John O'Donoghue (Kerry South, Ceann Comhairle)
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Deputy Deenihan was in possession and has eight minutes remaining.

Jimmy Deenihan (Kerry North, Fine Gael)
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Last night I discussed various aspects of the Bill. While welcoming the Bill I pointed out the existing inequitable system of payment support for those in long-term residential care and how the Bill offered vastly different levels of support to patients in the public and private systems. I also pointed out that while every resident in public long-term care has to pay the charges, these are capped regardless of the level of means, whereas the same individual availing of private long-term care may be entitled to a subvention to assist with some of the costs of care but this subvention is subject to rigorous means testing. Persons in private long-term care may therefore be deemed ineligible for the subvention and may be obliged to meet the full costs of care. In essence, the current system means that people on the same incomes can end up with vastly different care costs depending on what type of nursing home they use, whether it is public or private.

Overall, under the current subvention scheme, the State effectively meets only 40% of the estimated average cost of care in a private facility while meeting approximately 90% of the cost of care in a public facility. A number of examples were given to the House of patients in private care who now have no savings left, no house to sell and are in a very difficult and vulnerable situation. Only for the generosity of the owners of those private nursing homes, they would have no place to stay. It is the case that many patients are in private nursing homes who are not in a position to pay the full costs, which currently run up to €800 to €900 per week. This is the average cost of keeping a patient, paying the staff and making sure that medical and other needs such as food, are met. I hope the new arrangement will reverse this imbalance for the sake of our old people.

I refer to pressure on the acute hospitals sector. There are so few places available that patients with very minor ailments have to remain in hospital because there is nowhere else to send them. Sometimes families refuse to take relatives from hospital and this is putting significant pressure on the acute hospitals sector and is holding up beds that could be used for other procedures. This issue was raised by a number of previous speakers. I hope this new fair deal will free up additional places in hospitals for a greater number of people from the community at large.

Another issue referred to by a number of speakers is that of standards. I appeal to the Acting Chairman because I expect silence in the Visitors Gallery.

Noel O'Flynn (Cork North Central, Fianna Fail)
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It is not coming from the Chamber.

Jimmy Deenihan (Kerry North, Fine Gael)
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It does not distract me but out of respect for future speakers.

Noel O'Flynn (Cork North Central, Fianna Fail)
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Perhaps the ushers in the Visitors Gallery might keep order.

Jimmy Deenihan (Kerry North, Fine Gael)
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A number of people have referred to standards. When Deputy O'Dowd and others highlighted the horrors of the Leas Cross nursing home scandal, the Minister gave a commitment in the House that new standards for residential care would be introduced as a priority. More than three years later, it has still not occurred. A number of Deputies have emphasised this point in the House forcibly. Hopefully, when the Minister replies to the debate, she will be specific in her announcement of the new standards and will provide the House with a date.

In January 2007, draft standards for residential care settings for the elderly were published and formally referred to HIQA for finalisation. On 11 March 2008, HIQA approved the standards and submitted them for the Minister's approval, as required under section 10(2) of the Health Act 2007. To date, the standards have not been approved and it is unclear as to when that will occur. It is crucial that they be finalised and enforced as a matter of priority. The Minister must confirm and clarify whether they will comply compulsorily to both private and public nursing homes and, if so, the timeframe for their implementation.

According to the Minister, draft standards and the regulations required to underpin them are subject to a regulatory impact assessment before finalisation. Will she clarify when that assessment will be finalised and when the approved standards and regulations will be put in place? It is important that she provide this information in her reply this afternoon or whenever.

What plans does the Minister have to ensure that public nursing homes, which are often older than private nursing homes, will be able to cope with the cost of meeting new standards? From discussions with a number of private nursing home owners, I know that this is a concern for the public homes. They are worried that they will not be able to meet the new standards. Will the Minister of State clarify whether there is an intention to help the people in question?

Under the new scheme, money will follow the patient. Public nursing homes will compete with private nursing homes, but the latter already offer more competitive prices. Will there be a decrease in the number of public beds and a move towards private care? Ultimately, it is a matter of resources. Currently, the subvention scheme costs more than €900 million. Are there enough resources in the 2009 Estimates to ensure that the fair deal is initiated, standards are met and assessments are carried out? It looks as if there are not, but I look forward to the Minister of State's response to my questions.

John Cregan (Limerick West, Fianna Fail)
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I welcome the opportunity to speak on this important legislation. The Bill has been before the House for quite a while and every Deputy who has welcomed it is anxious to see it finalised with a view to its implementation at the earliest possible date. I welcome the fact that the Government has made an initial allocation of €55 million for that implementation, funding the support scheme for the second half of this year.

