Billy Kelleher (Cork North Central, Fianna Fail)
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I hope the Minister of State with responsibility for older people can bring clarity to the issue of funding for nursing homes in the context of the fair deal scheme, which so far the Minister for Health and Children, Deputy Reilly, has been unable to do.

Jerry Buttimer (Cork South Central, Fine Gael)
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That is not fair.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am talking about the fair deal scheme. This is not about political gamesmanship. This matter has caused a great deal of distress and concern to many families and individuals who were in the process of being assessed and approved for funding for nursing home support under the fair deal scheme. To date we have had conflicting views in terms of the Minister's statement that the immediate issue of funding had been resolved; that anyone who had been assessed would be approved under normal procedure; and that a review would be carried out simultaneously and the HSE's statement that it will continue to assess but not approve applications. There is a divergence of views on this matter.

When the Minister, Deputy Reilly, assumed office he took ownership of the HSE and amid a fanfare of publicity arrived at its headquarters and sacked the board. However, to date he has been shy in regard to pointing out where the funding allocated for the fair deal scheme in the Estimates and budget went and whether that funding had been misappropriated. The Minister said on a number of occasions that he had concerns about where the money provided for the nursing homes support scheme went and whether it had been misappropriated. The HSE has stated that all funding went to care for older people in accordance with the various subheads. This is causing a great deal of concern and anxiety among older people. Also, there is absolute confusion between the Minister, who runs the health services, having appointed a new interim board and the HSE.

I would appreciate if the Minister of State could tell us tonight that the HSE is wrong in not approving people who have been assessed for the nursing home support scheme. This would bring clarity to the issue. I would also like to know what is wrong with the budgetary provision allocated last year. This matter was brought to the Minister's attention when he assumed office around 6 or 7 March. It is clear from the briefing documents the Minister received at that time that there were difficulties with funding going forward in the context of the anticipated level of demand which was over and above that of last year.

I know that the Minister of State is committed to her responsibilities in this area. We all welcome the fair deal scheme, which has addressed the concerns of families and individuals in regard to how they will fund nursing home care for their loved ones or themselves. We must ensure we do not create further anxiety in this regard. The following is stated in the programme for Government - this was obviously written late at night or in the early hours of the morning and certainly not in Government Buildings: "Investment in the supply of more and better care for older people in the community and in residential settings will be a priority of this Government." It also states: "Additional funding will be provided each year for the care of older people." I am quite certain that the people who wrote this were at the time aware of the budgetary position and constraints facing the incoming Government yet it is stated that additional funding would be provided each year. I am assuming that includes 2011.

The scheme was suspended for a time. The Minister was eventually flushed out and made a statement that the immediate issue of funding had been addressed pending a review. It is hoped that the Government will live up to its commitment in the programme for Government that additional funding will be provided each year for the care of older people. The programme also states that funding will go to more residential places, home care packages and the delivery of more help and other professional community care services. While the programme contains a strong aspiration for support of older people we would really like to see people put the money where their mouths have been over the past number of years and months in particular to ensure the anxiety, fears and concerns of families and their loved ones are addressed immediately.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am disappointed that the Minister, Deputy Reilly, is not here to take this matter on the Adjournment. There is now serious confusion over what is happening with the fair deal scheme and it is the Minister's job to clear up that confusion and tell us, and more important, worried older people and their families how this is going to be resolved.

Last Wednesday, 18 May, it emerged in the media that the HSE had informed hospitals that funding allocated for the fair deal scheme in 2011 was running out even though we are only in the fifth month of the year. Naturally, these reports spread huge concern among older people and their families, including people already availing of the fair deal scheme and those who had applied or would be applying for it. Age Action reported that it was inundated with phone calls from concerned older people, some of them in tears.

On Friday evening we had the statement from Minister, Deputy Reilly, in which he claimed that €100 million in funding for fair deal was used for what he described as ancillary services, including therapies and drugs. The Minister was quoted as saying there was "tremendous confusion"between the HSE and his Department. He spoke of "some very strange figures coming through from various parts of the HSE." Then, quite amazingly, he said that through "confused messaging" money that belonged to one subhead has been spent on other subheads. We are talking about tens of millions of euros in public money. For "confused messaging" to exist about its allocation and spending is totally unacceptable. There was a sigh of relief when the Minister said that the fair deal scheme would recommence approving applications. That relief has been short-lived. I contacted the HSE only to be told that applications are not in fact being processed. I was told that the computer system for processing them has been shut down. In fact, the term used was that "the computer access has been disabled", which is shocking.

The HSE was reported today on the Irish Health website as stating that it has not yet recommenced approving applications for the fair deal scheme as it is still seeking clarity on the funding issue from the Department of Health and Children. The HSE also stated that it was not the case that money was diverted away from where it should have been spent, as claimed by the Minister. So, now we have the Minister and the HSE contradicting each other on this vital matter of the care of older people. Are we drifting, with our eyes wide open, into yet another crisis? When will the approval of applications re-commence? Staff in the various nursing homes support units throughout the country are denied access through the computer system.

