Dáil debates

Thursday, 6 July 2006

Estimates for Public Services 2006.

Vote 40 — Health Service Executive (Supplementary).

12:00 pm

Tim O'Malley (Limerick East, Progressive Democrats)
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The Health (Repayment Scheme) Act 2006 was signed by the President on 23 June 2006. The Act provides a clear legal framework for a scheme to repay recoverable health charges for publicly funded long-term residential care. All those fully eligible persons who were wrongly charged and are alive and the estates of all those fully eligible persons who were wrongly charged and died since 9 December 1998 will have the charges repaid in full.

The decision to limit repayments to estates of those who died since 9 December 1998 reflects the reference in the Supreme Court judgment to the possible application of the Statute of Limitations: "The State has available to it a defence of the Statute of Limitation i.e. a 6 year limit". The Government has a responsibility, in light of the substantial sums involved, to have regard to what the Supreme Court said about the Statute of Limitations to place appropriate limits on the scale of total repayments which today's taxpayer will have to fund.

Charges for publicly funded long-stay residential care have been raised by health boards from people under two sets of regulations: the Institutional Assistance Regulations 1954, as amended in 1965, which applied to all, including those with full eligibility, and the Health (Charges for In-Patient Services) Regulations 1976, as amended in 1987, from which medical card holders and those with dependants were exempt.

The Supreme Court judgment in the McInerney case in 1976 narrowed very significantly the grounds on which a charge could be raised for institutional assistance. It could only be made for shelter and maintenance without any medical or nursing care being provided. A circular from the Department of Health to the health boards in 1976 authorised a practice by which the chief executive officer of a health board could regard patients as not meeting the criteria for full eligibility while being maintained in an institution, since necessary general practitioner and surgical services were being provided for them, and so withdrew their medical card. The withdrawal of full eligibility in this way allowed a charge for inpatient services to be raised.

The health boards, with the knowledge of the Department of Health and Children, continued to raise charges under both sets of regulations up to 9 December 2004. On the basis of advice from the Office of the Attorney General, the Department instructed the health boards to cease charging all fully eligible persons in receipt of inpatient services in public long-stay institutions and in contract beds in private nursing homes solely by virtue of a contractual arrangement with a former health board with effect from 9 December 2004. By way of a goodwill gesture, the Government agreed to have ex gratia payments of up to €2,000 made to those wrongly charged and who were alive on 9 December 2004. The Health Service Executive made payments in excess of €21 million to approximately 10,800 individuals.

The Health (Amendment) (No. 2) Bill 2004 was passed by both Houses of the Oireachtas on 17 December 2004. The purpose of the Bill was to provide a statutory basis for the imposition of charges on those to whom inpatient services were being provided in public long-stay institutions. It also contained a retrospective element which provided that charges levied prior to the enactment of the legislation were also lawful. This Bill was referred to the Supreme Court for a decision on its constitutionality. The retrospective element provided that a relevant charge levied under section 53 of the Health Act 1970 for long-stay care prior to the enactment of the legislation was lawful. The Supreme Court decision of 16 February 2005 found this retrospective element of the Bill to be unconstitutional because of the property rights of citizens.

The charging for long-stay care was put on a statutory footing under the Health (Amendment) Act 2005 and is being implemented by way of the Health (Charges for In-Patient Services) Regulations 2005. These regulations were signed on 14 June 2005 and reinstated charges for inpatient services and provided for the levying of a charge in respect of the maintenance of persons in receipt of such services. The regulations were prepared following extensive consultation with the Health Service Executive and others.

The Supreme Court in its decision of 16 February 2005 did not consider the exposure of the State, or the magnitude of the sums involved, to justify the extinguishment of a property right. In light of the amount of repayment which would be due to individuals in certain cases and the overall amount of money involved, it was agreed a repayment scheme to repay fully eligible individuals who paid inpatient charges while in publicly funded residential care would be established and placed on a statutory basis. The Government agreed the key elements of the scheme for the repayment of these long-stay charges last year.

Extensive discussions have taken place with the Office of the Attorney General, the Department of Finance, the Office of the Revenue Commissioners, the Department of Social and Family Affairs, the probate office of the High Court, the office of the wards of court, the Law Reform Commission, the Office of the Ombudsman, the Courts Service, the Data Protection Commissioner, the Mental Health Commission and the Health Service Executive regarding the provisions contained in this Act. In addition, the national oversight committee which the Tánaiste appointed, which is representative of service users, including Age Action Ireland and the senior citizens parliament, has provided an independent input into the repayment scheme design. It will monitor the operation of the scheme to ensure it is implemented quickly and in the most effective way possible. The committee is chaired by Professor J. Bernard Walsh, consultant physician, St. James's Hospital, and reports directly to the Tánaiste.