The Bill would have been welcome during the country's boom period. Given the economic worldwide recession, it is now more important than ever that it be enacted. Many of my constituents who present to me, even those couples where both people are in employment, find supporting one or more elderly parents or relatives in private nursing homes difficult. We allowed this situation to develop despite the significant quantity of money that we were spending on subvention which, it has been stated, amounted to €300 million. While the spend was welcome, we must recognise the fact that the subvention only covered a small portion of the overall payment required to secure and maintain a nursing home bed for an elderly relative.

Even when times were good and there was full employment, many thousands of people were at the pin of their collars supporting their elderly relatives. We all know of families where some siblings care a great deal about the support they provide whereas others do not care as much. Many of those to whom I refer must live their own lives, meet their daily, weekly and monthly household bills and, in many instances, pay for their children's third level education. They are at the pin of their collars trying to make up the balance. Even with the elderly person's old age pension and the maximum subvention, there is a serious shortfall. Where only one family member is prepared to support his or her elderly relative, it is a considerable draw on his or her resources. Many people have found themselves heavily in debt as a result.

On the other side of the coin are the public residential care homes, of which there are two in my county, namely, St. Ita's Hospital in Newcastle West and St. Camillus's Hospital in Limerick city. Both are fine institutions that provide a top level of service, which is so good that everyone requiring residential care wants to be admitted to one or the other, depending on from where they come. Unfortunately, there are not enough beds to accommodate everyone and there is a significant dependence on the private sector to make up the missing complement. Most of the private nursing homes in my county with which I am familiar also provide a fine service.

While there may have been isolated instances of poor care, one is one too many. In the Leas Cross case, there was a shameful abuse of the elderly. This issue must be and is being addressed. I welcome that the elder abuse service is now in place. Unfortunately, it is necessary, given the remaining cases of elder abuse.

While I welcome the Bill, two buzz words that are being bandied about are "equality" and "equity". We have neither. One could develop the argument that there is discrimination, albeit unintentional. If two patients present to a public residential long-stay hospital, the good system in place assesses their financial means, social circumstances, dependency levels and ailments. Patient A is admitted to the facility and charged his or her pension minus a certain amount per week, which is rightly returned to the patient as spending money. It provides the family involved with a sense of consolation. As well as being guaranteed a top level of care, people are guaranteed that they will not need to put their hands in their pockets to come up with the balance, unlike in the case of patient B. Through no fault of the case conference but given the recession, the home must tell patient B that he or she cannot be accommodated.

As his or her dependency level is one, two or three, A, B or C or whatever, he or she must choose a private nursing home. While so doing for the level of care is fine, it places a huge financial burden on the family in question. I welcome the fair deal legislation under discussion today because it will bring about equity and a level of equality that is greatly desired by all. I understand the National Treatment Purchase Fund will act as the brokers that will agree on a price with such private nursing homes. I further understand that each elderly patient will pay the same amount, regardless of whether a public residential unit or private nursing home care is chosen, which will be highly welcome.

Much play was made of the clawback requirement in respect of a percentage being taken from a person's estate when he or she passes on to his eternal reward. I have discussed this issue with many constituents who have approached me with difficulties regarding subvention and shortfalls. While I have stated that the Government at present is in the process of introducing the fair deal system, most people wish to deal with the here and now. They want to ensure there is no serious draw on their financial resources arising from being obliged to support an elderly relative. Incidentally, the vast majority of people would love to keep their elderly relatives in their own homes with the support provided by the State and the help of their families and friends. However, as this is not always possible, unfortunately such people must be placed in long-stay care, which is a serious drain on people's resources. The clawback will be put in place and people will be well prepared to meet that demand if and when it arises. Their view is that if they are unable at present to afford to provide the requisite level of care and if an estate is bequeathed subsequently to their family, they then will repay the State in some fashion for what it paid for the care of their elderly relatives.

I have encountered another issue that I consider to be wrong. In respect of assessment for subvention, I meet many people whose elderly relative had been living alone in what was the family home but who suddenly required placement in a nursing home. It is difficult to ask one's mother, father, sister or brother to leave his or her home to enter long-stay care and it is completely unacceptable to penalise a family, were that home to remain empty. The HSE assesses the potential value of the income from that family home, were it to be let out as rented property. I certainly would not like to see an "For Sale" sign being erected beside my mother or father's house on the day after he or she entered a nursing home. However, in the event that such a family home is retained or not let out and no income accrues from it, a penalty is placed on the elderly relative because that asset and the potential income from it is taken into account. However, if a single family member still resides in that house, the same penalty does not apply. This is a difficult situation and while I consider it to be an anomaly that should have been addressed, obviously it was not and it is now too late to so do.

