David Norris (Independent)
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I welcome the Minister of State back to the House, refreshed after our short break. In 1990 the Health (Nursing Home) Act was passed by the Oireachtas, coming into force in September 1993. This was intended and proclaimed to be a radical improvement on the old system. The Ombudsman's report contradicts this, however, claiming that the Department and the health boards operated the new system in a way that was against the interests of patients and deprived them of their own money, a serious charge. She also stated that the Department was perfectly aware that its approach was legally unsound. This puts into context the remark on the other side of the House before the break that this was the best kept secret in the Civil Service. It is difficult to believe the political masters of the Civil Service were unaware of the situation, which was so widely flagged and so clear to the Ombudsman.

The doubtful practices listed include the making of regulations containing provisions which are likely to have been against the law, including at least one instance in which the likely invalidity probably had been known in advance. That goes back to the matter I have just raised. Also mentioned is the inclusion in a regulation of a provision which, it appears, was intended from the outset would not be applied. That sounds like sharp practice. A further doubtful practice was the unreasonable prolongation of discussions with the Ombudsman about practices which it appears were known from the outset to be invalid or incorrect. That is unjustifiable prevarication and it is totally disingenuous.

Finally, there was the failure of some health boards to alter practice, even where the legal advice was that the practice was incorrect and where the Ombudsman had expressed the same opinion. The health boards were advised legally this was inappropriate and the Ombudsman was expressing concern but the practice persists. No defence of ignorance could be entered.

The Ombudsman's experience of complaints between 1993 and 1999 suggests that the underlying problems of complainants which surfaced prior to September 1993 continued to manifest themselves under this new regime. There were plenty of problems and they were flagged. A serious situation has arisen recently with regard to the law on statutory rape and at its heart was the question of communication deficits, to put it politely. It seems this also happened here in the Department. That is regrettable and I hope the Bill goes some way towards mending the situation.

The Bill contains a provision for the recipients of this money to render it back to the State if they do not need it so it can be used by the health service. That may be an honourable thing to do but I hope that no moral pressure will be put on people to do so. I salute those I heard on the radio saying they were grateful to the health services for the way in which their relatives were treated. They also said they would not wish to take this money.

As I understand it, there is no systematic inspection of public nursing homes for the elderly. If that is the case, such a system should be instituted. While this is not directly germane to the matter, people should be made aware that the development of bedsores among patients in these institutions is absolutely unnecessary and indicates bad nursing practice. Relatives often believe that bedsores are the inevitable consequence of the aged being bedridden but they are not. The matter is a cause for concern and there should be regular inspections of nursing homes.

John Minihan (Progressive Democrats)
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I join with previous speakers in welcoming the Minister of State and his officials to the House. Just three weeks ago, we discussed ageism. In my contribution, I referred to research that noted the perception that the State does not do enough for older people. I said there was an onus on all of us to take steps to counter ageism, as well as highlighting the positive steps that are being taken specifically for older people. It is hard to know where this Bill and the problem that led to it, fits into all of this.

The Government fully accepts the Supreme Court decision that the retrospective imposition of charges on fully eligible persons for their publicly-funded, long-term care was unlawful. People with medical cards in public nursing homes, welfare homes or in contract beds which were established subsequently in private nursing homes, were illegally charged. That was the heart of the problem. It is right to establish the legal framework for making repayments to those who were wrongly charged and to pass this Bill as quickly as is reasonable, so that those who are due repayment will receive it as soon as possible.

The unlawful practice that brings us to today's legislation has been rooted in law for over 50 years. Health boards in this country have levelled charges for publicly-funded, long-stay residential care under two sets of regulations — one dating from 1954 and the other from 1976. Over the years, health boards, with the knowledge of the Department, continued to levy these charges right up to December 2004. At that point, the Department instructed the health boards, on the advice of the Attorney General, to stop these charges on eligible persons.

I commend the Tánaiste on grasping the nettle on an issue that has gone on for decades. Since doing so, the Government has taken reasonable steps to right the wrong. For example, the Government agreed to payments of up to €2,000 to those illegally charged who were alive on 9 December 2004. The Health Service Executive has paid more than €21 million to approximately 11,000 or more individuals under this plan. The Government is to be commended on providing this scheme which is specifically designed to be more attractive than taking litigation in the courts.

It is correct that repayments to those who are alive, or to their living spouse, will not be subject to income tax, and that those persons in receipt of repayments will retain their current social welfare pensions or allowances and their full eligibility entitlement for medical card status. Furthermore, repayments under the proposed scheme will not be considered when assessing entitlements to subvention.

Most important is the determination by the Government that the repayment process will be as simple and user-friendly as possible. Ironically, when we were discussing ageism here last month, much was made of the issue of stereotyping. The Irish Senior Citizens Parliament, among others, has warned against any generalisations — even those motivated by good intentions — about older people. In considering this Bill, it is difficult not to be mindful of the age and vulnerability of many of those to whom repayments are due. If this makes one guilty of stereotyping, then it is a misdemeanour motivated by a genuine desire on the part of the State to aid vulnerable citizens. One wonders if it is possible to act in such a manner without stereotyping.

