Ulick Burke (Fine Gael)

I thank the Cathaoirleach for selecting this item for discussion. What is happening in the Health Service Executive, HSE, western region in regard to providing for the needs of the elderly is nothing short of a scandal and it greatly discriminates against the elderly in the west. The failure of the HSE to rectify the position must be seen as a failure in the organising and carrying out of its functions. The Minister should intervene and address it. The Government's failure to recognise the needs of elderly people cannot be allowed to continue.

Some 20% of the total population who are aged 65 years and older live in the west. County Galway has the highest percentage of people in that age bracket of all of the HSE western counties, which represents a substantial proportion of the total population. The area of greatest concern is the inequity between the HSE western area, County Galway in particular, and the HSE eastern area covering Dublin. In County Galway the maximum rate of subvention for a private nursing home is €190 per week, whereas a person with less or, in some cases, more means can receive a subvention of €600 in the eastern region. Why does that level of discrepancy exist? We cannot find the answer to that and we do not know who will be responsible for it.

The O'Shea report clearly outlines three reasons for the difference, including the different treatment of assets between the HSE regions. In other words, in the western region, an assessment of the assets of a person — each and every penny he or she has — is taken into account, as against the position in the eastern region where there is wide variation in the interpretation of assets. That difference accounts for one reason in the variation in the level of subvention. Another reason is the different rules governing who is entitled to what are termed "contract beds". There is also the difference in eligibility for enhanced payments and the application of those.

We are told that the responsibility for private nursing home subventions at senior management level varies from health board to health board and from programme managers to regional managers to co-ordinators of services for elderly people. While such a variation in level of subvention exists, there will be no consistency and hence elderly people in the west and the HSE western area are falling out.

The differences in assessment of needs and the way in which they are interpreted has caused a problem. Added to this, the assessment of social factors also varies. According to the O'Shea report, assessments tend to include a social variable which takes account of the social, democratic, spatial, housing and family need circumstances of the older person. There is a strong subjective element in the consideration of social factors in placement of decision-making, which further exacerbates the position. The position with regard to the dependency assessment for the purposes of awarding subvention is therefore unsatisfactory. That is stated on page 54 of the O'Shea report. It clearly states that such assessment is unsatisfactory.

The variation of assessment in application of rules has led to both horizontal and vertical inequities in the treatment of older people applying for subvention both within and among the health boards. People with the same level of dependency are not being treated in the same way and there is a wide variation among the health boards in the proportion of applications being awarded subventions in the dependency categories which are placed. This leads to an unacceptable variation throughout the country.

In County Galway some 804 people are on the standard rate of dependency and 340 of those are on the enhanced rate. There is a wide gulf in regard to the rates at which they get that enhancement compared with the percentage in Dublin. Such variation is unsustainable. I ask the Minister of State to request the Minister for Health and Children to rectify this position immediately. It is not a case of Galway versus Dublin; it is a question of the provision for the needs of people in the west where there is a high percentage of people who are in the dependency category, the number of whom are increasing rapidly. This matters requires urgent attention, and the sooner the better.