It is estimated that up to approximately 20,000 people who are still alive and a further 40,000 to 50,000 estates will benefit from repayments under the scheme. The overall costs arising from the long-stay charges repayment scheme have been estimated at approximately €1 billion

Owing to the nature, volume and complexity of the repayments involved, it was decided, in line with the Government decision, to appoint an outside company with appropriate knowledge and experience in dealing with mass repayments. The HSE has selected a preferred service provider, a consortium comprising KPMG accountancy group and McCann Fitzgerald solicitors, to manage the repayment scheme within the agreed Government parameters. This company will also provide an independent assessment of the amount of repayment due to each applicant under the scheme, which will help to reassure the public that the scheme is being operated in the most equitable and effective way possible. The tender was awarded to the most economically advantageous tender. The award criteria was based on cost, technical capacity, legal expertise and economic and financial capacity.

The HSE has indicated that all EU guidelines and directives have been complied with in awarding the contract. The cost of the company will be based on the number of repayments, but has been capped at €15 million exclusive of VAT. The HSE is satisfied the successful consortium met the necessary criteria and is confident of the ability to deliver all aspects of the scheme. The HSE has worked directly with the Data Protection Commissioner to ensure that all necessary measures are in place to protect the confidentiality of information. It is understood from the HSE that a very small proportion of the work to be undertaken by the company will be sourced outside the EU. This work is of a data entry nature and will not involve the operation of help lines, the provision of information or any related matters, all of which will be performed within the State.

The HSE has supported the decision to engage an outside company, as the nature of the work is not one of its core functions. In any event, it would not be in a position to administer a repayment scheme of this magnitude within existing resources without having to divert staff from normal functions in the delivery of health services. The HSE is already committed to providing resources for the implementation of a unitary system for the delivery and management of health services at local, regional and national level, following its establishment in January 2005.

Consideration had been given to the involvement of public sector staff to assist in administering the scheme. However, the HSE informed the Department that the time constraints of the procurement process and the potential for significant logistical difficulties and protracted delays, with consequent implications for the commencement of the repayment scheme, did not allow for the implementation of this option. There would also have been a requirement to assign dedicated HSE resources to train and supervise such staff, thereby removing them from their normal duties with a subsequent effect on service provision.

However, in recognition of the importance of progressing repayments, the Tánaiste has asked the HSE to identify those living patients who were wrongfully charged and to calculate the details of the repayment due to them in as many cases as possible during the period prior to the selection of the outside company. This will ensure a significant proportion of patients should receive their repayments as soon as possible, with the repayment process commencing before the end of July.

The national repayment scheme will refund all those fully eligible persons who were incorrectly charged for publicly funded long-stay residential care. Medical card holders, and those aged over 70 with effect from July 2001, are considered to be fully eligible for the purpose of this scheme.

It has been agreed that those not having a medical card on admission but who fell within the income means threshold for a medical card, for example, those in receipt of the non-contributory old age pension, will be regarded as having full eligibility for the purpose of this scheme. This is because of the vulnerability of those in long-stay care, and being cognisant that the former health boards did not make a determination on eligibility status in many instances, based mainly on the incorrect assumption that full eligibility could be removed from long-stay care patients as set out in the Department of Health circular 7/76. This action will ensure the scheme is broadly inclusive and is implemented in a fair and equitable manner.

All those wrongly charged for inpatient services will be repaid in full. For the purpose of this scheme, community hostels which provide either medical or nursing care on a rostered basis are considered inpatient services, and residents will have any unlawful charges repaid in full.

Priority in making repayments will be given to those who are still alive to allow these people to benefit from the repayment by availing of comforts which they may not otherwise be able to provide. In the case of estates, it will not be those who actually paid the charges that will receive the repayment. Many of these living patients have already been identified as a result of the ex gratia scheme which was announced in December 2004. As mentioned earlier, at the Tánaiste's request, the HSE had already begun proactively calculating the amount of repayments due to living patients in advance of the selection of an outside company. This advance work will help ensure the repayments process will commence before the end of July.

It is important to note that the repayments will include both the actual charge paid and an amount to take account of inflation by reference to the consumer price index. The consumer price index is a widely accepted tool for monetary calculation over an extended period of time. Data from the CPI is also available on a regular basis, thereby facilitating a match with periods when payments are due. The CPI is also used by the Department of Social and Family Affairs in dealing with underpayments of social welfare entitlements.

