Colm Burke (Fine Gael)

I welcome the Minister of State to the House and thank her for providing that clarification in her speech.

I welcome the move by the Minister to restart the processing and acceptance of applications under the fair deal scheme. This move brings clarity to the situation and will be a relief for thousands of older people and their families throughout the country. I hope the 2,900 applications, which are pending, will be processed as soon as possible. I call for a fast-track procedure to be used for these cases.

Long-term nursing home care is a difficult decision for families and their loved ones, and should be as anxiety free as possible. This recent episode with the fair deal scheme highlights many of the problems we associate with nursing home care in Ireland. It is incredible that a scheme such as the fair deal one could run out of money less than two years after it was established. At that time, it was sold as a sustainable model for funding nursing home care.

I am calling for a 20-year national strategy for the care of the elderly. It should set out an all-encompassing vision for nursing care, a detailed step-by-step plan to achieve that goal, and develop a sustainable funding model with built-in, five-yearly reviews.

Planning for long-term care for our elderly is one of the most important duties of society. It should be one of the easiest strategies to formulate because statistics and projections give an accurate idea of how many older people the population will include in 20 years time. The figures we have to face in this regard are frightening. There are currently just over half a million people aged over 65, and around 125,000 aged over 80. Meanwhile, wehave 24,429 residents in nursing homes and over the next 20 years these figures will double.

Last week, population projections predicted that Ireland will have more than 1 million people aged over 65 - and more than 270,000 people over the age of 80 - by 2030. This will present a huge challenge to our health and social services, so it is imperative to plan for it now. Such an increase in the numbers of people in these age brackets makes it incumbent upon policymakers to plan now for the challenges we will face in the future. These figures require a comprehensive, holistic plan to ensure those who have spent their lives working and contributing to our society and economy are properly cared for.

I do not want any Member to take this personally but the approach the Department of Health and the HSE have adopted since the 1970s can at best be described as piecemeal and haphazard, lacking coherence and direction. There was no eye on the future, no forward planning and no big picture. We have witnessed mismanagement and an approach that is less connected with good policy and administration and more closely resembles fire fighting.

The nursing home care system in this country has been at the centre of some controversy in recent years, especially the nursing home charges scandal, where it was revealed that more than 300,000 people were charged illegally over a period of 28 years. It is interesting that, as far back as 1976 in the case of Maud McInerney, the High Court decided that nursing home care came under a definition of medical care and for 28 years the Department did not respond to it.

Time and again the HSE, its predecessors the health boards, and the Department of Health have been criticised for failures in the provision of nursing home care and provision. The Ombudsman's report, entitled "Who Cares? An Investigation into the Right to Nursing Home Care in Ireland", was published in November 2010, only a few months ago. That report states: "Access to nursing home care ... has been marked by confusion, uncertainty, misinformation, inconsistency and inequity." It is time we ensured such mistakes were not made again. The report also states: "At the administrative and institutional level, the continuation over such a long period of such unacceptable practices suggests inflexibility, non-responsiveness and a reluctance to face reality." The report further states:

Both the Department and the HSE have challenged the jurisdiction of the Ombudsman in conducting this investigation and both bodies have refused to provide information and documentation required by the Ombudsman for the purposes of the investigation. In the case of the Department, the refusal to co-operate extends to virtually all of the material sought. In the case of the HSE, while it provided material in relation to individual complaints, it refused to provide much of the other material required. In their submissions to the Ombudsman, having considered material from a draft of this report, both the Department and the HSE made further, and (in the case of the former) very detailed challenges to the Ombudsman's jurisdiction to undertake this investigation and to report on it to the Dáil and Seanad.

One of the objectives in setting up the Office of the Ombudsman was to ensure we would work together to provide solutions to the problems we face, but instead we seem to have buried our heads in the sand. We need to rethink how we deal with these issues.

This characterisation of the attitude within both the Department of Health and the Health Service Executive is a cause for serious concern. If this is the prevailing mindset of those involved in the administration of policy, then we have much to worry about. Part of the problem is placing legal obligations upon a body without providing adequate resources for that body to fulfil its obligations.

It is also necessary to consider briefly the 2005 Travers report on the practice of charging persons in long-stay care in health board institutions which also criticised failures on the part of the Department of Health. It is clear that in the past the Department of Health, the health boards and the HSE have behaved in a lax and less than circumspect manner in regard to care of the elderly and nursing care in particular. This failure by the Department to fulfil its role in policy formation is a serious issue and one I hope the Minister will address with all eagerness and haste.

Too often in the past we have failed to plan in Ireland and it is the vulnerable who have suffered most from such failure. There can be no excuse, however, not to plan for the drastic increase in the number of older people. We should see this as an opportunity to take care of our elderly, to recognise them, to show our respect and to honour their contribution to this country. We need to develop a system designed to meet the needs of double what the current system is handling. We need to make certain that any system of care has at its heart humanity, respect for human dignity and compassion. Any strategy must have at its core a fundamental respect for the wishes of the individual and his or her family. The goal of any system of elder care must be to enable our elderly to live in their own homes and communities for as long as they wish. Creative solutions must be employed in order that this aim can be achieved. We should look to other countries who are further along the demographic path we are heading, emulate what is good and learn the lessons from their mistakes. We need to ensure a whole community approach is adopted comprising solutions incorporating families, the voluntary and private sectors as well as the public system. No person should fear growing old in Ireland, unsure as to whether and how he or she will provide for himself or herself and his or her care. Community care, home help, day centres, community homes and nursing homes will all have a role to play in ensuring Ireland is a country for old people. All these services and facilities must be part of that mix in a long-term plan.

We must be realistic, honest and creative in the way we plan to fund any new system. Without adequate funding, the best designed systems in the world cannot function. The current fair deal model has its strengths but it also has its weaknesses. We must face up to the simple fact that a funding model dependent on a property market is inherently unstable. In many other countries there are systems working efficiently and well and we should examine those. We can use them as templates in finding a long-term, sustainable model for ensuring the recent funding issues will not arise again. This will present the greatest challenge in the formulation of any plan, but it is one we must address head on.