Rory Kiely (Fianna Fail)
Link to this: Individually | In context

I remind Members that a Senator may speak only once on Report Stage, except the proposer of an amendment who may reply to the discussion on the amendment. Also on Report Stage, each amendment must be seconded.

Fergal Browne (Fine Gael)
Link to this: Individually | In context

I move amendment No.1:

In page 10, to delete the figure inserted by Government amendment No. 14 at Committee and substitute "€20,800".

I again welcome the Minister of State and his officials to the House this week. I raised this point during the Committee Stage debate last week and the Minister of State should take it on board and accept it. On Committee Stage, the House amended the upper annual income limit for applicants from €9,000 to €10,400, to bring it into line with the pension rates. I have looked into this subsequently and in the 2005 budget, the Minister introduced a guideline to the effect that pensioners were allowed to earn an additional €100 per week without affecting their pensions in any way. This was increased to €200 per week in this year's budget.

My amendment is an attempt to bring the Bill in line with Government policy. The Government has stated that in addition to receiving their pension, pensioners are allowed to earn up to €200 per week. My figure of €20,800 is an approximation of what would be involved were someone to have a pension and to be earning extra income. It is possible that someone who worked on a part-time basis could suddenly become ill and would be obliged to enter a nursing home. This income would be held against him or her on entry to the nursing home.

Moreover, consideration should be given to index-linking this sum, as it will go out of date continually. I assume that regardless of who will be in power, next year's budget will increase the pension again. This will also happen in subsequent years and this sum will require continual revision. My amendment is genuine and the Minister of State would be foolish not to accept it, unless he possesses additional information. It is in line with Government policy as outlined in a guideline that allows pensioners to earn additional income without affecting their pensions. This is all I seek to do.

Mary Henry (Independent)
Link to this: Individually | In context

I second the amendment as this is a good point. Senator Browne only asks that these sums should be in line with Government policy and the Minister of State should accept this amendment. Moreover, the issue of indexation is highly important. I was under the impression that a general decision had been made that this would be the case. While such a decision may cover this issue, if not, I hope this proposal will be included within the Bill.

Brendan Ryan (Labour)
Link to this: Individually | In context

Lest my silence might be interpreted as disagreeing with my colleagues, I repeat that I have no inherent objection to requiring older people who are in long-term care or in nursing homes to make a contribution. My problem has always been with means tests. Means tests are either so severe that they exclude vast numbers of people or, if they are limited to determining those who can afford to support themselves, the cost of processing the tests is greater than the savings made.

Given the incidence of poverty among older people, the sum of €10,400 as the upper income limit at which they would be entitled to full financial support is offensively small. Effectively, it states that anyone who is in any way better off than poor is able to pay for themselves or to make some contribution. This is not true and I support the amendment as a reasonable attempt to decide on a reasonable figure.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

I thank the three Senators for their contributions, in which a number of issues were raised. I do not propose to accept the amendment and I will explain the reason.

The figure of €10,400 contained in Committee Stage amendment No. 14 is not a simple income threshold. An individual with the State pension as his or her only income and with no other assets would be eligible for the maximum level of subvention. Instead, this threshold should be read in conjunction with the property threshold. The increase in the basic maximum rate of subvention to €300 per week means that a person in receipt of the State pension with a house worth up to €364,000 and with no other income and assets may now just qualify for basic subvention. This constitutes a significant improvement on the past. In order not to hinder the potential for people to now qualify under this new increased rate, it was necessary to increase the property threshold and the related income threshold, to €365,000 and €10,400, respectively.

However, these are only technical amendments and will not prevent someone from receiving a subvention as the means assessment, as previously mentioned, will enable those with assets of up to €365,000 and a modest income to qualify for support. This is because it is the financial means assessment and the imputation of income from the principal private residence under that assessment that affects people's qualifying subvention and the amount they receive. The 5% imputation in the means assessment kicks in and makes all the difference.

However, it should be noted that the HSE has issued guidelines on the standardised implementation of the nursing homes subvention scheme for 2007. The guidelines clarify that the HSE will assess all applicants for subvention and will not automatically refuse an assessment on the basis of property thresholds. Although in general, applicants with properties in excess of €365,000 will not qualify for basic subvention, the 15% cap now means that after three years, the value of the property will be disregarded. In other words, if someone who has been in long-term care for more than three years now applies, no imputation will be taken in respect of the value of his or her home.

Brendan Ryan (Labour)
Link to this: Individually | In context

Is that on the assumption that such people will have been obliged to sell their homes by then?