There can be no doubt that avoiding an adversarial, inflexible and enclosed scheme is the right thing to do. Given the circumstances, the State should minimise inconvenience and the legal bill incurred by people wrongly charged. The same consideration should, of course, be given to their families, representatives or estates depending on the circumstances.

I am satisfied that many, if not all, representatives have moved beyond the usual political arguments and have instead focused more readily on the intention of the Bill before us. This is a Bill to introduce a scheme to repay wrongfully imposed charges to eligible persons, and it is right that there is broad political support for it. One aspect that has drawn particular attention is the HSE's procurement process for the logistics of the repayment scheme. The HSE's first procurement process generated many expressions of interest to design and administer the scheme. I understand that the HSE decided to re-run the competition for value-for-money and technical reasons.

As a public body, the HSE must, and does, manage its procurement processes independently and on objective criteria. A new procurement process was put in place and advertised in the Journal of the European Union last February. The HSE selected its preferred bidder on 1 June and, as we are currently inside the normal 15-day period when other bidders have the right to lodge objections, I do not wish to comment further at this stage.

Contrary to some views, consideration was given to the involvement of public sector staff in assisting with the administration of the scheme. From what I understand, however, the HSE informed the Department that the time constraints, potential for logistical difficulties and protracted delays made such an option undesirable. Dedicated HSE resources would have to be assigned and HSE staff would have to be specially trained. They would need dedicated supervision and would have to leave their regular duties, which would impact upon regular services. The commencement of the entire repayment scheme could be detrimentally affected, which is something I am sure all Members of the House would rather avoid.

I welcome the legislation. I commend the Government and, in particular, the Tánaiste on demonstrating the political will and ability finally to tackle this issue, which had rumbled on under a number of Governments. Following the Supreme Court decision, the Cabinet sub-committee considered its implications and correctly decided that money received by the HSE from the unlawful imposition of charges would be repaid. Charging for long-stay care has now been put on a statutory footing under the Health (Amendment) Act 2005, which is being implemented.

Of great importance to me and my party colleagues is the recognition by the Government that, regrettably, many of those patients due a repayment have varying degrees of mental impairment. It is imperative that the proposed scheme provides appropriate safeguards to prevent fraud. Though unpalatable to conscience, there are those who would exploit persons who receive payments and are not in a position to manage their own financial affairs. In light of this sorry fact, I welcome the legislation's provisions to allow repayments be placed in patient private property or PPP accounts, although this is not the normal understanding of PPPs. I understand these are to be employed to ensure repaid money is used for the benefit of the patient and that the money held in these accounts can be invested on behalf of the patient. The House will no doubt join me in welcoming the statutory framework to protect patients' interests, particularly where sizeable repayments are made.

The key, of course, is to simultaneously provide safeguards and autonomy for patients. I was heartened to hear the Department's acceptance that clarity and consistency are needed regarding these PPP accounts and I am interested to hear of Government plans to appoint an independent overseer in regard to the administration of these accounts. I hope the Minister will shed light on this issue. I welcome the Bill and commend the Tánaiste and the Government on their work to address a long-running and thorny problem. I hope that on every Stage it is the concerns and needs of the patient that remain our focus as we progress the Bill.

Brendan Ryan (Labour)
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Whatever criticisms I might have about the Bill and the mess which preceded it, I sincerely commend the Tánaiste on at least facing the fact and dealing with it. Along the way, we had the less than savoury attempt to hijack people's money through the previous legislation which was struck down by the Supreme Court. Many of us believed at the time that it was unconstitutional and a less than generous response to what was essentially the misappropriation of people's funds, and we welcomed the decision of the Supreme Court to defend what it saw as the property rights of elderly and vulnerable people.

Lest there be any misunderstanding, I declare a form of interest in that my mother is a patient of long standing in a public hospital for the elderly. She is the possessor of a medical card and is therefore a potential, if the House will excuse the expression, beneficiary of this Bill. I wish to make sure, therefore, that anything I say is not interpreted in any way as being connected to that.

I previously put on the record my personal view, which is that I see nothing objectionable in asking old people who receive the quality of care that my mother and hundreds of others received in St. Vincent's Hospital in Athy, to make a significant contribution towards the cost of their care if they have some income. That seems reasonable, rational and fair. I have no problem with the principle of the issue. It seems extraordinary that there are some people who have a problem with it, particularly one well-known and noisy late-night radio commentator who seems to believe the idea of asking people to pay was a betrayal of some socialist principle he had discovered but which I never found. I have no problem with the principle. I might quibble with the level of funds left to people, particularly those on the basic level of old age pension, for whom the remaining sum is quite small. While we could have been more generous, that is an issue of detail not principle, and it is not for this Bill.

In most of the schools of public administration, not just in this State or on this island but perhaps in the English speaking world, this saga will become one of the classic case studies. This country is — I say this despite all the qualms, quibbles and arguments we have — governed well in terms of the incorruptibility of public administration, has an extremely effective and functioning democracy, and has a vigorous and assertively independent courts system. How, given all of that, could a debacle of this magnitude have evolved through a succession of Governments?

