Frances Fitzgerald (Fine Gael)

I move amendment No. 2:

In page 9, between lines 12 and 13, to insert the following:

" "multidisciplinary team" means medical staff, nursing team, discharge coordinator, community services discharge liaison officer, dietician, physiotherapist, occupational therapist, speech and language therapist, pharmacist, social workers, public health liaison nurse, chaplain/spiritual advisor.".

This amendment deals with multidisciplinary teams. What the Minister of State has just said about what is included in care is very significant. She appears to be saying only bed and board is included in the 15% that will be taken from people and that other services are not included. This debate will probably continue as we go on. The Minister of State said a person with a medical card is entitled to whatever services, but although we are taking 15% from other people, they are not entitled to services such as occupational therapy, chiropody or any other services elderly people might need. The Minister of State could return to that as her statement was very significant.

On Second Stage I asked the Minister of State to outline what "care" meant and what people were entitled to by virtue of giving up 15% of their homes, and she appears to be saying they are not entitled to any of the other services. It is linked to this amendment, which proposes the Minister of State name what a multidisciplinary team is. Age Action has done much work on multidisciplinary teams. As I said on Second Stage, the people we are talking about are generally high-dependency. The assessment should not be strictly physical. It needs to examine issues such as mental health and mental capacity. It should also examine the elderly person's social and economic situation so a proper, holistic assessment can be made.

The Minister of State said "multidisciplinary" is not defined in the Bill. It is fraught with some difficulty on who should be included but it is worth trying to come up with a definition and we have suggested one in the amendment. We are not suggesting every person who is assessed needs to be seen by the entire multidisciplinary team, because they do not. The way the legislation is written allows that it would be the discipline appropriate to the case but that it would always be a geriatrician because that is built into the legislation. It is worthwhile building in a definition of a multidisciplinary team and ensuring people are assessed by the range of professionals that will make for the best assessment possible and the best outline of their care needs.

I am disappointed that even when the care needs assessment is done there is no guarantee the nursing home or care centre will receive it. It is still very flexible on whether they receive it. I respect issues of personal confidentiality but most residents would want their care needs assessment passed on so they would get the best possible care. Perhaps the Minister of State could address that in best practice regulations. We have discussed that before.

Where it is necessary, a multidisciplinary team assessment reduces the likelihood of mistakes and reduces subjectivity. We have had a long discussion in the House on the fact that what is proposed in this legislation is lacking independence. The Minister of State has not accepted, and made it clear she would not accept, any of the amendments to introduce some level of independence in making the care needs assessment or the financial assessment. The Minister of State has some minor amendment that addresses some of that in one area, namely, mental capacity.

Building into the legislation a definition of a multidisciplinary team would be helpful. By doing this and including it instead of "suitable person", the Minister of State would maintain flexibility and right of access to the team by allowing the HSE, a geriatrician, the older person and their specified person a chance to outline in the care needs assessment application the professional assessment they may feel is necessary. If one accepts this amendment, it means one can include a social worker where necessary but by keeping section 7(5)(a) the Minister of State is keeping the principle of flexibility. One would get only the team members one needs. One does not need to have all members assessing each person.

Introducing a further section down the line allowing an appeal is keeping within the principle of guaranteeing older people access to a multidisciplinary team. I would be interested to hear the Minister of State's response to this. It is helpful to name the potential members of a multidisciplinary team who might be called on. It ensures it is not a closed assessment by one geriatrician. It means the assessment is more likely to be comprehensive and in the person's best interest because all his or her needs are being assessed, and therefore the best care plan can be made for that person.