I welcome the opportunity afforded by this legislation to eliminate once and for all the discrimination that has taken place. I do not blame anyone as this is the way in which the system has worked. We have chosen to subvent private nursing homes at great cost. Obviously, this will stop and the State will have a system in place in which it will continue to pay for care in the main but in which those in private nursing home settings and public residential units will be asked to pay the same amount. This is welcome because I understand that approximately 8,000 people are in public long-stay care at present. I cannot praise such facilities sufficiently highly because I have experienced them in my own constituency. I also have had personal experience of them in respect of both my parents and the level of care and attention to detail given by those involved is second to none. Moreover, as I stated previously, in most instances the level of care in the vast majority of Ireland's private nursing homes is second to none. This also is to be welcomed because although one may criticise the Government for giving tax breaks to people to build such private nursing homes, the public system by itself would not be in a position to provide the requisite public bed capacity. As this would not have been possible, I greatly welcome that we now will be in a position to support all the people concerned. While the clawback will be in place, there must be some payback for the State's commitments.

This welcome legislation should pass through this House as quickly as possible to allow the Minister to enact this Bill and have the scheme up and running at the earliest possible date. I believe it will be broadly welcomed and will constitute a huge relief to many people, particularly in difficult economic circumstances in which there is significant demand on such people to pay for their elderly relatives. I am familiar with families in which one parent each of the husband and wife is in a nursing home. While having one elderly relative in a nursing home constitutes a major draw on resources, obviously having two relatives in nursing homes doubles that commitment. It is time to be honest and to note that regardless of whether one likes it, many siblings in many families either cannot or refuse to pay a fair share towards the support of their elderly relatives.

Deputy Deenihan made a valid point in his contribution when he referred to the occupancy of acute beds in some instances by elderly patients who cannot be moved from such beds because of the lack of step-down facilities. However, there is another reason. Were one obliged to make a decision today, tomorrow or next week about one's elderly relative, who is taking up an acute bed, and were one in a financial position in which one genuinely could not afford to pay for or support that relative in a private nursing home setting and furthermore, if one could not ensure the provision of a public bed in a public residential long-stay unit for one's relative, one would have a problem. In such cases, perhaps little blame should attach to those who walk away from the acute hospitals saying they could not take home their elderly relatives because they did not have the facilities or wherewithal to provide the requisite level of care. I refer to cases in which people cannot place their elderly relative in subvented nursing homes because they lack the wherewithal and financial resources to make up that gap of the additional resources required and who have been told that no long-stay beds are available in the public system. In some cases, the proposed new legislation should alleviate this problem to an extent and should free up some of those public beds. I believe it will and that this is a win-win situation.

While it still will constitute a massive draw on the State's resources, as I noted previously, most people would much rather keep their elderly relatives at home. In an effort to ensure this preference continues, the Government should at all times support in whatever way it can those families who are good enough to keep their elderly relatives in their own homes. I refer to measures such as home help and home care packages. This is being done at present and must continue because a massive saving accrues to the State in all such instances. Consequently, Members must ensure they do not simply pay lip service but continue to support and to increase support for all those who are good enough to do so, by way of the carer's allowance. The latter allowance is a payment of which many people can avail. While I accept it is means tested, it is available and acts as recognition for those who are good enough to care for their elderly mothers, fathers, uncles, aunts and other relatives, which is right and proper. This payment has been expanded and developed over a number of years and the excess amount that someone can earn has been increased continuously, which also is right and proper.

There are others who are good enough to care for elderly relatives in their own homes but do not avail of the carer's allowance. They take on these caring duties because they consider it their duty and obligation to do so. They are worthy of our admiration and gratitude. In the absence of their commitment and goodwill, the State coffers would face additional costs as a result of an even greater demand for long-term care beds.

I am glad to have had the opportunity to make a small contribution to the debate on this extremely important legislation. I welcome it warmly. In recent years I have made the point that the prevailing situation was not equitable and that people were facing serious financial difficulties because of it. I compliment the Minister of State, Deputy Hoctor, who has taken a particular interest in this legislation and has guided it through in recent months. I understand there were significant legal issues to deal with and that it was not a straightforward matter. I compliment the Minister of State on the introduction of the Bill in the House and I wish her well in bringing it to the Statute Book.

The public is crying out for a change in the system. We will undoubtedly take some criticism in regard to the claw-back. We can be sure there will be claims that Fianna Fáil is taking money from the dead. However, we must be realistic in these difficult economic times. This Bill seeks to ensure there is a fair and equitable system. I am confident that the public will ultimately thank us for putting this scheme in place.

Noel O'Flynn (Cork North Central, Fianna Fail)
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The next slot is allocated for an Independent Member. Since there are currently no Independent Members in the Chamber, I am advised to go back to the Government side. I call Deputy Browne, after whom I will call Deputy Bannon.

John Browne (Wexford, Fianna Fail)
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I did not expect to be called so quickly.

James Bannon (Longford-Westmeath, Fine Gael)
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Is it in order for another Government Member to be called?

Noel O'Flynn (Cork North Central, Fianna Fail)
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I have checked with the Clerk and am advised that this is the correct procedure. Otherwise, the sequence of speakers will be out of sync.