The only arguments I have with the present Government in this regard are, first, the extraordinary behaviour of the previous Minister for Health and Children, a matter to which I will return, and, second, the delay in producing the legislation. However, these issues are not central to the point. I question the scale of the debacle and the fact that a major Department, run in those days by a Minister and the health boards, which had well remunerated chief executives, could have been essentially ignorant of the fact that they were extracting vast sums of money illegally from elderly people, and that nobody noticed for a long time, which I believe.

I sincerely hope that, since this debacle emerged, the Department of Health and Children and all of the agencies for which it is responsible have taken steps to ensure their charging practices and other legislative functions or activities are grounded in sound legislation. It is the least we can expect from them. It would be nice to hear from the Minister that some systematic adjustment has been made in the Department to ensure such things cannot happen again, and that somebody is encouraged to play devil's advocate and to question in each case whether policy is within the law. That seems a reasonable request.

That said, I am intrigued as to how we could have had a health strategy which referred to the need for clarity on the question of the entitlements of the elderly while, in the discussions prior to the production of the strategy, the question of how much it would cost to provide proper services for the elderly apparently never arose, or if it did, the question of whether one was entitled to charge them more was never discussed. That is what I must believe. The Minister who was in office at the time assured us that in all the discussions which fed into the health strategy of 2000, the question of the charging of the elderly for services, if it was discussed, was discussed in such a way that the question of whether we were entitled to charge them never arose.

We then had the universal extension of medical cards to all those over 70 years of age, a decision with which I agree, in spite of some noises from within my own party, apart from anywhere else. It was a sensible decision because the proportion of people over 70 who are outside the means test is so small as to make the process of means testing counterproductive in terms of any kind of cost-benefit analysis. Anyone who listens to older people would know that women in their 70s — we are referring overwhelmingly to women in this case — were mostly dependants. They were, therefore, having to manage money in a way they had never had to do previously when their husbands were alive. To add the fear and concern of having to pay for medical bills left people in their later years with an additional and major worry just as their health began to fade a little.

It was, therefore, a perfectly reasonable policy. However, the fact that it was a good idea does not mean I approve of the bad way it was implemented. Again, I am intrigued as to whether any questions were asked about how much it cost. If no fundamental questions are asked about how much things cost, how in God's name does the Government do its business? If the question of how much things cost arises, the question then arises of where revenue comes from and that should make one look at the legislative and legal basis for charging people. Again, one must express scepticism and wonder that it was not discussed.

Then there was the Ombudsman's report on charging the children of elderly people for care. This report went to the Department but even it, which was not directly connected with this issue, did not raise any concerns about the legal basis for charging people. The upshot of all this is that this debacle will become a case study to be examined, parsed and analysed by students of public administration throughout the English speaking world and, perhaps, beyond. There cannot have been many greater debacles in an open and free society where one can readily get information.

I am intrigued by the determination to have an external agency administer and organise the repayment scheme. The HSE said it would require the diversion of staff and some of its dedicated budget. However, how will the agency or body that has been identified but cannot yet be named be paid? Will some of the money that was due to be allocated to elderly people be used to pay it? If not, will it be paid for with a separate budget? If there is a separate budget, why not give that budget to the HSE to do this job?

I can only think of one explanation, the Tánaiste's determined belief that the private sector will always do a better job than the public sector. That belief has driven her for most of her political career. It is regrettable that it is inserted in this Bill. Someday we should have a debate with the Tánaiste about the fact that, despite her ideological determination to foist a privatised health service on us, the most privatised health service in the world is also the most expensive and, in terms of both life expectancy and infant mortality, perhaps the poorest at delivery. I refer to the United States health service.

I have no hang-ups about who should do this job but I am sceptical about the concept of a non-nationally based agency having some type of mysterious expertise which means it can deal with this issue in a more efficient way than a dedicated group seconded from the HSE. I smell the whiff of ideology running through this. There is a significant, peculiar belief in this country that there are people called experts and that if we could only find them, they would do these jobs far better than the people who are already doing them.

We deal with this by importing consultants and also in the extraordinary system whereby senior executives of local authorities often must get permission from somebody called "the Minister", who in most cases turns out to be a junior official working from the same manual used by the well paid and well qualified local official. However, the Minister is the power and there is a belief that the Minister can do it better. What is needed, in fact, is transparency and accountability at local level and a clearing away of the fog that generally surrounds many local functions, whether they are carried out by the HSE or the local authorities. The excuse one is usually given with regard to any project being carried out by these bodies is that the estimated cost cannot be revealed because the information is commercially sensitive. Later, when it turns out that they got it all wrong, we are told it is because certain things were not adverted to.

I have long given up on the idea that if a hospital is to be built, we should not have some idea in advance of the official cost estimate and it should not be published near tender stage because it is commercially sensitive. I believe that is a smokescreen to dilute any level of accountability. It is time we ended it. Instead of going through the rigmarole of two or three levels of approval, we should make the system more transparent and open and, therefore, probably more accountable. In time, it will be more efficient as a body of learning is accumulated at local level, whether it be local authority or health service.

