Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I understand Deputy Boyd Barrett is sharing time with colleagues in the Technical Group.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I wish to share time with Deputies Fitzmaurice, Wallace and Tom Fleming.

As the Minister, Deputy Varadkar, is aware, ALONE has stated the waiting list for nursing home places is spiralling out of control. Those are pretty dramatic comments. The waiting lists are completely unacceptable for elderly people who are trying to get into nursing home care. I am aware from anecdotal evidence that the bureaucracy is extremely difficult to navigate and it takes a long time for people to even get through this fair deal scheme. The Minister himself has acknowledged the fundamental problem is that the budgets are capped and this is the reason for these unacceptable waiting lists. I do not lay responsibility simply at the present Administration's door but I draw an analogy with the housing crisis, which is similar. It is almost exactly the same except for the older population in need of nursing home care. Once upon a time, there was adequate public provision of housing and of nursing home care. It was perceived to be the responsibility of the State to provide both of these things directly. In recent years, there has been a creeping privatisation of both these areas, that is, the areas of housing and nursing home care. This has led to an increasing reliance on the private sector and on a model of funding such care through the fair deal scheme, in which people pay for these things out of their own assets, that is, out of their own houses or incomes, rather than funding them through central taxation in a progressive way. Essentially, the chickens are coming home to roost in this regard, just as they have with the housing crisis. The private sector cannot deliver and a two-tier system is developing. The answer to this crisis is that direct public investment in public nursing home care is needed, rather than a model that is failing in depending on the private sector.

Michael Fitzmaurice (Roscommon-South Leitrim, Independent)
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First, I have been contacted by many families in recent months, particularly from my own electoral area, and some have been crying on the telephone about what is going on. All Members are aware that no matter how one dresses up these figures, between 2,000 and 2,500 people are waiting to gain access to the fair deal scheme. At present, it is not a fair deal but is a bad deal and that is how they are looking at it. A figure has been given out of a waiting time of 15 weeks. I know of several families that currently have been waiting for between 20 weeks and 24 weeks. As for the turnaround about which Members hear, it is not happening. The numbers in acute units in hospitals are building up and the mathematics in this regard do not stand up when one considers what it costs to take care of someone in a hospital as opposed to a nursing home. All Members of course agree that measures such as home help require building up but one cannot rob Peter to pay Paul. One must put money into the two different methods of looking after the elderly. There is another side to this issue that people have not considered. If a nursing home that operates as a 30-bed or 32-bed unit loses two to three people, it starts to make it unviable. One then will have job losses and down the road, one will have an entire system in chaos.

Members have gone down a road whereby they basically are taking it out on the most vulnerable. People who have worked for this country, made many sacrifices and helped in many ways, now are being treated as second-class citizens. Members should ask themselves whether they should hang their heads in shame at what is going at present in that they are not looking after the most vulnerable people. I acknowledge the Minister has recognised the problem but the funding must be made available. While it is great to hear the Minister for Finance state the growth rate next year will be 4% but when facing such a scenario, Members must look after everyone. These people, with a system that currently is in chaos, need help and I urge the Minister to examine this issue and to solve it straight away because it will give ease to families and to those who are waiting day after day to get the telephone call confirming they have been accepted for the fair deal scheme.

Mick Wallace (Wexford, Independent)
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It is pretty well accepted that the Government's method of dealing with the banking crisis has had a significant impact on the more vulnerable in society, which includes the elderly. After suffering the devastating cut of 19% to the respite carer's grant in 2012, last year's cut of €35 million to the fair deal scheme probably was both unfair and short-sighted. The Government must take a serious look at this cut and reverse it. According to ALONE, nursing home waiting lists are spiralling out of control. At present, there are 2,100 people on the fair deal waiting lists, compared with 654 in February 2014. Waiting lists have tripled in size and the average waiting time for approval now is 15 weeks. Excessive waiting times of up to four months for fair deal approval actually can put patients' health at risk as it means vulnerable older persons often are left with no alternative but to avail of care within acute hospital settings that are not specific to their individual requirements. Other elderly people are forced to cover the full cost of their care themselves for months while they wait for approval and incur significant financial costs and pressure. Long waiting times both adversely affect applicants to the fair deal scheme and have serious implications for the wider health service, which already is under severe strain as a result of successive cuts that have left hospitals overcrowded, understaffed and overstretched. Hospitals are hindered in their efforts to free up beds because patients who are fit for discharge cannot get places in nursing homes. As I mentioned in the Chamber recently, this is directly linked to how last Sunday week, an ambulance waited for three hours outside Wexford General Hospital because there was no trolley onto which to put the patient. This was because the trolleys were being used as beds because of the number of beds that had been closed down and it is all connected. I acknowledge the Minister did not decide the budget for the health system and he has only recently come into his post. I do not know whether he will decide it the next time around either or whether he will be told how much he will get. However, six months ago, the ECB stated the biggest threat to Ireland's finances was the overspending on health. I hope the Minister will adopt a much better approach than that and that the people who are in need of most help are of greater priority than the concerns of the ECB.

Tom Fleming (Kerry South, Independent)
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It is unfortunate that the crisis in the funding for the fair deal scheme is escalating as the winter months approach as it puts more than 2,500 patients and their families in a dilemma. They face delays of up to four months and in the meantime, these additional patients are rapidly coming on-stream to a growing waiting list. The current crisis is exacerbated by Ireland having the fastest-growing ageing population in Europe, with more than 60 people per week being added to the waiting lists for nursing home places. There is a need to re-evaluate the solutions to stem the avalanche of elderly people requiring institutional care. Consideration must be given to more preventative methods, for instance to prevent premature cases of people ending up in long-term nursing homes.

There is a need for additional funding and resources to be allocated in respect of community care and community nursing. There is also a need for extra supports for day-care centres. In many instances, the latter are relying on voluntary carers and local fund-raising to provide the essential services required.

We must re-examine the stringent criteria which apply in respect of eligibility for carer's allowance. Applications are being refused on foot of an over-zealous interpretation of the medical card guidelines and, as a result, the caring relatives of patients are being wrongly deprived of social welfare assistance in many cases. There are those who provide 24-hour care and supervision in respect of their elderly relatives and many of them do not get any respite from this continuous care. They obviously become burned out and suffer from stress as a result and they do not receive any remuneration for the work they do. There is a need for the criteria to be relaxed in order that more of the applications made by these worthy individuals might be approved. We must put in place a system whereby these overworked carers might occasionally enjoy a break at weekends and proper holidays.

There is also a need to appoint more geriatric consultants in our hospitals in order that patients might be reassessed and re-evaluated and have their conditions re-diagnosed. In many instances, re-diagnosis can give people a new lease of life. We need to keep those to whom I refer out of long-term care if possible because the position in that regard is currently unsustainable. Additional moneys must be provided in respect of housing aid for the elderly. Such aid must be delivered quickly by the local authorities. I ask the Minister to consider the three suggestions I have made in the interests of ensuring that the majority of people might remain in their homes, if at all possible.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I call Deputy Mulherin. I understand she is sharing time with a number of colleagues. Is that agreed? Agreed.