The scheme will include a transparent and user-friendly appeals process that will be independent of the HSE and the company engaged to administer the scheme. Suitably qualified independent appeals officers will be appointed to consider appeals. The appeals process will allow both written and oral submissions to support an appeal. Applicants to the scheme will be advised of the outcome of their application as soon as possible, and they will be provided with details of their entitlement to appeal if their application has been rejected or if they dispute the amount of the repayment. Applicants will also be informed of their right to bring a complaint to the Office of the Ombudsman. The legislation allows for regular reports on the operation of the appeals process, which will be laid before the Oireachtas.

The Department of Health and Children had previously indicated that funding of €400 million would be required for the health repayment scheme in 2006. It was originally anticipated that repayments would begin in May of this year. Due to a prolonged tendering process and the extensive consultation required in the drafting of the Bill, repayments will not commence until late July or early August of this year. It is now estimated that the total funding required to service the health repayment scheme for 2006 is €340 million. The revised estimate is based on a reduced volume of repayments to be completed this year.

As already indicated, approximately 20,000 people who are still alive, and approximately a further 40,000 to 50,000 estates, will benefit from repayments. In order to begin making repayments as soon as possible, the HSE has indicated that the details of 7,600 living patients have been calculated. In addition, the HSE will also have completed 3,500 calculations in respect of those who are deceased, making an overall total of 11,100 calculations at an estimated cost of €222 million.

It is envisaged that these initial repayments will be made in the first two months of the service provider's appointment, with a further 4,000 living persons receiving payment in the current year at a further cost of €80 million. In addition to the cost of the actual repayments including interest, there will also be an additional funding requirement for the outside company. The total cost of the outside company has been capped at €15 million excluding VAT, but the actual cost of the company will be based on the number of overall repayments and will not be known until all the repayments have been completed. A costing of €5 million has been provided for 2006.

A further €33 million has been set aside for other costs associated with the scheme, which will include the costs associated with any additional repayments which may be issued in the current year; establishing and resourcing the appeals process under the scheme; and the cost of employing staff from the probate office to process streamlined applications for probate from estates.

The figures provided for the cost of the repayments outlined above are based on estimates provided by the HSE, which indicate the average repayment due to an individual is approximately €20,000. This average figure will vary depending on length of stay and the amount of health charge paid by the patient in the first instance.

In conclusion, the total funding requirement for 2006 has been revised downward from €400 million to €340 million, with the balance of the funding of €660 million required in 2007 and 2008.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I wish a good summer to Members and staff of the Houses, who work so well during the year.

We have heard much debate on this matter over the past 18 months, and we should reflect a little on it. Departments responsible for health and justice matters are two major social bodies in any country's government. Fianna Fáil, which claims to represent two of every five voters in this country, has no control over these two Departments. The Progressive Democrats, as far as I am concerned, does not have an ethos which allows it to empathise with the people who most need the Department of Justice, Equality and Law Reform and the Department of Health and Children.

Tim O'Malley (Limerick East, Progressive Democrats)
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I strongly resent that remark.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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There has been a slump in the corporate governance of these Departments under the PDs. The attitude of Fianna Fáil to the slump is no surprise to us in the House. They have failed completely to provide political leadership.

As Fine Gael spokesperson on health and children, there have been three major issues in which I have had an interest in recent weeks: the statutory rape crisis, the report of the Commission on Assisted Human Reproduction and the legislation to which this motion refers. There a common theme running through these three issues. The response time one would expect from the Government with regard to dealing with the important issues I have just outlined is an absolute disgrace. Something else these three issues have in common is that the Supreme Court is playing, or could potentially play, a central role in them. All that indicates to me is complete incompetence on the part of the Government. The Supreme Court pushed the statutory rape issue, the Supreme Court is central to the legislation referred to and it looks like the Supreme Court will decide on the report on the Commission on Assisted Human Reproduction because the Government is failing to do its job. That is incompetence. A constant factor in all of these issues is the involvement of the Progressive Democrats. Although it has always claimed to be good on corporate governance, the Progressive Democrats has been central in some of the greatest messes we have witnessed in this House.

Tim O'Malley (Limerick East, Progressive Democrats)
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These messes were there a long time and Deputy Twomey's party also was in government, and he well knows that.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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The disengagement of Fianna Fáil from any of these issues is also of great concern to the people. In fact, the only political slump that we are seeing at present is how the coalition, of which Deputy Tim O'Malley is a part, is governing the country. Some €340 million will be paid out this year to repay illegal nursing home charges. Some €600 million must be paid out next year.