I wish to comment on the donation of prescribed repayments. There is a valid ethical issue involved in that concept. I am not unhappy that people who have some money should pay for the services being provided to them. The logic of that is that neither the individuals nor their children should benefit from these repayments in terms of their personal affluence. However, the concept of giving money to even a ring-fenced fund to be administered by a HSE that has just awarded its chief executive a €32,000 bonus for running one of the worst health services in Europe is not appealing. Whatever few euro come to my dear mother as a consequence of this and if I and my brothers decide it is to be used for some purpose, we will use it locally and in a way whereby we can ensure it will not add to the already enormous salary of the CEO of the Health Service Executive but to provide a service in the hospital where my mother is receiving care of a quality that would not be available in any privately run institution.

Geraldine Feeney (Fianna Fail)
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I am pleased to welcome this Bill. Much has been said about the overcharging of elderly long-stay patients in public nursing homes. Earlier today I watched the debate in my office as I made some notes. It appeared to be a balanced debate. However, I am now of the opinion that it is only somewhat balanced because there is some political point scoring taking place. That saddens me because this issue was a huge political football when it was debated some months ago.

Senator Quinn said the Government was again embarrassed this week with the introduction of this legislation in the House after having been so embarrassed last week. I was away last week on Oireachtas health committee business but I followed what happened. Senator Quinn and other people who think the Government might be embarrassed should note that I sat with Senator Browne on the health committee that considered the Travers report and conducted an intense investigation of its findings. Indeed, the committee sat for months hearing evidence. What I took from Mr. Travers's report was that mistakes were made but that it would be wrong to try to apportion blame to any one particular Government, that the mistake stemmed back over 30 years and all Governments of all persuasions, if one was to apportion blame, would have blame mounted on them. It is wrong to say it is a Government problem and that the Government did not pick up the ball quickly enough.

I take my hat off to the Tánaiste and Minister for Health and Children, Deputy Harney, who, when she became aware something was wrong, acted quickly and engaged Mr. Travers who worked long hours during the Christmas holiday to provide her with the report. We are at a stage where the Government believes repayment should be made and rightly so. The money illegally taken from elderly patients should be paid back. The amount cited of €1 billion is a large sum in anyone's language, particularly when equated to the overall health budget of €12 billion.

The Bill provides that those persons who were wrongly charged and are still alive, including the estates of persons who were wrongly charged, and have passed on since December 1998, will have every penny taken from them paid back in full. I do not know if account has been taken of inflation or interest paid on the money owed to those involved. Others speakers have said that 20,000 such patients are still alive and between 40,000 and 50,000 will have their estates benefited to the amount outstanding.

I listened with interest to what Senator Ryan had to say. My aunt died in a public nursing home. Her family has told me that their mother was so well looked after, no money could have bought them the care she got in a private nursing home. They were very pleased. I could say that is one family that will not be looking for whatever money is being repaid to their mother because they were very pleased with the care she was afforded. Where a family does not wish to take the money being repaid for their loved one, it should be able to give it to the institution which looked after that person. Such money would then be given to local institutions in Sligo, Athy, Tullamore, Bantry or wherever the hospital or nursing home is located. I ask the Minister of State to examine that issue because, as Senator Ryan has said, we are putting money back into a big pot and much of it might go on administrative duties rather than helping over-stretched units in which loved ones had been cared for. It is important that local units benefit from whatever money is repaid in the event of a person not taking it, whether the loved one has passed away or is still living and may not need it.

The important issue is the care of the elderly, and their needs must be to the fore in developing policy in the future. In some cases vulnerable people would have nobody to speak up for them, in other cases where families could speak up, they were afraid to do so in case their loved ones might not get the care and attention they deserved. We should ensure this practice will never happen again. As Senator Ryan has said, other Departments should look at this issue and examine their own codes of practice, particularly payment charges, to ensure they are above board.

Section 17(2) provides for the recovery of any moneys obtained through fraud or overpayment. Every euro must be repaid correctly and promptly. Given the enormity of the sum outlined earlier, due care must be taken that sums are repaid to the correct person or to those people's estates. Section 16 which is equally important provides for an appeals mechanism to be put in place for those who believe they may not have been dealt with fairly in the repayment process. Hopefully it will not be necessary to use this section but, if so, at least it exists.

I am pleased the Bill deals with the unfortunate situation of patients who have a degree of mental or intellectual impairment. It will ensure that where there has been a deterioration in the intellectual capacity of a patient, his or her rights are protected by the use of a patient private property account and that any funds accruing to the patient in this category will be used for the benefit of that individual and that the money can be invested on behalf of the said patient.

I heard somebody speak of applications made to the agency that will look after the payments that have not been acknowledged. These cases arise where families or people involved in the overcharging are waiting to recoup what has been taken from them. That is wrong because we are dealing with vulnerable people. They should at least be afforded a short letter stating that the application has been received and is being dealt with and that the agency will be contact in due course. Many of those people may have nothing else to worry about and may sit or lie all day long wondering if they filled in the form correctly or if it was received.

I commend the Bill and look forward to the subsequent Stages.

