Frances Fitzgerald (Fine Gael)

Senator Rónán Mullen and Senator Nicky McFadden have put the case extremely well. There is a real danger of minimalist standards, combined with the lack of an independent review. There is a striking lack throughout the Bill of provision for independence or independent reviews, or involvement by people other than the HSE. This can be linked to an earlier amendment I put down which was supported by my colleagues. That amendment provided for a report to the Houses about the amount of money. When the Minister responded to that proposal, she said that what I had said about mental health was not correct. It was correct; I have checked it. There was a special allocation for the implementation of A Vision for Change, but that money was hived off. What the Minister said was incorrect. The money was put aside for mental health but it was hived off and not spent in the area for which it was allocated but on general health. That is the reason for having the specifics built in and the Minister reporting back to the House. It happened previously and it could happen in this area as well. That is also the reason there must be provision for independence in the Bill, whether it is with regard to care assessments or other reviews, the nursing homes, disputes about fees or other issues. There must be provision for independent review but it is not included to the necessary degree in the Bill.

The other issue is the care assessment. It is assumed that we are discussing quite high dependency persons. High dependency generally means there is a range of needs that must be assessed. It is unlikely that one discipline would be able to do that. The Minister should name a social worker and a psychiatrist in the list of the potential people who should make assessments. In addition, she should go into more detail about the guidelines she intends to publish. Perhaps she will clarify whether this area of assessment will be addressed in the guidelines, how the multi-disciplinary assessment will be carried out and by whom. What is the standard of assessment?

Previously, when I worked as a social worker, I was involved in assessments and they can vary. Senator Callely said assessments often need to take place over time, and that is true. It is likely that a number of disciplines would be required and that there would be certain minimum standards. It would be necessary to examine the physical, psychological and mental health and the social care provisions. In most cases all these issues would have to be addressed so a proper final care assessment can be carried out. That should be spelt out. The specificity which Senator Mullen discussed is the key point because without it one is potentially dealing with low standards and lack of proper assessments. My other point relates to long-term residential care services. What exactly are we talking about here? This is not spelt out in the Bill and many people are concerned about it, including many providers of such care and people who work with the elderly. If a person is obliged to give up 15% of his or her home, to be taken from the family, exactly what will he or she get for it? What level of care and what services will people receive? Will physiotherapy and occupational therapy be included? What minimum and maximum standards are guaranteed in the legislation given what is proposed, namely, the financial intrusion and demands made and the precedence to be set in the taking of money from estates? This may well be necessary but what will people get for their 15%? Is this information outlined anywhere? Will the Minister of State address this matter?

Might there be a situation in which nursing home residents would not have the same entitlements to specialised equipment, therapies and access to allied health professionals they currently enjoy in the community? We know that community services are lacking for the elderly at present but I acknowledge there have been great improvements, for example, in access to occupational therapy. Occupational therapists call to elderly people in their homes, make assessments and provide the aids and equipment necessary and this has led to a qualitative improvement in people's lives in the community. However, is there a possibility that people might end up in nursing homes without such access, having had 80% of whatever money they might have, such as pensions, taken? They might not have access to money to be able to afford to get basic services they badly need. What will nursing homes do if they find themselves in this situation, without any clarity?

I intend to discuss section 11 of the Bill and I hope my colleagues will do so also, especially the lawyers in the House. I am intrigued by this section which states there is no obligation to provide for or arrange for the provision of any such services. I find that an extraordinary paragraph. Perhaps it is pro forma but it brings up the issue of an obligation to provide services. Where is that laid down? What is the obligation and what is the standard of such services, considering the 15% of money and estate that is to be taken?

I ask the Minister of State to return to this matter. Is one entitled only to one's health care, food and bed, or are other services such as physiotherapy, chiropody and occupational therapy included? How can we find out about this? How can we know what is included? Where is it specified in the legislation? Will it be included in any guidelines the Minister of State will publish? If not, there will be a very big gap with very serious financial consequences for individuals, nursing homes and the State. This is an issue we must discuss in the House and there must be clarity on it from the Minister of State, either now or on Report Stage.