Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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5. To ask the Minister for Health if he will provide details of the review of the funding of the fair deal scheme; if there are plans to charge older persons more for their care under the scheme; the percentage of assets and income planned to be taken; if a further proportion of the funding will come from the public purse; and if he will make a statement on the matter. [8165/15]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The recent remarks by the Minister of State, Deputy Kathleen Lynch, regarding the future funding of the fair deal scheme have caused considerable concern and, for some, fear. Will she confirm today that there will be no increase in the forfeit contribution requirement and the 7.5% per annum up to a three-year ceiling State take of the property value of the service recipient following his or her demise?

Kathleen Lynch (Cork North Central, Labour)
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The nursing homes support scheme is a key component of our health service and a recurring theme of our discussion this morning. While older people prefer to remain at home if possible, there will always be a need for long-term nursing home care. The scheme's introduction in 2009 relieved families of potentially very onerous expense and ensured equity of treatment based upon means, regardless of the type of nursing home care provided. It involves a very significant financial commitment on the part of the State, with €948.8 million allocated to the scheme in 2015. This represents an increase of €10 million on the 2014 figures.

When the nursing homes support scheme commenced, a commitment was made that it would be reviewed after three years. This review is being carried out by my Department in collaboration with the Health Service Executive, with analysis and recommendations provided by Deloitte Consultants on specific issues which required specialised expertise. The review is considering the long-term sustainability of the scheme, including funding arrangements. No decisions have been taken and no plans put in place regarding changes to the way the scheme currently operates.

Between now and 2024 the population over 65 years is projected to increase by some 200,000. Based upon current trends, those requiring long-term care will increase by a third over the same period. On that projection, spending on the scheme at current prices would approach €1.3 billion per annum from its current level of just under €950 million.

The review of the nursing homes support scheme, as well as considering how the scheme has operated to date, is expected to identify some of the broader issues that will need to be considered and tested more fully into the future, including the future financing of the full range of supports for older people, how community and residential supports and services should be balanced, and whether new care approaches can contribute positively. A continuum of more efficient care might serve to reduce the number of people requiring nursing home care and limit the projected increase in the cost of the scheme.

There is much reference these days to the challenges that demographic trends represent. That we are facing these challenges should be welcomed, as it means we are achieving longer lives for more of our people. It is these older people and their families who will be the central priority in planning services and supports for the future.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister of State's response is not a reply to the question I posed. In the course of her attendance at a recent meeting of the Joint Committee on Health and Children, she stated: "The idea that a person with means would pay in the range of €250 to €290 per week for a service that is costing anything up to €1,200 to provide is unsustainable." In a subsequent interview she stated that struggling families will not face extra costs or lose supports. In the confusion around all of this and the absence of certainty - there is no detail in the Minister of State's reply today - it is understandable that people are experiencing considerable concern and some fear as to what lies ahead.

It is incumbent on the Minister of State and her colleague, the Minister, to clarify the situation for those already in long-term residential care and the many who are currently seeking to access long-term residential care because they are no longer able to provide for themselves independently and do not have the necessary familial supports in order to live independently. When will the review conclude? When will it report? When will we have the certainty? Can the Minister of State say anything to the cohort of people whom I have referred to that will allay the real fears that I have described?

Kathleen Lynch (Cork North Central, Labour)
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Everyone agrees that the current scheme is unsustainable. We do not have enough money. Delayed discharges are a major difficulty for the entire health service. However, this is not just a question of the fair deal scheme. As I have been saying for a considerable time, it is also a question of the community-based services that each and every one of us would prefer were we to need them. We would be able to stay in our own communities and homes. Mr. Tony O'Brien reiterated at the meeting what I had been saying for the past 12 months, that being, the fair deal scheme must become demand led. It is as simple as that. The scheme is perfectly constructed to be demand led. It has a tight access point and stringent eligibility criteria.

We will need more money. It is estimated that, were we to make the scheme demand led, it would cost approximately €1.3 billion, which is exactly what we pay in disability services every year.

We cannot pretend that this is not an issue. We have reduced the waiting time to 11 weeks, but even that time is still impacting on families. We must continue the work. For the past 12 months, I have worked with the Minister for Health on ensuring that we put in place a scheme that benefits those of us who might need it in future and that people do not delay too long in accessing the service. Unless families are extraordinarily well off, they cannot pay the type of money that is necessary to keep their loved ones in continuing care.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There can be no question but that our senior citizens not only require, but are deserving of our collective societal support in every and any way that we can provide it. The Minister of State made reference to Mr. O'Brien's contribution at the last Oireachtas health committee meeting. He also indicated in his reply that day that we were looking at the 11 weeks rolling out to up to 20 weeks by the end of this year. This is a very worrying situation.

It was also indicated that the Government would discuss the review in Cabinet at the beginning of next month. That is what I noted. That is March, which is only around the corner; March is this weekend. I asked the Minister of State in my supplementary question how quickly we expected this review to be presented and the clarity that we need issuing from it.

Kathleen Lynch (Cork North Central, Labour)
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I am sorry.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In conclusion, it has to be responsive to the needs of people. It cannot operate on a capped basis, telling people to wait until January or September. That is not on and has to change.

We also need to take on board the requirement of increased numbers in terms of beds availability. Increasing the capacity of existing long-stay residential provision is required. Responding to the Health Information and Quality Authority, HIQA, reports in the way that we have without actually building in additional capacity is a real failing and poor use of public moneys in times of design teams and contractors.

Kathleen Lynch (Cork North Central, Labour)
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I apologise for not answering the question on the review. As we speak, the review is on the desk of the Secretary General of the Department of Health. I have not seen it. I have heard snippets of what is in it, but that is about it, and it would be unfair to comment further at this stage.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister of State could share the snippets.

Kathleen Lynch (Cork North Central, Labour)
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I will not. I have not seen them, so I am not certain that they are correct. I will get the review shortly and it will go to the Cabinet. I am not certain that it will give us or recommend what is necessary. Rather, I believe it is an examination of how the scheme has operated and whether we need to change it. I do not believe that it will recommend, for instance, that the way of accessing should be different, but I am not certain. As soon as the process is complete, I intend to publish the review.

I agree with the Deputy in terms of beds capacity and availability. However, if we get the balance right between community services and beds, the need for the latter will not be as great as we imagine.