Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I welcome the opportunity to raise this extremely important issue in the House even for only two and a half minutes. I was shocked when I got a phone call recently from the relative of a 99 year old in a nursing home in County Cavan who has been asked to pay the increased charges that the nursing home wants from 1 January this year because the Minister and the HSE have decided that no further increases would be allowed under the subvention system. This is supposed to be because the fair deal — or fairytale deal — that has been talked about has never been delivered. In December 2006 it was first hinted that there would be a new fair deal for nursing home charges. The details of that scheme were announced in February 2007 and we were advised that it would be brought through the Cabinet, Dáil and Seanad and be in place for operation on 1 January 2008. However, as of today we have not seen sight of that Bill and the Minister has refused to allow the subvention offices to deal in a sympathetic and realistic way with such situations. This is not the only case — I have several other letters. I welcome the fact that the Minister of State, Deputy Hoctor, is here as the matter relates to the elderly.

After nine years in a nursing home being covered by the pension and subvention, how can I say to this lady or her family that suddenly she must find the money, at the same time as the Minister has taken an increase of €35,000 for herself? I accept that does not apply to the Minister of State. I refer to the Minister, Deputy Harney.

Máire Hoctor (Tipperary North, Fianna Fail)
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The Minister, Deputy Harney, has not taken the increase either.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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She has agreed it. At the same time she is asking the 99 year old person to pay the extra amount. Another nursing home has a similar situation where a man has already got a bill for €500 for the first ten weeks of this year. It is absolutely disgraceful. Are the elderly being asked to bear the brunt of the cutbacks and the other problems at a time when the better off are being made even better off? Regardless of what the Minister of State has said all that has happened is that the ministerial salary increases have been postponed to September. I urge the Minister of State to ensure the situation is rectified. Some €110 million was transferred from this section to prop up the overall HSE, which is unacceptable when the aged are being ordered to pay for something to which they are entitled.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Today I tried to extract information from the Taoiseach on the status of the fair deal scheme. He ends his time as Taoiseach as he began by keeping his cards close to his chest. I could only get an indication — I could not call it a commitment — that the health (long-term residential care services) Bill would be published in this term. Nothing was said to address the concern and distress caused to older people and their families by the current uncertainty over this scheme. A debacle is the only word I can use to describe that the legislation is mired in problems. I ask the Minister of State to confirm whether the €110 million allocated to the scheme has now been diverted. I also ask the Minister of State to where it has been diverted if that is the case. Will it be used to provide alternative services for older people?

In November 2007, nine organisations working with older people joined together to express their concern at the fair deal proposals. They raised the lack of clarity about what older people would be entitled to. They also stated the scheme was an erosion of the entitlement to State-funded long-term care in public nursing homes through the State's proposed claim to a proportion of all disposable income as well as up to 15% of the estate after death. It seems that this property provision has caused the constitutional and other legal difficulties for the legislation. That problem should have been obvious to the Minister, the Cabinet and the drafters of the proposed legislation. The Government failed to heed the warnings and now €100 million allocated to the scheme is to be diverted. This is gross mismanagement and older people in nursing homes or those who expect to enter such care are being left in a state of doubt and confusion again. Instead of proceeding with this scheme the Government should move towards direct provision of care for older people in their homes, the community and, where necessary, in public nursing homes.

On a related matter, I deplore the decision of the HSE to close 12 respite beds for patients with Alzheimer's disease in Cherry Orchard Hospital. Approximately 24 individuals are affected, for many of whom residential care is not available. Now even respite care is being taken away. I urge the Minister of State to have that specific and disgraceful development addressed urgently.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am taking this matter on behalf of the Minister for Health and Children, Deputy Harney. I thank the Deputies for raising these questions as it provides me an opportunity to outline to the House the improvements made to the existing nursing home subvention scheme and the position in respect of the new nursing home support scheme, the fair deal.

Government policy regarding older people is to support people to live in dignity and independence in their own homes and communities for as long as possible and, where this is not possible, to support access to quality long-term residential care. This policy approach is renewed and developed in the latest partnership agreement, Towards 2016. The nursing home subvention scheme was introduced in 1993 to assist with the cost of private nursing home fees. A subvention may be paid where a person has been assessed as needing nursing home care by the Health Service Executive and where the person has satisfied a means test.

Since 1 January 2007 there are no longer three separate rates for subvention. Persons who apply may receive any amount up to a maximum of €300 per week. The change in the rate means that many people who were not previously eligible for subvention may now qualify for a payment. The payment of subvention is managed by the HSE under the Health Act 2004. In 2007 the HSE finalised and circulated national guidelines to the local health offices, for the standardised implementation of the nursing home subvention scheme. Under the guidelines, the assessment of means will now be carried out using a national standard financial assessment method. In addition to the increased rate of basic subvention, a person may receive enhanced subvention. This is a supplementary subvention, which may be paid by the HSE, to a person in or entering private long-term care. The amount of enhanced subvention paid is at the discretion of the HSE and varies according to the cost of care and the circumstances of the applicant.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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That is not true. There is a maximum.

Máire Hoctor (Tipperary North, Fianna Fail)
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Enhanced subvention should be used to develop consistency between the payment of subvention and the new nursing home support scheme, and to work towards equalisation of the level of support paid to people in different areas taking local prices and a person's means into account. The HSE guidelines provide that an applicant for enhanced subvention will be subject to the means assessment. Regarding the specific case raised by Deputy Crawford, I understand from the executive that the individual concerned is on the current maximum enhanced subvention rate.

The new nursing home support scheme, a fair deal, was approved by Government and announced in December 2006. The fair deal is designed to remove real financial hardship from many individuals and their families who, under the old system of nursing home subvention, are forced to sell or re-mortgage homes to pay for the cost of nursing home care. This is the essence of the policy.

Since December 2006, my Department has met groups and organisations, including the national federation of pensioners associations, the Irish Farmers Association, the Irish Senior Citizens Parliament and the social partners. The Department also attended the Irish Senior Citizens Parliament AGM at its request and participated in a workshop on the new scheme.

The Bill to provide for the scheme is currently being finalised by the Office of the Attorney General and I hope to publish it as soon as possible following Government approval. On publication of the Bill, further engagement will take place with stakeholders on the details of the new scheme. This will take place under the auspices of Towards 2016. The subsequent presentation and passage of the legislation through the Houses of the Oireachtas will be a matter of priority for me as I wish to make the benefits of the scheme available to older people as soon as possible.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Where is the €110 million? The Minister of State did not answer that question.