Michelle Mulherin (Mayo, Fine Gael)
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Ireland has an ageing population and we are aware that we ourselves are getting old. In that context, we must ensure there is proper and comprehensive care available for the elderly and those who are incapacitated. The most desirable for anyone who is elderly or incapacitated is to be in his or her home. In such circumstances, I welcome the €10 million that has been provided in the budget for next year in respect of intensive home-care packages. I also welcome the additional funding being provided in respect of ordinary home-care packages. The latter will allow those who are incapacitated or infirm, but who are deemed fit enough, to be discharged from hospital and sent home. These people will still require support in their homes, either on a temporary or more permanent basis. Home help and other supports are essential to make it feasible for a person who is incapacitated or infirm to remain in his or her home. There are legions of carers throughout the country who make it possible for people with disabilities to live in their homes. I know some of these carers and I am aware that what they do is a real labour of love for them. To avoid such individuals becoming burnt out, we must strive towards providing supports to ensure they enjoy some quality of life and that their lot is made easier and more bearable.

When the nursing homes support scheme was established in 2009, the admirable objective relating to it was to make nursing home care accessible and affordable for everyone. Another objective was that individuals who benefit from the scheme might make a contribution. It is a matter of great concern that, as a result of budgetary constraints, there is currently a 15-week waiting list to access the scheme. Some 1,993 people are currently on the list. Budgetary constraints and a lack of money are, unfortunately, a reality of life for the Government. The former are both most acutely felt in the context of the health budget, particularly that part of it which relates to vulnerable individuals. The budget for this year alone was €939 million. In a reply to a parliamentary question I tabled recently, the Minister indicated that since 2009 the amount of money secured through the scheme in the form of loans from individuals stands at only €30.5 million. There is obviously a large gap between what people are contributing and the actual cost of operating the scheme. I accept that this is the reality and that the matters to which I refer must be considered by the Minister.

We must also reflect on the reality for those individuals on the 15-week waiting list to which I refer. Those on the list do not all fall into the same category. Some of them are in hospital beds awaiting discharge, so we know they are being cared for properly. This is not, therefore, an issue. There are others who are still living at home awaiting admission to nursing homes. The State is in a position to provide care packages for these people, even on a temporary basis. One would hope the individuals involved are being properly cared for and supported in their homes while they wait to be admitted to nursing homes. There is one category in respect of which there is particular financial hardship. I refer to those who have been forced to enter private nursing homes and who know they are going to qualify under the fair deal scheme. These people are obliged to fund their own care to the tune of thousands of euro each month. This is money which they take from their savings and when they are eventually admitted, they are not paid any arrears. I am aware of two cases - both of which I brought to the attention of the Minister - where the savings of the older people involved were completely depleted. These are extremely difficult cases with which to deal because they relate to those who are the hardest pressed. The money in question means a great deal to these people. I am of the view that the latter should be given priority in the context of any solutions which might be brought forward.

A review of the scheme is currently under way. This review is examining how the scheme might be made more sustainable, how the issues and delays relating to it might be addressed and how the matter of funding might be dealt with. This is an extremely important matter. If people are kept in acute beds or step-down facilities, the cost to the State is considerably greater than would be the case if they were admitted to nursing homes.

I am of the view that we cannot do enough for carers who care for people in their homes morning, noon and night and who protect the dignity of those individuals. However, I accept the reality that exists. Carers are fundamental to the notion of ensuring that people remain in their own homes. Carers should be always supported. Ultimately, it is cheaper to ensure that someone remains in his or her home. I am aware of instances where certain carers have reached their wits' end and are completely stressed out from being obliged to deal with various situations. However, they continue to provide care for people who, in most cases, are probably family members. We must remember that carers also have lives of their own. I would like to think they will take centre stage in the context of examining how we will provide for those who are elderly or incapacitated to be cared for in their homes.

Michael McNamara (Clare, Labour)
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The Minister will be aware that the fair deal scheme is a source of concern to me. I raised the matter with him in correspondence and he replied to the effect that when the nursing homes support scheme commenced, a commitment was made that it would be reviewed after three years. That review is currently under way. There are certain aspects of the scheme which require urgent consideration. Obviously, the level of funding is unlikely to change dramatically just because a review into how the scheme operates is under way. Every funding line is dependent on available resources and the resources available in the State for many, if not all, services are still constrained and are likely to remain so for at least the lifetime of this Government, however long that might be. Obviously, the maximum length of that lifetime is known but the minimum is not.

Delay is an inevitable aspect of administration. However, the way in which the nursing homes support scheme operates almost incentivises delay on the part of the HSE and those who administer the scheme. Applications are made and all applicants are put on a placement in chronological order to ensure equity nationally. The current delay is approximately 15 weeks. If one does not have moneys available to cater for the number of applicants - effectively, that is the current position - the best thing to do is delay making any adjudication on applications. This avoids people who have been approved being left on the waiting list.

It seems to be a slightly bizarre use of State resources, particularly because the cheapest place to look after people in need of care is their home, as Deputy Mulherin said. Obviously, the next cheapest place is a nursing home. The most expensive place is a hospital. Beds in the category-four hospitals are obviously at a greater premium than the step-down hospital beds.

While I appreciate that funding is constrained, it appears to be increasingly the case that a number of people in community hospitals could be accommodated elsewhere if their applications were properly dealt with under the fair deal scheme. There are those in category-two hospitals, such as those in Ennis and Nenagh, whose medical care might be equally well provided in community hospitals. It is not provided in the latter because there are people in community hospitals whose fair deal applications have not been dealt with. While there is an incentive to delay dealing with applicants under the fair deal scheme, this is clogging up other beds that are much more expensive for the State to provide. This seems to be symptomatic of some of the difficulties that exist within the HSE and the fact that there is not really an incentive not to exceed any particular budget because budget lines are not desegregated sufficiently in the HSE. That is a broader issue.

I welcome the spotlight being shone on this issue. I hope that, notwithstanding funding shortfalls, the scheme can be run in a more efficient manner. Perhaps other budget lines could be examined to determine whether, if by providing more funding for the fair deal scheme, savings could be achieved elsewhere through freeing up much-needed beds in acute hospitals.

John O'Mahony (Mayo, Fine Gael)
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I welcome the opportunity to contribute to this debate. There is a problem and it is very obvious with the lengthening of the waiting time for approval under the fair deal scheme. I raised this a few weeks ago in a Topical Issue debate. I know from speaking to the Minister that he is very conscious of this issue and that it needs to be addressed. The problem is that the scheme is demand led and there is a limited amount of money to deal with it. Having said that, given the trauma experienced by the families involved it is important that they see some change or means of addressing the problem.