James Bannon (Fine Gael)
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I welcome the Minister of State at the Department of Health and Children, Deputy Séan Power, to the House to debate this important Bill. That the Bill is before the House is a miracle in itself given the number of major health Bills that go through the House each year. It is amazing that the Minister and her lame-duck Government was able to have it here at all. Apart from amending legislation, on average there has been one health Bill per year over the past three or four years. We waited ten years for the Medical Practitioners Bill, five years for the Pharmacy Bill, and legislation dealing with the HIQA and nursing is pending.

While waiting for the Minister to publish this Bill we were told the delay was due to the fact that outside companies were quoting €50 million to administer the scheme. I do not accept this argument. Given that it has taken the Health Service Executive five months to advertise for the first tender for the provision of the service, it was a ludicrous excuse for the delay in making the repayments.

What makes the excuse even more extraordinary is the fact that the HSE, despite the Minister's pessimistic and strangely negative views, is quite capable of administering the scheme. By proposing to employ consultants to undertake the repayments and by providing in the Bill for the recruitment of external administrators, the Minister is showing contempt for the HSE. In true Fianna Fáil-Progressive Democrats style the Government is adding €50 million to the list of incidents of taxpayer's money that has been squandered, including the PPARS fiasco a few months ago. "Easy come, easy go", will be remembered as the slogan of the Fianna Fáil-Progressive Democrats coalition. What is it that makes the Government embrace one financial fiasco after another and for how long can we continue to take such wanton and deliberate waste? Considering the repayments will cost the taxpayer in excess of €1 billion, how can the Tánaiste and Minister for Health and Children contemplate spending an extra €50 million on outside consultants when the HSE is paid, willing and able to do the job? This defies logic and makes the public wonder at the wastefulness of this incompetent Government. The Tánaiste should be here in person to explain why she has squandered many millions of taxpayers money as have other Departments in the Cabinet.

In view of the fact that in February 2005 the HSE began to collect information on those who may be entitled to repayments it is surprising the Tánaiste still seems intent on bringing in consultants to administer the scheme. The HSE has already competently managed the payment of over €20 million in ex gratia payments to over 10,000 people. The information, structure and expertise are all present in the HSE.

The Tánaiste's insistence on hiring outside consultants can only be interpreted as a vote of no confidence in the relevant section of the HSE. If it cannot manage a reasonably straightforward task such as this repayment scheme how will it cope with national health emergencies? There is evidence it is not coping with the crowds at accident and emergency units. Moreover incompetence has been exhibited in dealing with other areas of the health service such as providing adequate resources to home help and carers. All of this proves the Government's negligence towards and disrespect for the elderly in our society.

I will not accept the Tánaiste's word that the HSE is incapable. It is the Government that is incapable. We should point the finger at the Tánaiste, whom the dunce's hat fits well. The Tánaiste, in a burst of uncharacteristic haste, rushed through the Health Act 2004 which established the HSE and we are now paying the price. What was wrong with elected Members, the voice of the people, being on health boards? She has given them a mere talking shop role in the new HSE. People elected to local authorities all over the country are frustrated at the lack of interest shown by the Department of Health and Children in their views. I have received feedback, and I am sure my colleagues on the Government side of the House have heard the same, suggesting local elected representatives feel they do not have a role in the process. They say their piece but officials are anxious to get away and so on. I was a local representative for 19 years and it was always important to listen to the people on the ground, which is something this Government is failing to do.

Last Sunday the supporters of Dublin's Gaelic football team came to Longford and heckled the Taoiseach over his incompetence and being out of the country last week when he should have been at home finalising important legislation in the other House. People were disappointed and annoyed. He was hissed at on Battery Road in Longford.

John Dardis (Progressive Democrats)
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That is not relevant to the debate.

James Bannon (Fine Gael)
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I am pointing out the incompetence of the Government.

Geraldine Feeney (Fianna Fail)
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The Senator is not doing a very good job.

James Bannon (Fine Gael)
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I am not blaming the Tánaiste alone. However, she bears a large amount of responsibility for problems we have encountered in the health service.

There is nothing perfect about this Bill. The explanatory memorandum is totally inadequate and is almost identical to the press release announcing the publication of the Bill. The purpose of the explanatory memorandum is to explain the Bill section by section. Given that the legislation has taken a year to prepare, the lack of clarity in the so-called explanatory memorandum is inexcusable. What chances have the elderly got of gaining information from such a slipshod document? This does not apply only to my side of the House, I know members on the Government's side are very disappointed with it also.

My colleague Senator Browne has studied the various sections of the Bill that require amendment and, like the explanatory memorandum, are far from perfect. I will not waste time by going over ground covered by Senator Browne, Senator Ryan and other Members from this side of the House. In the interests of the elderly in State care every "i" must be dotted and every "t" crossed. Their hard work and sacrifice brought the country to its current position of financial strength and we owe them no less. These are the people who slaved in difficult times rearing large families and they have been treated shabbily. It is important that the Bill looks after them properly. Many of these people experience great anxiety, indeed some went to their graves worrying, and this Government has done little but neglect them.

Geraldine Feeney (Fianna Fail)
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The Senator's own party formed part of those Governments.

