Olivia Mitchell (Dublin South, Fine Gael)
Link to this: Individually | In context | Oireachtas source

The next issue will be raised by Deputies Mattie McGrath, John O'Mahony and Denis Naughten.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

The situation is out of control. I watched the Minister of State, Deputy Kathleen Lynch, with Deputy Denis Naughten on television recently and the answers given were not answers. I watched the Minister of State when she was in opposition and she must know the hardship and anguish caused to families who must make a decision after trying their best to care for their families at home for as long as they can. When people make the decision to go into the fair deal scheme, they must wait up to 16 weeks to get a placement. I want to kill the myth that there is no capacity in nursing homes, as portrayed in the television programme by the Minister of State and the Minister. It is untrue. In south Tipperary, 12 beds are taken up by patients who are not fit to go home. The families are traumatised because they cannot take them home and they are waiting for nursing homes to go to. The patients are in long-stay beds, which is having a major knock-on effect on hospitals throughout the country. There is one hospital in Clonmel and there are stepdown facilities in Carrick-on-Suir, Clogheen and Cashel.

I ask the Minister of State to take her head out of the sand and deal with the issue. Talking about capping in this issue is the cruellest word she can use. People are at the end of their lives, having given service to the State and paid their taxes, as have their families, while the Minister of State talks about capping the funding. It is totally insensitive and it is a different Minister of State from the person I saw in opposition for four years. The Rottweiler was over here but now she reads out speeches prepared by the HSE and the Department of Health. The Minister of State should hang her head in shame because of the crisis, the trauma caused and the waste and occupancy of beds being held up for so long. I beg the Minister of State to do something. We are in the winter months and hospitals will get busy. Families are traumatised, having made the decision to care for the family properly. The system is cruel, ineffective and inept in sorting out the problem. It is another crisis and it is a fine mess the Government has created.

It was a good scheme set up by a previous Government but let us imagine using the term capping in this context. The Minister of State can throw her cap at it or throw her hat at it. She should have some dignity and, if she cannot sort it out, she should resign as Deputy RóiinShortall did.

John O'Mahony (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I do not know how I will follow that.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

Deputy John O'Mahony knows the truth.

John O'Mahony (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

This is an issue for all Deputies in the House. It is a very good scheme, but it is a major issue for families with elderly parents waiting on the list, some of whom have taken out loans to pay €800 or €1,200 in some parts of the country. Last February, the waiting time was four weeks and it has grown rapidly to 16 weeks.

The health service plan is coming out in the next few weeks. The question is how a demand led scheme will be dealt with in that plan. There is a 4% increase annually in the number of people over 80 years and the issue is to try to find a solution. It is causing trauma and people who cannot care for the elderly at home want to try to get into the scheme. Four or five weeks was acceptable but 16 weeks is unacceptable. I want to hear that there is some plan to deal with it. This is clogging up beds in acute hospitals and it costs far more than beds in nursing homes. The argument put by nursing home owners and families is that rolling out the scheme could save money. I hope there is some way of dealing with it in the coming weeks and months. Will the waiting time increase to six months, eight months or 12 months? It can be argued that we are in crisis now but the longer timeframes would be unacceptable. There must be a reduction to reasonable waiting times.

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

If someone applies for the fair deal nursing home scheme, the first payment will not be received until 13 March 2015. That leaves three categories of people, one of which is those who are in nursing homes. The families of these people must find a minimum of €13,000 to fund the nursing home stay between now and when the payment kicks in. The other group of people involves those who, according to HSE medical staff, can only be cared for in a private or public nursing home and are remaining in their homes because families cannot afford to put them into nursing homes. It is leading to two problems, one of which is the potential risk of neglect to the person, through no fault of the family, by remaining at home when the person needs to be in a nursing home. The second is that many of the people will end up back in hospital with preventable conditions.

I know an elderly person in my own constituency who had to be taken from a private nursing home because the family could not afford it. That person was admitted into an acute hospital pending approval of an application to the fair deal scheme.