As short a time ago as last February, the waiting period was down to four weeks. In April, it expanded to six weeks. It expanded to seven to eight weeks in May and to 12 weeks in June. It is now 15 weeks. This merely outlines the problem. If families have to put their loved ones into a private nursing home for 15 or 16 weeks, they must stump up approximately €13,000, which causes all kinds of problems. I know families who have taken out loans to achieve this.

Effectively, the fair deal scheme is good. The Minister's problem, which has been outlined already this evening, is that there are 20,000 additional people over 65 every year, and there is an increase in the population over 80 of 4% per year. I welcome the fact that there is a review of the scheme and believe it must be made sustainable. The HSE service plan is due in the next couple of weeks. I presume and hope the issue will be addressed in that, certainly in the short term. People tell us the system is currently in crisis, but if the waiting lists are not reduced dramatically in the coming few months the problem will worsen.

Deputies on all sides of the House realise the difficulty associated with dealing with this issue but also realise the importance of addressing it. I have no doubt, having spoken to the Minister, that he has plans to address it in the short term. The issue will be ongoing unless there is some long-term solution found.

Áine Collins (Cork North West, Fine Gael)
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I welcome the opportunity to speak on this important issue. Because of the ageing demographic profile of our citizens, there is no doubt that the nursing homes support scheme needs to be kept under constant review. A review of the scheme is currently under way and it will consider its future funding and sustainability. An important part of this will be to assess how community and residential services are balanced. The current scheme is very expensive and places a huge financial burden on the taxpayer. In 2014, €939 million was provided in the budget Estimates. However, analysis clearly demonstrates that the funding was inadequate to meet the need. The cost to the Exchequer and taxpayer will without doubt increase in the coming years. The Minister must continually examine new ways of caring for the elderly in our communities.

The nursing home option is probably the least favoured by those in need of care. Being looked after at home or in the community is the preferred option in most cases. In these circumstances, any improvements in the existing or new care systems implemented must provide as much certainty as possible. This certainty is essential for the peace of mind of potential patients, and it is perhaps equally important for the peace of mind of their children and carers.

I encourage the Minister to consider more villages for the elderly where they can live independently but at the same time have their care needs met. If more money were provided by the State for direct nursing home provision, it would save millions of euro by making more acute hospital beds available. The current qualifying conditions for home care packages are very generous and should be kept. One does not need to have a medical card; there is no means test and no assessment of one's income. The supports one receives will be based on one's assessed care needs, subject only to the limit to the resources available in the local health office area. This limit is a problem as it can be difficult enough to get an adequate home care package, even if it would appear far more satisfactory from the patient's perspective and most definitely from the taxpayer's perspective.

The current review of the nursing homes subvention scheme must be combined with a new approach to home care packages. The carer's allowance and carer's benefit are very useful in helping people to remain at home. The scheme in this regard, as it currently stands, is very broad. It is not based on any continuing medical needs assessment of the individual once the initial determination has been made. A review of the system that emphasises the amount of care required based on the medical assessment could lead to greater assistance being provided to carers looking after a person who would otherwise have to go into a nursing home. A close examination of this system could also be beneficial from the perspectives of the carer and taxpayer.

Sheltered housing units provide security for elderly people in transition. A clear and obvious mistake being made at present is that the sheltered housing organisations are continuing to build one-bedroom houses. Every house for an elderly person needs a room where a relative, carer or child can stay. The new building regulations will ensure that houses are more suitable for elderly people and people with disabilities in the future. All these avenues must be continually assessed and changed to make it easier for people to remain at home.

My one concern about this motion is that it may place undue emphasis on nursing home subvention. There can be other methods and means of effecting improvements to ensure the care of the elderly and disabled. Nursing home subvention will always be one component of the long-term solution but our primary objective as a society should be to care for our elderly and disabled in the best possible way, as close to their community as possible. We must appreciate that it is our sons and daughters who will be paying for our care through the taxation system, as is absolutely correct. Therefore, it is essential that we develop not only the best care system but also the most economical one for the generations to come. It is essential to construct the necessary infrastructure to enable us to offer the best care to the elderly.

Mary Mitchell O'Connor (Dún Laoghaire, Fine Gael)
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8 o’clock

My parents are in their 80s. They live at home. They would not want it any other way and nor would I. I believe that living at home is every elderly person's first preference. It is where they feel safe, where they know best and where they feel happiest. They continue their independence, they are close to their family and they remain a part of their community.

I understand that living at home is, unfortunately, not an option for all. Some older people require care and assistance and the Government must strive to ensure that appropriate and varied accommodation options and services are offered to those who want to stay at home and those who need the support of a nursing home. Older people who have worked all their lives and helped this country through previous recessions deserve fair, equitable and affordable treatment.

For years we have all been told that Ireland will have an aging population. This means a greater demand for services and accommodation assistance. The fair deal scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. To date, I would say that the scheme has been a success but with an aging population and increasing demand that exceeds the funding that can be released we are, unfortunately, looking at waiting times. While I strongly disagree with waiting times of 15 weeks, I believe we should look at how we can provide a continuum of care and, perhaps, a more appropriate funding scheme for older people in Ireland - I refer to care complete with the appropriate care services and even social activities that would prevent isolation and loneliness for older people.

Let me emphasise here that the Government spends a large amount on this scheme - nearly €1 billion each year. To be precise, it is €939 million this year. The Government is committed to providing for old people. We cannot have situations known as bed-blockers or those involving the inappropriately placed older person.

The fair deal scheme alone cannot address all these problems that are relevant for the elderly and the sick. Reductions of €35 million have been made in this year's scheme but €23 million of this funding has been allocated instead to alternative community services. These services can deliver a greater range of care options, prevent unnecessary hospital admissions and provide rehabilitation to support the older people to return home. Some €10 million has been allocated to provide intensive home-care packages, a welcome move. Many older people want to stay at home and this funding will ensure their continuum of care, their happiness and continued well-being. A further €10 million has been allocated to address funding shortfalls in the provision of public short-stay beds. Some €3 million has been also allocated to commission 25 intermediate transitional care beds. These steps will help to ensure a holistic approach to providing care for older people. They will help ease the pressure of demand on the fair deal scheme and it will help provide for alternatives.

I welcome the review of the scheme which is currently under way. However, I have been given detailed information that care in private nursing homes is cheaper to deliver than care delivered in public nursing homes. Why is this? It is also essential that this review considers not only the future funding and sustainability of the scheme, but also how community and residential services are balanced.

The well-being and continuum of care for the older person must continue to be the key focus of the Government. I know that the Minister, as a doctor, wants the best for the elderly.

Jerry Buttimer (Cork South Central, Fine Gael)
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One of the main benefits of the nursing home support scheme for individuals and families is that it gives them certainty about how much nursing home care will cost. Without this scheme many families would not know how much caring for their loved one will cost and they would not know how much they would have to put aside each week so that their elderly parent, as Deputy Mitchell O'Connor alluded to, gets the care he or she needs.