There is potentially another illegal nursing home charges issues, which I have constantly raised on this side of the House with both Deputy Tim O'Malley and the Tánaiste and Minister for Health and Children, Deputy Harney, and to which I have never receive a clear answer. This issue is private nursing home charges on those over 70. Every time the Tánaiste has been asked about this, her reply is that the courts will decide. What is our role here in this House? Are we legislators or do we take our diktat from the Supreme Court? The Department of Health and Children officials have expressed concern about this issue, but not one Minister in the past 18 months or two years has shown the leadership he or she is supposed to show in his or her Department or has come in here to tell me that I am wrong about the illegal nursing home charges for private patients in private nursing homes. Not one Minister has come in here to disclose the Department's good advice on this and to state why the Department is standing over this. When the Travers report was discussed in the Joint Committee on Health and Children, we asked about the charges in private nursing homes. The Government has not answered in two years. I suppose this should not surprise us because it has taken the Government 18 months to come to this point.

The Tánaiste stated, when the legislation was first thrown out by the Supreme Court, that both herself and the Taoiseach felt strongly that these repayments should be made quickly because of the age and the vulnerability of the people who are still alive. As Members will be aware, the average length of stay of a person in a nursing home is between two and three years. It will nearly be two years before the Department makes the first repayment, in other words, many of the people of whom we spoke when we first raised this issue are now dead. That is the sort of useless foot-dragging Government we have at present.

This is the last sitting day before the summer recess. During the recess the Minister of State, Deputy Tim O'Malley, might go to the trouble of getting an answer to my question. Deputy Harney's predecessor in the Department of Health and Children, the Minister, Deputy Martin, not having read his briefing documents, told the Joint Committee on Health and Children that he had no responsibility for the illegal nursing home charges. At that time the Minister of State, Deputy Tim O'Malley, acknowledged that he saw the importance of that memo when it was shown to him and maybe he might have the intellectual capacity to come back into this House and tell us whether we are wrong on the issue of the charges for those over 70 in private nursing homes.

Deputy Harney is showing almost the same cavalier attitude of Deputy Martin to what potentially may be a considerable cost to the taxpayer next year. It just goes to show that the Progressive Democrats is infected with the Fianna Fáil virus, that life begins and ends at election time. The Progressive Democrats has shown no consideration for what may happen to the public finances in the future. It has shown no consideration to the people for whom it is supposed to be responsible and that is why I say that the Progressive Democrats ethos does not fit well with looking after the elderly. It has a casual attitude and does not quite understand the concerns of the elderly. It merely see all of this as a routine it must go through. That is why the people are growing tired of it after five years. The people are growing tired of it because it's competence in providing good government is failing day by day.

One of the questions we asked on Committee Stage was why the Government was unable to look within the capacity of the Civil Service to make these repayments. It seems amazing that the HSE has the details of 10,500 people involved who it maintains are still alive and the Minister of State stated that there are approximately 20,000 people involved who are alive. As the HSE identified these 10,500 last December, I am sure it has identified far more since. While, according to the Minister of State, the Department will hand all this information over to a private company, it seems all the company must do is sign the cheques. How difficult could it be for the company to find the remaining people involved? The HSE has more or less done all the hard work for the company, in the case of the people who are alive.

The Department also has probably identified the vast majority of the 40,000 or 50,000 people involved who are deceased. No doubt a significant amount of work has already been done on that by the HSE. The HSE has identified those whose estates must undergo probate because it has already identified what level of resources it will need to do that. A considerable amount of this work has been done.

While the Minister of State stated that the HSE would not have the resources to do this work, and I agree with him for a different reason, what of the other Departments? The Department of Agriculture and Food made significant payments on an annual basis and it does not make those payments any more. The Department of Social and Family Affairs, which is more or less the Government's bank, makes significant payments every week. Is it really beyond the Government to get the heads of these Departments together to see if a solution could be reached, where the civil and public services could provide a significant amount of the resources and back-up to make these repayments, rather than adopt the knee-jerk approach of contracting it out to a company?

I have serious concerns about the HSE. If half of the concerns expressed to me about the HSE are true, we will be back after the next election looking at the Health Act 2004 which established the HSE. I hope the Department of Health and Children stays together and functions well because it looks like it might take over many of the functions of the HSE in the future.

The Tánaiste seems oblivious to what is happening in the HSE. She has really distanced herself to an unbelievable extent. I recognise she is doing it for political reasons. She thinks that any scandal will not stick to her if she sets up all these groups. The HSE has been established almost as a semi-State company with little accountability, and yet the Government seems to be almost trying to ignore the concerns that people are expressing about it.