A third cohort consists of more than 700 people who are fit to be discharged from hospital but must remain there. This is effectively taking 250,000 hospital bed nights out of the system. The only way to effectively tackle the congestion is to ring-fence the €25 million announced in the budget specifically for that purpose. That should be ring-fenced to treat older people before they need to go into hospital, and for those who end up in hospital, it should be used to get them well and out of hospital as soon as possible. The way to do this is threefold. We must increase long-term care capacity in the form of long-stay beds and the community care model by extending the fair deal scheme to include community supports. We need to reduce the number of older people attending our emergency departments by opening medical assessment units and urgent care centres in smaller hospitals, as well as maximising the use of technology for remote consultation. We also need to increase the rate of discharge into long-term care and the provision of short-term beds. This will unlock the capacity problem within our acute hospital system.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I have distributed a note which will tell Members everything they need to know. The Government did not cap the fund referred to by Deputy Mattie McGrath. Fianna Fáil did so and he was a member of that party.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

The Government has been happy to keep the cap.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

No; Fianna Fáil capped the fund and he was a member of the party.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

Why is the cap not raised? If the cap fits, wear it.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

The Deputy agreed to it.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

Lift the cap.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

He was warned about it. As people listen to the Deputy, we can answer him.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

It should be the same as mental health funding.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

Deputy Dennis Naughten must have got hold of the plan, because everything he suggests needs to be done.

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

Good.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

The €25 million in question is ring-fenced. I agree with Deputy John O'Mahony's comments; it would be unsatisfactory for the process to run to six months. The only way people would wait until March of next year after having applied now would be if we did nothing. It will happen if we do nothing, but that is not what we will do. We are committed to acting; it is not as if this issue is going away. This is not a problem that can be resolved in a week. It will continue and worsen, which is why we need a plan. We are not at the point of crisis, which can only occur if we do nothing about the issue and allow it to continue. There must be a plan to deal with an issue coming down the road. There are families suffering badly and, equally, there are people in hospital of a later vintage who do not want to be in there. They are conscious that this matter is being discussed in the media and in here, so we should not add to their distress. Deputy Mattie McGrath may not like to hear that fact.

There are just over 2,000 people awaiting approval for the Fair Deal scheme, but these are not the same 2,000 people every month. There are 788 people in acute hospital beds, and these are not the same people every month. Every month we issue 515 allowances to people who are awaiting approval for the fair deal scheme, and these people come off the list. They get a bed in a long-stay care home or a type of step-down respite. We need more of this.

Mount Carmel is part of the process and it will be the first community hospital in Dublin city. There are community hospitals around the country and Deputies Mattie McGrath, Denis Naughten and John O'Mahony all know them. In Cork we have a substantial community hospital that deals with old-age psychiatry and all it entails. Mount Carmel will deal with long- and short-stay cases as well as providing the intensive rehabilitation that people need after hip or knee procedures. There is also scope for intensive physiotherapy.

There is a plan, but it must be put into action. Deputy Denis Naughten spoke of a delay, but this will only happen if we do nothing, which is not an option. It is not as if this will go away. We know the number of people over 65 is increasing every year by 20,000, with the number of people over 80 increasing by 4% every year. Those people will need more services. There is a big difficulty with our acute hospitals and it is not just about people who are inappropriately placed. Accident and emergency departments are clogged because there is nowhere in a hospital for people to go. As there is a knock-on effect throughout the system, we must act. We have a substantial plan, which we have discussed in great detail.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

My goodness, how would one follow that? The Minister of State will certainly have a place in the Cork Opera House after the next election. She will be there, or a place like it, if she acts as she has done. She stood up and said she had a plan. Was it Abraham Lincoln who said he had a plan or a dream? The Minister of State does not have a plan, a dream or a vision for sorting this out. The Government closed our hospital for psychiatric services in Clonmel. The Minister of State knows where I am talking about. She promised all the plans in the world and the rolling out of community services, but that has not happened. The Minister of State may read out figures, but when will the plan be implemented? For example, when will Mount Carmel come on stream?

The Minister of State has listened to us this evening and may hear of this issue every day of the week. If she is honest with herself and looks into her heart, she will realise that although the Government has had five-point and three-point plans in the past, all of them were for naught and they have gone up in smoke. Nobody believes the Government, as it has no plan, vision or idea. I salute the manager of South Tipperary General Hospital, as well as the people of Clogheen and Carrick-on-Suir, for the work being done. They are under pressure trying to do deals with nursing homes that are offering places. These people want to free up beds while the Minister of State is rubbing her hands and talking about a plan. The opera house will welcome her with open arms after the next election. It is where she will end up with that kind of talk.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

The Deputy will do anything to get elected.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

I was elected.