John Browne (Wexford, Fianna Fail)
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It was my understanding that I would speak after Deputy Bannon.

Jan O'Sullivan (Limerick East, Labour)
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On a point of order, the sequence is generally Government Member, Opposition Member, Government Member and so on, irrespective of whether or not a particular speaker takes his or her slot. That is my understanding of the procedure.

John Browne (Wexford, Fianna Fail)
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I was told coming into the House that I would speak after Deputy Bannon. I have no difficulty in keeping with that arrangement.

Noel O'Flynn (Cork North Central, Fianna Fail)
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Is it agreed that Deputy Bannon, who has been in the Chamber for a considerable time, should speak first? Agreed.

James Bannon (Longford-Westmeath, Fine Gael)
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This Bill is undoubtedly long overdue but whether it has been worth waiting for is debatable. I welcome any initiative that will support the elderly and their families. However, I am concerned that there seems to be a general acceptance of the premise that the elderly should contribute towards their care if they are adjudged capable of affording it, without due regard for what that means. This is the problem with the Bill. Ensuring there are equitable procedures in regard to who can afford to pay and who cannot and what they can or should contribute is a delicate balancing act.

Adjudging individuals as being capable of affording something and the ability of those persons to make payment without causing harm to themselves and their families are two entirely different matters. Assessing the elderly and imposing charges on the extent of their income and wealth is not only to impose charges on them but on their children and grandchildren. How is account taken of years of work and payment of taxes during the employment lives of these people? The elderly contributed greatly to this State for many years through their hard work. They made it what it is today, or what it was until recent years, before Fianna Fáil paralysed the economy and blew the boom.

Our elderly have a right to pass on the fruits of their labour, including their family homes, to their children and grandchildren. Where an elderly person signs over his or her home to a son or daughter, the latter is then the legal owner of the property. However, the State will insist on taking its cut when the elderly person dies in order to cover the cost of care in his or her latter years. Why should the new owner have to pay 15% of the value of the property under this so-called fair deal given that 80% of the patient's income was already allocated for his or her care?

In anticipation of properties being transferred into new ownership in this manner, the Bill contains an anti-avoidance provision, whereby assets and income transferred within a five-year period prior to an application for State support are to be taken into account in the financial assessment. This, as I said, is a direct attack on the sons and daughters of the elderly who are entitled to inherit their family home which, in many cases, they have worked hard to maintain. It is unfair that the children of the elderly are being financially penalised due to their lack of ability or qualification to give their parents the care they need and deserve. The parents in turn are left demoralised and upset by the pressure they are putting on their sons and daughters and the loss of their savings, which they had hoped to pass on to their children. It has been customary in this State for generations to pass on what was earned in one's lifetime to one's family.

Government policy as outlined in Towards 2016 is to support people to live in dignity and independence in their own homes for as long as possible and, when that is no longer possible, to support access to quality long-term residential care. In the fair deal scheme published late last year, the Minister promised to make nursing home care "accessible, affordable and anxiety free". However, the budget effectively put paid to such grand aspirations by reducing tax relief on medical expenses from 41% to 20%, in direct contradiction of the fine words "accessibility" and "affordability".

Under the proposals to fund long-term nursing home care, older people could be left with nothing because of the charges that will be levied and the inequitable cap on funding. The deferred contribution based on the family home will be capped at 15% of the value of the property, but the charges on other assets will apply for the duration of care. This is blatant robbery and extortion, holding the elderly who are reliant on care to ransom. It puts a whole new spin on the Robin Hood story. The Government is robbing the elderly and infirm to balance the books of an Exchequer emptied by its own squandering and mismanagement. Elderly people displayed the fury they felt at their shabby treatment when they protested outside Leinster House shortly after the budget. Government Members should hang their heads in shame for the ovation they gave to the Minister for Finance on budget day.

To expect full acceptance of this Bill with all its grey areas is to expect too much from the Opposition. If there is an acceptance of valid points on Committee Stage, perhaps some justice may be achieved for the elderly. The Minister appears to regard the elderly as a soft touch. The appalling measures proposed in budget 2009 in regard to medical cards for the over 70s suggest that, in her innocence, she assumed the elderly would accept anything. That was not the case. Elderly people are well tuned into what is happening and they came out in their thousands to protest. They should be applauded. I hope they will persist in their campaign on behalf of senior citizens. We will all be in that category some day. The Minister of State was wrong about that and she is also wrong about the finer details of this Bill.