While we in this House often criticise the parliamentary affairs division, that division is just a manifestation of the wider problems within the HSE. If information encounters a difficulty in flowing back to the chief executive's office which responds publicly to Deputies in this House, what problems are occurring behind closed doors? Ministers need to wake up and smell the coffee because their only role is to run the health service competently. They are supposed to act as chief executive officers of their Departments, not as television stars with big egos jockeying for position within their respective parties. That is why it has taken 18 months for the Government to come close to repaying people who were abused by the State. The Tánaiste should get a move on and make the repayments properly.

Are further problems regarding illegal nursing home charges being covered up? I have raised this issue previously and I will continue to pursue it. The Minister of State should not hide behind the courts. As legislators, we do not have to wait for courts to decide because if problems are identified, we can legislate to address them. Would the Government parties wait, as they almost did, for the courts to decide to allow child rapists to walk free? Is their attitude that cavalier that they do not care and they will wait for a diktat from the Supreme Court when it reaches a decision? The Opposition is concerned about accountability, transparency and good corporate governance. These are buzz words Ministers throw out at press conferences before they run helter skelter when there is trouble. Every strategy and document is launched at a press conference and there is no question of anything being introduced in the House because the Tánaiste is afraid of accountability. However, when she was asked a difficult question at the press conference for the launch of the cancer strategy, the HSE chief executive officer, Professor Drumm, who is not part of the political Executive that is supposed to respond to the people, jumped in to reply.

Ministers are disengaging from their duties and the public and that is why they are losing the confidence of the people. I recently watched a television programme about Margaret Thatcher's government. Her Ministers became so arrogant and incompetent towards the end, I had a sense of déjÀ vu as I was reminded of the behaviour of our Ministers. The people are concerned about health, justice, crime and public expenditure. The issue of illegal nursing home charges has been discussed thoroughly but the Government has been damn slow to address it. Are Ministers trying to cover up more banana skins in this regard because they are afraid to acknowledge they may have been responsible for incurring a significant liability on behalf of the taxpayer as well as treating vulnerable elderly people in a cavalier manner?

1:00 pm

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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It is important to acknowledge what happened and why €1 billion of the health budget is being set aside to make reparation to elderly vulnerable people and their families who were robbed by the State. This is a lamentable record, although I appreciate a number of Administrations are to blame. However, €1 billion is being taken out of the health budget, which could have been spent elsewhere. For example, an additional 350 hospital beds could have been provided and many other services could have used this money. However, the State must repay money it took illegally from people who were extremely vulnerable.

The bill should not be as high and that is the Government's responsibility. If the then Minister for Health and Children, Deputy Martin, had undertaken the simple task of reading his brief, as a Minister should, the cost would have been less. If his well-paid political advisers had done what they were supposed to, the bill would be less. The most disturbing aspect of the increased bill, which resulted from the Minister's failure to do his job, is that the Government, composed of the Progressive Democrats, which is supposed be the watchdog, and Fianna Fáil, has exonerated the Minister and rewarded him with a transfer to a more tranquil Department, where it is all good news for a change. The then Secretary General of the Department of Health and Children took the hit and that is no way for a Government to operate. It highlights a paucity of leadership, which is both revealing and disturbing, not only in the Department of Health and Children but throughout the Government. At the very least, we need to ensure those who are in positions of responsibility accept it and do not only accept the trappings of office such as the large salary, the minders, the driver, the advisers and all the praise and flattery that goes with the position. When they do not live up to their duties, the buck should stop with them.

That attitude has pervaded the entire Government. For a long time the Taoiseach managed to deflect criticism but that is no longer the case. He became known as the Teflon Taoiseach but this culture has pervaded the Government in a corrosive way. The Taoiseach's attitude is not working any longer and, generally, the Government is feeling the heat. The Minister for Justice, Equality and Law Reform, about whom there is a touch of a school boy, uses a silly phrase in this regard. However, support for both Government parties has slumped but that was inevitable given their record. If there were ministerial accountability — I do not only refer to the former Minister for Health and Children, Deputy Martin — the public at least would feel a sense of security that some principle remained within politics and the Government.

The costs that have been added unnecessarily by privatising the process are questionable. Why was a process embarked on to employ a private company to manage a simple set of procedures? What is the big deal? Not only did the Government hire a private company, the company tendered late and the process was repeated so the company could win the contract worth €15 million. The appeals process cost €33 million and, therefore, a total of €48 million will be paid for administration alone. We do not need to spend money like that. The Civil Service has spare capacity. As Deputy Twomey pointed out, 400 officials in the Department of Agriculture and Food processed very complex payments, which were abolished following the introduction of the single payment scheme. The Department of Social and Family Affairs made repayments when the European Union decided that married women were being discriminated against. The then Minister for Social Welfare, Proinsias De Rossa, did not need to hire a private company as a crutch on which to lean. Payments of much greater amounts are made by the Department of Social and Family Affairs as a matter of course. To be fair to that Department, the improvements made during the past ten years in terms of efficiency and better service are quite remarkable. It seems the Tánaiste and Minister for Health and Children is obsessed by some type of old fashioned or ideological thinking whereby she has no faith in anything the public sector does. It must be private, otherwise it is no good.