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

Moreover, the HSE may still consider such individuals for enhanced subvention and consequently, although the figure of €10,400 could be raised, it would be futile to so do. It could also raise public expectations unfairly and arguably, it could be seen as being misleading, as people with houses valued at more than €365,000 and with income of €20,800 would not be eligible for subvention, by virtue of the means test and the income imputed from their properties.

Senators Henry and Browne both mentioned the possibility of indexation. While I appreciate their argument, it is inappropriate on this occasion. Later this year, the Government will introduce a new nursing home support scheme, namely, a fair deal on long-term nursing home care. As it will not contain any income, property or wealth thresholds, including indexation in this Bill would serve no purpose. Under the proposed new scheme, which will take effect from 1 January 2008, everyone will be eligible to apply for support.

As for the issue on social welfare raised by Senator Browne on Committee Stage and again today, the earnings disregard for non-contributory pensions is now €200 per week. This means that income from employment of €200 per week is disregarded in the means test for State pensions. The underlying reasoning is simple, namely, those who wish to continue in employment after reaching the normal retirement age should be, as far as possible, facilitated and supported. While this in no way affects the financial assessment for subvention applicants, it should be noted that this is less than the amount of income that is disregarded under the financial assessment for subvention.

Rory Kiely (Fianna Fail)
Link to this: Individually | In context

Amendments No. 3 is an alternative to amendment No. 2, therefore, amendments Nos. 2 and 3 may be discussed together by agreement.

Brendan Ryan (Labour)
Link to this: Individually | In context

I move amendment No. 2:

In page 17, to delete lines 13 to 19 of the text inserted by Government amendment No. 25 at Committee and substitute the following:

"(2) The Health Service Executive shall publish all information supplied to it under subsection 1(a) and may for statistical purposes retain and process information given to it under subsection (1) provided that information supplied under subsections 1(b), 1(c) and 1(d) is not publicly disclosed except in the form of a summary so compiled so as to prevent particulars relating to the identity of any person for whom any home care provider provides home care services being ascertained from it.".

The Cathaoirleach knows I never disagree with him. However, I do not agree these amendments are alternates for an important reason. My amendment is almost identical to that of the Minister of State. It states the Health Service Executive shall publish all information supplied to it under subsection 1(a), which is the identity of the home care provider. The Minister of State's amendment states the information may be publicly disclosed. Mine uses the word "shall" while the Minister of State's uses the word "may".

With all due respect to the Cathaoirleach a difference exists between them. This difference goes back to a view I have held for 20 years on the public's right to information. The Minster of State will quote vast volumes from the Office of the Parliamentary Counsel to show that "may" means "shall". It does not. We have plenty of evidence in legislation to show if a Government wants something to happen the word "shall" is used and if it wants to leave a little wiggle room it uses "may".

God knows what reason the HSE might find to delay, slow down or hold up publication of the names of people. People might regard it as commercially sensitive and such information is precluded from release under the Freedom of Information Act. It is one reason for not disclosing information. Given that the Minister of State uses the word "may" a home care service provider could object to it, leading to a long rigmarole.

Am I causing the Cathaoirleach——

Rory Kiely (Fianna Fail)
Link to this: Individually | In context

The amendments are not being taken together because they are the same; it is because one is an alternative to the other.

Brendan Ryan (Labour)
Link to this: Individually | In context

I agree a large overlap exists.

I am glad the Government tabled its amendment. It would have been an unfortunate omission to leave the Bill as it was. While I do not wish to blow my own trumpet this is the third time in less than two years I had to point out errors in legislation. The National Economic and Social Development Office Bill had a section prohibiting Members of the Oireachtas from being members of the National Economic and Social Forum. Prior to the summer of 2005 we dealt with the issue of institutional redress. As the legislation was written, people who wished to appeal could not do so themselves.

I wish people would read their amendments and by that I do not mean the Minister of State. Sometimes the errors stand up and hit one, as this one did, the minute one reads it. Although I was poorly prepared that day because I was busy with something else, as soon as I read the amendment on Committee Stage it was obvious either it had malicious intent, which from the moment the Minister of State spoke I knew was not the case, or a mistake had been made. It would have slipped through if we had not delayed Report Stage for a week. I am grateful to the House for delaying it.

I apologise for straying.

Rory Kiely (Fianna Fail)
Link to this: Individually | In context

The Senator was straying.

Mary Henry (Independent)
Link to this: Individually | In context

I do not wish to be accused of straying.

