Derek McDowell (Labour)

I was going to leave some reflections on the bigger issues until last but as Senator Maurice Hayes and others have introduced them, I will commence with them. I do not accept the general proposition that we should ask people to pay for care in the circumstances which currently operates. The current system is a typically Irish mess with several different tiers where people are asked to pay for long-term nursing home care. On the one hand, there are those, specifically covered by the Bill, in public homes and beds who are asked to pay a significant proportion, 80%, of their old age contributory pension towards the costs while on the other hand, there are those who can afford to pay for any measure of care, whether it is nursing home or medical care. Many people are somewhere in between, in long-term care subvented by taxpayers' money. The result does not provide an even level of care for everybody that the system should aspire to do. It is a mess because there are so many people who fall through the system who cannot get access on a reasonable basis.

The public system in many parts of the country is little short of a joke. In north Dublin, it is extremely difficult if one is looking to access a public bed in these circumstances as the waiting list is years long. I have had the experience of desperate relatives looking to me to help them jump the queue. It is heart-rending when little or nothing can be done for them. These people are often at the end of their tether with nowhere to turn. There are not enough public beds. Many people are forced to consider private nursing homes. However, even with the benefit of subvention, they cannot afford it. I do not buy into the notion of charging by user charges paid when dealing with long-term care. A better way of doing this needs to be examined.

The Department of Social and Family Affairs has started such an examination. Last year, it produced an interesting and stimulating policy document which canvassed an additional 1% payment on PRSI to provide for such care. This deserves serious consideration. I believe we should look at the idea of private insurance, as people prefer that to social insurance. A system could be introduced where everyone would be obliged to either contribute to a social or private insurance system to ensure they are pre-funding any care which they may require in the future. It is society's responsibility to ensure that our old people are dealt with properly. The ad hoc system of means-tested user charges does not operate that well.

I have never been a fan of the long-term pension fund. It is somewhat strange to be dealing with the needs of pensioners in 20 or 25 years time when we all accept that today's pensioners are not well looked after in pension or care provision. When people who have contributed much in their taxes are old and require care some means must be found to ensure they receive a benefit from the fund. This is better than saying to today's pensioners that when they are dead in 20 years' time, their offspring will get a decent pension. I do not accept the notion that we can predict with any certainty the demographic profile of the State in 20 years. It has dramatically changed in the last 20 years from a relatively high birth rate to a low one and which is now going back up. The dependency ratio is changing, thankfully for the better, by virtue of the number of immigrants and people contributing towards the labour force, which no one predicted ten years ago. A solid case can be made for accessing available funds to measurably improve the provision of long-term care. We all accept this and the Tánaiste has claimed it is one of her priorities.

I commend the Tánaiste for acting decisively in introducing the Bill. This is an issue that has been ticking away in the cupboard for several years, ready to explode. The Minister of State at the Department of Health and Children, Deputy Brian Lenihan, said it was important when mistakes are made they are recognised, responsibility taken and the lessons learned and applied. I am not sure we are doing this as responsibility is not being allocated. In the note prepared by the Secretary General of the Department, it is clear that no one is taking responsibility. In effect, the note claims that the Department was terribly busy during this time with the health strategy, the EU Presidency and everything else and it slipped through the system. This may very well be the explanation. People may have been overworked and may have taken their eyes off the ball with the result that the problem persisted. If so, it is not good enough as it does not point the finger of responsibility in a way we are entitled to insist should happen.

The Ombudsman was aware of this problem for five years and pointed it out. We know what happened in the South Eastern Health Board and that it has been in the Department for 21 months. We know a decision was taken on 16 December to do something about. Something was initiated but not pursued. We do not know why it was not followed through. Claiming that everyone was too busy is not good enough.

The meeting of 16 December 2003 is important. The then Minister for Health and Children, Deputy Martin, claims he arrived late to it. While we can accept this, the minutes would have been provided to him later. The Secretary General of the Department and the Minister's officials must have been aware that the substantial body of legal advice should have been brought to his attention. It is remarkable that no one took the trouble to sit down with the Minister for five minutes to explain the existence of this long-standing problem and how it must be dealt with eventually. If the then Minister, Deputy Martin, was not available to deal with it, then surely the then Minister of State at the Department of Health and Children with responsibility for services for older people, Deputy Callely, should have been asked. Deputy Callely is not known for his reticence. I would be interested to hear his explanation. Like most of his constituents during that period, I received much literature from Deputy Callely detailing his good work on behalf of older people. I am sure he would like to take the opportunity to explain his views——