Rónán Mullen (Independent)

Like Senator Norris, I admire the Minister of State's demeanour while regretting her lack of flexibility. The word, "flexibility" is key. The Minister of State herself spoke of the need for flexibility. The word can be a euphemism when we think how the wheels of authority grind. The need for flexibility can permit an unhelpful vagueness about what is to be provided. We should focus not so much on flexibility as on accountability and excellence. That is the reason we are proposing a high degree of specificity about what is required when an assessment is being made.

I remind the Government that its record is not good in this regard. Should we depend on everything being fine because the language is sufficiently broad to include everything that might be required? Recall that although people have a constitutional right to State-funded nursing home care, less 80% of the non-contributory pension, the authorities have not wanted people to know about that. Health care professionals who advised people who were thinking of opting for the relatively high cost subvention scheme of nursing home care for loved ones of their right to State-funded nursing home care were regarded as going offside. When they said that if they were told the constitutional position is otherwise, they would advise people accordingly - I spelt this out on Second Stage - the HSE officials more or less said: "You know the score". This is the State's record. Recall, too, that in recent days we have been discussing the Ryan report and the failure of the apparatus of the State to treat people properly. It is happening in this area too, in a different way. People have not been encouraged to pursue their rights.

I would go further. Earlier, my amendment proposing the inclusion of the therapeutic needs of the person was ruled out of order. Under the guise of generosity and giving people peace of mind, what has really happened here is that the State has not wanted people to know their rights. Then it holds out the so-called fair deal as a type of manna from heaven. There is something wrong with that. There is also something wrong with the fact that in a system where the State proposes to take money from people in the form of a proportion of the value of their property after their death, which is unprecedented, the people who would avail of such provisions are not guaranteed, at least, all necessary therapeutic care. We are aware of the diversity of needs of people in long-stay residential care. What should be on offer from the State, which presumes to take some of their property after their death, is at least everything they might be able to get if they were on the top plan of the VHI. That would be cherishing all the children of the nation equally, including our older citizens.

Therapeutic care in nursing homes is important and should be front and centre of what the State proposes to provide. Consider a person who has a swallowing disorder or a condition that might require some form of speech therapy. Is that provided for or guaranteed under this legislation? I do not think so. However, it arose in the Leas Cross report, and calls for such care provision were included in the Irish national audit of stroke care. That was accepted. It is interesting to note that Appendix A in the HIQA nursing home regulations for standards in residential care refers to the need for a minimum data set for needs in nursing homes. I am talking about an all-encompassing assessment of the needs of people who go into long-term residential care, with their full range of needs being assessed and set down. It would be much more than the rather vague assessment in which merely one person might be involved, as proposed by the legislation for the care assessment.

Something more thorough is required and this is aspired to by HIQA in the appendix. Not only would this help to ensure that the various needs of the person going into long-stay residential care would be addressed but it would also ensure thorough data for assessing how our nursing homes are performing, data which could be compared with international experience. However, I do not believe that is forthcoming and I regret that very much. At least we should be considering a national computerised system that gives instant feedback on each person's needs as well as our ability to assess the quality of the response at any time.

That is the reason for our concern. When the Minister talks about flexibility, what she is really endorsing is an unhelpful vagueness that will, on occasions, not prevent the correct assessment from taking place but very likely on other occasions will provide cover for an inadequate response to the care needs of the individual.