Even talking about payment for care of the elderly is unthinkable when one considers the disgusting state of our nursing homes, which are supposed to be elderly friendly. There are very good nursing homes throughout the country but some are in a deplorable state. At a time when the Government is promoting a so-called fair deal for those needing nursing home care, the condition of many homes throughout the country is disgusting. One in three complaints against nursing homes has been upheld, a shocking statistic outlined in various reports. In my constituency, Longford-Westmeath, I have made repeated representations in respect of the upgrading of the external and internal built environment at St. Mary's Care Centre, Mullingar. The situation at the centre is undoubtedly one of perspective. On the one hand people are crying out for action to upgrade some undeniably basic conditions, and on the other there is a concerted effort to deny any deficiencies exist and to brush the matter under the carpet. While the reality lies somewhere in the middle, the fact that the cash-strapped HSE has said that a new centre is being planned to replace the current structure at St. Mary's in 2011, is indicative of the recognition of existing problems.

Any mid-century building, let alone one that was built as a workhouse and not as a hospital or care centre, is certainly in need of urgent upgrading to bring it to 21st century standards for the care of our elderly. However, for patients in St. Mary's, who are caught in the middle of the debate on its merits or demerits, the care they received from the very dedicated staff, within the restrictions of Government cutbacks imposed on them, is first class. Those who work in the hospital — doctors, nurses and staff — give excellent care in a dreadful environment of dilapidated buildings. This was highlighted in recent media reports. The actor Gabriel Byrne spoke of the right of all our people to have a degree of respect and dignity in their final years. That is also the aim of politicians.

It would be extremely blinkered to deny that some of the facilities at St. Mary's are in an appalling condition and I have photos to prove this. I have also seen the evidence that restorative and remedial work needs to be carried out at St. Mary's, with certain areas in the built environment presenting serious health and safety issues. The centre also came in for criticism in the recent investigative report by the Ombudsman into the care of a patient. The report highlighted the deterioration of the patient in a short space of time. The response by the HSE to the complaint by the patient's daughter was extremely badly handled and unacceptable. The bottom line is that overworked and under-resourced staff members are fighting an uphill struggle to provide necessary care for elderly infirm patients, while being very much at the mercy of HSE cutbacks. This should be a wake-up call for the Minister of State and the Government. I invite the Minister of State, Deputy Hoctor, to visit the dilapidated buildings in the midlands and to put her shoulder to the wheel to ensure they are upgraded. This is in the interests of patients, relatives and staff. Nothing is as demoralising for staff as a substandard building.

For too many elderly people, remaining in their own homes is not an option as social workers and other heath professionals are just not available to provide the care they need. This creates a desperate situation for relatives when they cannot access community care. Deputy Cregan referred to the lack of beds for elderly patients in Limerick. That is not a problem in Longford, where there is a fine facility in St. Joseph's on the Dublin Road. When will the Minister of State provide funding to allow the newly-constructed 20 bed unit at St. Joseph's, Dublin Road, Longford, which has been idle for the two a half years, to open? I was there when Ministers visited the hospital and praised the fine facilities but this Government has failed to provide funding for the staffing of the building. I ask the Minister of State to do so because it is badly needed to cope with the demand for the elderly throughout the region.

One person in 20 in this country is elderly and these people are being asked to bear the burden of the Government mismanagement of our finances. At a time when they should be enjoying care-free retirement, the Government is doing all it can to fleece them of their savings and entitlements. The inescapable fact is that the number of people aged over 65 has increased by 7.3% since 2002. It is set to increase to more than 800,000 by 2025 and will have tripled by 2050. Add to this the fact that Government spending per head on older people is among the lowest in the OECD countries at 0.67% of GDP, compared to an OECD average of just 1%, and we have a picture of a Government with its head in the sand on the issue. Life expectancy in Ireland now exceeds the EU average and the requirements associated with such an increased life span will not go away and should be provided for.

Nursing home care, medical cards and pensions are all under attack from this uncaring Government. It is despicable that the elderly and very young have become the perceived soft option target of choice for this Government's savage cutbacks, which are necessitated by their own inadequacies and incompetence. We have evidence of this on a daily basis in the media and in the performance by Ministers in this Chamber. They seem jaded and resemble prisoners in a dungeon or people who have been shipwrecked. They are not performing on behalf of the citizens who elected them. It is disgusting that the Government has forgotten the elderly, who have paid their way all their lives and earned the right to adequate provision by the State for their later years. Can the Minister of State reassure us that elderly and vulnerable people will not be thrown out into the streets if they cannot afford charges? Some people in society are very vulnerable, will not be able to pay and will suffer. Some provision should be made for them.

I await the response of the Minister of State to the issues raised in this important debate. If God spares us long enough we will all be elderly one day and it is important that we have facilities for people in their retirement years, including those who suffer from disabilities, who cannot cope with life, who suffer from Alzheimer's disease and other age ailments.

There is a need for an Alzheimer's unit in County Longford. Elderly people must travel up to 50 miles outside the county to avail of those facilities. It is not fair to take people out of the environment they are used to. Perhaps the Minister will concede and do something to provide a unit for patients with Alzheimer's disease in County Longford.

