Seán Barrett (Dún Laoghaire, Fine Gael)
Link to this: Individually | In context

Question 14: To ask the Minister for Health and Children the status of the fair deal Nursing Home Support Scheme Bill; when she expects it will be returned from the Attorney General's office; when she expects it will be published; if the plan was poorly planned and prematurely announced; and if she will make a statement on the matter. [16272/08]

Enda Kenny (Mayo, Fine Gael)
Link to this: Individually | In context

Question 33: To ask the Minister for Health and Children if the Health Information and Quality Authority is adequately staffed and funded to carry out nursing home inspections; the length of time it will take HIQA to carry out inspections on all the nursing homes here and approve them for the proposed fair deal scheme; the provisions that will be put in place for nursing homes that do no pass the criteria; and if she will make a statement on the matter. [16357/08]

Jim O'Keeffe (Cork South West, Fine Gael)
Link to this: Individually | In context

Question 53: To ask the Minister for Health and Children the reason for the delay in the publication of the Bill providing for the replacement of the current system of nursing home subvention; the outstanding issues unresolved in relation to this Bill; and the additional level of resources that will be required to fund the fair deal system. [15761/08]

Joanna Tuffy (Dublin Mid West, Labour)
Link to this: Individually | In context

Question 71: To ask the Minister for Health and Children if the issues that have delayed the publication of the fair deal legislation have constitutional as well as legal implications; when she expects to publish the legislation; and if she will make a statement on the matter. [16256/08]

Seán Sherlock (Cork East, Labour)
Link to this: Individually | In context

Question 87: To ask the Minister for Health and Children if the Health Service Executive has been instructed to divert the €110 million allocated in budget 2008 for the implementation of the fair deal scheme into other areas of health spending; and if she will make a statement on the matter. [12252/08]

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

I propose to take Questions Nos. 14, 33, 53, 71 and 87 together.

The Bill providing for the new nursing home support scheme, A Fair Deal, is currently being finalised by the Office of the Attorney General and will be published when it has been approved by Government.

Details of the fair deal were announced in December 2006 to facilitate full consultation with the social partners and other stakeholders. The legislation is complex and requires careful drafting to ensure the interests of older people requiring residential care are fully protected. In the course of progressing the legislation, the Department has received legal advice on a number of matters, some of which are the subject of consideration in the context of finalising the Bill. The issues are legal rather than constitutional in nature. However, it would not be appropriate to comment further until the Bill has been brought before the Government for approval.

The fair deal is designed to remove from real financial hardship individuals and their families who under the current system of nursing home subvention must sell or remortgage their homes to pay for nursing home care. There will be one transparent system of support towards the cost of care that will be fair to all irrespective of whether they are in public or private nursing homes. The basic commitments of the new scheme are that individuals will be asked to contribute, based on income and assets; the HSE will meet the balance of cost in homes approved for the purpose; individuals will not have to sell or mortgage their homes; individuals will not have to borrow to fund costs; individuals will not experience unaffordable costs and an individual's family will not have to find money for his or her care.

The new scheme encompasses five key steps. The first of these steps is a care needs assessment carried out by a multidisciplinary team of HSE health care professionals. A person assessed as requiring residential care can apply to the HSE for a means assessment to calculate his or her contribution to care. Under the scheme, people requiring long-term residential care will contribute 80% of their assessable income, for example, their pension(s), whether for public or private nursing home care. Depending on the amount of a person's assessable income, there may also be a contribution of up to 5% of a person's assets. The State will meet the full balance of cost thereafter in public or private nursing homes.

Payment of the contribution based on assets can be made at the time when care is received or may be deferred until settlement of a person's estate. This deferred contribution will be based on the actual number of weeks spent in residential care, the cost of care and, consequently, may be less than 5% per annum. No one will pay more than the cost of their care. In addition, where the deferred contribution applies to the principal private residence, it will be capped at a maximum of 15%, or 7.5% in the case of one spouse in long-term residential care while the other remains in the home. This means that after three years in care a person will not be liable for any further deferred charge on the principal residence. It also means that as much as 85% of the value of the principal residence may be maintained for the beneficiaries of the person's estate. This is not something that can be guaranteed at the moment.

