Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank all the Senators for their contributions, their thoughtfulness, the amount of time they have put into considering these issues and their assistance in formulating my thoughts on a new home care scheme, which seemed to be the focus of most contributions. That is, of course, linked to the fair deal scheme. I will answer a few questions, if I may.

Much was made of farm assets and small businesses. Nearly ever Senator referred to those matters. People will be aware of the story to date. The Irish Farmers Association, IFA, among others, has been leading the lobby on these matters for a number of years. It has put forward a number of different proposals for ways to ease the burden on farm families who are subject to the fair deal scheme. I have had a number of meeting with the IFA, as did my predecessor, the Minister of State, Deputy McEntee. On taking office I committed to getting this issue off the table as quickly as I could and to try to move it on. We went through a period of negotiation, I dealt with my officials and we looked at a number of different scenarios. I came back to the IFA last week and confirmed to it that my preferred option would be not to negotiate any further schemes based on 90% of assets and so on. I explained that progress could take another four years if we were to negotiate on those terms. I told them that it would be cleanest and most efficient to treat farm assets and small business assets in the same way as the principal private residence and to apply the three-year cap. That is the most efficient way I can deal with this and the IFA seems to be reasonably happy with that suggestion. I have outlined the process from here. Obviously there will be legislation, because the fair deal scheme was established through legislation. Primary legislation must be changed and that will probably take me to the end of the year. Subsequent to completing my negotiations with the Attorney General's office we should be in a position to draft legislation and begin the legislative process early next year. That is my hope and my ambition. Sometimes it is a case of "events, dear boy, events" and things can be overtaken, but that is my ambition and that is where the scheme stands.

On the issue of additional charges in nursing homes, to which many Senators referred, as Minister of State I can choose to bring in legislation in the morning - or at least to put legislation before the Houses for consideration - to legislate on this matter but my hope is we can engage with the industry to deal with it through self-regulation. If the industry refuses to deal with it, I will certainly come back to the House to introduce legislation to force it to so do. Somebody once said - I am not sure who it was - that the more legislation there is, the less justice there is. I am not sure who said it but I read it at some point. We should avoid legislation if we can and I am fairly confident from my engagement with Nursing Homes Ireland, which is the representative body for its members, that it is very anxious to deal with the issue of additional charges.

I want to give the same message a number of times and it is that I have asked nursing homes to flag additional charges at inquiry level as opposed to the day on which one lands one's loved one, one's mum or dad, into the nursing home. That day brings trauma. One's loved one is in their bed and then one is given a list of additional charges. One is typically given the charges on the day one signs the contract. That is not good enough and it is not acceptable. That is catching people blindsided. I have asked nursing homes to flag additional charges in an open and transparent way, to put them on their websites and to publish them in so far as they can. I have asked that they be flagged at inquiry stage, that is, when somebody is approved for the fair deal scheme and is looking at which nursing home he or she would like to go to. The nursing homes have agreed to do that and I understand many of them are in the process of doing so already. I have also asked them to develop a standardised template for these charges and to consider preparing something like a profit and loss account which would show clearly the amount of charges collected from residents in a year on one side and, on the other side, what those charges were spent on.

We do not want to throw the baby out with the bathwater. The last thing I want to see is elderly people in nursing homes with their heads thrown sideways, sitting and staring out a window for eight hours a day. We do not want to kill social activities programmes. There are many voluntary groups and schools which are quite willing to come into nursing homes to provide entertainment and play music and so on and which do great work. We want to ensure that there is a good, lively social programme in every nursing home. If there are charges attached to that, we want to ensure that they are open, transparent and consistent. I am confident, from my negotiations and engagement to date, that the industry is making good strides towards that. It appreciates the pressure on it to deal with this, and I believe that it will.