John Browne (Wexford, Fianna Fail)
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I will be reasonably brief. I compliment the Minister of State, Deputy Hoctor, on her contribution to this Bill and her very deep interest in supporting such a worthwhile Government initiative. The new fair deal legislation is very welcome, as it stems from the time of the illegal charges in our nursing homes up and down the country. Much time, effort and work has gone into developing the legislation.

I am sure many different Departments were involved in the development of the legislation, which I understand took four years to produce. Those involved included the Departments of Social and Family Affairs, Health and Children and Justice, Equality and Law Reform. Other bodies, such as local authorities, were also involved in providing information during the preparation of the Bill, which I sincerely welcome.

All of us have been touched by the need for change in the nursing home subvention area. From county to county and even within counties, people were not paid a uniform amount of subvention. This was not fair or equitable. As politicians we came across many cases where one person up the road was getting one amount in a bed subvention while a neighbour may have been getting a different amount. The amount of money depended on who the person was dealing with in the HSE. This placed some very severe financial difficulties on the children of older people who had to go into nursing homes.

I am not so sure the term "nursing home" is the best one to describe where senior citizens go. In many cases, such people go to places which extend their living facilities — perhaps they should be called senior citizen living centres rather than nursing homes. Many people who go to nursing homes are in very good health but for different reasons they may decide to leave their homes. They may live in rural areas, there may be nobody to look after them or the local shop or post office may have closed down. Many people who go to nursing homes are very active and full of life. These people, or their families, would have paid large amounts of money for this up to now. In some cases older people sold their houses or other property and moved into nursing homes.

It is important that nursing homes are not just nursing homes. They should provide recreational facilities for many of the people living there who want to be very much part and parcel of the community. Such people do not want to be confined to nursing homes — they want to go to bingo, senior citizen outings, the Christmas parties and all of that. It is important that the owners of nursing homes provide such facilities for people living in them.

Most older people want to remain in the community and we should consider this seriously. It is very traumatic for older people, who have lived in a community all their lives up to the age of 70, 75 or 80, to go into a nursing home for reasons they have no control over. It is very important that we consider how to facilitate people through home care and other initiatives to allow them stay in their community. It is very important that the post office network, the rural transport initiative and other areas are continually considered to see how we can ensure facilities remain available for people if they want to stay in their own home or community. In this way they would retain access to the shops or be able to travel to the nearest town under the rural transport initiative scheme. It is important that while, on the one hand, we are catering for people who want to go into nursing homes, on the other we should also cater for older people who want to continue living in their community.

I see Deputy D'Arcy is present. We are very lucky in Wexford in that we have the new St. John's Hospital for older people, constructed over the last two years. The first phase has been completed and is open while the second phase of 54 beds has been completed and will open shortly. That will give over 100 new bed units in Enniscorthy. We also have Ely nursing home in Wexford, the two senior citizen hospitals in New Ross and the Gorey hospital.

Deputy D'Arcy has been very critical of the HSE because it has not upgraded that hospital. We hope the Minister of State, Deputy Hoctor, and the Minister, along with the HSE, will extend and develop the Gorey facility. Gorey and its surroundings have expanded greatly over the past number of years with people coming from Dublin to live there and commute to work. In many cases people do not have work but they still live in the community. It is important we continue to provide the infrastructure, as well as the funds, for the fair deal nursing home scheme. I put on record my compliments to the people involved in the running of the facilities in the Wexford centres.

We also have the valuable and important day care centres, which are important to older people. I am very annoyed that the HSE has decided to introduce a charge for people going into day care centres. In many cases the day care centres allow people to stay in the community. They come to the centre during the day to meet their friends and neighbours, have a meal and play bingo, pool, darts or whatever they want. It is a very important facility and the HSE should think again about putting a charge on those who use it. It is not the right way to go.

I do not have a major problem with clawback. During what was perceived as the illegal nursing home charges issue, many people claimed money because their elderly relative was in St. John's Hospital in Wexford or different hospitals around the country. The administration told me such people did not come to see their relatives very often but when the money was there to be claimed, it was claimed. I have no problem with clawback. I understand in the UK there is a clawback system but this system must be fair and equitable. If the house is to be sold on we will get a clawback but if the family in question continues to reside in the house, that is different. I do not have a major problem with the process.

There is an issue with hospital beds. At any given time in Wexford hospital there are between ten and 20 elderly patients ready to go home but they have nowhere to go. These people take up hospital beds through no fault of their own. There should be a greater participation between the HSE and the private nursing homes in that sense. Surely it is cheaper to keep people in a nursing home than in a hospital. There is the cost of the hospital accommodation to consider but other people are also being deprived of the chance to come to hospital for operations or other treatment. Far greater co-operation is needed between the HSE and the private nursing homes in dealing with the matter.

