Brendan Ryan (Labour)

Whatever criticisms I might have about the Bill and the mess which preceded it, I sincerely commend the Tánaiste on at least facing the fact and dealing with it. Along the way, we had the less than savoury attempt to hijack people's money through the previous legislation which was struck down by the Supreme Court. Many of us believed at the time that it was unconstitutional and a less than generous response to what was essentially the misappropriation of people's funds, and we welcomed the decision of the Supreme Court to defend what it saw as the property rights of elderly and vulnerable people.

Lest there be any misunderstanding, I declare a form of interest in that my mother is a patient of long standing in a public hospital for the elderly. She is the possessor of a medical card and is therefore a potential, if the House will excuse the expression, beneficiary of this Bill. I wish to make sure, therefore, that anything I say is not interpreted in any way as being connected to that.

I previously put on the record my personal view, which is that I see nothing objectionable in asking old people who receive the quality of care that my mother and hundreds of others received in St. Vincent's Hospital in Athy, to make a significant contribution towards the cost of their care if they have some income. That seems reasonable, rational and fair. I have no problem with the principle of the issue. It seems extraordinary that there are some people who have a problem with it, particularly one well-known and noisy late-night radio commentator who seems to believe the idea of asking people to pay was a betrayal of some socialist principle he had discovered but which I never found. I have no problem with the principle. I might quibble with the level of funds left to people, particularly those on the basic level of old age pension, for whom the remaining sum is quite small. While we could have been more generous, that is an issue of detail not principle, and it is not for this Bill.

In most of the schools of public administration, not just in this State or on this island but perhaps in the English speaking world, this saga will become one of the classic case studies. This country is — I say this despite all the qualms, quibbles and arguments we have — governed well in terms of the incorruptibility of public administration, has an extremely effective and functioning democracy, and has a vigorous and assertively independent courts system. How, given all of that, could a debacle of this magnitude have evolved through a succession of Governments?

The only arguments I have with the present Government in this regard are, first, the extraordinary behaviour of the previous Minister for Health and Children, a matter to which I will return, and, second, the delay in producing the legislation. However, these issues are not central to the point. I question the scale of the debacle and the fact that a major Department, run in those days by a Minister and the health boards, which had well remunerated chief executives, could have been essentially ignorant of the fact that they were extracting vast sums of money illegally from elderly people, and that nobody noticed for a long time, which I believe.

I sincerely hope that, since this debacle emerged, the Department of Health and Children and all of the agencies for which it is responsible have taken steps to ensure their charging practices and other legislative functions or activities are grounded in sound legislation. It is the least we can expect from them. It would be nice to hear from the Minister that some systematic adjustment has been made in the Department to ensure such things cannot happen again, and that somebody is encouraged to play devil's advocate and to question in each case whether policy is within the law. That seems a reasonable request.

That said, I am intrigued as to how we could have had a health strategy which referred to the need for clarity on the question of the entitlements of the elderly while, in the discussions prior to the production of the strategy, the question of how much it would cost to provide proper services for the elderly apparently never arose, or if it did, the question of whether one was entitled to charge them more was never discussed. That is what I must believe. The Minister who was in office at the time assured us that in all the discussions which fed into the health strategy of 2000, the question of the charging of the elderly for services, if it was discussed, was discussed in such a way that the question of whether we were entitled to charge them never arose.

We then had the universal extension of medical cards to all those over 70 years of age, a decision with which I agree, in spite of some noises from within my own party, apart from anywhere else. It was a sensible decision because the proportion of people over 70 who are outside the means test is so small as to make the process of means testing counterproductive in terms of any kind of cost-benefit analysis. Anyone who listens to older people would know that women in their 70s — we are referring overwhelmingly to women in this case — were mostly dependants. They were, therefore, having to manage money in a way they had never had to do previously when their husbands were alive. To add the fear and concern of having to pay for medical bills left people in their later years with an additional and major worry just as their health began to fade a little.

It was, therefore, a perfectly reasonable policy. However, the fact that it was a good idea does not mean I approve of the bad way it was implemented. Again, I am intrigued as to whether any questions were asked about how much it cost. If no fundamental questions are asked about how much things cost, how in God's name does the Government do its business? If the question of how much things cost arises, the question then arises of where revenue comes from and that should make one look at the legislative and legal basis for charging people. Again, one must express scepticism and wonder that it was not discussed.

Then there was the Ombudsman's report on charging the children of elderly people for care. This report went to the Department but even it, which was not directly connected with this issue, did not raise any concerns about the legal basis for charging people. The upshot of all this is that this debacle will become a case study to be examined, parsed and analysed by students of public administration throughout the English speaking world and, perhaps, beyond. There cannot have been many greater debacles in an open and free society where one can readily get information.

I am intrigued by the determination to have an external agency administer and organise the repayment scheme. The HSE said it would require the diversion of staff and some of its dedicated budget. However, how will the agency or body that has been identified but cannot yet be named be paid? Will some of the money that was due to be allocated to elderly people be used to pay it? If not, will it be paid for with a separate budget? If there is a separate budget, why not give that budget to the HSE to do this job?

I can only think of one explanation, the Tánaiste's determined belief that the private sector will always do a better job than the public sector. That belief has driven her for most of her political career. It is regrettable that it is inserted in this Bill. Someday we should have a debate with the Tánaiste about the fact that, despite her ideological determination to foist a privatised health service on us, the most privatised health service in the world is also the most expensive and, in terms of both life expectancy and infant mortality, perhaps the poorest at delivery. I refer to the United States health service.

I have no hang-ups about who should do this job but I am sceptical about the concept of a non-nationally based agency having some type of mysterious expertise which means it can deal with this issue in a more efficient way than a dedicated group seconded from the HSE. I smell the whiff of ideology running through this. There is a significant, peculiar belief in this country that there are people called experts and that if we could only find them, they would do these jobs far better than the people who are already doing them.

We deal with this by importing consultants and also in the extraordinary system whereby senior executives of local authorities often must get permission from somebody called "the Minister", who in most cases turns out to be a junior official working from the same manual used by the well paid and well qualified local official. However, the Minister is the power and there is a belief that the Minister can do it better. What is needed, in fact, is transparency and accountability at local level and a clearing away of the fog that generally surrounds many local functions, whether they are carried out by the HSE or the local authorities. The excuse one is usually given with regard to any project being carried out by these bodies is that the estimated cost cannot be revealed because the information is commercially sensitive. Later, when it turns out that they got it all wrong, we are told it is because certain things were not adverted to.

I have long given up on the idea that if a hospital is to be built, we should not have some idea in advance of the official cost estimate and it should not be published near tender stage because it is commercially sensitive. I believe that is a smokescreen to dilute any level of accountability. It is time we ended it. Instead of going through the rigmarole of two or three levels of approval, we should make the system more transparent and open and, therefore, probably more accountable. In time, it will be more efficient as a body of learning is accumulated at local level, whether it be local authority or health service.

I wish to comment on the donation of prescribed repayments. There is a valid ethical issue involved in that concept. I am not unhappy that people who have some money should pay for the services being provided to them. The logic of that is that neither the individuals nor their children should benefit from these repayments in terms of their personal affluence. However, the concept of giving money to even a ring-fenced fund to be administered by a HSE that has just awarded its chief executive a €32,000 bonus for running one of the worst health services in Europe is not appealing. Whatever few euro come to my dear mother as a consequence of this and if I and my brothers decide it is to be used for some purpose, we will use it locally and in a way whereby we can ensure it will not add to the already enormous salary of the CEO of the Health Service Executive but to provide a service in the hospital where my mother is receiving care of a quality that would not be available in any privately run institution.