We need to make people aware that within the last year or two, the Ombudsman got jurisdiction over nursing homes. Therefore, if any family comes into a Senator's office with a concern about charges and how they are being spent, the family will first need to take it up with the nursing home to get clarity, but if they are not satisfied they can go to the Ombudsman, who will investigate. I recently met the Ombudsman. He only received 30 complaints about nursing homes last year, only one of which related to additional charges. Again I encourage any family that has concerns about additional charges to avail of the Ombudsman's services, and I ask each Senator to get that message out. It is a free, efficient and effective service.

Senator Kelleher asked about engaging with Professor O'Shea, which she suggested to me before. I have not done so yet, but I will attempt to so do in the future. She also made a point about deteriorating in hospital, which I very much accept. That is one of the big challenges for society. People, and particularly elderly people, are very vulnerable in hospitals. It would be far better and healthier for us to protect them and support them to live in their communities.The challenge for us all is to try to reorient the current system, with up to €1 billion spent on the fair deal scheme, into the community, where we are spending approximately €360 million on home care packages and home help hours, and to try to get the money away from the one side. However, one cannot just remove something and not replace it with something else. We must gradually bring down the nursing home care bill, which I hope we can do, and increase the bill on the other side. I have an interesting statistic on that. Since the introduction of the fair deal scheme in 2009, which is not that long ago in the greater scheme of things, the average stay of a resident in a nursing home has gone from seven years down to 2.2 years. It is a very welcome development that that is the average length of time people are spending in nursing homes as a result of the fair deal scheme.

Senator Kelleher also asked about the next steps and the timeline, as did Senator Ó Donnghaile, and some other Senators might have asked about them. The next steps are as follows. The public consultation finished yesterday. The Department is going through the submissions received. When I last checked, I think there were about 2,300 submissions. I suspect there were many more in the final week. Whatever came in the final week will be added to the 2,300, and the Department will, I hope, have a report published on those submissions by the end of this year. Then it is up to us to go back out and deal with HIQA on the regulation of a home care scheme. Someone spoke about including the home care package under the fair deal scheme. That will not be considered. The fair deal scheme is a very separate scheme. It is there for long-term residential care. We want to create a fair deal-type scheme in the community. Bearing in mind that this is not an ambition or a target, it took nine years to devise the fair deal scheme. I certainly do not intend anything like that length of time to be spent devising the scheme and its introduction. The next steps are to get the report published by the end of the year, start engaging with HIQA on the regulation of it and carry out some other work teasing it out. I envisage getting a scheme up and running in its entirety in probably 18 months to two years.

Senator Kelleher mentioned dementia, which is a societal time bomb awaiting us all and is a hugely pressing challenge. I had meetings today with the HSE and the Department on this very issue, trying to increase funding for dementia care and recognising it as a top priority because that is what it is for society. For whoever will be here in years to come, in the next three, four or five years, and for all of society, this will become an increasing challenge.

Senator Feighan spoke about farm families, his mum's care and the self-employed. Again, I will just say that I have noted his comments and his concern for people who do not have pensions and the self-employed who have shares instead of pensions.

Senator Ó Donnghaile spoke about celebrating longer years as an opportunity. I could not agree more with him and I speak all the time about the fact that while we have been very successful in adding years to life and that the number of people living over 65 and 85 is doubling and tripling, respectively, we must add more years to life. That is the real opportunity. The Senator is absolutely right. It is an opportunity for us to add years to those lives. He also spoke about small businesses and voiced his concern about additional charges, which I have addressed.

Senator O'Reilly spoke about the public meeting in his area and the charges and contributions towards home care, which I think I have addressed.

Senator Byrne spoke about farm assets and home care and the nursing home payment to clients. Many people ask the question, if my mum were in a nursing home, it could cost €1,000 or €1,100 a week to have her there, so why can I not get some of that money to continue to support her at home? I think this is what Senator Byrne was talking about. Unfortunately, we do not have that flexibility in the fair deal scheme. It is very much committed to the long-term stay and one cannot pick or choose. However, the ambition is that in another two years one will be able to decide whether one wants to go into a nursing home or put one's loved one into a nursing home or whether one wants to be supported in the community.