The provisions of the Bill should be administered promptly, fairly and without too much bureaucratic nonsense. With the old scheme of bed subvention, I have had cases where it has taken three, four or five months to get approval for such subvention. I hope that will not be the system here and we will not have all kinds of bureaucratic delays. We need dedicated people in the HSE to deal with the applicants and people involved. It is very traumatic for older people to have to move out of their home and into a nursing home, only then to find it is taking ages to have their application dealt with. It adds to the trauma and difficulty. It is very important, when the Minister is designating the scheme, that there should be little bureaucracy and prompt action.

I welcome the Bill and the fact that the Minister of State, Deputy Hoctor, is taking a keen interest in ensuring all aspects of it are approved as quickly as possible. Inspections of nursing homes, as provided for in the Bill, are very important. We have some excellent nursing homes, some good nursing homes and some not so good nursing homes. Some of them simply want to fill the home and get the money while providing little by the way of facilities. Many of those in nursing homes are still active and it is important that homeowners recognise that and provide such facilities. From visiting homes in Wexford, I know that many of them provide recreational facilities and parties but it is important that we keep the pressure up through inspections and ensure our nursing homes are run properly and kept clean, with the right numbers of staff and proper procedures in place to look after people, without decisions that will affect patients being made behind closed doors.

I welcome this Bill and hope its provisions will be implemented as soon as possible rather than our having to endure a load of bureaucracy.

Michael D'Arcy (Wexford, Fine Gael)
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The position on the subvention in recent years was unsatisfactory. Arbitrarily, some people got different amounts depending on who made the determination. Whenever decisions are made like that, they create doubt and uncertainty and that leads to anger. There have been far too many occasions where one family paid much more than another family in similar circumstances. This will remove some of the uncertainty, a welcome advance.

I thank Deputy Browne for making many of the points I was to make on Wexford already but I will mention some of the services available there, services Deputy Kehoe has pursued since his political career began. St. John's Hospital is a fantastic facility with excellent staff and backup services. Every person I have seen there is satisfied with all that is done for them. Far too often the health services are not too good at telling us how well they do some things. We should pursue this and provide extra funding to ensure that something done well is replicated. Phase one of the hospital is reaching a conclusion with more than 100 beds in place.

Ely House, just across the bridge in Wexford, is also very good and the New Haughton Hospital in New Ross is excellent. Deputy Browne, however, mentioned Gorey District Hospital, which is the standard former district hospital that was built during the 1940s. Only a couple of residential long-stay beds are in place there and there are ten or 12 beds altogether. This exercises me because a huge number of people have relocated to north Wexford, many of whom did so to retire. Those people are in their late 60s and in ten years, if we do not extend services, there will be a domino effect. As good as St. Johns, Ely and New Haughton Hospital are, if we do not provide additional bed space for those who will need it in ten years or so, the entire county will experience major difficulties.

The population of Wexford has doubled in the past 25 years. If we look at the CSO figures, we can see many of those are elderly people who left to work in Dublin in the 1960s and have retired to Wexford. The savage loves the native sod and this is their native county but it is still a good staging post for contact with children reared in Dublin. The Minister of State must consider the extension of services for the elderly at Gorey District Hospital.

I can only speak about those nursing homes of which I have experience and while they are good, they are not as good as the State services being provided. Nursing homes exist to make a profit but they are being squeezed because of costs rising in recent years. Costs are declining now but I appeal to the Minister to consider Gorey District Hospital for extra funding.

It is unfortunate that an elderly person from my area can be transferred to State facilities a significant distance away. One gentleman from Coolgraney, close to the Wicklow border, was transferred to New Haughton Hospital in New Ross, almost 60 miles away. It was a traumatic experience because the man did not know anyone. Dublin is closer to Coolgraney than New Ross. This was the same as moving the man to a nursing home in Dublin. That is not good enough, we must allow people to stay in their local area if it is at all practical.

I have experience of the community volunteer sector in Wexford and it is outstanding. Volunteers provide a service that is much cheaper than would be the case under the HSE. Those services, particularly drop-in services, are vital because they help to keep people at home, interacting with other members of the community. We should facilitate this not cut it; many voluntary groups received a 1% cut in funding. That was not fair or reasonable, particularly when these sectors do the same work for less than the State sector.

The HSE refund scheme can cause problems. I have dealt with inquiries about overcharging and I did not find those working the scheme helpful. They were not facilitating people to make inquiries even though the money was obtained illegally by the State.

I hope the fair deal will give people the opportunity to enter a State facility safe in the knowledge that everything they have will not be consumed to pay for their care. I am concerned about assets and the inclusion of land and property, where a 5% contribution based on such assets can be deferred. In the case of the principal residence only, the deferred contribution will be capped at 15% of the value of the principal residence for a maximum of three years. That is one issue. Alarm bells always go off with me when I see a matter of interpretation.

