Seán Power (Kildare South, Fianna Fail)

The decision of the Supreme Court on 16 February 2005 in the matter of Article 26 of the Constitution and the Health (Amendment) (No. 2) Bill 2004 has brought clarity to the matter of the provisions of the Bill. The Supreme Court found the retrospective provision of the Bill in making lawful the imposition and payment of such charges in the past unconstitutional in so far as this concerns the property rights of citizens. The Supreme Court did not find the approach to the proposed charges in the Bill to be repugnant to the Constitution so the prospective provisions to allow such charging in the future were not found to be repugnant to the Constitution.

The debate in this House has, in general, been constructive and fair, with contributions from Members on all sides. A number of Senators asked why the practice of charging continued for so long. In setting up the Travers inquiry, the Tánaiste has tried to establish the answer to that question. In seeking apologies Senator Burke was jumping the gun in this regard. In fairness, we should await the findings of the report rather than jump to conclusions before it is published. It is due to be published in the near future when we will debate the matter in more detail.

The Department of Health and Children is studying the Supreme Court judgment in detail and will take on board all the consequences for policy and law arising from the judgment. It is very important that charges for long-stay care are placed on a sound legal basis, which is what we are endeavouring to do. The decision of the Supreme Court allows for the introduction of a new Bill to provide the legal basis for charges for inpatient services in long-stay institutions. The Government yesterday approved the Bill that provides for the imposition of such charges in respect of all persons irrespective of their eligibility status for health services. The intention is that the Bill will be presented to Dáil Éireann with a view to its passage through the Oireachtas as soon as possible.

It is the position currently that charges are not being imposed. Following receipt of further advice from the Office of the Attorney General, the Department of Health and Children instructed the health boards to cease imposing any financial charges on fully eligible people in receipt of in-patient services in public long-stay institutions with effect from 9 December 2004. By way of a goodwill gesture the Government agreed to have an ex gratia payment of up to €2,000 made to those with full eligibility who have paid charges and who were alive on 9 December 2004. The Health Service Executive is making the necessary arrangements in regard to this scheme and so far payments in excess of €15.7 million have been made to approximately 8,500 individuals.

It is intended to introduce a repayment scheme which will replace the ex gratia schemes. A special Cabinet sub-committee comprising the Taoiseach, the Tánaiste, the Minister for Finance and the Attorney General has been established to consider the issue of repayment in light of the judgment. The sub-committee is meeting today to consider all the options for an efficient and effective repayment scheme, including the Statute of Limitations, without the need for litigation. This matter will be considered at full Cabinet again next week. It is estimated that at least €500 million will be repaid. Any payments made under the ex gratia scheme will be taken into account in calculating any further moneys to be repaid.

The Government is determined to ensure that the repayment scheme which will be put in place is fair and reasonable to all concerned. The speed of action in setting up the Cabinet sub-committee coupled with the immediate Cabinet follow-through demonstrates the seriousness and concern with which this issue is viewed. It is the Government's intention to devise a scheme which is fair and one which will ensure that the people entitled to a repayment will be paid as quickly as possible. We will put in place a scheme that will ensure that those who are entitled to compensation will not require legal assistance to collect that payment.

It is important to note that what is at issue is the legal basis for the imposition of charges for those receiving inpatient services in public, long stay institutions. The principle of imposing charges is not at issue. As has been noted by previous Governments over the past 30 years, it is fair and reasonable that those in receipt of publicly provided residential long-term care should make some payment towards accommodation and daily living costs if they can afford to do so, just as they would if they were living in the community. This principle was most recently underlined in the health strategy, Quality and Fairness — A Health System for You. It supports the aim to provide as high quality a service as possible, to make the most equitable use of resources and to help maximise the availability of services.

It is recognised that quality care is expensive and that the bulk of the cost of providing a high standard of quality care should be borne by the Exchequer. It is estimated that the charges imposed on those in public nursing homes represents approximately 10% of the overall cost of care. It therefore represents a modest contribution towards the total cost of treatment and maintenance. Having listened to the contributions to this debate, that view appears to be shared by the House.

I appreciate this opportunity to speak to Senators on this matter and I thank them for their contributions.