Given that Fianna Fáil, when in Government, has not been prepared to develop a policy regarding the care of the elderly and allowing for the fact that the Minister, Deputy Varadkar, in the recent budget achieved an increase in the health budget where we are now spending €13 billion, an increase of €635 million on last year, it is extraordinary that Fianna Fáil put this motion before us. It behoves the Members opposite, rather than coming in here with a condemnatory motion, to put forward a motion regarding their own health policy on care of the elderly.

Notwithstanding that, there are problems with the fair deal scheme. The waiting period between application to the scheme when a person takes up residence in a nursing home and the time of the first payment needs to be address. During this time the person or his or her family end up carrying the full cost of the nursing home which can prove difficult, both emotionally and financially.

I very much welcome the remarks of the Minister of State, Deputy Kathleen Lynch, last night that the scheme is being reviewed and I would ask that the Ministers in the Department provide a clear timeframe for when this review will be completed. It would also be useful that the terms of reference for the review take account of demographic changes. We all understand that the population is living longer and the age cohort concerned is increasing. The Department of Health estimates that an additional 1,000 long-term residential care beds each year will be required over the next seven years. This places additional pressures on the funding requirements but it is something that must be planned for as soon as possible. Something Fianna Fáil did not do in Government was plan for the future. The Minister of State, Deputy Kathleen Lynch, was correct to draw attention to this.

The review will also consider the effectiveness of current methods of negotiating and setting prices, which must be up for discussion. It has been described to me as a "cost plus system", a system that encourages a high cost base and does not incentivise efficiencies. I say that as somebody who visited a number of nursing homes in my constituency recently. We must ensure that this process is a real negotiation that enables nursing homes to have the financial capacity to re-invest so that they can maintain and improve their facilities for those who live in them as their new homes. We should also look at enabling a third-party review or arbitration of the negotiation process which will help to ensure fairness.

One issue that we need to be conscious of is the recruitment and retention of qualified staff, particularly nurses. From speaking to the nursing home owners, I note that as soon as the HSE advertises and recruits nurses, they draw from the private nursing home sector. As the Members know quite well, the private nursing home sector cannot offer the same package of remuneration and terms and conditions, and I would hope that the review process would also examine whether this should be a factor for consideration when negotiating and setting prices.

I hope that the review process will help to develop a comprehensive approach to the care of elderly citizens. I note that one aspect of the review is looking at extending the scheme to community-based services and other sectors, such as disability and mental health. It is helpful that this is being considered, as these services are every bit as important as nursing home care. I would share some of the concerns of Nursing Homes Ireland about this proposal. Given the forecasted increase in demand, we must ensure that funding for nursing home care is not diluted. Perhaps the review should also consider whether it would be better to establish a similar but separate scheme for community-based services.

Earlier this year the Joint Committee on Health and Children, which I chair, published a report on end-of-life care. Some of our recommendations related to access to long-stay care facilities. I ask the Minister for Health to consider these proposals in the context of the review of the nursing home support scheme. The current scheme deals with everyone on a chronological basis but it might be appropriate to prioritise some patients based on medical condition. The committee suggested that this should be done for palliative care patients, enabling them to access residential care in a timely manner and thereby facilitate their final medical care in a more appropriate setting.

The committee also suggested that consideration could be given to extending the definition of long-term residential care services and the range of services covered by the scheme.

I have already referred to the matter and it is something that is being examined. In reviewing the current fair deal scheme, an evidence-based cost of care model could also be used.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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Is it agreed that Deputy Kitt will share time with his colleagues? Agreed.

Michael Kitt (Galway East, Fianna Fail)
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I compliment Deputy Billy Kelleher on tabling the motion which he ably moved yesterday evening. There has been much praise for the fair deal scheme. The scheme is not the problem, but rather the waiting list for applicants. Families have told me that due to budget cuts, people are waiting to get into nursing homes. Processing applications is now taking longer. Previously that was a simple procedure. I understand 2,083 people are on the scheme’s national placement list, with a waiting time for funding approval of 15 weeks from the date of determination. One must ask the reason for that, and why in my constituency the elderly aunt of a constituent was approved on 9 July 2014 and funding was made available on 29 October 2014, a total of 16 weeks later. That is the type of delay people face. It is very disappointing to hear of hundreds of people waiting for funding. It is a serious situation when a person goes into a nursing home and must wait for funds to become available as it leads to financial hardship. The Minister heard about cases where people have had to pay up to €13,000. Payments are no longer backdated, as happened under the nursing home subvention scheme.

We must examine how the crisis could be avoided and what we will do to improve the situation. I am aware that funds were diverted from the fair deal scheme to the community care area and home-based packages. I would like to see both areas funded properly. With a diminished budget, we will have problems retaining beds and we must consider what could be done to improve the situation. Only a few people were approved for the fair deal scheme in County Galway last week. Given that a minimum of an additional 7,600 beds are required for long-term residential care between now and the end of 2021, we must ensure careful planning in the area. Based on population projections, there will be a significant national deficit of long-stay beds by 2016 based on a target of 4% of older persons in long-stay care. We also require carers to provide care. Between 2009 and 2012, approximately 340 new nursing beds were available per annum. That compares to annual increases of approximately 1,000 per annum in the preceding years. We will hear about more cases of older people not getting a bed under the fair deal scheme.

Some people would like to be cared for at home but supports are needed for that also. Nursing homes are a more appropriate and affordable setting than an acute hospital. The cost of providing nursing care in a hospital compared to a nursing home is a multiple of between five and eight times the cost. Nursing homes have raised with me and many colleagues the level of funding they get. The matter should be investigated given that different levels of funding for nursing homes is provided even in the same town. The average cost for a resident in a private nursing home is €750 a week compared to a weekly cost in an acute hospital of in excess of €6,000. One can see the difference in the figures. I hope we will not have a situation any longer whereby people cannot access nursing homes and they remain in acute care which will cost the State more money. In County Galway, 85 people were waiting to access the fair deal scheme in September 2014, an increase of 286% on September 2013. I hope the Minister will plan better for the future in this regard.

I note that Dr. Tony O’Connell, the national director of acute services in the HSE, referred to the fact that the HSE was hampered in freeing up beds because patients fit for discharge cannot leave and no nursing home places are available due to cutbacks. He said it costs hospitals approximately €200 a day to care for patients while the cost drops to €100 once they are in a nursing home.

Many people attacked the fair deal scheme when it was introduced in 2006. It was called a death tax on the elderly. A rate of 5% was applied each year for the first three years adding up to 15% of the cost. The Government increased the rate from 5% to 7.5%, which adds up to 22.5% over three years. That shows we have not really thought out how we will fund the fair deal scheme but we should have a clear policy on it in the future.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I welcome the opportunity to contribute to the debate and compliment my colleague on introducing the debate which is timely given the current crisis in the fair deal scheme. Before I speak to the motion, I wish to thank the Minister for Health, Deputy Leo Varadkar, for rowing back on his original decision to cut funding to St. Christopher’s in Longford.