I second the amendment. It is much better to have openness in this area. Commercial sensitivity is pleaded far too frequently including with regard to the National Treatment Purchase Fund. I got that point in before the Cathaoirleach stopped me. One knows the ire caused by the fact one cannot find out what are the costs of various procedures and operations because it is considered commercially sensitive.

Not unnaturally, public hospitals feel they are shabbily treated. If they were given more funds they might be able to do at a much reduced rate what is done in private hospitals. We still have the spectacle of consultants from public hospitals in a position to carry out procedures in private hospitals or in public hospitals on Saturday mornings under the National Treatment Purchase Fund.

We must consider the economics of these issues and stop talking about matters being commercially sensitive. Senator Ryan brought up a good point. I accept the Minister of State's amendment goes some way towards ameliorating the situation. Perhaps he will also consider Senator Ryan's amendment.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

As Senator Ryan indicated, he raised the issue of disclosure of information relating to home care providers on Committee Stage. It was a valid point and I thank him for bringing the issue to the fore. He stated he was poorly prepared.

Mary White (Fianna Fail)
Link to this: Individually | In context

He was on the ball.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

It is just as well we do not meet him too often on a good day.

People often question the role of the Seanad and its necessity. Senator Ryan showed the role the Seanad has, particularly that of a vigilant Senator, in checking legislation.

Brendan Ryan (Labour)
Link to this: Individually | In context

The Minister of State should stop or I will begin to blush. I am not used to this.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

One should give recognition when it is due.

Brendan Ryan (Labour)
Link to this: Individually | In context

I appreciate that and I thank the Minister of State.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

Senator Ryan made a good point which we took on board and acted on.

Brendan Ryan (Labour)
Link to this: Individually | In context

Will the Minister of State accept my amendment?

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

I gave the Senator the good news before the bad news.

Brendan Ryan (Labour)
Link to this: Individually | In context

I had a funny feeling there would be a sting in the tail.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

It is not proposed to accept amendment No. 2 and when I explain Senator Ryan will accept my point. We often spend time considering the words "may" and "shall" when discussing legislation. Amendment No. 3 is more appropriate with regard to publishing or making available information. The reason for not accepting amendment No. 2 is not because we do not see the merit in the principle behind what is suggested. However, a few small differences exist between what the Senator proposes and what we propose based on advices received.

Amendment No. 3 takes on board the point raised by Senator Ryan and is similar in spirit but different in the detail to amendment No. 2. Most importantly, the reference to the non-disclosure of details collected on home care providers has been removed. It was only ever intended to protect the personal details of individual persons and not companies. This what the Bill will do if amendment No. 3 is accepted.

I strongly stress the reason behind the original amendment was to collect statistics on the provision of home care which could then be used to evaluate and make improvements to the services provided. It was never intended to establish a system whereby the HSE would collect information on home care providers but would not make it available to the public. No secrecy issue arises. The HSE provides information on home care companies working in particular localities to individuals on a regular basis. We will not in any way hinder that in this Bill.

Senators will see we will not only remove the non-disclosure clause on home care companies but we will also remove it from individuals in receipt of home care. I assure Senators this in no way means details relating to such individuals will be made public, except in statistical format. Anything else would be unacceptable and unthinkable. We will remove this clause because we received advice that to specify in the Bill such details will not be disclosed is redundant insofar as a statutory duty to protect privacy already exists.

The Data Protection Act 1988 already applies to all personal data held by the HSE. Under the Act, while the collection of such data is legitimate the HSE is obliged to protect the privacy of individuals by not disclosing the information to others and by not using it without further consent for purposes other than those stated, which in this case is for statistical purposes. In addition, the Health Act 2004 places an obligation of confidentiality on all HSE staff. Therefore, I assure Senators data on individuals in receipt of home care is already well protected in legislation.

Amendment No. 3 addresses a key concern raised by Senator Ryan, namely, that the HSE would collect the details of private home care companies but would be able to release this information only in statistical format. This amendment specifically provides that information relating to the names and addresses of companies providing private home care may be publicly disclosed by the HSE. The amendment does not oblige the HSE to publish every piece of data received as the burden of so doing is considered unnecessarily onerous. Questions also arise as to how they would be published, in what format and how often, etc. The crucial point is that the information collected can be made available to the public at any time, as is the norm with information collected by the HSE and other bodies. This provision will now give the HSE power to do that for reasons of transparency and openness.

The reference to the publication of data on home care providers relates only to legal persons. A home care provider is defined in the Bill as a natural or legal person who provides, at a charge, home care services. Where the person is a legal person, in other words a business set-up to provide home care services for profit, the Bill will now clearly provide that the HSE may publish its details. However, where the provider is a natural person, this individual may not want his or her name made public, for obvious reasons.