We are paying a price for an extremely blinkered Minister who does not understand the public service or the health service terribly well, and at every stage seizes the private solution whether it is private hospitals or private companies managing relatively simple processes or running GP services. It is an easy solution, but it is not the right solution. To every difficult question, as HL Mencken stated, there is a quick, easy and wrong solution. The Minister has found the wrong solution yet again in this instance.

The Labour Party carried out a study of Deputy Harney's first year in office and I noted what she stated regarding these payments. On 14 April 2005 she stated, "I hope we will start to make repayments towards the end of the year, beginning in autumn. . .". That referred to autumn 2005. We now hear it will be July and into the autumn of this year before these repayments are made. It shows more lethargy, delay and prevarication.

Even when the Minister acts quickly, she does not get it right. When she introduced legislation after this scandal was unearthed, she refused to accept that constitutional issues were raised. It was as if a pigheadedness drove her and she continued regardless of the best advice given by this side of the House. Fortunately, the President referred the legislation to the Supreme Court where it was struck down quickly and new legislation had to be introduced. Even when she speeds up, the Minister does not seem to be successful or productive.

On a number of occasions, Deputy Twomey raised the issue of the rights of elderly people in private nursing homes. I agree with him that it is important to hear the Government's view on this issue. The previous Ombudsman, Kevin Murphy, produced a report in which he clearly stated that in his view a sizeable cohort of people are entitled to free care. Kevin Murphy came before the Oireachtas Committee on Health and Children and I remember asking about this matter. It was clearly flagged and that was quite a number of years ago. Mr. Murphy left office clear in his own mind that this was the case.

Since then, we have not heard from the Government what is its position or what is the advice of the Attorney General. What we do know is that cases are going through the courts and eventually the courts will make a decision and the Government will react. At that stage, another bill must be paid which, because of prolonged inaction, will be higher than it should be.

Debating an Estimate such as this also raises other issues regarding the care of the elderly. Many people were shocked by the extremely revealing RTE programme on Leas Cross. We tend not to think too much about what happens within nursing homes. Many nursing homes are excellent. My mother lived in a nursing home for a number of years and I pay tribute to all those who looked after her. They did a wonderful job.

However, without proper scrutiny we do not have the confidence to state in all cases our elderly are well looked after in nursing homes. I will quote the Tánaiste and Minister for Health and Children again. On 31 May 2005 she stated, "The relevant Bill to establish the social services inspectorate on a statutory basis to deal with both private and public nursing homes will be published later this year". The reality is this has been subsumed into another Bill and we have yet to see it. Inspections with prior notice to nursing home owners are not good enough. Inspections of public nursing homes are in-house in the sense they are not examined by an independent body. That is not good enough.

I do not want to pre-empt any investigation but in a recent case, Hannah Comber regrettably slipped in a chair and died from being choked by a restraining belt. A group has been established to investigate that case and I welcome that investigation. However, it seems indicative that all is not right in terms of ensuring the elderly are protected. I note a social worker is not in the group.

The point was made to me that clear guidelines are required on the use of restraining belts and restraints in psychiatric institutions or nursing homes. That point has certain validity. The Irish Association of Social Workers produced an ethical statement on the use of restraints in residential hospital and institutional care settings. The statement sets out clearly a framework whereby the use of restraints can be permitted in an ethical way which is protective of the patient. Will the Minister examine that short document to see whether these measures, which I imagine are commonplace when dealing with frail people or within the psychiatric services, are appropriate?

Reference must be made to another issue when discussing care for the elderly, which is community care and home care packages. This Government promotes itself as one which cares about the elderly. However, currently we have 41 public health nurse vacancies and 100 vacancies out of 280 public health doctor posts. We have fewer community nursing beds than we had in 1997 and Limerick has seen a reduction of approximately 60 beds. The reality is that community services for the elderly are shrinking.

