Brendan Ryan (Dublin North, Labour)
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I thank the Minister of State for coming into the House to take this debate.

The fair deal scheme was introduced on the basis of the core principle that long-term care should be affordable and that a person should receive the same level of support, whether he or she chooses a public, voluntary or private nursing home. The scheme was envisaged as enabling people in need of long-term nursing care and their families to access such care in a timely and cost-effective manner. It should be acknowledged that the fair deal scheme benefits a significant number of older people and is a considerable improvement on the level of support available under the previous subvention scheme.

We need to see an increase in the funding for the fair deal scheme which I understand stands at approximately €963 million. There is a cost argument as we are spending too much money in keeping qualified persons in hospital beds. However, there is also a compassion argument which is more important and compelling. It is costing taxpayers more than €500,000 a day, or €4 million a week, to keep qualifying persons in hospital beds, waiting for funding for a fair deal scheme nursing home bed. There are 2,135 people waiting just over 15 weeks for approval under the scheme. While that number fluctuates, the overall statistics point to a fourfold increase in waiting list numbers since January 2014, when some 500 people were on the list for an average period of just four weeks. It is no coincidence, therefore, that the increased waiting time in processing fair deal scheme applications is a contributory factor in the overcrowding crisis in accident and emergency departments in recent times.

It is a very emotional time for a family when they have to move a loved one into a nursing home; it is never an easy time. However, the current position is compounding the problem as the funding caps under the scheme are impacting on the processing time for applications and the waiting time for a suitable permanent placement. In summary, the funding cap placed on the fair deal scheme is adding to the crisis in accident and emergency departments, which is having a knock-on effect for patients, families and the overall cost of running the health service. It is my considered view that the fair deal scheme needs to be demand-led.

Emmet Stagg (Kildare North, Labour)
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I also thank the Minister of State for coming into the House to deal with this issue. Her dedication to the task of providing world class services for the elderly is not in doubt.

How we treat the elderly is a fair mark of our society. They were the creators of the society and systems we now enjoy. They worked hard, often for low pay, paid their taxes and are now entitled to the best care that can be provided, if possible in their own homes and, where that is not possible, in available care facilities of high standard. It is not acceptable that the elderly are left in acute hospital beds when what they need is nursing home care. It is not acceptable that they are left in their homes where they can no longer be adequately cared for.

The fair deal scheme is just that - a good deal for those who need nursing home care. This excellent scheme was intended to be - I emphasise this point - demand-led where the service would be provided when required. The current practice, inherited by the Minister of State, whereby the scheme is capped financially, leads to inevitable delays in the service being provided and real hardship for the elderly persons left waiting. I am asking that the resources needed to provide a demand-led service be provided by the Government and that the waiting for essential care for long periods be ended. Senior citizens deserve no less.

Kathleen Lynch (Cork North Central, Labour)
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I thank Deputies Brendan Ryan and Emmet Stagg for raising this issue which is very pertinent at this time, given that we are in prolonged discussions with various Departments and desperately trying to do what they are asking for. As they rightly pointed out, the nursing homes support scheme provides financial support for those who require long-term nursing home care, with residents contributing a portion of the cost in accordance with their means, which is essential. It is a scheme which relieves families of potentially very onerous expense and even protects the greater part of the value of a participant's main residence. However, it is also expensive. The amount allocated to the scheme in 2015 is €948.8 million. Again, demographic trends mean that the scheme is under pressure because of the increasing numbers of older people in the population. The number of the population over 65 years is growing by approximately 20,000 each year and the population over 80 years which has the greatest need in terms of utilisation of health services is growing by some 4% per annum.

The scheme is demand-led but, as Deputy emmet Stagg rightly pointed out, resource-capped. In the Nursing Homes Support Scheme Act 2009 a provision was included in order to ring-fence the funding for the scheme and ensure it was used for the provision of financial support under the scheme. To manage the available funds through the year, the HSE operates a national placement list in order of when applications are approved, which is very important, and funding is released in strict chronological order as it becomes available. As of 16 January, there are 1,313 people on the placement list, with an average waiting time of 11 weeks, down in some cases from 17 and 18 weeks. The budget for the scheme in 2015 is €948.8 million, an increase of €10 million on the figure for 2014. Some €10 million allocated to the scheme related to the delayed discharges initiative.

