they will do as good a job, if not better, than the outside grouping referred to by the Minister of State that will carry out this function, which also will place an additional cost on to the State.
We ask the Minister to accept the point made. I do not expect him to turn, however, because he has not acceded to our request on different Stages of the Bill. We ask him to delete "including" and substitute "being".
I support the Labour Party amendment. Since 1997, 175 reports have been submitted to the Department of Health and Children in respect of its work. There is a proliferation of reports and a lack of activity on sorting out the difficulties in our health service. This legislation will mean there will be another involvement of consultants. Surely the health service in particular or the public service in general have the necessary expertise. We have had some excellent performances and services from other Departments, including the Department of Social and Family Affairs, which deals with a complex area but is efficient in the way it carries out its work across a range of payments, regulations and appeals. Surely that level of experience, not alone in the Department of Social and Family Affairs but in other Departments like the Department of Agriculture and Food, which deals with complex issues concerning payments from the European Union with detailed regulations, many of which are difficult even to read let alone implement, can be called on by the Department of Health and Children. If that expertise, coupled with its own expertise, is available there is no need to spend vast amounts of money on external consultants to carry out what in effect is repayment of moneys the criteria for which will be clear and transparent. Surely that scheme can be operated by the public service rather than having to again engage expensive external consultants.
We hear about ongoing discussions on increasing the number of staff in the Department of Health and Children and the Health Service Executive. We hear also of the expertise that was available to each of the health boards, now concentrated in the Health Service Executive, but the management of seven health boards is now reduced to the management of one Health Service Executive. The expertise and professionalism of the people who have become available as a result of the rationalisation of the health boards could be applied to distributing funds, the criteria for which will be clear and transparent.
I support Deputy Ryan's case in regard to amendment No. 2. I concur with the argument he presented in this case. In trying to tease this out with the Minister of State, is he able to advise us as to his Department's assessment of the number of people it would require to oversee and conduct the processing of applications and the follow through work the whole procedure would entail? Do we know if that has been assessed? Can he tell us why it is believed it is not within the compass of the HSE or the Department to administer the scheme if that was an option? Has there already been an exploration of outside bodies to determine interest and availability of players from within the private sector? Can the Minister advise if any such explorative exercise has been employed?
I recall the various figures we all cited on Committee Stage and the Minister's information shared with us. Can he tell us the up to date position on the numbers of people who have come forward and registered their expected entitlement to repayment? Has there been any revision of the figures cited heretofore on the expected total number of applicants who will present? From my notes I see it was suggested that repayments would be due to some 20,000 people who are still alive and that a further 40,000 to 50,000 — these are significant, ballpark type figures; the gap between 40,000 and 50,000 is not small — would be a "guesstimate" of the estates that would benefit. Has there been any further revisitation of those figures and can the Minister share with us the up to date information? Is there a greater exactitude regarding same?
There is not only a principle involved here but this scheme will be a significant charge on the Exchequer in the first instance in terms of ensuring the repayment of moneys taken illegally from residents in long-term residential care institutions. The added cost of engaging private sector handlers and the overseeing of the repayments scheme will add additional cost, which one presumes will come out of the overall health budget. There is, therefore, genuine and well-founded concern on the part of Members that this would be wasteful and should be avoided. We would like to hear the Minister of State's arguments on why the Bill leaves this open to applicants in the private sector. I believe the simple mechanism presented by Deputy Seán Ryan and his Labour Party colleagues of substituting the word "including" for "being" achieves the required result. I commend the amendment and await the Minister of State's response to the various points we have raised.
The Deputies have raised a number of issues with which I will try to deal. I cannot accept the amendment as it would not allow for the appointment of an outside company to administer the scheme.
The Government decision allowed for the appointment of an outside company to provide an independent input into the process. The current public tendering process is at a very advanced stage. It is expected that a decision on the appointment of a preferred service provider will be made when the board of the Health Service Executive meets on 1 June.
The outside company will provide an independent input into the administration of the scheme and will also have the necessary experience given the magnitude of the repayments involved. Those applying for repayment may not have been satisfied if the Health Service Executive had been assigned responsibility to calculate the amount of repayments due because the former health boards had applied charges in the first instance.
The company will help to reassure the public that the scheme is being operated in the most effective and equitable way possible. The HSE has informed my Department that it is satisfied the company recommended for selection is the most economically advantageous option and that the costs will be significantly less than those quoted in the first tendering process, which was halted in December last year.
The HSE has also stated its support on the decision to engage an outside company because it is not in a position to administer the scheme itself. The making of repayments on this scale is not core work and, given its extensive commitments to the provision of health services, the resources required to administer the scheme are not available within the HSE without diverting staff from normal duties. We are not making this up or stating it within the Department. The HSE has itself stated this. The notion has been put around that since the health services were reformed, there are hundreds or thousands of people twiddling their thumbs looking for other jobs. These people all have serious jobs to do.