Compared with Northern Ireland, we are a disgrace. Chiropody services are unavailable because chiropodists are effectively on strike regarding public patients. Chiropodists will not visit nursing homes and I fully understand why. What they are paid is pathetic. These are the type of quality of life services which elderly people require. One may wait eight or nine months for a visit from an occupational therapist to approve a disabled person's grant. That is the reality at community level and it must be addressed. Meanwhile, we put this money aside to pay our debts.

Photo of Paul GogartyPaul Gogarty (Dublin Mid West, Green Party)
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I wish to share time with Deputies Ó Caoláin and Connolly. I speak on behalf of my colleague, Deputy Gormley, the health spokesperson of the Green Party, Comhaontas Glas, who has raised the issue of conditions in nursing homes and patient care for many years. He has called for more emphasis on community care, an issue I will return to.

My party welcomes the provision of the Supplementary Estimate; that principle is established. We are concerned, however, about the wider implication in terms of the delay, the fact the President had to determine the position for the people, and the principle now established of elderly people having to pay for their own care. That is wrong. I have said previously in the House that whatever about the measures being put in place to pay for the money stolen in the past, there is a wider problem in terms of what happens in the future. I will not go into that now because my time is limited.

My colleague, Deputy Gormley, asked me to raise a number of issues, one of which is community care, which he described to me yesterday as being in a shambles. I am aware of that also in my constituency. The position appears to be that one hand of bureaucracy does not necessarily know what the other is doing. There is no co-ordination. For example, a relative of an elderly patient who is in need of some community care was told she would have to wait up to four years before she could be assessed by an occupational therapist to determine if she would qualify to apply for a grant to install a shower. Thankfully, that case was sorted out fairly quickly. We found out that if the person is over 80 the waiting list is a year, not four years. This individual, miraculously, found out that she would be served within five or six weeks. I am delighted the highlighting of that issue helped in some small way but there are similar cases throughout the country where a lack of funding and targeted resources are affecting elderly people, no more so than in nursing homes.

The need for an independent inspectorate for public nursing homes was raised earlier by Deputy McManus. There is little point in informing a nursing home that it is about to be inspected because everything will be ship shape during that period, only to return to its normal way of operating following the inspection.

I was invited to a particular nursing home to meet and talk to the constituents living in the home. It was a very nice day. The residents of the nursing home enjoyed the visit but when it came to following up on the visit I found, from examining the marked register, that not one of the residents had voted. I suggest that is because the proprietors of the nursing home were more interested in the photo-shoots and the publicity surrounding the visit of a candidate but when it came to putting their money where their mouth is, they did not bother arranging for a bus to bring the residents to vote. That is just one example of the sort of treatment residents are subjected to in some nursing homes.

We need more, smaller, community orientated facilities. I acknowledge the role the Government has played in some situations but to reiterate on behalf of my colleague, Deputy Gormley, there is not sufficient funding. The available funding is not being targeted in the right areas. There is not enough co-operation among various sections within the Department of Health and Children and also in terms of the Department of Social, Community and Family Affairs. I have more comments to make but as the time is limited I will pass to my colleague.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Sinn Féin will not be opposing this Estimate. We recognise it is necessary for the long overdue payments to people who were wrongly charged for nursing home care and also for their heirs in many cases. We oppose the referral to the committee without debate. Our position has been vindicated by its appearance on today's Order Paper when the issues we raise will be lost in the welter of all the other issues that will be addressed today, the last day of the Dáil sitting.

Very serious issues have arisen regarding the tendering process for the Health Service Executive contract to administer the repayment scheme for people wrongly charged for nursing home care. During the debate on the legislation I raised questions about the wisdom of contracting out this contract to the private sector. Now we find that the firm selected wanted to outsource the work to India and that this may be in breach of European Union regulations. Regardless of whether it is in breach of EU regulations, this is yet another farce. It is incredible in the context of the nursing home repayment debacle.

Questions have also arisen about the way the tender was sought. It was reported on 28 June that KPMG, the private consortium selected by the HSE to administer the refund of nursing home charges, is to be paid up to €15 million for the job. The HSE has confirmed that that figure does not include value added tax, which means it will be much more. The HSE has also confirmed that the consortium plans to out-source some of the work involved in the administration of the refunds to India.

When that was first revealed, a question was raised about whether such outsourcing was permissible under EU regulations and data protection. The HSE has claimed that EU law facilitates the transfer of data outside the EU for processing where certain contract clauses are used. It said it had worked with the Data Protection Commissioner to ensure all necessary measures were in place to protect the confidentiality of information. Many questions arise about all of that and there is fairly universal concern, and not just on the Opposition benches. I ask the Minister to address it substantively in his closing remarks.

