Phil Prendergast (Labour)

I welcome the Minister of State, Deputy Áine Brady, to the House. As the Labour Party spokesperson on issues affecting older people, I particularly welcome the measures in the legislation for the provision of simple electronic forms of charging, order and discharge application. However, I do so guardedly given the Health Service Executive's track record in regard to technology. Given the current state of transitional uncertainty as the executive restructures and reconfigures, I have serious concerns about any aspect of change. The great ongoing transition in the delivery of services makes me fearful for the vulnerable in our society, including older people.

The Minister of State claims these provisions will ensure a speedy, standardised and extremely cost effective approach to the processing of charging orders. She said in the Dáil last month that these new provisions would ensure families are not unduly delayed in selling or transferring property. I hope this does not mean the process can commence without the family's consent. Some clarity in this regard would be welcome because the issue of property value is sure to be problematic. Wills are often written on the basis of distributing assets according to their financial value. With house prices in such a precarious and unpredictable state, the contribution to the Health Service Executive based on the value of the home may become a cause of dispute for beneficiaries of the will. That must be clarified.

I particularly welcome the decision to accede to the request of my colleague, Deputy Jan O'Sullivan, that the applicant's family be informed of the details of all available facilities and be allowed to choose a particular nursing home. Geography is a relevant factor and it is important that, where possible, people receive the care they require locally. I am aware of instances in south Tipperary where people have had no option but to take a nursing home bed in south Kilkenny. There is nothing wrong with Kilkenny - it is where I am from - but this creates problems for people in view of the lack of public transport. This is a matter of basic rights and dignity as well as a practical concern. Not everybody's needs are the same and facilities must be tailored to individual requirements.

The Government has gone some way to addressing the concerns of the Labour Party in respect of the fair deal scheme, but there remain matters of significant and legitimate concern. For instance, the Government has a long track record of implementing schemes which are so poorly funded that few can avail of them. That must not be allowed to happen in this case. The Minister of State was asked about this last month and her answer was not acceptable, offering no assurance about the ongoing funding of the scheme. There is a danger that as demand increases, access will decrease. When the Bill was published, the Minister, Deputy Harney, said:

I am very pleased to publish this draft legislation. For the first time it will make the arrangements for financial support for people who need long-term care comprehensive, clear and coherent. It is totally fair. It is clear, sustainable and affordable.

I understand funds have been set aside for the scheme this year, but this signifies little given that it is not due to come into operation until the last quarter. The scheme will be little more than another fig leaf for the Government if we cannot obtain an absolute commitment on funding into the future. There is a concern that funding may become unavailable or may be sidelined into some other programme that is considered more urgent. Particular sections of the population will always consider their needs greater than those of anybody else.

There are various examples of where funding has been cut for particular services. I have just come from the launch of a report by the Sub-Committee on the High Level of Suicide in Irish Society which reviewed the Government's mental health strategy, A Vision for Change, and other issues. Funding for mental health services has been reduced by 12.5% this year at a time when the suicide rate has never been higher, causing horrendous grief to many people. We have all been touched by the issue. As a midwife for many years, I am gravely concerned that €10 million could not be found for the cervical cancer vaccine programme. It is likely that the cost of the scheme may have reduced since the announcement not to proceed with it. This issue must be reviewed. I am aware this does not come under the remit of the Minister of State. However, as a woman, she will appreciate what I have been hearing on the doorsteps. I retain a deep sense of disquiet that so many young women are being caused worry and distress in the absence of a vital preventative service. I have strayed from the point somewhat but this is an issue about which I feel very strongly. It will have to be brought back on to the agenda. It is gravely flawed to have reneged on a commitment which brought hope to so many people. That was not the correct course.

I reiterate the importance of commitments in regard to funding into the future. There cannot be a situation where a person who qualifies for the scheme cannot avail of it as a result of inadequate funding. This could place an intolerable strain on older people and their families. The intention behind the Bill is to provide assurance and certainty to families and to the many people who, on the basis of the scheme, will plan years in advance. It is entirely unacceptable, therefore, that this matter has not been firmly nailed down.