This is not the type of job which the HSE has the necessary expertise to do.
Consideration was given by the HSE to the involvement of public sector staff to assist the executive in administering the scheme, but the HSE has indicated that this approach was not taken due to a number of factors. These included potential industrial relations difficulties, the requirement to assign dedicated HSE resources to supervise these staff and remove them from normal duties, the time constraints of the public procurement process and the potential for significant logistical difficulties and protracted delays which would have to be factored into the tendering process if the staff were to be taken on board.
This is the largest repayment scheme ever undertaken in the State. The State has been found by the Supreme Court to have been wrong——
Yes. Not that we take any comfort from the Supreme Court finding that something was done which should not have been, but the practice was accepted by successive Governments and the majority of the people involved. They felt they were getting good value for the care given. That aside and following the Supreme Court decision, we have a responsibility which we have acted on. By appointing an outside company, a certain credibility is lent to the process. The people need have no doubt that the process will be carried out in a fair manner.
Deputy Ó Caoláin raised some questions. We expect the claims of those living to be somewhere between 16,000 and 20,000. With the previous legislation there was an ex gratia payment of up to €2,000. Just under 11,000 people were paid under that scheme. At the moment we have in the region of 22,000 applications for repayments. That would include both living people and estates. It is estimated that between 40,000 and 50,000 estates could be entitled to repayments. With regard to required manpower, the HSE has indicated that it would require approximately 100 people over a period of two years to deal with the claims.
As I stated earlier, I did not expect the Minister of State to change his approach at this stage. If the will had been there, it could have been dealt with. It is ideologically driven and it is a vote of no confidence in the departmental staff and the public sector. I am not stating the Department of Health and Children would be the prime mover in this regard, but the Tánaiste and Minister for Health and Children, Deputy Harney, generally goes to the private sector to deal with an issue. That is incorporated in this legislation.
I have no indication from the Minister of State of the basic cost. What is the projected cost of operating this scheme? Is there any indication what this may be? It may be premature to ask that now. We can get that response. It is a fundamental issue and I regret that the Minister of State is not prepared to accept this amendment.
The Dail Divided:
For the motion: 74 (Dermot Ahern, Noel Ahern, Barry Andrews, Seán Ardagh, Niall Blaney, Johnny Brady, Martin Brady, James Breen, John Browne, Joe Callanan, Pat Carey, John Carty, Donie Cassidy, Michael J Collins, Mary Coughlan, Brian Cowen, John Cregan, Martin Cullen, John Curran, Síle de Valera, Noel Dempsey, John Dennehy, Jimmy Devins, John Ellis, Michael Finneran, Dermot Fitzpatrick, Seán Fleming, Mildred Fox, Pat Gallagher, Jim Glennon, Noel Grealish, Mary Harney, Seán Haughey, Jackie Healy-Rae, Máire Hoctor, Joe Jacob, Cecilia Keaveney, Billy Kelleher, Peter Kelly, Séamus Kirk, Tom Kitt, Michael McDowell, Tom McEllistrim, John McGuinness, Paddy McHugh, Micheál Martin, John Moloney, Donal Moynihan, Michael Moynihan, Michael Mulcahy, M J Nolan, Éamon Ó Cuív, Seán Ó Fearghaíl, Charlie O'Connor, Willie O'Dea, Liz O'Donnell, John O'Donoghue, Noel O'Flynn, Batt O'Keeffe, Ned O'Keeffe, Tim O'Malley, Tom Parlon, Peter Power, Seán Power, Dick Roche, Mae Sexton, Brendan Smith, Michael Smith, Noel Treacy, Mary Wallace, Joe Walsh, Ollie Wilkinson, Michael Woods, G V Wright)
Against the motion: 48 (Bernard Allen, Dan Boyle, Pat Breen, Tommy Broughan, Richard Bruton, Joan Burton, Paul Connaughton, Paudge Connolly, Joe Costello, Seymour Crawford, Seán Crowe, Ciarán Cuffe, John Deasy, Jimmy Deenihan, Damien English, Olwyn Enright, Martin Ferris, Eamon Gilmore, Paul Gogarty, Tony Gregory, Joe Higgins, Michael D Higgins, Brendan Howlin, Kathleen Lynch, Pádraic McCormack, Dinny McGinley, Finian McGrath, Arthur Morgan, Catherine Murphy, Gerard Murphy, Denis Naughten, Dan Neville, Caoimhghín Ó Caoláin, Fergus O'Dowd, Jim O'Keeffe, Brian O'Shea, Jan O'Sullivan, Willie Penrose, Pat Rabbitte, Seán Ryan, Trevor Sargent, Joe Sherlock, Róisín Shortall, Emmet Stagg, David Stanton, Billy Timmins, Mary Upton, Jack Wall)
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Stagg and Neville.
Question declared carried.