Most individuals providing home care services do so free of charge. Where a charge is raised, it is simply to cover expenses such as transport costs or may constitute what may be considered pocket money. This is not the same as providing home care services for business purposes and most individuals carrying out such work do not make a profit. For reasons of data protection and individual privacy, while we have provided for the public disclosure of any information collected in statistical format, the HSE now has the explicit power to publish the names and addresses of private home care providers where such providers are companies. This means the public will be able to avail of details of private companies while individuals in receipt of home care, as well as those providing home care directly and not through a company, will remain fully protected from any of their details being made public.

Brendan Ryan (Labour)
Link to this: Individually | In context

I have learned the hard way to be wary of any Government explaining that it does not want to make public disclosures because they may become too cumbersome. In my experience of a variety of Governments in the past 25 years all disclosure is deemed too cumbersome so their instinct is to disclose as little as possible. It is a pity the Minister of State did not say explicitly which data must be published but I will not make a huge issue out of it. I accept the HSE will publish information because it is beginning to develop an understanding that disclosure is better than the opposite. The best way to deal with public complaints is to put everything out in the open, because the case can be better made, rather than selectively withholding information. The delays in publishing the report of the inquiry into Leas Cross probably did more harm to the image of the HSE than the contents of the report itself. The public perception that, for whatever reason, the HSE was reluctant to publish made the disclosures, when they finally came, appear even worse than they actually were.

I am sorry the Minister of State will not accept my amendment. I dream about these things but I appreciate his kind words, which were nothing less than what I would expect from a man for whom I have considerable regard. He is nearly from my own parish so I have little choice in that.

Camillus Glynn (Fianna Fail)
Link to this: Individually | In context

This is a mutual admiration society.

Brendan Ryan (Labour)
Link to this: Individually | In context

I have held him in high regard for some time. He has also been helpful to my family on a few occasions.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

This is a straightforward technical amendment relating to correct referencing on foot of advices received from the Bills office.

Fergal Browne (Fine Gael)
Link to this: Individually | In context

I am not happy with this Bill and can envisage it causing major problems for both HSE staff, who must try to work out rates of subvention, and patients and their families. The Minister should consider my earlier suggestion as a way to encourage private health insurers to give customers the option of paying extra for their premia——

Rory Kiely (Fianna Fail)
Link to this: Individually | In context

The Bill has now passed and we cannot discuss it again.

Fergal Browne (Fine Gael)
Link to this: Individually | In context

I wish to comment on the Bill following its passing. Not everybody ends up in a nursing home. I believe the figure is less than 10%. However, for those who do, it is very expensive and a mechanism for planning ahead will avoid having to take the family home into account. Selling it, whether before or after the person's death, will be awkward.

I suggest that when the Government intends to give detailed replies to amendments in the future, Ministers provide copies of their replies to Opposition Members so that we can read them, as most times they go over our heads and it does not serve democracy very well. We could look through them and pick out details to scrutinise, which is our job.

I am not happy with the fixed, rather than index-linked, amounts in the Bill, which will be a problem for the next Minister for Health and Children, or the relevant Minister of State.

Mary Henry (Independent)
Link to this: Individually | In context

I congratulate the Minister of State for the way he has brought this Bill through the House. I support the Minister's belief that people should be looked after in their own homes for as long as is possible as that is what the vast majority want. People in hospitals who are old and dying only wish to get out again and return to their own home. I have heard them say so many times and it is very important we help them in that way.

In recent years, Government policy has been to rely very much on private nursing homes. I have no philosophical argument with that but we must consider the level of trained staff in private nursing homes and their ability to support patients as death approaches. The situation is not like in public hospitals, where there were many trained nurses who knew that, for all of us, an end would come at some stage.

I have had the unfortunate experience of being in the accident and emergency department at St Vincent's Hospital, not that I was in a particularly bad way. I was very well treated but saw three elderly people who were close to death and had obviously been brought in by people who were panicking about what might be said to them had they died in a nursing home. However, they were going to die and an accident and emergency department is no place to die. Worse still is an acute bed in a hospital.

I am aware the Government intends bringing forward further legislation on nursing homes but we must ensure the patient's welfare, both in life and through death, is properly protected. Hospices provide a wonderful palliative service but they cannot be everywhere so we must enhance the training of staff in private nursing homes, who require more support than those in public nursing homes. Over 50% of the beds in the Dublin area are now in private nursing homes, which represents a huge change because it used to be between 20% and 30%. It also puts a huge burden on accident and emergency units and on acute beds. It is unnecessary from the point of view of the hospitals and very wrong from that of the patient.