Leo Varadkar (Dublin West, Fine Gael)
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In fairness, it was never my decision.

Robert Troy (Longford-Westmeath, Fianna Fail)
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The Minister is getting the credit for intervening so he might as well take it. I was in Longford last night and a couple of hundred people attended the AGM of St. Christopher’s. Many parents and service users are very relieved at the intervention, which is welcome.

In recent years we have repeatedly heard the mantra from An Taoiseach that he wants Ireland to be the best small country in the world in which to do business. However, we should hear him say that we want to be the best small country in the world in which to be a child. What about being the best small country in the world to grow up in? What about being the best small country in the world in which to raise a family? What about being the best small country in the world in which to grow old? When one looks at many of the policy decisions taken in recent years, it is not the best small country in the world in which to grow old. One need only look at the savage attack on the number of medical cards for senior citizens. Not alone have we removed thousands of medical cards, but we have removed certain items covered by medical cards. We have increased prescription charges. We have abolished the free telephone allowance, something that is leaving older, vulnerable people in a difficult situation, in particular in rural areas because their personal alarm or panic button is reliant on having a land line in the house. Those benefits were abolished by the Government. Cuts were also made to housing aid for the elderly and those with a disability. The budgets have been cut and the eligibility criteria have been modified, which makes it far more difficult for anyone to avail of the grant. There has been a reduction in the electricity allowance and the introduction of property tax for senior citizens. The property tax takes no account of a person’s ability to pay. An older person might live in a valuable house but they have a finite weekly income, which in many cases is only €230 a week. They simply cannot afford the additional stealth taxes and cuts the Government has introduced in recent years.

Not alone is it more difficult for people to live at home, but we are now saying to elderly people that they should not get sick, and if they do, they must be prepared to wait. There is a concerted effort by the Government to leave people languishing on waiting lists. That is morally wrong. Senior citizens, our parents and grandparents, have made this country what it is today. They deserve to be treated with decency and respect. People talk about the fair deal scheme, which was introduced by the previous Government in order to ensure that elderly people could have peace of mind in the event of becoming sick or incapacitated and that they would be looked after in their old age.

The previous Minister decided to divert €23 million from the fair deal budget to community care. I welcome the aim that where possible, older people should be supported in the home.

That community budget needed additional funding. In the Longford-Westmeath area the home help hours were reduced from 331,000 in 2001 to 245,000 in 2013. At a time when the population is getting older this is a savage cut to the number of home help hours provided. It flies in the face of what this Government is saying, that it is taking the money out of the fair deal scheme to provide supports for those living in their own homes. This is not the case.

Why does it always have to be a case of taking funding from one scheme to the detriment of other schemes? Why does every section in the HSE work in a silo? Why is there no consideration given to the effect of a decision in one department on another department?

Acute hospital beds are being blocked because families cannot take people home and elderly people with no families have nowhere to go. Not alone are elderly patients blocking beds, they are not receiving appropriate care. They are susceptible to picking up infections and viruses, they are not being offered activities during the day to stimulate their minds and they are receiving no entertainment. Quite often they are left languishing in acute hospital beds beside people who are terminally ill and dying.

If the Minister does not wish to consider the well-being of patients, surely the economic consequences must be part of his considerations. We are aware the cost of keeping a patient in an acute hospital bed is approximately €200 a day while the cost in a nursing home is €100 a day.

I know of the case of a young man who was in a serious accident. Thankfully, after a number of months in rehabilitation he was ready to be discharged home. However, he was left waiting for a number of months, despite the fact that he was ready to be discharged, because there was not a sufficient budget in the community and disability sector to bring him home. He was left waiting in an inappropriate care setting at a far greater cost to the State because one sector would not talk to the other. That does not add up.

I have plenty more to say but my time has run out.

Niall Collins (Limerick, Fianna Fail)
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One of the distinct advantages of the Irish political system is that the vast majority of public representatives are very much in touch with how people are feeling and the effects of Government and State decisions on their everyday lives. Some people criticise us and refer to clientelism and say we are wasting our time holding clinics. I can attest to the fact that every week when I hold clinics across County Limerick, the three issues most often raised are medical cards, access to fair deal and the accident and emergency crisis in University Hospital Limerick. As a public representative for Limerick I know that the elderly in Limerick are a very worried bunch of people because of the crisis which has developed in the access to fair deal.

In January and February of this year, the waiting time for approval was four weeks; in April and May it had increased to seven and eight weeks; in June to September it rose to 12 to 14 weeks; and in October it peaked at 15 weeks. It is unacceptable that people have to wait so long for approval for their funding. Unfortunately, many of those people, by virtue of their physical condition and infirmity, have no choice but to go to a nursing home. They are then forced to carry the cost of the nursing home bed while awaiting for the allocation of fair deal funding. This is not good enough.

The Minister as well as the people who are participating in this debate live in the real political world. We know that politics is about choices and priorities. The budget was a giveaway to people who earn €80,000, €90,000, €100,000 and in excess of €100,000.

Leo Varadkar (Dublin West, Fine Gael)
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It helped those who earn €32,000 and €40,000, as well.

Niall Collins (Limerick, Fianna Fail)
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The budget gave tax cuts of up to €600 million and yet our elderly people in Limerick, across the mid-west and elsewhere in the country are facing a funding shortage for the fair deal scheme. That is wrong. The people know it is wrong. The Minister for Health needs to take some positive steps to address the situation. It is simply not good enough. The Government's budget gave a tax break to high earners and it is penalising the people who built this country.

I have raised it with the Minister and he will be aware of the crisis in the accident and emergency unit in University Hospital Limerick. When he next visits Limerick I ask him to take the opportunity to go to the University Hospital Limerick to see the absolutely chronic conditions which nurses, doctors, staff and patients must suffer. The physical built environment in which the accident and emergency unit operates is so unfit for purpose that it is bordering on criminal. National and local patient support groups are calling public meetings on the matter. I know the Minister is well informed about the situation and that he is concerned about it. I ask him to take steps to address the situation and to visit Limerick to see it for himself.

I have raised with the Minister the issue of primary care. The HSE must roll out the primary care centres. The HSE primary care model is bureaucratic and it throws too many impediments in the way of general practitioners entering into arrangements with the HSE to provide primary care centres. I acknowledge that those primary care centres already in operation are very successful. However, the property estate management section of the HSE is a bureaucratic nightmare in how it interacts with general practitioners and the bureaucratic hoops which the GPs must negotiate to reach an arrangement with the HSE to establish a primary care centre. These centres are hugely valuable in communities and they will help to alleviate the numbers presenting at accident and emergency units and address the issues associated with the elderly by keeping them living in their homes and so ease the pressures on the health service.