I will forward this reply in full to both Deputies, but I believe we need to talk about some other issues concerning the fair deal scheme. For example, the review of the scheme which I expect to receive in the next few weeks will tell us that it is unsustainable in its current financial make-up, given the demands on it. What it should tell us and what I would like it to tell us is that people will be able to access the fair deal scheme in the community, rather than having to avail of long-stay nursing home care, if that is their preference.

It is about preference and choice. I would hate to think that because I had reached a certain age and despite the fact I was capable of making these choices myself, my choices would be limited. We also need to look seriously at the issue of capacity. Even if we could provide a fair deal scheme place for everybody in hospital who needed one, there are certain areas of the country where we do not have the capacity to move patients from hospitals.

I am a great believer in identifying difficulties and finding solutions. If the fair deal scheme was resource and demand-led, it would provide comfort for both the public and private sectors and deliver more of the beds we so desperately need. The fair deal scheme must be a combination of the two options. It must be about choices in the community and ensuring that if people are offered a bed, it is in an the area close to where they live and those who might wish to visit them. For example, if the patient is in Naas or Kildare, the bed offered should not be in some place that is inaccessible to him or her such as in Waterford. We need a full and wider debate on this issue. We understand the difficulties, but we need to come up with perhaps different solutions.

Brendan Ryan (Dublin North, Labour)
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I thank the Minister of State for her comprehensive response which demonstrates the control she has of this brief. I agree fully that making the fair deal scheme demand-led would provide an incentive to provide a further supply of long-term beds to meet the additional capacity required. We know that there is the demand, but like the housing market, part of the problem is supply. The budgetary cap acts as a disincentive for investors in the private sector and adopting a demand-led approach would be of benefit and help to achieve a better supply. We have a scheme that is fair, but it can work better. We need more investment in it and a greater supply of beds, be they in the public, private or voluntary sector. We are in economic recovery, but this recovery should be felt by all, particularly those who are most vulnerable. The people who qualify for the fair deal scheme are predominantly elderly. I agree fully with the Minister of State on the importance of choice. There should not be just one solution for those in need of care. Where people need security and comfort that cannot be provided by family members, they will certainly not be found in hospital wards.

I thank the Minister of State for her sterling work in this area, but I must ask: why has the scheme been designed in such a way that it is not demand-led? She has responded to this question and obviously the cost of the scheme in recent times has been a significant factor. If we are entering recovery, this area is one in which we should see the benefits of that recovery.

Emmet Stagg (Kildare North, Labour)
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I thank the Minister of State for coming to the House to deal with this issue. The medical card system which is far more expensive than the fair deal scheme is entirely demand-led. If a person qualifies for a medical service, he or she receives that service, with no waiting time for access. Nobody says in November that all of the money is gone and that a service cannot be provided. The system should be similar to that for the fair deal scheme. If people qualify, the service should be provided when needed. I believe the Minister of State agrees with us on that point.

Has any calculation been made of the extra funding that would be required, over and above the current figure of €900 million, to fill the gap in order that the scheme would be demand-led and a service provided as required? Will the Minister of State also ensure the HIQA beds in the public sector are upgraded to the point where they would no longer be under threat? I understand there is a period of grace in which this could be done and that she is in the process of doing this. It is important that these beds are retained in the system in order that there will be no shortage of resources.

Kathleen Lynch (Cork North Central, Labour)
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I could not agree more with the Deputies. I have made it clear that we cannot afford to lose any bed, private or public, for older people. In regard to the fair deal scheme, we also need to look at the issue of funding and the notion that if one lives in Dublin, X amount is paid per bed, while the rate is different if one lives in Wicklow or Galway. No account is taken of the needs of the person concerned. We need to look at this issue because the needs of some people are greater than those of others and they need more care and attention. We need to look seriously at the range of needs involved.

On the issue of cost, I am told that if we were to make the scheme resource and demand-led, it would cost an additional €30 million a year. In some years the cost would be higher and in others lower. However, if we do not do this in a planned way and a way we can see what we will be doing six months down the road, the cost will be twice that figure or more. It is about planning and ensuring we know exactly where we will find capacity and how we will meet demand as it arises.