Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank the Ceann Comhairle for selecting this topic.

I seek a commitment from the Minister for Health to facilitate a right of access to the nursing home of their choice for older people in need of long-term residential care whose home address is on this side of the Border but whose nearest or preferred nursing home is situated north of the Border. Prior to the introduction of the fair deal scheme older people in need of residential care could take up unhindered residence in nursing home facilities in the Six Counties. This is an important issue for people in my constituency of Cavan-Monaghan, particularly for those from communities that do not just run along the Border strip but straddle it, just as they have straddled the inter-county lines over many generations.

Before the fair deal, subvention travelled with the older person. With the advent of the fair deal a partition descended once again in our midst, turning lifelong friends and neighbours away from each other and forcing older people, whose residence is located south of the Border, to look to often more distant locations from their home for residential care in their own county or in neighbouring counties. This is discriminatory and grossly unfair. It also ignores the important role these facilities north of the Border have had and could play again in helping to meet the ever growing demand of our ageing population.

There are excellent nursing homes in County Monaghan, both public and private, but we do not have sufficient capacity. However, the core issue is the right of choice and access, if preferred, to a nursing home that is closest to one's own home, family, extended family, friends and neighbours. This is not an unreasonable request. We must revisit the terms of the nursing homes support scheme, the fair deal, to provide for older people in the circumstances I have described, respecting their and their families' choice and wishes. Whatever the outcome of the referendum today in Britain and in the North, in this jurisdiction we should be lifting borders, not imposing them.

I appeal to the Minister to respect the rights and wishes of communities, families and older people in Border areas. They do not see their location as peripheral. They see only the hills, roads and the features of their area that go way beyond an artificial Border which has always failed to drive them apart from family, friends and neighbours in childhood, adolescence and adulthood. It should not drive them apart in their later and dependent years. I ask the Minister to do the right thing and not to offer excuses for inaction. People want and deserve voices in politics that are solution driven. Is the Minister, Deputy Harris, such a voice?

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy for raising this issue. I do not offer excuses as a cover for inaction but I am duty bound to point out the factual and policy considerations relating to this issue that must be discussed. Like the Deputy, I hope there are not more borders in place tomorrow on the island of Ireland and that the outcome of the referendum on Britain's place in the European Union does not pose additional difficulties. There have been many good developments in the cross-Border development of our health service in recent years and I am eager to continue that.

I am taking this debate on behalf of my colleague, the Minister of State with responsibility for older people, Deputy Helen McEntee, who is unavailable. Government policy is to support older people to remain in their own homes and communities for as long as possible. There will, however, always be a cohort of older people who require a quality long-term residential care option. The nursing homes support scheme, or fair deal as it is commonly known, is a system of financial support for those assessed as needing long-term nursing home care, regardless of their age. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The 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.

The applicant is free to choose any public, voluntary or approved private nursing home in the State. Of course, the home must have availability and be able to cater for the applicant's particular needs. The scheme has a net budget in 2016 of €940 million. This represents an increase of €43.1 million on the 2015 outturn. It is expected that the scheme will provide financial support to 23,450 clients on average per week in 2016.

The scheme has a statutory basis and is governed by the Nursing Homes Support Scheme Act 2009. It replaced the nursing home subvention scheme which had been in existence since 1993, and the system of contract beds and long-stay charges in public nursing homes. To be eligible to apply for the scheme, an applicant must be ordinarily resident in the State. This means that they are living in the State for at least a year or intend to live in the State for at least a year. The nursing homes support scheme does not extend to homes in Northern Ireland and it would not be possible to include facilities outside of this jurisdiction in key elements of the scheme. For example, prices payable under the scheme are negotiated by the National Treatment Purchase Fund. Such facilities are also subject to regulation by the Health Information and Quality Authority, HIQA, which has no jurisdiction within Northern Ireland. This issue was given careful consideration before the scheme was introduced in 2009. The decision not to extend the scheme to Northern Ireland was taken by the Government of the day on the basis of legal advice received from the Office of the Attorney General.