Colm Keaveney (Galway East, Fianna Fail)
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I do not know if there is any truth in the rumour that the Minister somersaults in celebration down the ministerial corridor on a daily basis as he is the main benefactor of the mess of Irish Water. That mess has been delivered by his party and those limping with him in government. What he has successfully managed to do - I know he agrees with me on this point - is to distract the public and the media from the mess that he is covering up in the public health service.

Leo Varadkar (Dublin West, Fine Gael)
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That is a new one in fairness.

Colm Keaveney (Galway East, Fianna Fail)
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I know the Minister was on a different brief, but while the public is consumed with the crisis in Irish Water the Department of Health is failing to address the concerns being highlighted this evening. The Minister will have to up his game and start addressing this. He cannot just cruise into the next general election hoping he will not be held accountable for what is going on in the health service.

Like the Minister I am prone to googling. On Monday I googled "Mr. Leo Varadkar" and "Irish Water". Since the beginning of this month the Minister has made comments on Irish Water on 30 separate occasions. When I googled "Mr. Leo Varadkar" and "the fair deal scheme" it returned four results. The Minister is deliberately stoking up a distraction from the mess. I know it is not to do with having confidence in the Minister for the Environment, Community and Local Government, Deputy Alan Kelly. I am sure he is shaking in his boots tonight. The Minister clearly does not give a damn about the crisis in our nursing home system. He is more concerned about flagging up debate and sticking his nose into a debate and absenting himself from addressing the situation being highlighted.

I see the real distraction, which is the demise of the Minister's political party and the opportunity he has to take out the Taoiseach, Deputy Enda Kenny, as leader. That is what is going on. That is why he is speaking about Irish Water. He certainly does not want to speak about health. He certainly does not want to speak about vulnerable old people who are carrying a burden because of the Minister's inactivity in addressing the spirit of the fair deal scheme.

With regard to Cabinet collective responsibility, the Minister denied the waiting lists published recently, for which he is responsible, exist. He denied they were stoked up and fiddled. He is sitting on a document which has a direction to cover up and "smeargle" waiting lists. He is camouflaging the disaster. That is what is going on. As Deputy Collins stated, we are meeting the consequences of the camouflage system.

I understand the Minister is a GP, which is an area that is suffering greatly. As a Deputy from rural Ireland I ask him to pay immediate attention to the crisis emerging with the exodus of GPs from the country. However, this pales into insignificance relative to the loss of our young nurses who have gone through a qualification system in Ireland at a cost to the Exchequer. Not that the Minister is responsible, because he was not at Cabinet the day they were given the yellow pack deal. This is why Irish nurses will not stay in the system and it is causing a crisis. They are voting with their feet and going to work in England, after the Exchequer has taken the liability and cost of training invaluable front-line staff.

This motion deals with a part of the health service about which the Minister has spoken only four times since the beginning of the month. However he has spoken about Irish Water 30 times. As the Minister is on his iPad he can qualify whether I am correct. It is probably a greater number now because my research was effective until Monday. I would say the Minister has spoken more times on Irish Water in the past 48 hours then he has about the fair deal scheme. That is how much he cares about elderly people. That is what is going on.

Originally the Minister and the Government committed to a review. The Minister is smirking, but I know he is not smirking at me. I know he has disdain for people like me, but I have a mandate to be here to say what I am saying, because I am saying it on behalf of people who are stuck with the liabilities he is ignoring. He can smirk all he wants, I know it comes naturally, but I have a mandate to say what I am saying. There the Minister goes for the water again.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy has two minutes left.

Colm Keaveney (Galway East, Fianna Fail)
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The Minister has an unwillingness to deal with the reality of the situation, unlike his great leader who wants to let Paddy know. The Minister is failing to inform himself on the scale of the situation. I know the Minister is a decent person, and if he has the information we have he must find it very difficult to put his head on the pillow at night. People are being discharged from hospital early and wards are being closed as a consequence of budgetary restrictions. The Minister is precipitating the accelerated discharge of vulnerable and sick people who do not know their rights. They find themselves in a broken care pattern, where their children have emigrated as a consequence of our austerity and the Minister has slashed home helps and broken the carer's arrangement, but he denies the problem.

In July the Department advised the Minister's friend, the previous Minister for Health. On Tuesday I told the Minister he had shifted the blame for this mess to the previous Minister. The Minister was advised about the budgetary shortfall but has done nothing. This is his legacy so far. The Minister for Health's legacy for this month is to have spoken 30 times on Irish Water, but he has done nothing for senior citizens and their domestic circumstances. He can smirk at me and lie behind this ideology, where somebody must pay €1,000 a week because of a deliberate administrative strategy. I have somebody in the Department, who rang me to tell me what is really going on.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you. You have seven seconds.

Colm Keaveney (Galway East, Fianna Fail)
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This is an administrative decision, directly from the Minister, to them to slow it down. It is true. The Minister is the author of this decision. It has his fingerprints.

Leo Varadkar (Dublin West, Fine Gael)
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If it is true, substantiate it. It is an allegation-----

Colm Keaveney (Galway East, Fianna Fail)
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Go to the-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy is over time.

Colm Keaveney (Galway East, Fianna Fail)
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No, the only person over time is that gentleman across there.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Excuse me-----

Colm Keaveney (Galway East, Fianna Fail)
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Pick up the glass of water and go on to Facebook, will you?

Leo Varadkar (Dublin West, Fine Gael)
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It is an allegation the Deputy will not be able to substantiate because it is false, and shame on him for making false allegations in the House where he is under the protection of privilege.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Keaveney should sit down and behave himself.

Colm Keaveney (Galway East, Fianna Fail)
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Tell the Minister to behave himself.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Will you sit down and behave yourself?

Colm Keaveney (Galway East, Fianna Fail)
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I will sit down if you refer back-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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And speak through the Chair in future.

Colm Keaveney (Galway East, Fianna Fail)
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I am speaking through the Chair.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I call Deputy Smith.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I am glad to have an opportunity to make a short contribution on this important motion. Our party spokesperson, Deputy Kelleher, has tabled a very reasonable, fair and important motion. Once again, Deputy Buttimer spoke about us having a motion which does not deal with the real world, but it very much does deal with the real world. If he listened to colleagues from his own party who spoke earlier, they all pointed out the difficulties which arise with the fair deal scheme. All of us who do constituency work have queries every day of the week on the long delays in accessing nursing home care.

Deputy Buttimer also stated no investment was made during the lifetime of the Fianna Fáil Governments, but this is absolutely incorrect. I can speak about my county in particular, where we had major nursing home developments in the early 2000s in Ballyconell and Virginia. Alongside these public nursing homes, primary care centres were also built and provided and they provide an excellent service for these two particular towns and their catchment areas.

Many speakers on all sides of the House stated the desire and aim of all of us is to keep as many people at home for as long as possible. We all want maximum support for home care packages, but there has been terrible pressure because of the reduction in home support hours. Many decisions to approve home support hours make no sense because they mean a half an hour or 45 minutes care for a person who needs far more than this.

