Ulick Burke (Fine Gael)
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I thank the Cathaoirleach for selecting this item for discussion. What is happening in the Health Service Executive, HSE, western region in regard to providing for the needs of the elderly is nothing short of a scandal and it greatly discriminates against the elderly in the west. The failure of the HSE to rectify the position must be seen as a failure in the organising and carrying out of its functions. The Minister should intervene and address it. The Government's failure to recognise the needs of elderly people cannot be allowed to continue.

Some 20% of the total population who are aged 65 years and older live in the west. County Galway has the highest percentage of people in that age bracket of all of the HSE western counties, which represents a substantial proportion of the total population. The area of greatest concern is the inequity between the HSE western area, County Galway in particular, and the HSE eastern area covering Dublin. In County Galway the maximum rate of subvention for a private nursing home is €190 per week, whereas a person with less or, in some cases, more means can receive a subvention of €600 in the eastern region. Why does that level of discrepancy exist? We cannot find the answer to that and we do not know who will be responsible for it.

The O'Shea report clearly outlines three reasons for the difference, including the different treatment of assets between the HSE regions. In other words, in the western region, an assessment of the assets of a person — each and every penny he or she has — is taken into account, as against the position in the eastern region where there is wide variation in the interpretation of assets. That difference accounts for one reason in the variation in the level of subvention. Another reason is the different rules governing who is entitled to what are termed "contract beds". There is also the difference in eligibility for enhanced payments and the application of those.

We are told that the responsibility for private nursing home subventions at senior management level varies from health board to health board and from programme managers to regional managers to co-ordinators of services for elderly people. While such a variation in level of subvention exists, there will be no consistency and hence elderly people in the west and the HSE western area are falling out.

The differences in assessment of needs and the way in which they are interpreted has caused a problem. Added to this, the assessment of social factors also varies. According to the O'Shea report, assessments tend to include a social variable which takes account of the social, democratic, spatial, housing and family need circumstances of the older person. There is a strong subjective element in the consideration of social factors in placement of decision-making, which further exacerbates the position. The position with regard to the dependency assessment for the purposes of awarding subvention is therefore unsatisfactory. That is stated on page 54 of the O'Shea report. It clearly states that such assessment is unsatisfactory.

The variation of assessment in application of rules has led to both horizontal and vertical inequities in the treatment of older people applying for subvention both within and among the health boards. People with the same level of dependency are not being treated in the same way and there is a wide variation among the health boards in the proportion of applications being awarded subventions in the dependency categories which are placed. This leads to an unacceptable variation throughout the country.

In County Galway some 804 people are on the standard rate of dependency and 340 of those are on the enhanced rate. There is a wide gulf in regard to the rates at which they get that enhancement compared with the percentage in Dublin. Such variation is unsustainable. I ask the Minister of State to request the Minister for Health and Children to rectify this position immediately. It is not a case of Galway versus Dublin; it is a question of the provision for the needs of people in the west where there is a high percentage of people who are in the dependency category, the number of whom are increasing rapidly. This matters requires urgent attention, and the sooner the better.

Batt O'Keeffe (Cork South Central, Fianna Fail)
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I am pleased to have this opportunity to deal with this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank the Senator for raising the matter as it provides me with an opportunity to outline to the House the current position with regard to the nursing home subvention scheme.

A nursing home subvention may be paid towards the cost of private nursing home care, where a person is unable to meet the cost and where he or she has been assessed as needing nursing home care by the Health Service Executive and where the person has also satisfied a means test. The amount of subvention granted will depend on the degree of nursing home care required, that is, medium, high or maximum level, and it will take into account the amount of the person's assets, including property, stocks and shares, savings, etc. The rates of subvention payable are as follows: in the case of medium dependency, the rate is €114.30 per week; in the case of high dependency, the rate is €152.40 per week; and in the case of maximum dependency, the rate is €190.50 per week.

The nursing home subvention scheme was introduced to assist with the cost of private nursing home charges and was never intended to cover the entire cost of nursing home care. Under article 22.3 of the Nursing Home (Subvention) Regulations 1993, the HSE may enter into an arrangement with a registered private nursing home to provide inpatient services under section 52 of the Health Act 1970. In making such an arrangement the HSE may pay more than the maximum rate of subvention, relative to an individual's level of dependency, in cases where, for example, personal funds are exhausted, in accordance with article 22.4 of the Nursing Home (Subvention) (Amendment) Regulations 1996. The application of these provisions, however, is a matter for the HSE in the context of meeting increasing demands for subventions. The average rate of subvention paid by the HSE generally exceeds the current approved basic rates mentioned above.

Spending on the nursing home subvention scheme has increased from €5 million in 1993, when it was introduced, to a figure in the region of €140 million in 2005. The Government allocated an additional €20 million towards the nursing home subvention scheme for 2006 to provide for extra subvention payments and to address the variations in payments in different areas, as alluded to by the Senator.

The projected expenditure on nursing home subvention, which includes enhanced subvention for the HSE western region in 2006, is €48,591,000. The HSE western region provides subvention and enhanced subvention on an individual needs basis in line with current legislation, namely, the Nursing Home Act 1990, and regulations, that is, the Nursing Home (Subvention) Regulations 1993. Applications for enhanced subvention are dealt with on a case by case basis in each local health area. The supports paid by the HSE vary from person to person and region to region, depending, for example, on nursing home fees.

The Health (Nursing Homes) (Amendment) Bill 2006 is designed to ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and to help the HSE to implement the scheme on a standardised basis across the country. In addition, national guidelines on nursing home subvention are currently being developed by the HSE to ensure an even and equitable application of the scheme nationally.

The future of residential care funding was discussed by the social partners as part of the Towards 2016 negotiations. The ten-year framework social partnership agreement 2006-16 states that there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. In addition, the agreement also states that the level of State support for residential care should be indifferent as to whether that care is in a public or private facility. The Department is currently drawing up proposals as agreed with the social partners in Towards 2016.

Ulick Burke (Fine Gael)
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In cases where a glaring inequity between one patient and another existed and equalisation measures are put in place, will retrospective compensation be given to those who were penalised by the system, particularly in the west?

Batt O'Keeffe (Cork South Central, Fianna Fail)
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The question of retrospective payment does not arise because in each area the subvention depends on the cost of the nursing home care. Nursing home care costs differ greatly between areas like Dublin, Cork, Galway and areas of rural Ireland. In some rural areas, the costs of care are much lower than in others. I do not envisage any retrospective payment being made. There will be some equalisation of the system but that will always take into account the cost of the nursing home in the specialised area, the ability of the individual to pay and his or her income and assets.