Where a spouse or certain dependants are living in the principal residence, the contribution may be further deferred until after the death of that spouse or dependant or until such time as a person previously qualifying as a dependant ceases to qualify as such. Finally, individuals can choose care in any approved private or public nursing home subject to availability and an ability to meet their particular needs. If an individual opts for a private nursing home, he or she will make a co-payment to the nursing home and the State will meet the balance of the cost to provide the service. If the individual opts for a public nursing home, the State will collect the co-payment and provide the service.

An additional €110 million has been provided for the introduction of the new scheme in 2008 and the development of long-term residential care services. I confirm to the Deputy that the HSE has not been instructed by Government or my colleague, the Minister for Health and Children, Deputy Mary Harney, to divert into other areas of health spending the €110 million allocated in budget 2008 for implementation of the fair deal scheme. However, it should be noted that the provision of 200 additional contract nursing home beds by the HSE was approved by the Minister for Health and Children in January of this year. The cost of the additional beds is to be met from within the HSE's total financial allocation in respect of long-term residential care services for older people.

Current standards for nursing homes are set out in the Care and Welfare Regulations 1993. The HSE inspects private nursing homes on the basis of these standards but public homes are not inspected. The Health Act 2007 provides for the registration and inspection of all nursing homes, public, private and voluntary. Future inspections will be carried out by the Office of the Chief Inspector of Social Services which is part of the Health Information and Quality Authority. The existing inspection and registration systems for residential services will be replaced by a strengthened and expanded system. Deputies will be aware that the board of HIQA submitted draft standards for approval by the Minister for Health and Children, as required under section 10(2) of the Health Act 2007. These draft standards are currently under consideration by the Department. The standards and regulations required to underpin them will be subject to a regulatory impact assessment, RIA, before finalisation. It is hoped work on the RIA and the regulations will commence later this year. In the meantime, the Health Service Executive continues to carry out inspections of private nursing homes under the Care and Welfare Regulations 1993.

Additional information not given on the floor of the House.

This is the first full year of operation of HIQA and the organisation is still in the process of recruiting staff and building up its operational capacity. It has been allocated a budget of €16.8 million in 2008 to meet the estimated costs of its planned work programme, including the phased commencement of nursing home inspections by the Office of the Chief Inspector of Social Services.

Under the fair deal, the National Treatment Purchase Fund, NTPF, will negotiate prices for long-term care with private nursing home owners on behalf of the State. While private nursing homes will also have to be registered to be approved for the purposes of the scheme, HIQA will not have to carry out inspections on all nursing homes prior to the introduction of the scheme.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

A number of issues arise. Earlier, the Minister alluded to the fact there had been a huge improvement in respect of waiting times. The matter was raised with the Minister by my colleague, Deputy Jan O'Sullivan.

During the past 30 days there were, on average, 300 patients lying on trolleys in hospitals. On one day alone, there were 397 patients lying on trolleys in our hospitals. This does not compare well with the situation three or four years ago.

Accident and emergency departments are at crisis point. This issue is kernel to the problem. Some 57,000 bed days were lost last year at Beaumont Hospital and the Mater Hospital. This is equivalent to the closure for one year of a 150 bed hospital. There was no place to which patients could be discharged to continue their recovery.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

Deputy Reilly must ask a question.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

The question is coming. The recent NCB report indicates that the number of people living beyond 65 years will during the next ten years increase by 167,000.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

The Deputy must ask a question. A number of other Deputies wish to ask questions.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I understand that. We do not have enough nursing home beds. I put it to you, a Leas-Cheann Comhairle, as you are harassing me, that the question stated quite clearly when the Minister expects the nursing home support scheme Bill will be returned from the Attorney General's office and when she expects it will be published. With due respect, Sir, she did not answer either question.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