An issue to which reference has not been made is having a better whole of Government approach to housing adaptation grants. Far too often applications are with local authorities for a particularly long time, and unfortunately this causes undue stress, distress and annoyance for families and the person who needs the care and attention. If house improvements are to be carried out they should be carried out when the people need these extra comforts and facilities in their home and not after they wait for years for them to be delivered. It causes frustration and annoyance.

The fair deal scheme was introduced a few years ago, and it has proved to be very successful. It needs to be funded adequately. It was introduced because of the ageing demographics in the country. It was innovative and progressive, and based on providing financial support to people who need long-term nursing home care, whether in a private or public facility. It allowed people make a small contribution to their care, with the State taking on the major burden. It is quite ironic that at the time the Fine Gael leader, who is now Taoiseach, spoke about a new death tax.

It showed how out of touch he was regarding that policy. The three-year cap is a very good provision in the scheme.

In my constituency, Cavan-Monaghan, there has been a dramatic increase in the number of people on the fair deal scheme waiting list, which has increased by 300% in one year. In a relatively small area approximately 83 people were on the waiting list in September. The families of those people, who are contacting the public representatives, are very worried. This whole area needs to be addressed. I hope the service plan the HSE will produce shortly will put adequate funding in place for this very important scheme. The last thing elderly people, whose health and lifestyle are deteriorating, and their families need is the constant worry about getting access to a nursing home bed when they need it.

In recent weeks I have come across cases of people in Cavan-Monaghan who had been in Our Lady of Lourdes Hospital in Drogheda and were placed in a step-down facility in County Louth, which is quite a distance from most parts of County Cavan and County Monaghan. That shows the pressure on nursing home places and step-down facilities. It gives rise to pressure on families who do not need extra stress at a time when their loved ones' health is deteriorating.

Leo Varadkar (Dublin West, Fine Gael)
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I am often complimented on my political skills and abilities. I got a very interesting one tonight; I did not think I was capable of organising the entire Irish Water debacle all on my own, just to cover up the problems in health-----

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister had help from the Taoiseach, in fairness.

Leo Varadkar (Dublin West, Fine Gael)
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-----which I am certainly not trying to do. I will ensure the person in my Department who supposedly made the comment is fully protected should Deputy Keaveney wish to substantiate that allegation, which I believe to be entirely false. I am sure he will not substantiate it.

I appreciate the opportunity to address the House on this important issue. I wish to respond to some of what was said in the debate this evening and last night, which may be of interest to Members. Last night, Deputy Sean Fleming drew attention to the need for better links between hospital and community services. I agree with him that effective linkages in this area are essential if we are to get maximum benefit from available resources and provide the most appropriate care to patients. Improving this area is very much on the radar of both the Department and the HSE.

The Deputy also called for dialogue with private service providers who feel that they are being locked out of essential consultations on future plans. I fully subscribe to the principle of dialogue and consultation, and stakeholders already have access to officials in the Department of Health and its Ministers. For example, public consultations preceded the review of the fair deal scheme and took place during the preparation of the dementia strategy. A further meeting for private nursing home providers with my officials was agreed to as recently as this week. Indeed, I addressed their conference last week.

A number of Deputies argued that moving suitable patients currently in acute hospitals to less expensive nursing homes could free up significant funds. This is a nice idea but it is too simplistic and misunderstands how health spending works. It is true that a nursing home bed costs less than an acute bed, but it is invalid to argue that when we move a patient from that acute bed, we can then take that money and give it over to a nursing home or elsewhere because the vacated acute bed will be filled immediately by a new patient - perhaps one of the many on our waiting lists.

People who make the argument that it is cheaper to have patients in a nursing home than in a hospital do not quite understand how it works. Their economics and logic work if, after the patient is discharged to the nursing home, the hospital bed is closed behind him or her. That is something I am not willing to do at a time when patients are on trolleys and so many people are on waiting lists. I want to keep all those beds open for those who need them. So there is no false economy here. The savings that people suppose exist unfortunately do not.

Deputy O'Donovan was concerned that outsourced home-care services cost the HSE far more than is paid to the workers providing the service. These services are procured by the HSE by competitive tender and include an assessment of the tenderer's capacity to provide a quality service. The objective in the future will be to identify providers in each region who can provide home supports on the most economically advantageous basis and the HSE will be responsible for that.

Deputy Ó Caoláin claimed that the review of the fair deal scheme had been completed and is being withheld. This is not the case. The review has not been completed. External consultants have reported on specific aspects of the scheme but this is and always was only an input to the overall review. When the review is completed the input from Deloitte & Touche, the consultants in question, will be published along with it. I expect the review to be completed in the first couple of months of next year.

Deputy Ó Caoláin also expressed concerns that older people formerly enjoyed universal eligibility for public facilities and that this is now removed. That is not the case. In fact, universal eligibility for public facilities remains but it is now augmented by universal eligibility for any private facility that can meet their demands. Patient choice is central to this.

Deputy Mitchell O'Connor asked why it costs more to have somebody in a public nursing home than in a private one. I am not sure why that is. In part it may be down to staffing levels being higher in HSE nursing homes or it may be down to pay scales. However, I suspect the real reason is the dependency ratio. People who are in public nursing homes and HSE nursing homes often have greater and more complex needs. That is often missed by those who suggest that the private sector can do things cheaper. They do not always compare like with like.

The Minister of State, Deputy Kathleen Lynch, and I are very aware of the very long waiting list for the fair deal scheme. We are not satisfied with it. We are working very hard in the context of the service plan to do everything we can to reduce the waiting list in coming weeks.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I call Deputy Calleary, who is sharing time with Deputy Kelleher.

Dara Calleary (Mayo, Fianna Fail)
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I thank Deputy Kelleher for giving us the opportunity to discuss the issue, which Deputy Niall Collins and many others have said is a major bone of contention at clinics across communities.

Since the Minister's arrival in Hawkins House, he has approached the role with some degree of candour and straight talking which contrasts greatly with his predecessor. However, we will get a chance to adjudicate on how effective that has been when we see the service plan next week. At the heart of that service plan must be a real commitment to overall community care and, within that, elder care.

The Minister spoke about his wish to keep open beds particularly in areas where surgery is needed, which we all support given that waiting lists are growing at an exponential rate. However, this was what was happening under the fair deal scheme when it was working well. I pay tribute to the hospital management in County Mayo where they had a very good step-down process for Mayo General Hospital using the three community hospitals in Ballina, Belmullet and Swinford and using the community nursing homes. However, because Mayo General Hospital was so good at doing it, it found that its budget was cut and it was penalised for being able to deliver on target. Unfortunately the system of step-down beds, which is essential particularly in large rural counties such as mine, has deteriorated considerably during the year. Substantial waiting lists are beginning to build in the Saolta university hospital group for things like orthopaedics, ophthalmics and surgery that could be done were beds available.

