Frances Fitzgerald (Fine Gael)

She has certainly had a baptism of fire in her portfolio, given the difficult situation that arose recently concerning the medical card decision. We had a good debate on the matter in the House earlier. I hope the Minister of State will have an opportunity to familiarise herself with it because some very interesting concepts were aired during that discussion. It is the first debate I have heard in this House on the policy behind the decision, as regards how we can approach universality or selectivity. That question, which is at the core of our attitude to services, will increasingly come into focus. It certainly came into sharp focus when we had the debate on medical card eligibility.

I have a number of questions on the fair deal legislation. First, when will that legislation be introduced in the Oireachtas? Many Members are keen to know the timeframe for its implementation. Second, there is concern that the amount of funding allocated is lower than anticipated some months ago due to the budgetary situation. Perhaps the Minister of State can outline to the House the implications of that lower budget and how she sees it working out. Third, has the Attorney General given a view on whether there are any constitutional issues concerning the family home, taking money and the approach that underpins the legislation? I would be interested to know if any questions arose concerning the constitutionality of the proposed legislation.

We in Fine Gael have several questions and concerns about the legislation, including the implications a decision to fund long-term care might have for a family, the family home and for farmers. These questions need to be teased out. There will need to be a good information campaign on the legislative provisions in order that people will understand the choices they make. People can often make hasty decisions on long-term care due to a medical emergency, for example. They will therefore need to be familiar with the legislation because of the major impact it will have on families. I welcome its publication, however, and when it comes before the House we will examine it in detail.

Whether people are in nursing homes or other residential care settings, it is critical that they are assured of high standards and a good quality of life. We have had appalling scandals in this regard. While there are many excellent nursing homes and residential care centres, no more than in the area of child care, we must ensure that high standards are maintained. Last week, there was a report in The Irish Examiner on the inspection regime for child care facilities. It was interesting to read that report which reflected the kind of concerns that can arise. Even though families are placing their children in day-care settings, there is still some appalling bad practice in such centres. It is one thing to have standards but it is another to implement and monitor them. The question of the implementation and monitoring of standards and of ensuring inspectors' reports are acted upon is critical. This is evident in the area of child care and I expect the very same issues will arise in the implementation of standards in nursing homes.

There have been scandals, mishaps, oversights and errors, some of which have been life-threatening. We were all horrified when we saw the programme on Leas Cross and when the hidden camera recorded the way in which elderly people were dealt with. It has to be every family's nightmare to organise residential care and then to find out, accidentally or otherwise, that a loved one has not been receiving care but rather has been subjected to what amounts to cruelty or elder abuse. This is a huge issue and it is a great worry for families with loved ones of any age in residential care, but especially in the case of the elderly. If the decision is made for an elderly person to go into residential care, the State must be able to assure the family that it is concerned about the standards, that these will be monitored and that the family can have confidence in the care.

I welcome the changes to the health legislation which ensure all residential settings for both elderly and younger people will come under the scope of the standards. This is a really welcome development. I also welcome the wide consultation in which the Minister and the Minister of State engaged and the working group assembled to collate these standards. There is cross-party political agreement that we need to have a set of standards put in place to which all nursing homes must adhere to ensure the safety and dignity of patients and to provide a system which affords all older people in need of care the most competent and compassionate care available.

The Minister of State has provided some clarity with regard to the draft standards but I ask her to reiterate when the agreed standards will be published following the consultation. I ask the Minister of State to explain how the standards will be implemented. Some will be set out by way of primary legislation but how will the non-regulatory standards be enforced and implemented?

All nursing homes need to be registered by law. I refer to the draft standards and ask for clarity. They state that if the nursing home setting is not in compliance with the regulations, it may fail to achieve registration status or it may lose the registration status. However, it is likely in some situations that the residential care setting will be given a conditional registration for a defined period of time during which it will be expected to come into compliance with the regulations. I ask the Minister of State to clarify what this means. Will nursing homes still be able to register if they do not meet these standards? Who decides whether a service provider is refused registration status? The word, "may" is not clear and is open to interpretation. I am assuming the standards will be mandatory. I ask the Minister of State to clarify. If an operating service provider is found to be in breach of the regulation, will it be required by law to shut down the service until the regulatory standard has been met or will it be allowed stay open even if in contravention of standards? I ask the Minister of State for her initial understanding, even if some of this detail is not yet decided.

I am concerned that we could end up with a two-tier set of standards if there is ambiguity about the implementation of the standards. The nursing homes will be concerned and this is understandable given that the same issue about a transition period between adoption of standards and their implementation arose with regard to child care facilities. The question arises as to the cost of implementing these standards. Will the nursing homes be given help with the implementation of the standards? In the case of child care facilities, capital grants were often used by providers to make improvements to services. Different nursing homes will have different demands in terms of the amount of work or adaptation which they will require to meet the new standards. There may well be a discrepancy between public and private nursing homes. Is it intended to introduce grant schemes to enable nursing homes to pay for quality and standards upgrades? I refer in particular to public nursing homes. A number of them will need to change to a considerable degree to meet the standards which the Health Information and Quality Authority has outlined.

I welcome the concept of standards, as does everyone. It is clear these are overdue. We want to see the publication and implementation of the completed agreed standards as a matter of urgency. I would be grateful if the Minister of State would clarify the points I have raised. Lessons must be learned from the Leas Cross debacle and something similar must never happen again. I look forward to prompt action from the Minister of State.