The pressure on the fair deal scheme in the past year has already led to a situation where there are increasing numbers of delayed discharges of older people from hospitals, that is, older people are being kept in hospital beds longer than medically necessary because there are no nursing home places for them to go to, or now, as it seems, no fair deal scheme in operation to support them. The longer this situation drags on the worse the bed shortage in our already over-stretched hospitals will become. We have some 1,500 public hospital beds closed and, despite their election promises, there is no sign of the new coalition Government opening any of them.

We need absolute clarity and we need it now. We need the funding confusion cleared up and the funding restored. We need applications to be approved and older people to have some sense of security. We need all available beds accessible to those already cleared to occupy them.

These are real people. Tonight, in my home town of Monaghan an 89 year old lady remains in her flat, dependent on a limited home-care package and the continuing 24/7 care of her loving family. She was approved for fair deal access to a bed vacancy in a local state-of-the-art nursing home that became available yesterday. However, with no fair deal final processing she is unable to take up the offer at this time. That is outrageous. There are many other older people like the lady I refer to.

I appeal to the Minister of State, Deputy Lynch, to impress on the Minister to have the blockade of the computer system lifted and the process recommenced immediately.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputies for raising this issue. I agree with both of them that this is a very worrying time, not just for elderly people but for their families and those who support them.

This issue relates to the nursing homes support scheme, the fair deal, which is a system of financial support for individuals in public, voluntary and approved private nursing homes. The scheme is available to anyone assessed as needing long-term nursing home care, including dementia-specific nursing home care. The scheme involves a fundamental change in the way in which long-term nursing home care is funded. The new scheme supports the individuals in need of long-term nursing home care, not the facilities providing the care. This means that money follows the patients, regardless of whether they choose public, private or voluntary nursing homes. It ensures that these facilities are not being funded for empty beds. Almost 21,000 applications for the scheme have been received since its commencement, with nearly 3.000 applications received in the first quarter of 2011. Over 16,000 of these have been processed to completion.

It is important for people who are already in care to be assured that there is no threat to them. Old people are vulnerable enough and it is easy to worry them.

The legislation underpinning the scheme enshrines the principles of a resource cap, patient choice and funding following the patient. In this regard the total long-term residential care budget in 2010 was €979 million. The budget for long-term residential care in 2011 is €1.011 billion. This is effectively funding for the nursing homes support scheme, albeit that transitional arrangements, for example subvention, contract beds and saver cases in public nursing homes, must also be facilitated from within the subhead. The Nursing Homes Support Scheme Act 2009 defines "long-term residential care services" as maintenance, health and personal care services. The services which fall within the scope of long-term residential care include nursing and personal care appropriate to the level of care needs of the person; basic aids and appliances necessary to assist a person with the activities of daily living; bed and board; and laundry service.

The cost for each public nursing home has been determined using the definition of "long-term residential care services" underpinned by an agreed set of cost components which has been laid before the Houses of the Oireachtas. The scheme does not cover therapies because a person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by the nursing homes support scheme. In other words, a person can continue to receive goods and services in accordance with the terms of these other schemes regardless of whether they are in a private nursing home or elsewhere. In determining the services covered by the nursing homes support scheme, it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, goods and services that are already prescribed for individuals under an existing scheme are not included in the services covered by the new nursing homes support scheme because this would effectively involve paying twice for the same items or service.

As the Deputy is aware, the Minister for Health and Children has recently been made aware of a serious shortfall in the budget for this year. The budget is coming under pressure from, among other things, increases in overall costs and increases in net demand for long-term care. Furthermore the HSE has advised that the long-term residential care subhead is also funding services other than those covered by the nursing homes support scheme.

I should point out that we understand these other services, which include therapies and medications, are being provided to people in nursing homes. The Minister is currently seeking to ensure that only agreed costs are met from the long term residential care budget. The Minister has sought further information about the level of funding provided for, and the costs drivers impacting on the fair deal budget. The main priority at this stage is to establish what steps might be taken to allow more people to benefit from the scheme. In the meantime, applications for financial support under the scheme will continue to be accepted and processed. However decisions to grant approval will be subject to the availability of funding. A full examination of the funding situation is underway, conducted jointly by the Department of Health and Children and the HSE. The commitment in the programme for Government to review the fair deal scheme will be undertaken separately.

I find it rich to listen, not to Deputy Ó Caoláin, but to a Deputy who was a Minister of State when the Government allowed the Minister for Health and Children to distance herself so far from the Department that it was not merely at arm's length but out of her control. What we are looking at here must have been seen by the previous Government before it went out of office.

Billy Kelleher (Cork North Central, Fianna Fail)
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We did not write the programme for Government. The Government wrote it. We do not mind being blamed for things we are responsible for.

Kathleen Lynch (Cork North Central, Labour)
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I find it difficult to listen to that kind of rhetoric-----

Billy Kelleher (Cork North Central, Fianna Fail)
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We had to listen to it for 14 years.

Kathleen Lynch (Cork North Central, Labour)
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-----putting elderly people and their families under such pressure.