The change in Mayo is particularly stark. We have gone from 18 people waiting this time last year to 71 today. That represents 71 families across the county who may not have the money and are being forced to leave their families to be in hospital beds they do not want to be in or have to stump up very large sums of money in order to give their loved ones the care they need. That is not fair. When talking about economic recovery and fairness, the fact that 71 families are waiting for the go-ahead to allow their loved one to stay in a nursing home does not represent recovery. That is surely not the kind of recovery anybody in this House would support.

The Minister spoke about community care. Deputy Troy made a point earlier about the HSE's unique ability to work in silos where the H does not talk to the S, the S does not talk to the E, and the E does not talk to anybody. Community care in terms of home help hours seems to operate separately from the fair deal scheme even though they should be absolutely linked.

Home help hours in my county have been cut. In some instances, people get 30 minutes a day. The carer is hardly in the door before it is time to go again. If home help is to be effective, it must be related specifically to the client and not provided on the basis of an idealistic management information system where the person providing the home help is running around like I do not know what trying to get a half hour done here and a half hour there. Home care packages should be tailored to the needs of the patient and not to the budget of the relevant community care department. Unfortunately, at the moment the budget is winning out.

Deputy Smith raised an important point. Housing aid for older people and adaptation grant schemes are operated by local authorities. I pay tribute to Mayo County Council, which uses a good system for housing adaptation in particular. If people need their house adapted to get them out of hospital, this is done quickly because the council manages its budget to ensure money is available. I brought the Minister of State's predecessor, Áine Brady, to the county to see how it works. However, unless there is togetherness in the system, the scheme will not work and we will end up with the appalling delays being experienced under the fair deal scheme.

I listened to the usual choir of Fine Gael backbenchers with their choral notes from the party press office during the debate. It was the usual performance. Three years later, the story has not changed but the singers have worsened and the tune still does not make sense. This happened on their watch. The delays and the moving around of funding, which has resulted in the delays, happened under the former Minister, Deputy Reilly, their deputy party leader. No matter how much crowing and complaining they do, they cannot ignore that reality. The thousands of additional families who are waiting on a decision under the fair deal scheme and who cannot access a bed in a nursing home tonight can only look at one man who made the call and that is the Minister, Deputy Reilly. When the current Minister for Health publishes his service plan, he must make sure the decisions he makes do not have such an impact on people and do not result in a 300% increase in the number of people awaiting care, as is the case in my county.

I refer to the issue of GPs, who are essential to community care. The Minister recently referred to receiving various offers from Canada to work there for large sums. The difficulty in securing and protecting a rural GP service is real. Unless he and the HSE look at the system differently and reintroduce the rural practice allowance as a matter of policy rather than the HSE having to apply for an allowance for every post depending on who applies for it, these posts will not be attractive. The Minister should make this attractive. It is a fantastic challenge for people to work in a rural area but it is also a professional challenge, which requires financial and systems support that is not available currently unless people go looking for it.

The Government has made a number of attacks on older people, including in respect of medical cards, the telephone allowance and the bereavement grant. Every support for older people has been targeted by the Government parties. I do not know what older people did to them but they clearly did something.

Medical cards are also an important element of community care. The Government cannot say there is a recovery when the parent of a child with Down's syndrome is forced to go on the national airwaves to have their medical card application dealt with. That happened last week. I had been dealing with this case through the system. The mother had no more patience and she spoke about her case on the national airwaves. It worked because the local Government Deputy contacted her within minutes of her appearance on the radio and the Minister's office contacted her within hours. Parents of children with Down's syndrome should not have to do that. The Minister should do something for the parents of children with disabilities in his service plan next week.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank all Members who contributed to the motion. We received a great deal of criticism from Government Members for tabling it. They said it was ill-timed, it was not constructive and it did not provide solutions, yet they then spoke to the substantive issue, which is the difficulties people face in accessing fair deal scheme beds.

The waiting lists speak for themselves. A total of 560 people were waiting for four weeks on average last January for approval under the scheme whereas now more than 2,100 are waiting on average for 15 weeks. This issue is very much to the fore of people's minds. It affects significant cohorts of the population, especially those who are vulnerable. When I asked the Taoiseach on the Order of Business earlier for a debate on the HSE service plan that will be published next week, I described the programme for Government as a book of fiction. The more I read it, the more I think the programme is fraudulent. Under the heading, "Fairness", the Government parties state in the context of care of older people and community care:

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.

Additional funding will be provided each year for the care of older people. This funding will go to more residential places, more home care packages and the delivery of more home help and other professional community care services. The Fair Deal system of financing nursing home care will be reviewed with a view to developing a secure and equitable system of financing for community and long-term care which supports older people to stay in their own homes.

9 o’clock

Four years ago in 2010, the Taoiseach shouted to the 30,000 people protesting on Molesworth Street about the then Government's removal of the universal right to a medical card for the over 70s, "Shame on them; shame on them; shame on them", referring in that regard to the Government of the day. He was passionate. The then leader of the Labour Party, Deputy Gilmore, was equally passionate. I almost believed them myself.

Kathleen Lynch (Cork North Central, Labour)
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The Deputy was always easily led.

Billy Kelleher (Cork North Central, Fianna Fail)
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I now know, however, because of what is happening here in the context of the funding the Government is putting in place for the provision of care for older people, that they were only weasel words. Not only has the Government reduced the level of funding for the nursing home support scheme, it has reduced the threshold for a medical card in respect of a couple from €1,400 to €900. This is having a huge impact on people. People are contacting our offices daily about the fact that they now have to pay €144 per month for drugs.

Eric Byrne (Dublin South Central, Labour)
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Did the Deputy remind them why that is the case?

Billy Kelleher (Cork North Central, Fianna Fail)
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They are living on €900 gross a week. The policies being pursued by this Government, which Deputy Eric Byrne supports regularly, are undermining the fabric of society.

Eric Byrne (Dublin South Central, Labour)
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I am very happy to do so in order that we can rescue this country.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Deputy certainly is.

Eric Byrne (Dublin South Central, Labour)
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Fianna Fáil left this country in ruins.

Billy Kelleher (Cork North Central, Fianna Fail)
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Everybody in this House will agree that a nation is judged on the basis of how it supports children and older people. In this context, the Government has been mean-spirited. It has insulted in a gratuitous manner older people who have given lifelong service to this country and who in their hour of need want the support of this State in the context of their being able to access a nursing home bed. This Government has also told them that they must wait 15 weeks when most in need and that they will be billed in the meantime while their applications are being processed. That is wrong.

We are asking that in the context of the HSE service plan due to be published next week the Government would provide adequate funding in 2015 for the fair deal scheme. We will provide Government with every support in ensuring that money is extracted from the Minister for Public Expenditure and Reform, Deputy Howlin, and the Minister for Finance, Deputy Noonan, thus ensuring older people can access their entitlement with dignity and in a speedy fashion.

I commend the motion to the House.