Section 10 sets out the terms of the financial assessment of means. Under the terms of the Bill, the HSE is entitled to seek an assessment which will be conducted by a suitable person of its choosing. There is a lack of clarity as to whether this suitable person will be a staff member of the HSE who may or may not have the knowledge, experience or the ability to conduct the evaluation.

If the HSE wishes to establish the market value of an item, it is not bound by any valuation accompanying an application for State support but it is empowered to select a suitable person. Will the HSE employ a person from within its own ranks or will it appoint an independent third party? An independent third party should be chosen but there are concerns. If a valuer values for a seller or for a purchaser, there is always a disparate gap, which can be significant. We need to be careful about that. If independent valuations are to be done, there are sources of information we can use to ensure a correct current evaluation is available and that properties are not overvalued because of the State trying to acquire as much income as it can to defer the cost of people being in the care of the State.

If a discrepancy is found between the market value of an asset established by the HSE and that submitted with an application for support, the HSE is not bound to this valuation. If there is considerable disparity between the values identified, this could have significant implication for the applicant or for the State. As I said, somebody will be displeased. Under the legislation, there is no opportunity for recourse to find agreement on the issue. It is important that suitable provisions are put in place to deal with this eventuality.

Also, it is not clear from the section who is considered a suitable person and what is meant by "in such a manner and by such means as it thinks appropriate." That is open to legal challenge and much interpretation. We must get clarity and establish exactly what that means. We should do so in the House rather than let people pursue the matter in the courts which will cost individuals or the State significant funds.

Under section 10(5), the Minister must clarify who pays for the valuation and if this cost is incorporated into the repayment of ancillary State support. Again, we do not know the position in that regard. Section 10(7) states that any information and-or records requested as part of the assessment of means must be provided within 28 days from the date of the request unless otherwise specified by the HSE. Applicants might have to request documentation from local authorities, third parties or Government bodies and that might take longer than the four weeks in question.

Section 29(7) states a person may not request a financial review unless 12 months has elapsed since the most recent financial assessment and that the HSE must be satisfied of a material change in the financial circumstances of the person. Again, we are back to interpretation which we should thrash out in the House. The Minister should be able to come back to us before we complete the Bill so we know exactly what those sections mean. They are loose and open to interpretation. God knows, this process has been going on since December 2006. Loose wording such as this should not be part of the legislation.

If anything, the volatility of the financial markets over the past 12 months proves that a person's financial circumstances could fluctuate substantially within a short period of time and that a person's ability to pay could be seriously hindered. There is a significant reduction in house prices every quarter, contrary to what some of the auctioneering bodies are saying. Information is available to the State when properties are bought and sold. That is where people could lose out and be charged more than they should be. Equally, as we saw during the Celtic boom era, it is possible market values could be out of date. There is a need to bring clarity to the matter.

Section 31 provides for certain decisions of the HSE to be appealed within 60 days of notice of the decision being given to the appellant. The HSE shall appoint a suitable person to consider the appeal. The Minister has heard my views about loose language in the Bill; there should be none. Appeals should be conducted by an independent third party in order that a fair and reliable resolution can be reached with which both the applicant and the HSE are satisfied. It is important that this third party acts in good faith and to the best of his or her professional ability so that no party feels aggrieved. I do not expect the State to be done out of funds nor do I expect the State to do anybody out of funds in regard to the value of his or her property.

On the assessment of income, is money awarded under the nursing home repayment scheme considered? Again, there is no clarity in regard to that matter. Are income assets owned in 2009 assessed on their value or at what stage are they assessed on their value? Similar to the equity markets, if a person had shares in any of the banking institutions in mid-2007, at what stage will those equities be valued? Will it be at the 2007 or 2008 rate, or at their market value as at the date the person enters a State facility or a nursing home requiring funds?

There is a lack of clarity in regard to the assessment of cash values. We need clarity in this regard because we certainly do not need another version of the health repayment scheme in a number of years time. Stocks, investments, art collections and vintage cars all fall within the definition of cash values. Again, at what rate will they be valued, how will they be valued and who will value them? The encashment value of a product may be worth less than the actual nominal value. Will it be the market value on the day or the encashment value?

The Fine Gael position is that a financial review should be conducted by independent third parties in order that a fair and reliable estimate may be established with which both the applicant and the HSE are satisfied. This deals with cash and property values. Members of the public will not be long in telling the Government if they are not satisfied with the scheme. I am surprised by the number of occasions we have to revisit legislation. This process started in December 2006 and we need to get this legislation right. We do not want to have to amend it in the future. We must thrash it out in the House and ensure everybody is satisfied.

In regard to the foreign property aspect of the legislation, tens of thousands of people in the State own foreign properties. Is such property assessed as a cash or a relevant asset? The opinion to defer payment against foreign property assets, as is the case with the principal private residence, is not available. Therefore, money charged against a foreign asset must be raised each year. People could find themselves in difficult circumstances with falling asset values in terms of foreign property.