Beverley Flynn (Mayo, Independent)
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I wish to raise an issue that has been raised many times by people on all sides of the House. I do so because of the decision by the Health Service Executive in County Mayo not to pay any more enhanced subventions for new applicants. The HSE has increased its subvention payments in the south and east to approximately €750 per week. This situation has arisen despite the fact that the Tánaiste last year gave an undertaking at a meeting of the Oireachtas Committee on Health and Children that she would bring about equality of subvention rates across the country, that she recognised discrimination existed and would do something about it. In April 2005 the enhanced subvention rate in County Mayo was €200, while in the east of the country it was €600 per week. In February 2006 it was €310 per week in Mayo and €720 in Dublin. Today it is €310 per week in Mayo while it is €750 in Dublin. Despite the Tánaiste's assurances, over the past year we have seen the gap widen between subvention rates in County Mayo and County Dublin.

I am particularly disappointed that the HSE in County Mayo has decided that no new applicants will get enhanced subvention, which means the most a maximum dependency person can get, based on the means test, is €190 per week. This is having a serious effect on the situation in our accident and emergency departments. If we are serious about tackling that problem, this is one of the critical areas in which we can do so. The Tánaiste agreed that it is discriminatory and made a commitment to do something about it.

I will anticipate the Minister's reply, as there have been many similar replies on this matter. I do not want to know that it is a means-tested payment. I know that. I do not want to know the subventions available to medium, high or maximum dependency people. I have that information. Neither do I want to know that €140 million was spent on subventions in 2005. I do not want to know that €20 million was allocated in the budget to deal with subventions and to bring about equality because, as I have already stated, that €20 million is already spent and has made no difference. We have moved backwards from the position last December when the €20 million was allocated. Finally, I do not want to know that a working group in the Department is working on the question of how to deal with long-term care because I am aware of that.

Having been a member of the Oireachtas Committee on Health and Children for a number of years, I am aware that there have been many positive developments in long-term care, particularly home-care packages, of which 500 were announced last year. These allow people to be looked after at home rather than put into a nursing home. I support this excellent Government policy. However, of the 500, five were made available in County Mayo. Some 3,000 are to be made available in 2006 and Professor Brendan Drumm has promised that we will get more of them. However, as the Minister can see, they are not a real alternative.

The only way this situation will be tackled and genuine equality achieved across the country is by putting serious money into the system so that people in County Mayo do not receive €190 per week while a person in Dublin gets €750. The Minister may argue that nursing home charges are more expensive in the city and that is true, but not to that extent. This issue must be tackled. On one occasion last month there were 30 people on accident and emergency trolleys in my county. There is no reason for people to be on trolleys. Despite the ten-point plan implemented last year, no contract bed was awarded to Mayo General Hospital.

I ask the Minister to throw away the script that has probably been prepared for him mentioning all the items I have listed, and to tell me what the Government will do to honour the commitment given in the budget and in the committee last year. I hope it can be honoured. Many people who operate excellent nursing homes in the west of Ireland find it difficult to survive and, sadly, many patients take up acute beds in hospitals. Although these people should not be in hospital and are more suited to a nursing home, they and their families cannot afford to pay the difference between €190 and the nursing home charge, which is probably in the range of €600 per week.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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Tá mé ag tabhairt an fhreagra seo ar son an Aire Sláinte agus Leanaí, an Teachta Harney.

Beverley Flynn (Mayo, Independent)
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Tá an tAire Stáit ag caint as Gaeilge.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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Níl morán le rá agam mar dúirt an Teachta nach mbeadh sé ceart an freagra iomlán a thabhairt don Tigh seo.

Seán Ardagh (Dublin South Central, Fianna Fail)
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Níl ach cúig nóiméad ag an Aire.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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Tá a fhios agam. Ba mhaith liom buíochas a ghabháil leis an Teachta as ucht an cheist seo a phlé ar Athló on Tí. It gives me an opportunity to outline to the House the current position on the nursing home subvention scheme. I fear the Deputy has heard these ominous word before. The Deputy is aware of the principles of the subvention, the criteria applied and the fact that there are different rates depending on whether the applicant is of medium, high or maximum dependency. The scheme was introduced to assist with the cost of private nursing home charges and was never intended to cover the entire cost of nursing home care. Under Article 22.3 of the nursing homes subvention regulations 1993, the HSE may enter into an arrangement with a registered private nursing home to provide inpatient services under section 52 of the Health Act 1970. In making such an arrangement the HSE may pay more than the maximum rate of subvention relative to an individual's level of dependency, for example in cases where personal funds are exhausted, in accordance with Article 22.4 of the Nursing Home (Subvention) (Amendment) Regulations 1996.

In the context of the matter the Deputy has raised on the Adjournment this evening the following Delphic sentence is what I can convey to her: the application of these provisions is a matter for the HSE in the context of meeting increasing demands for subventions.

Beverley Flynn (Mayo, Independent)
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Please, Minister.

Séamus Healy (Tipperary South, Independent)
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The Minister may stop talking.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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The average rate of subvention paid by the HSE generally exceeds the current approved basic rates. Although the Deputy appealed to me not to trespass on her time and outline to the House the amount of expenditure that takes place on the subvention, I have to point out that expenditure on the scheme has increased from €5 million in 1993 to €140 million last year. I do not propose to go into the details of the last budget or the investment package there, however it involves substantial additional funding.

Seán Ardagh (Dublin South Central, Fianna Fail)
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Probably €20 million.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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The Department is examining primary legislation to expand the policies and principles of the subvention scheme to facilitate implementation of the scheme by the HSE throughout the country. This is proceeding through the Dáil and may afford the Deputy a legislative peg on which to hang her argument again. The thresholds contained in the Nursing Homes (Subvention) Regulations 1993 on an applicant's assets and the value of an applicant's primary residence were increased by regulations on 14 December 2005 to bring them into line with modern valuations. A working group chaired by the Department of the Taoiseach and comprising senior officials from the relevant Departments was established following the publication of the Mercer report entitled, Study to Examine the Future Financing of Long-Term Care in Ireland. This group is examining the options on a sustainable system of long-term care, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea. The Government is considering the report of that group.

The future of residential care funding was discussed by the social partners as part of the report Towards 2016: Ten Year Framework for the Social Partnership Agreement 2006-2016, which states that there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. Perhaps there is some comfort for the Deputy there. The agreement also states that the level of State support for residential care should be indifferent as to whether that care is in a public or private facility.

Beverley Flynn (Mayo, Independent)
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I thank the Minister.