John O'Mahony (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her explanation and I am glad to hear there is a plan. We will all watch it very closely. The key point is that the system is capped but demand is increasing. Will the 2015 allocation, in addition to the measures mentioned by the Minister of State, reflect the increasing demand that is evident each month?

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

It will not. There are two separate issues. As the Minister of State has admitted, there are 788 people fit to be discharged from hospital tonight and there is a cost to the health service of approximately €700,000 every night. The €25 million must be ring-fenced, and it could be the most radical reform in our health service during the term of the Government if this process is implemented properly. The difficulty is that such action will only deal with approximately one quarter of people on the waiting list for the fair deal nursing home scheme. We need additional money put into the scheme for the 1,500 other people; this should be the €23 million taken from the scheme last year. I can tell the Minister of State where to get the money. If the Government rolls out the national stroke programme and removes the seven telemedicine stroke machines that are currently in a warehouse in the Minister of State's home county of Cork, it would save the health service €55 million per year. Based on the ESRI report, it is estimated that the additional impact of the complete roll-out of the national stroke programme would be to reduce nursing home admissions, saving €23 million per annum. That is the same amount of money taken from the system last year. I urge the Minister of State to implement the stroke programme, save the money and ensure these older people have access to nursing home beds.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

There was a recent Topical Issue dealing with stroke care. The stroke programme is being rolled out.

We reduced the percentage of people moving from acute hospitals to nursing homes from 17.3% in 2009 to 14.5% in 2012. The percentage of patients discharged directly home has increased from 49.4% to 51.5%.

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

The Minister of State refers to phase one - much more can be done under phase two.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

The neurological strategy is being rolled out. The one point on which I do not agree with the Deputy concerns the €23 million to which he referred. We must ensure older people have a choice in where they stay. A great number have expressed a preference to stay at home or, failing that, in their own communities. The figure of €23 million relates to this.

I wish to inform Deputy John O'Mahony that the fair deal scheme is not demand-led and this presents a difficulty. He is right to be concerned about this because it places great pressure on families. The sustainability of the scheme also presents difficulties. The report on the review of the scheme will be ready around the end of January next year and will tell us much but not everything. It will say much about the sustainability of the scheme. Families are paying nursing home fees out of their own pockets and the average cost is around €800 per week. In places where demand is highest and beds are relatively scarce such as in Dublin, Galway, Cork and Limerick the costs can be even higher. Sustainability will be a difficulty if the contribution from the person in need of care is to be between €280 and €290 and the State is to pick up the rest. This applies to public and private nursing homes. If needs increase, sustainability will present a difficulty. The fair deal scheme is not demand-led, which presents another difficulty.

I do not agree with Deputy Denis Naughten on the figure of €23 million.

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

Additional money will have to be made available.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

The fund should be increased, although not necessarily by taking money from the fair deal scheme, as it stands.

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

I would have no difficulty with that.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

We should increase the fund for home help and enhanced home care packages.

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

The Minister of State's predecessor refused an amendment I tabled last July on that very issue.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I cannot do anything about that now, but I only approach things in the way I would like them to be dealt with.

Mattie McGrath (Tipperary South, Independent)
Link to this: Individually | In context | Oireachtas source

The Minister of State should remove the cap.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

That is how I judge myself, which is why I am not as abusive to Deputy Mattie McGrath as he is to me.

Olivia Mitchell (Dublin South, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State. The next Topical Issue is to be raised by Deputy Dan Neville on the need for a bypass at Adare, County Limerick. Is the Minister of State, Deputy Kathleen Lynch, taking this matter?

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

Yes, I am on the rota today.

Michael McGrath (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thought only senior Ministers were to take Topical Issues.

Denis Naughten (Roscommon-South Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

We had the senior Minister already.

Olivia Mitchell (Dublin South, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Deputy Kathleen Lynch is a senior Minister.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

The other Topical Issues are related to my Department.