Will the Deputy please take his seat for a moment, as he is required when the Chair is on his feet? The Chair is not harassing anybody. This is Question Time. The Deputy is a new Deputy and latitude is given to new Deputies. At Question Time what is in order is the putting of questions so that we can allow in as many Deputies as we can. I have five Deputies on my list. If Deputies proceed to make speeches, there is no time for others to get in and it is not fair. The Deputy has already had the benefit of a number of priority questions, because he is the spokesperson for his party, but I do not want to exclude other Members who also have rights in this House. The Deputy may put his question.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I reiterate that Question No. 14 was clear and concise. It asked the Minister when she expects the nursing home support scheme Bill will be returned from the Attorney General's office and when she expects it will be published. She read a speech that lasted for six or seven minutes and failed to answer the question. I would like that question answered. When bringing forward the legislation, will the Minister ensure there is adequate time to discuss the heads of the Bill properly because there are many issues within it, such as issues around land ownership, farmers, small shopkeepers, etc., which have to be considered? If I can be allowed one further supplementary, has the Minister any contingency plan in place to support nursing home patients in the likelihood that pharmacies will withdraw their service during the course of this week and will she ensure continuity of supply of medication for the most vulnerable in our society?

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

I wish to point out to Deputy Reilly that I attempted to answer a number of questions in my reply to Deputies who are not present. However, I will answer the question put to me, that is, when the fair deal legislation will come before the House. We all acknowledge, right across the board, that this is complex legislation. Much consideration has been given to it. The Deputy will recall that all the stakeholders were consulted in the earlier stages and it is still with the Attorney General's office. A very positive meeting took place last Wednesday in the Attorney General's office, at which I was present, on the finalisation of the fair deal. We expect the legislation to come before the House shortly and we expect it will be finalised before the summer.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

Can the Minister of State give us any idea why the Bill has taken four months given that it was supposed to be published before Christmas and that it was only delayed because there was not enough time for consultation? Can she say why it has taken four months to sort out the legal problems? In regard to the €110 million set aside for the purposes of the fair deal legislation, the Minister of State said the HSE was not told it should spend it in other areas. Can she tell me if the HSE was told not to spend it in other areas? In other words, did she tell the HSE to ring fence it and use it for the care of the elderly? There are families out there who were waiting to get this and they are struggling to pay the costs. The Minister of State said people could choose to go into private or public care. Originally we were told that the National Treatment Purchase Fund had a role in allocating people to certain nursing homes. If people can choose where they go, what exactly is the role of the National Treatment Purchase Fund in this matter?

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

We appreciate the length of time it has taken to publish the Bill. It was never anticipated that it would take this long. We looked to 1 January. Unfortunately, we were unable to reach that target due to the legal implications. I stated in my reply that the implications were more legal than constitutional.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

Can the Minister of State give us a hint of what they were?

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

I would like to be able to say today we will have it next week, but we are not certain. We must have robust legislation in this area. It is important legislation for families. We intend to have it finalised before the summer. On the issue of costs, again I refer to 1 January when we did not anticipate this would be an issue because we believed the fair deal scheme would be up and running. However, the €110 was ring-fenced for the fair deal scheme. The HSE has been in negotiations with the nursing home organisations to see what is the best way forward. We appreciate there are families who are under extreme duress at present where charges have been increased by nursing homes. To be fair to the HSE, it had not anticipated this increased cost.

Jan O'Sullivan (Limerick East, Labour)
Link to this: Individually | In context

What about the role of the National Treatment Purchase Fund?

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

The role of the National Treatment Purchase Fund is to negotiate and meet with the nursing home providers on the issue of costs and to assess cost needs. If a patient opts for the fair deal, a care-needs assessment will be carried out but not by the National Treatment Purchase Fund.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context

We have been advised that a sum of €110 million was set aside specifically for the introduction of the fair deal scheme and that it has been diverted. Will the Minister of State be specific and tell us if, indeed, that €110 million has been diverted and, if so, to what purpose? Has she taken the required steps to ensure it is specific to the needs of older people or is it the case that it is part ring-fenced and safe for the specific purpose for which it was intended? Will she accept that Deputies will be concerned because the HSE has demonstrated a skill at diverting moneys from their intended purpose to other uses?