Brendan Ryan (Labour)
Link to this: Individually | In context

I thank the Minister of State for the spirit in which he dealt with our little complaints. I appreciate his good humour and willingness to respond.

Like my colleagues, I do not regard the Bill as a momentous event. We have not yet started to embrace the gradual change to an ageing society, which is not as dramatic as scaremongers would have us believe. There is a resistance to the idea of universalism in the provision of support for the elderly. The story described by Senator Henry is hair-raising and distressing and must be addressed.

I have a simple belief, namely, all ways of doing something should be rational. It is irrational for the Bill to distinguish between house prices in what is called the Dublin area and elsewhere in the country. A gradual banded spread of 20 km to 50 km in radius might be rational, but basing this provision on the Dublin area and north County Wicklow, which is probably more expensive than parts of County Dublin, is irrational and makes for arbitrariness on the part of decision-makers. The HSE is so big and unresponsive that to allow arbitrariness to creep in is a mistake.

Nevertheless, it is better to have something rather than nothing written down. It is a step forward and a recognition of a work in progress. The Minister of State informed the House that there will be further legislation, which will be the case irrespective of who is in power, but if there is a change in Government, that legislation will be different than what is currently intended.

Camillus Glynn (Fianna Fail)
Link to this: Individually | In context

I thank the Minister of State and my colleagues on all sides of the House for passing this important Bill, which brings into focus the need for people in the medical field to pursue careers in geriatric medicine and geriatric nursing. That people are living longer is to be welcomed. A related debate focuses on what role people in their winter years can play in society. In many respects, they are an under-used resource, which is regrettable.

I will not delay. References pertaining to further legislation are welcome. Everything going well after the big day, I trust that we, like democrats, will be back here agreeing to differ on these points instead of arguing on them.

Brendan Ryan (Labour)
Link to this: Individually | In context

We will be on different sides. Senator Glynn will be on this side and I will be on that side.

Camillus Glynn (Fianna Fail)
Link to this: Individually | In context

The Senator might as well dream here as in bed.

Seán Power (Kildare South, Fianna Fail)
Link to this: Individually | In context

I thank Senators for their contributions since Second Stage, the interest they have shown in issues concerning the elderly and the help they have given in promoting that cause, which is a priority of the House and is debated regularly.

The Bill was designed to put the current subvention arrangements on a sound legal footing. The bulk of the amendments made in the Seanad relate to a range of interim measures put in place in respect of 2007 that will benefit many of those in private nursing terms in the immediate term prior to the introduction of the new nursing home care support scheme in 2008. The interim measures have been in force since 1 January and are being transposed into primary legislation via this Bill.

A single maximum subvention rate of €300 has replaced the previous three levels of dependency and the property threshold has increased from €300,000 to €365,000 in respect of houses outside Dublin when combined with an income of at least €10,400. A person's residence will only be taken into account for a maximum of three years. A number of other changes have been made. For example, the net effect of another provision is to enable private home care providers to be exempted from VAT, which is in line with the Government's policy focus on home care and will encourage more growth. It will reduce the cost of home care, which will be welcome news for those availing of it or who wish to avail of it.

The House will agree that amendments tabled on Committee and Report Stages relate to positive changes that will make the subvention scheme fairer and more equitable, thus contributing to the well-being of our elderly citizens. More changes will follow in the form of the new nursing home care support scheme. Senators would acknowledge that the current scheme is far from perfect. We have made a number of changes to improve the lot of an additional 2,000 people who would not have been eligible for subventions previously.

The new scheme, entitled A Fair Deal, has been well publicised and will take effect on 1 January 2008. After extensive analysis, it is viewed as the fairest and most equitable means of supporting elderly people in residential care. It will create an equitable scheme for those in public and private care and will bed down the concept of co-payment between the individual and the State for the cost of long-term care.

Legislation is expected before the Houses in autumn. Regardless of who is in charge of the ship at that time, we will have ample opportunity to examine and debate the legislation. I hope that we will all be present to do so.

Mary White (Fianna Fail)
Link to this: Individually | In context

Hear, hear.

Rory Kiely (Fianna Fail)
Link to this: Individually | In context

When is it proposed to sit again?

Camillus Glynn (Fianna Fail)
Link to this: Individually | In context

At 2.30 p.m. next Tuesday.