Martin Mansergh (Fianna Fail)

I welcome the Minister of State to the House. I also welcome the measures for the elderly in yesterday's budget, namely, the social welfare increases, the income tax exemptions and the home packages for the elderly. I have seen many instances where caring for the elderly, the very sick or the disabled at home can work very well but we cannot feel as proud of our care of the elderly as we would often like to feel. We have had the Leas Cross Nursing Home scandal and there is probably an uneasy feeling that it may not be an entirely isolated instance. We have had the case of the illegal deductions from welfare payment, which has now been straightened out, but it was embarrassing for the entire political system. Undoubtedly, we need a legislative framework and that is being offered to us.

The core of the legislation is in two parts. The first is the assessment of the degree of dependency of applicants for health care, which seems to be reasonable. What I find more problematic, and it is not only confined to this area, is the exhaustive means testing of people who are old and sick. It is not a very dignified activity for people carrying it out or for those who must undergo it. The cases one encounters most often are people of relatively modest means but who are, nonetheless, above a certain threshold where after a year or two of care — sometimes people are in care for some time — the means become rapidly depleted and family members find themselves having to scramble around to provide funds to fill the gap.

There are major problems of public policy that affect every country. I was struck by what the British Health Secretary, Ms Patricia Hewitt, said when she claimed that increasing life expectancy and medical advances would lead to new pressures which would need to be reconciled with the public's expectations about taxation. She stated that in a frank manner that does not always happen here. It is often said that politics is the art of the possible, but I have come to the view that politics is the art of the impossible. It involves reconciling conflicting demands. We have heard from the other side of the House about universal nursing home care, and a good prima facie case can be made for that. At the same time, Ministers and former Ministers have suggested that we raise taxation in order to cope with the demands and reforms that are needed in the health service. My general impression is that those arguments do not go down very well with the public, especially when the Government is running a significant surplus.

I would like to put forward a third solution that is not based on either universal provision or means testing down to the last good and chattel. We do not know which of us will reach what Gore Vidal called the hospital stage of our life. Which of us will go into nursing homes and which of us will drop dead one fine day or after an illness of short duration? Even with increased life expectancy, the vast majority of us will probably not go into a nursing home at any stage of our life. If we become infirm, we may be cared for at home or go into a home for short periods. Given that we are talking about a small minority who go into nursing homes, it might be possible to have a specialised health insurance scheme. The risk would be borne by all of us, as distinct from the current situation whereby due to a turn of fate, some individuals and families are hit infinitely harder than others. If one were to encourage such an insurance scheme, it would avoid the costs of a universal system that need a rise in taxation, while at the same time it would not push families to the pin of their collar.

It is very often the people in difficulty who are subjected to means testing. I do not see such testing as part of a very humane society. While I support the Bill, I hope that we continue to look at alternative, more humane, methods to deal with this. Very few of us will be in a nursing home for four or five years. It might happen to the odd individual, but it will happen to very few. Surely it is something against which we can insure.