Will the Minister indicate if serious consideration was given to the carrying out of this work by the HSE? What are the working conditions of the people in India who will be doing this outsourced work? Will Irish taxpayers' money be used to the benefit of employers who may be exploiting workers with pay and conditions we would not tolerate in this country?

The HSE has said it initiated the tendering process last July but the initial process was abandoned and a second one started in February 2006. What was the reason for that? That must be explained. What was the difficulty with the first tendering process? A reply from the HSE to a parliamentary question from the Minister's colleague in Government, Deputy Glennon, stated that after short-listing 12 expressions of interest, three companies were invited to submit a tender. The HSE further stated:

The reason that the procurement process was terminated in 2005 was due to the fact that one of these tenders arrived late for consideration, a second tender was found to be materially non-compliant and the third tender was materially compliant subject to some minor issues. With only one tender remaining in contention, it was decided to fold the process and to commence a second process with the possibility of a more competitive market response.

The KPMG consortium has confirmed it was excluded from the first tendering process because its submission arrived late. It tendered again when a second competition took place and was successful. Again, it is reasonable that people would ask if the process was abandoned and restarted to ensure the successful tender by KPMG?

The Estimate before the House is for the €340 million due to be refunded this year out of some €1 billion overall due to people who were overcharged. That money must be allocated and paid out but we have every right to raise the questions that I and other Deputies have raised today. I hope the Minister will satisfy not only our intent at getting to the full facts but a much wider public interest.

Paudge Connolly (Cavan-Monaghan, Independent)
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I welcome the opportunity to speak on this issue. The nursing home charges fiasco has turned into a major issue but it would have been a non-issue if there had been some honesty in high places. That is one of the tragedies of the whole process because there were people who knew that what was happening was a con or a deceit. While people do not mind paying for a bed, they do not like being conned. People I have met recognise that they do not get anything without paying for it. To add insult to injury, the instruction to the health boards was not to charge those creating a sufficiently big fuss, which was a serious deception and a very shabby way to treat a very vulnerable group of people at the end of their lives.

Last week the Minister of State, Deputy Seán Power, made a presentation to the Oireachtas Joint Committee on Health and Children during which he referred to different levels of return to people. I detected that this might refer to people who had been in mental health institutions or people of intellectual disability. I would like that issue clarified in the House today. I could not support such differences in repayment.

Deputy Ó Caoláin spoke about outsourcing, with which I also have major difficulties. When the contract was agreed with the Health Service Executive I have no doubt that no reference was made to the fact that part of the work would be sent to India. We have no way of knowing whether these people are paid 50 cent an hour. Is this another Gama? It sets a precedent which should be addressed. The work is not highly technical. Many students here could do this type of work during the summer and we would keep the money in the country. We cannot let this happen again.

Some people who had worked for health boards left and got their superannuation. When they had to return to work and repay their superannuation, the health board charged them a compound rate of interest, which was a severe penalty to those wanting to get back into the workforce and wanted to buy back their pension rights. People whose money was taken illegally are getting repayment which only reflects the consumer price index increase. There is a significant difference between these two cases. I would like some consistency with the Health Service Executive in terms of returning money.

The issue for most people is getting a nursing home or acute hospital bed when they are sick. If their lives are in danger, they need to be able to get a bed in an acute hospital. Upwards of 2,000 beds can be occupied by elderly people who are inappropriately left in general hospitals. A general hospital costs approximately €700 per day. However, if the patient is transferred to a nursing home, €700 would pay for a bed for a week. Despite this, we have difficulties with discharge. Nursing staff know that a significant issue when elderly patients are clinically fit for discharge is where to send them. Should they be sent home? Does the home need repair work? Do the patients need care hours which will cost? Obviously it would be much cheaper and more satisfactory for patients if that were delivered in their own homes. The major issue is that of subvention, which comes from a separate budget to that for hospitals. In-house fighting takes place in the health services. If those responsible for community-based services are not prepared to pay, the patient will be left in hospital occupying a bed.

Too often we hear of the negative aspects, which reflect badly on those working in nursing homes. We should acknowledge the brilliant work done by a large number of people in nursing homes. People feel that what happened in Leas Cross has reflected badly on staff in all nursing homes, which is not the case. Many very happy people are in nursing homes. When the Inspector of Mental Hospitals was due to visit a psychiatric hospital, it was notified approximately three months in advance which gave it the opportunity to put its best foot forward. Nursing home inspections should be unannounced and regular.

Photo of Brian O'SheaBrian O'Shea (Waterford, Labour)
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I must now put the question.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Is there to be a response from the Minister of State?

Photo of Brian O'SheaBrian O'Shea (Waterford, Labour)
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No. That is not included in the order of the House.