Is the Minister of State aware that in November 2007, nine organisations dealing with the needs of older people came together and represented the real concerns of senior citizens at the lack of clarity in the fair deal proposals? Given that is the case and that they have further highlighted the erosion of the State's responsibility to provide public nursing home facilities and supports for access to same, as a matter of right and entitlement for every citizen who requires that service in later life, is it the case, as has been suggested, that the difficulties with the fair deal proposals that are currently being considered by the Attorney General are all in that area in terms of a demands——

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

I must call the Minister of State.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context

I am just finishing the question.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

By way of information, Deputies have one minute in which to put a question. I have already allowed two-and-a-half minutes to the Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context

I am very sorry. I am grateful to you for your patience. We may need this support ourselves some day. Is it the case that the difficulties are around the whole area of the contribution that is expected from senior citizens and their families and the real concern rests around the whole issue of up to 15% of the estate of the person being provided for? I ask the Minister of State to be specific.

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

It is in the interests of older people, often the most vulnerable in society, that we protect them with the strongest and most robust legislation possible. I am aware of the groups who met at that particular time. Those same groups also engaged in the stakeholders discussion at Fairleigh House with the Minister, Deputy Harney, some months earlier. It is not in the absence of consultation that this has come about. We must consult the Attorney General to finalise the issue and ensure that the legislation will protect the interests of older people when it finally comes into this Chamber.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context

I asked if the €110 million has been diverted and, if so, to what purpose?

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

The €110 million has been ring-fenced for the provision of the fair deal scheme. However, 200 beds have been allocated from that fund, obviously with the approval of my colleague, the Minister, Deputy Harney, since January 2008 to meet the demand spoken of in the House. We intend to have the fair deal legislation before the House in the summer. The stakeholders will be informed of it when it reaches the House.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

I will take a final supplementary from Deputy Crawford.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
Link to this: Individually | In context

The fair deal scheme has been talked about for almost two years. In February 2007, we were guaranteed it would be in place on 1 January this year. Is it possible to secure a fair deal for those currently residing in nursing homes? Is the Minister of State satisfied that an old age pensioner in receipt of €218 per week should be asked to contribute €70 per week towards the cost of keeping his or her spouse in a nursing home because the amount of subvention has been capped? Is that a fair deal for ordinary people in my constituency of Cavan-Monaghan? Dozens of people have been affected by the instruction issued to the subvention office not to increase the amount of subvention paid this year.

Which nursing homes in Cavan-Monaghan provide care for €531 per week, the guidance figure for the subvention office? Thankfully, the office is paying somewhat more than this. We do not seek a fair deal for future residents of nursing homes but for senior citizens currently in residential care. This matter must be urgently addressed and the sum of €110 million to which Deputy O'Sullivan referred should be used for this purpose.

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

I remind the Deputy that the reason for producing the fair deal is to render private long-term care anxiety and stress free for patients, the most important persons concerned, and their families. The increase in the subvention to a maximum of €300 is a clear recognition by the Government of the difficulties endured by families who have relatives in private nursing homes. When a member of the Fine Gael Party last held the position of Minister for Health, legislation ensured that the families of patients in private nursing homes were assessed using a means test .

Seymour Crawford (Cavan-Monaghan, Fine Gael)
Link to this: Individually | In context

I assure the Minister of State that the then Minister reopened closed wards.

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

In 1997, when the Tánaiste, Deputy Brian Cowen, was appointed Minister for Health he changed the legislation and recognised that families should not be responsible for the care of patients in private nursing homes.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I ask the Minister to answer the question I put to her earlier, namely, whether she has a contingency plan in place to support nursing homes in the event that many pharmacies withdraw from the general medical scheme and cease to provide services by the end of the week. Most of those in private nursing homes are GMS patients. I would appreciate if the Minister of State answered the question rather than responding to other questions she may have in mind or questions Deputies outside the House may wish to have answered.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

The Minister of State may respond to the Deputy's supplementary question, although it is outside the scope of the group of questions under discussion.

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

I will answer the Deputy's question. I understand the Irish Pharmacy Union and other interested stakeholders are meeting today. Positive negotiations have taken place on this issue in recent days and we expect positive news to emerge in the coming days.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

There are no contingency plans in place.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
Link to this: Individually | In context

The Deputy is making an assumption.

Máire Hoctor (Tipperary North, Fianna Fail)
Link to this: Individually | In context

The contingency plan is that the discussions will continue.