Senator Colm Burke spoke about the challenges ahead and said that if current trends continue, there will be 40,000 people in nursing homes, and if 23,000 cost €1 billion, we will be looking at a doubling of the cost to €2 billion. It is vital, therefore, that we very rapidly take the steps towards reorienting towards community care. Senator Burke also spoke about the rising cost of nursing homes. I am aware of many of these issues and have had numerous engagements with Nursing Homes Ireland. The National Treatment Purchase Fund, NTPF, is the body that negotiates nursing homes. It is reviewing its pricing structure with nursing homes at present and will have that concluded by year end. Something that will be done next year is a look at the cost of private nursing homes versus public nursing homes. There is a commitment as part of the implementation of the review in 2015 to look at that into next year. I have also been speaking recently to Nursing Homes Ireland about adequate payments to reflect the level of care in the context of delayed discharges and dealing with those challenges. At present it is a very rigid payment structure. It is one payment and one payment only and does not reflect the level of care provided. I have been speaking to the Department, the NTPF and the HSE to try to bring about solutions to this. It will take some time before we get what is called the SAT, the standard assessment tool, up and running, which can assess the level of care, but I am aware of the issue and am interested in seeing its resolution. I am aware of the increased cost of staffing in some hospitals because of their geography. I ask Senator Burke to send me a note on the calculation of the interest on moneys invested. He seems to have a good grasp of it, but I am not aware of it. I will certainly have it looked into for him and would welcome his thoughts if he had time to send me a note. The regulation of home care is a feature of the new home care scheme. It is not there at present, which I regret. I would like it to be there. There is no point in bringing in regulation through the existing scheme because it would delay the introduction of the new scheme. I would prefer to concentrate on getting the new scheme up and running as quickly as possible, and that is my present ambition.

Senator O'Donnell spoke about the role of carers, which is very important for us to recognise and protect. He spoke about the timeline from here on, which I have also reflected in my comments. I note that there was no mention at all of HIQA, which is interesting from the point of view of our discussing nursing homes. I will make one point about HIQA, which often arises as an issue and a challenge, and various nursing homes and the HSE find the HIQA experience very frustrating. We as a society have an awful lot to be very grateful to HIQA for because it has really upped the ante beyond recognition in the past ten years on the standing of living of our elderly, and I always want to commend it on that at every opportunity. However, I am aware it creates a very healthy tension between providers of care for the elderly and, of course, it represents the system, and I as Minister must keep away from involvement in that regard. It is an independent body. I do not tell it how to do its business. Issues arise from time to time but, on balance, the winners of the healthy tension it has created have been our elderly, which I very much welcome.

Overall, the fair deal scheme, by and large, for most of us - all of us here are practising politicians - does not come up an awful lot in our day-to-day business. Of all the schemes on which we get representations and with which we have difficulties, notwithstanding the complexities of it and issues with it, I think by and large it works fairly well and is a good scheme.

I like to acknowledge good practice when I see it. I was in Galway yesterday. COPE Galway - I do not know whether any Senators are aware of it - provided 45,000 meals last year as part of its traditional meals on wheels. This ties in with the fair deal scheme and our ambition to keep people at home. COPE Galway has a superb service. Senators should go and see it and try to replicate it in all our communities. It has the highest standards as regards the Q mark and hygiene. Its key focus is nutrition and it delivers meals seven days a week to elderly people living on their own. It has a bus service going out into the communities and many volunteers helping with it. It is a very noble aspiration. For those of us who are practising politicians in our own communities, this is something we should all try to see replicated. Again, there is an awful lot of a voluntary effort to it, which I very much welcome and support. The State cannot and will not do everything. We can spend all the time we want giving out about the State's failure or we can ask what we ourselves can do about it, getting communities up and running, tapping into the volunteerism that is there and seeing something like COPE Galway, which, as I said, provided 45,000 meals with the highest nutrition standards to elderly people living on their own last year. It is doing an enormous amount to keep people well in their own homes and out of nursing homes.

I hope I have answered all the questions.