James Bannon (Fine Gael)
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Even today the Taoiseach said that for 25 years he has been either part of the Cabinet or on the Front Bench. The health boards have not been set up all that long. Consider how many years Fianna Fáil and the Progressive Democrats have been in Government since the health boards were set up in the 1970s.

Geraldine Feeney (Fianna Fail)
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Put it the other way, how long has Senator Bannon's side been in Government?

James Bannon (Fine Gael)
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They have been in Government for over 20 years of that period.

Geraldine Feeney (Fianna Fail)
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That says a lot about Senator Bannon's party.

James Bannon (Fine Gael)
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They must take responsibility for their neglect and wastefulness. The opinion polls indicate that it will not be long before the public tells this Government to get out and get lost.

Geraldine Feeney (Fianna Fail)
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The votes must be in the ballot box, never mind the opinion polls.

Brendan Daly (Fianna Fail)
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I welcome this legislation and thank the Minister of State at the Department of Health and Children, Deputy Seán Power, for the interest he has shown in caring for the elderly since his appointment to the office. The Minister had the opportunity to see some of the work relating to this issue in various institutions on a visit to County Clare. He would have been made aware of the dissatisfaction many people felt about this episode.

In a climate of financial buoyancy it is perhaps understandable that we have forgotten that during the period referred to by Senator Bannon many health boards were under severe financial pressure and had overspent on their budgets. At the time the Government made strenuous efforts to deal with overspending by the health boards and there was an outcry from the public. The Government had to do so, however, to deal with the financial crisis in which it found itself. I was in the Government from 1987 to 1989 and I am aware of the problems that were experienced in trying to bring the country's finances under control. It is easy to talk about the success of the health boards today but they ran up huge debts back then and it was in this light that severe restrictions were introduced in order to get them back in shape financially.

I recall requests from public representatives in many constituencies seeking the abolition of the health boards. They wanted the system to return to the control of the local authorities, where the changes were made in the 1970s. Many people felt there was insufficient local democracy in the health boards. Regardless, a situation developed wherein people were charged for services for which they should not have been charged. I will not go through that area again, it has been debated here previously.

It is important that we now press ahead with the legislation. I received refund application forms from the HSE during the week for people who contacted me and feel entitled to refunds for some of the payments they made. I recall the small hospital in Kilrush being closed circa 1987 because of the financial constraints on the health board at the time. A committee of local people got together, and with some small assistance from the national lottery, reopened the 21-bed institution and got it back on course again. They now have 55 patients in that hospital, which is run as a charitable organisation by local people, and are looking to extend the facility.

When those efforts were being made by the local voluntary committee to reopen the institution, there was substantial public response and an enormous voluntary effort provided to enable the get the hospital on the way. Televisions were provided by local people, a painting committee painted the entire institution from top to bottom, the building was modernised and with a very small donation by the national lottery, it has been providing a service for people who would not otherwise have been able to avail of such a service.

People are entitled to their refunds, but they might think seriously now about making donations to various institutions which have provided a very good service over the years. They are still finding things difficult and we all know the great cost these days of providing attention for an elderly person in one of the private or public institutions. Perhaps when the refunds are made, many people entitled to refunds might consider making donations towards the continuation of institutions in their own localities, similar to the hospital in Kilrush. We have many such institutions in County Clare which are dependent on some assistance from the national lottery or from the Department of Health and Children, but which are also greatly reliant on local voluntary efforts, church gate and door to door collections and fund-raising events such as walks, to support the installation of various equipment. When the refunds are made, perhaps some encouragement might be given to people, by tax incentives or otherwise, to make donations to these institutions which would help them to continue providing services at great cost, and provide extra accommodation which will need to be provided, especially in some of the western areas where there will be a continuing need for more beds. Difficulties will arise again. We are currently in a healthy financial position but it might not always be that way, and since we are in such a position, those who benefit from this legislation might consider making some charitable donations towards those institutions to enable them continue the work they are undertaking.

Martin Mansergh (Fianna Fail)
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I welcome the Minister of State and the Bill, which seems to set up a model administrative system for the repayments. Undoubtedly there are some uncanny echoes in this episode, now going back a couple of years, of what happened last week, where the constitutionality of a provision that has been there for a long time was called into question.

In politics, one cannot often be responsible for the crises which come at one, but one should be judged on how one handles them. Regarding this issue, the Tánaiste was not long in office when the alarm bells started ringing, and she has handled the matter well. There seems to be a broad consensus in the House that some deduction for payments for care were justified, but equally that they had to be on a clear legal basis. One could not have a situation where payments were being deducted on dubious legal authority. The first Bill produced was referred to the Supreme Court, a sensible precaution by the President to judge its constitutionality. The thinking then had to be revised and this repayments scheme instituted. Whatever criticisms people may have about practices of successive Governments, I do not think there can be any serious criticism of the system of repayment now being put in place.

I get a little tired of the rather low level political charges which characterise the contributions of Senator Bannon. I would like to think we could debate these matters calmly, and while I might be tempted, I am not going to go into instances of incompetence, real or alleged, under other Governments. I do not know if the public wants that. It wants a system whereby if something has gone wrong, it will be put right as efficiently and expeditiously as possible.