While my response is somewhat negative, the rationale for it is based on the legal advice of the Attorney General to the Government of 2009. One of the issues is how one can ensure qualities and standards when HIQA does not have jurisdiction in Northern Ireland. There are also the other points I outlined. That said, I have had an excellent conversation with my counterpart in Northern Ireland, the Deputy's party colleague and new Minister for Health, Social Services and Public Safety, Michelle O'Neill. We had a constructive conversation last Monday about areas of cross-Border co-operation. There is a great deal being done for children with heart conditions and there are plans to do more regarding organ donation. I would welcome the opportunity to discuss a range of issues with the Minister, Ms O'Neill, and I look forward to meeting her in Dublin on 4 July. I will be happy to discuss this matter with her, but I must sound serious caution in terms of the difficulties that currently exist.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I knew the Attorney General would be cited in the Minister's reply. Indeed, it was the single line response I received to a recent parliamentary question I tabled on this issue.

It is most unsatisfactory. I live very close to the Border but there are people who live even closer who naturally gravitate towards the little community hall, nursing home facility, church and all the other facilities that make up an identifiable unique community. They want to be able to stay with their friends and relatives - people with whom they have spent a lifetime engaging with in all the different facets of life - yet they are being forced to part because they cannot afford to pay the entire cost of their care, the fair deal being an essential element for access.

We need a "can-do" situation regarding this matter. This anomaly or discriminatory situation has only arisen in the past seven odd years and I believe it is essential that it is made a priority for the engagement referred to by the Minister. I welcome the planned engagement with the Minister of Health in Northern Ireland, Michelle O'Neill, MLA, who is a very experienced Minister who was formerly Minister for Agriculture and Rural Development in the last administration in the Northern Ireland Assembly. Leaving aside political differences and the jibing that can take place in this Chamber, I am appealing to the Minister because I could name these people. They are people I am thinking about as I stand before the Minister making this appeal. It is in their interests and those of the families that they are allowed to remain where they want to be in their final years for whatever time they are granted and that their loved ones and those who would visit them have reasonable access. This is part of the essential care and provision for people placed in long-stay residential facilities.

I will not use a battleaxe approach with the Minister over this. I urge him to recognise the reality of the constituents about whom I am thinking. The Minister may not be able to identify with them personally because it is not the area he represents but I ask him for the empathy that will open the door to resolve this vexed matter.

Simon Harris (Wicklow, Fine Gael)
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I am the Minister for Health for people in all parts of this country so I am very sympathetic to the point the Deputy is making on behalf of his constituents. However, I wanted to highlight the challenges and difficulties we face in this regard. These are not new challenges or difficulties and they do not come as any great surprise to Deputy Ó Caoláin as an experienced Deputy in this House because they were highlighted, considered and debated in this House in 2009. Seven years later, he is still highlighting and debating them with me this evening. These issues were considered in great detail by the Government of the day and the Attorney General in 2009 and I am sure they were subjected to a significant debate in this House with different views on different sides.

The issues are not straightforward and simple. If they were, this anomaly, as the Deputy calls it, would never arisen in the first place. I will engage with the Minister for Health in Northern Ireland, Michelle O'Neill, MLA, on this issue as one of a number of issues, some of which have been identified by her and others by me, that we would like to discuss as part of how we can support each other's health systems and support citizens on the island of Ireland in terms of ensuring that they can get the best outcome from the health service. When I meet the Minister in Dublin in July, I will certainly raise this issue with her, as, I am sure, Deputy Ó Caoláin will as a colleague.

I am more than happy for discussions to take place but I am duty bound to highlight the challenges in terms of the national treatment purchase fund and changes that have occurred in recent years such as the development of HIQA, which was not an issue in previous years, and the fact that we must ensure proper quality and safety for patients. HIQA does not have jurisdiction in Northern Ireland. I know this would be a concern for the Deputy who has been a great advocate of patient safety in this House. We need to get this right. I will undertake to engage with the Minister on the issue and to keep in contact with the Deputy. I am not unsympathetic to the point he makes but I do not have a ready-made solution for it this evening. However, I will certainly engage with my counterpart in Northern Ireland and keep in touch with the Deputy.