Rónán Mullen (Independent)

Gabhaim buíochas leis an Seanadóir Quinn as ucht a cuid ama a roinnt liom. Cuirim fáilte roimh an Aire Stáit. I have welcomed the Minister of State to the House previously. If she pardons me, I will start on a slightly negative note, in that it would be helpful if we could be supplied with ministerial speeches earlier in the proceedings. She had interesting comments to make and Senators will want to respond. It would be wonderful if members of the Government would circulate speeches days in advance. This would seem to create a somewhat artificial situation but, as Ministers and Ministers of State generally speak from prepared notes, having an idea of what they will say would be useful for Members. The point of the exercise is for us to make representations and proposals to the Government and for the Government to respond. It is not the Minister of State's fault, but I would be grateful if she took this message with her. I am concerned about the speech because I noted the Minister of State's comments regarding the fair deal nursing home scheme and the €100 million that seems to have been spent elsewhere, with only €48 million being spent on the scheme. This chaos is troubling people.

Approximately €1 billion has been allocated for nursing home support. According to one programme I heard, though, some €1.5 billion will be required. If so, will there be enough money to fund the system for everyone who needs it? One must be concerned about the HSE's modus operandi, given the spending of money under the wrong heading. However, another concern relates to the apparent serious discrepancy between private and public nursing home costs. According to some reports, private nursing homes cost up to 50% less than their public equivalents. The Minister was correct about this being an unsustainable situation, one that points to a lack of efficiency and value for money within the public service. If so, why does the Minister's focus appear to be on reducing costs in the private sector? Saving €20 million would be great, but greater savings might be made by addressing the public provision of nursing home care.

While the train has left the station to some extent, Professor Des O'Neill, a gerontologist and someone whose opinions on this matter we should take seriously, has raised an important issue, namely, the difference in attitudes towards funding long-term nursing home care for older persons and other types of care, such as cancer care - an expert in this field is a Senator - and coronary care. People are required to stump up for nursing home care with their private property, a scenario never envisaged in respect of the other types of health care. Professor O'Neill has referred to the fair deal scheme as the great candy snatch of the 21st century. Is it not dangerous that the State is endorsing an approach whereby the frailest and most complex group of people in society - I do not mean this in a disparaging sense, as I am only referring to their needs - are seen as a soft touch across the board and are not receiving equality of treatment with other illness groupings, for example, sufferers of cancer and heart disease? We need to discuss this issue. A question must be asked about the underlying philosophy of our approach.

Yesterday was World Elder Abuse Awareness Day. Although a related matter is before the courts, I ask the Minister of State about the current controversy. Is it not frightening that a controversy has arisen about a home that the Health Information and Quality Authority, HIQA, investigated and deemed not to have any problem? If HIQA orders a home to close, must people be removed from a setting where, whatever its faults, they are comfortable? Should we not consider an examinership system whereby someone could take charge of and run the home? Perhaps this is already the case, but a certain amount of confusion is caused in the public's mind when people are told of HIQA securing an order to close down a home. I wonder about the impact of such an order on residents. Perhaps the Minister of State could explain the situation to us.

I wish to raise an issue of concern to older persons in care. Recently, a woman wrote to me about what she called the appalling practice in our hospitals of having male and female patients in the same ward. She described how a person aged 92 admitted to Beaumont Hospital was nursed in a six-bed ward with five men. When she brought this to the attention of one of the managers she was told the person was probably not aware of her surroundings, which, again, shows a certain underlying attitude. Another lady brought to an accident and emergency department in the middle of the night suffering with high blood pressure was placed on a trolley in a big open ward with a man on either side of her, one of whom was disoriented and kept putting out his hand and touching her. My correspondent adds, in a somewhat dry aside, that this treatment was not conducive to lower the woman's blood pressure. I do not wish to trivialise this matter. An issue arises in regard to how we are treating people in full time care. I raise this issue in the context of hospice friendly hospital care.

I accept this matter is not directly related to the fair deal scheme but this debate provides us with an opportunity to raise issues and touch on human dignity in the context of the care of older persons. Perhaps the Minister will today or at a later stage set out the Government's attitude to men and women being put into full time hospital care settings in a manner that is not conducive to their dignity or, at least, does not honour their wishes.