I note there is a sort of Pavlovian ideological reaction on another side of the House when there is any question of getting some outside or private firm, with experience in a particular field, to manage a function. I have a pragmatic attitude in most instances, though certain core functions should be left to the public sector, but I do not believe this scheme of repayments necessarily falls into that category. Much play was made of the Government's use of consultants. I regret in some ways — this is true of all governments — the loss of confidence in decision-making, or of one's own ability within one's own departmental resources to take decisions without having to bring in consultants to double-check matters. However, fairly large sums of money are involved and I suppose people, especially civil servants, but also politicians, want to be protected from precisely the charges of incompetence which were flung across the House a few moments ago.

Nevertheless, I do not think that employing consultants necessarily protects a government from things going wrong. One can see that in this country and in Britain, with regard to information technology brought in to perform certain tasks, and perhaps being asked to do tasks which are too ambitious for the state of the technology. The marketing people do not honestly admit that. It is a real problem that needs to be reflected upon. If I was in the Minister's position, my instinct would be to employ the minimum of consultants to save the public purse. One must ask if in certain circumstances that might be a false economy. If one makes a decision without full knowledge of the facts it may end up costing more. That is a matter for reflection and self-critical debate in the public service and political system. It must not be simplified by heated political charges about one system or another.

I liked the devolved system of decision-making of the former health boards, introduced by Erskine Childers in the 1970s. Perhaps it was not functioning efficiently and it was time to change the process. I do not go along with the populist argument that it is wrong for the man who is running the health service on a day-to-day basis to get any kind of bonus. He is running a large and vital public service. The petty begrudgery, loved by the popular media, will get us nowhere in this matter.

Senator Daly spoke about the closure of small hospitals in 1987 and 1988 due to financial stringency. Many of them could now have a function as convalescent step-down facilities for acute hospitals. Just as we are reopening railway lines, we could reopen these hospitals for specific functions which they are capable of performing.

Paul Bradford (Fine Gael)
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I welcome this long overdue Bill which I want speedily enacted so that the repayments scheme can get under way in the near future. I hope the energy put into this debate, with the political excitement and the public anger about nursing home repayments, will be matched in the broader debate on care for the elderly. Care for the elderly is not just about nursing homes or securing a bed for an elderly relative in a local nursing home. We must ensure the elderly can be looked after in their communities and with their families for as long as possible through the carer's allowance and other grants and schemes. A national debate is needed on care of the elderly. Although the Bill is important in righting a wrong that was done, the real wrong is our inability to allow the maximum number of elderly people to reside where they prefer, which is in their communities with their families or in their homes.

Timmy Dooley (Fianna Fail)
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The real wrong that is being done is that unfortunately this money will now be used to facilitate families whose loved ones are deceased. In many cases the money would be better spent in the provision of services and facilities for the care of the elderly. It is the first time since I was elected to the House that I have not welcomed a Bill. While I recognise its necessity to address certain technical issues, it is sad that this kind of money is committed. In some cases, it is seen as a second SSIA. Families concerned are wondering how to split up the proceeds from parents who are long since deceased and where they will take their holidays with the money. It brings out the worst trait in human behaviour. It will work against the provision of the services needed for care for the elderly.

Seán Power (Kildare South, Fianna Fail)
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I thank those Senators who participated in the debate. I welcome the broad support from most Members for the introduction of the legislation. The enactment of the Bill will be a key milestone in ensuring repayments will be made as promptly as possible to all those who were wrongly charged for publicly funded long-stay care. Senator Quinn accused the State of stealing this money. I am not happy with the use of the word "stealing" in this case. My understanding of stealing is that it refers to someone taking something without the knowledge of the owner.

Fergal Browne (Fine Gael)
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That was the word used by the Taoiseach to describe Willie Walsh's behaviour.

Seán Power (Kildare South, Fianna Fail)
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While there was no clear legal basis for the practice, it went on for a long time. It was done in good faith. The majority of the people receiving care did not object to making the contribution towards the cost of their care and were happy to make that small contribution. The Government fully accepts the judgment of the Supreme Court and on foot of that, the Bill was introduced.

The legislation will provide a framework to enable repayments to be made to all those alive and the estates of those who died since 9 December 1998. They will be refunded the charges from the time they were charged to 9 December 2004 when they ceased.

In recognition of the special needs of those in long-stay care, the Bill will put in place appropriate safeguards to protect those who may not have the functional capacity to manage their financial affairs. This will prevent resort to wardship or the use of widespread psychiatric assessments which could substantially delay repayments being made. The scheme will apply to fully eligible people, that is medical card holders and those aged over 70 years with effect from July 2001. To ensure repayments are made in an equitable manner, those without a medical card on admission to long-stay care but who fell within the income means threshold for a medical card, will be regarded as having full eligibility for the purpose of the scheme. It will include those patients in publicly funded long-stay care, in public-contracted beds in private nursing homes and in receipt of inpatient services in community-based facilities.

The tendering process for design of the repayment scheme was implemented. The Health Service Executive decided on the appointment of a preferred service provider at a meeting of its board on 1 June 2006. No information can be made public on the preferred service provider until an interval of 14 days has elapsed. No substantial query or objection has been made by any of the unsuccessful bidders.