The Minister of State's reply in the Dáil was far too cagey and evasive, particularly in respect of a matter of this importance. What she said suggests that the Labour Party's concerns in this regard are well founded. In that context, my party has already proposed a simple solution. Will the Minister of State clarify the position with regard to her comments, "On the care needs, we do not accept that the benchmark for dependency will be moved upwards, particularly because it will be subject to a multidisciplinary panel of professionals and their codes of ethics"? What will be the benchmark for dependency? The Minister of State also indicated in the Dáil that:

This will equalise access for both public and private patients because, as must be acknowledged, the majority of provision in nursing homes is in the private sector. By law, the care needs assessment, which is holistic in nature, must take family, social and community circumstances into account.

I am concerned in this regard and perhaps the Minister of State will clarify the position.

During her contribution to this debate, the Minister of State indicated:

That agreement reaffirms Government policy to support older people to live with dignity and independence in their homes and communities and to support access to quality residential care when needed. [I am in complete agreement in this regard] It also contained the following principles to guide the development of future policy on long-term care for older people. All relevant public services should be designed [Again, I agree with this] and delivered in an integrated manner ... Care needs assessments should be available on a timely, consistent, equitable and regionally balanced basis.

I am interested in the fact that it will be regionally balanced. On what basis has the Minister of State decided what constitutes something being regionally balanced? I take particular cognisance of the fact that acute services will be cited in one particular area in Cork. The Teamwork report, which was published yesterday, has given cause for a great deal of concern in this regard.

I was actively involved in nursing up to two years ago and there was always the concept of a "golden hour" whereby people with acute myocardial infarctions or serious disorders or diseases had to receive treatment within the first hour of being admitted to hospital. Surveys were carried out at the hospital in which I worked in respect of how quickly people received treatment and the long-term outcomes that resulted. I accept that the position varies from individual to individual but the research heavily supports the fact that people who received immediate treatment did far better than those who did not. Some of the latter actually passed away. What does the Minister of State mean by a regionally balanced basis?

The Minister of State also indicated that: "The use of community and home-based care should be maximised and should support the important role of the family and informal care." There is not enough time for me to discuss the entire matter of carers in the home and those who provide a home care service. These people are responsible for providing millions of hours of care each year. They are under-resourced and underfunded but they provide the most excellent service to people in their own homes. Providing such care represents the optimum and it is what we all want. I have met those in the Carers Association who provide a service to their own families and loved ones and who also provide such a service to others on a community basis. I am aware the country is in a bad position financially. However, let us consider the case of a person who is content and well enough to live at home and whose confidence is strengthened by the fact that he or she will be visited by a carer for two or three hours per day. Where his or her care is cut to two, three or four hours per week, his or her confidence will be sapped.

Last week I was lucky enough to visit the Marian Court in Clonmel, a sheltered housing facility for the elderly. I met some wonderful people there who have a great sense of fun and youth. Marian Court is a fabulous facility and the services on offer there cost €100 per week. People can obtain a four-course hot meal during the day and have access to beautiful gardens. The facility is situated adjacent to the local church, which means that the needs of everyone living there are likely to be met. This is a fantastic care-taking facility where assistance is available to local elderly people. I cannot praise Marian Court highly enough.

The dignity of older people must be maintained and they should not be obliged to worry. Unfortunately, however, they are concerned in light of the sensational reports that appear in the media every day regarding the recession. I met some people at Marian Court who are in their 70s and 80s and who read the newspaper on the Internet each day. I admire them because it was recently enough that I began to do so. These people are worried as a result of what they are reading. Financial concerns can give rise to high blood pressure and create a lack of confidence, which in turn can cause many problems.

My area of expertise in nursing was midwifery and I found that a woman who was confident when commencing the process of childbirth had a much shorter and easier labour than someone who was frightened and who did not have someone to attend to her needs. I am of the view that I have a depth of personal experience which allows me to speak on this subject.

I thank the Minister of State for coming to the House. I hope she will be able to address some of the concerns I have expressed.