Senator Ryan asked why a private company was appointed. Since it was the State which took the money from these patients, it is important to have an independent party involved in administering the scheme. Not only does it reassure the public but it is important the scheme is introduced quickly. Members have been critical of the Tánaiste and Minister for Health and Children on the appointment of an outside company. The Health Service Executive indicated it is not in a position to administer the scheme. It is not its core function anyway. Some Members believe 200 people in the executive who could do this task are sitting in a room, scratching themselves, looking for work . It was important to get a company with experience in large repayment schemes. This is the largest repayment scheme undertaken in the history of the State. It is important that the money is given to the patients affected as quickly as possible.

Senator Mansergh summed up Senator Bannon's contribution fairly well. It is with some reluctance that I would even reply to Senator Bannon, and this notion of throwing out any figure one likes so that it might stick. Senator Bannon wondered why anyone would contemplate paying €50 million to an outside company to administer the scheme. The good news for Senator Bannon is that we are not contemplating it either.

The application process, as I mentioned earlier, will be as simple as possible. January 2008 is the deadline for submitting applications, not for the making of repayments. Valid applications will be paid until all have been dealt with. Fully eligible persons currently in care and those who have left care recently will be readily identified by records held by the institution. The HSE will ensure applications are submitted on behalf of those in the care of the HSE who are unable to make the application themselves due to a physical or mental disability, or ill health.

The application process will identify the personal representative in the case of estates and will also provide the necessary documentation to help protect the State against fraudulent claims. Applications will be processed as quickly as possible after they are received and the uppermost consideration will be to ensure that a relevant person receives the full amount of repayment due to him or her.

Consideration was given to the inclusion of a deadline for making repayments. However, a deadline was not included for practical reasons, especially due to instances where patients were in long-stay care over an extended period of time and possibly in multiply institutions. To date, the HSE has received 22,000 registrations of interest for repayment. In order to ensure that those eligible for repayments are aware of their entitlements an extensive communications process will be developed around the scheme and this will include television, national and local radio and newspaper advertisements including advice and assistance on how to apply.

The scheme contains a provision to enable those due repayments under the scheme to donate all or part of the repayment specifically for one-off improvements in public health services for older people and persons with disabilities. The fund will only be used to provide for improvements which would not otherwise have been met by an allocation from the Minister for Finance or any other Minister.

The scheme includes an independent transparent, user-friendly appeals process and the Minister will appoint suitably qualified independent appeals officers to consider appeals. Regular reports on the operation of the appeals process will be laid before the Oireachtas. All applicants will be advised of their right to appeal and how to make an appeal, and applicants will also be informed of their right to bring a complaint to the Office of the Ombudsman.

The overall cost arising from the long-stay charges repayment scheme has been estimated at €1 billion. An appropriate allocation for 2006 will be made when legislation is passed by the Houses of the Oireachtas and the balance will be required in 2007 and 2008.

If I have time, I will deal briefly with a number of queries raised. Senator Browne asked about the tendering process and wondered whether the second process would be any better. While I cannot give him figures here today, the HSE has indicated there is a significant saving by having the second tendering process and that it will work out much cheaper than was originally proposed in the first round. On the possibility of a challenge, we live in a democracy and anyone who wants to challenge the legislation is entitled to do so. We are happy that the tendering process was fair and above board.

Senator Norris expressed concern that we had not used the word "regret". We very much regret what happened, that we took money from people without the proper legal framework to do so. We are sorry for that. While I suppose words are one way of expressing regret, repaying them might be appreciated all the more and that is what we are doing.

The processing of applications will begin this month. There will be no delay. The money is being provided and we have no wish to delay the process of the applicants receiving their money. We hope that this process can be done as quickly as possible. In reply to Senator Feeney, the repayments will also include interest in accordance with the consumer price index. I hope I have dealt with most of the queries raised.

Fergal Browne (Fine Gael)
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Will the Department write to inform the people concerned?

Seán Power (Kildare South, Fianna Fail)
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Some months ago we set up a helpline where people could telephone and register. Anyone who telephoned and registered on the helpline was given a number. As I stated earlier, there will be a major publicity campaign informing people of how to apply.

Mary O'Rourke (Fianna Fail)
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Will that include telephone numbers?

Seán Power (Kildare South, Fianna Fail)
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Yes. It will be as clear as possible.

Fergal Browne (Fine Gael)
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A direct mail shot would be useful.

Paddy Burke (Fine Gael)
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We are in injury time.

Seán Power (Kildare South, Fianna Fail)
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I will not delay the House any longer. I thank the Members again for their contributions. I would be happy to have this Bill processed through the House as quickly as possible so that the moneys can be repayed to those who really own it.

Paddy Burke (Fine Gael)
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When is it proposed to take Committee Stage?

Mary O'Rourke (Fianna Fail)
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Next Tuesday.

Paddy Burke (Fine Gael)
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Is that agreed? Agreed.

Paddy Burke (Fine Gael)
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When is it proposed to sit again?

Mary O'Rourke (Fianna Fail)
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At 10.30 a.m. tomorrow.