Paul Bradford (Independent)
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I welcome the Minister. I look forward to his reply, as he is under orders to be positive, to provide solutions, and not to talk about problems. I am sure my query will be dealt with.
I wish to speak about the Fair Deal scheme - not how it operates, but its current funding. The Minister could probably give some of the same answer that he gave to the previous speaker. The scheme is a positive and effective one, which I discussed on many occasions with a previous Minister and Tánaiste, Mary Harney. I am concerned that we see the Fair Deal scheme as the only way of dealing with the accommodation needs of the elderly community. I hope, as the Minister plans ahead, that home care packages, home help services and carer's allowance - although that is within the remit of another Department - will receive significant focus. I noted in passing an interesting piece of legislation, perhaps not yet debated in the other House, tabled by Deputy Willie O'Dea of Fianna Fáil. He suggested that where a person is deemed eligible for the Fair Deal scheme, the cost of the scheme be made available for private care or home care arrangements. We need to be much more flexible in regard to care of the elderly.
It has come to my attention from a few individual constituency cases, about which I have made inquiries of HSE staff, that since mid-summer or thereabouts a number of applicants have been approved as eligible for the Fair Deal scheme from a medical and income point of view, but the sanctioning of these applicants has slowed down by as much as 60%. People who were advised in mid-summer that they would probably have to wait six or seven weeks for the final sanction have found that the waiting period has more than doubled, but I appreciate that this is a funding issue. In one case, I put much pressure on a family, at the behest of a hospital, to have the person taken home from the hospital on the advice that the Fair Deal scheme wouldapply afterfive or six weeks, but now it could take ten, 12 or 15 weeks. I know it is a funding problem, but the Minister may be in a position to comment. It appears the situation has deteriorated since mid-summer. There was a blip in February and March and the situation improved, but since late June or early July delays have increased significantly.
Perhaps the Minister would give an overview of his future approach to care of the elderly. While I want to see the Fair Deal scheme supported, encouraged and properly funded, there must be solutions other than nursing homes.I have said here often that if our only aspiration for the elderly is a clean nursing home bed, that is inadequate. Care in the community, care in the home, family support, carer's allowance, home help and so on should play a much more significant role. The taxpayer would benefit because it is less expensive. The older person would benefit as he or she would be with family, friends or neighbours. Perhaps the Minister will work on this issue and comment on the current funding difficulty for the Fair Deal scheme.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Senator for raising the issue. I am taking this Adjournment matter on behalf of the Minister of State, Deputy Kathleen Lynch, who has responsibility for older people and who is speaking at a health-related conference.

The nursing homes support scheme is a system of financial support for individuals who require long-term nursing home care. Anyone who is ordinarily resident in the State and who may need nursing home care, regardless of age, can apply for the scheme. The total budget for long-term residential care in 2014 is €939 million. It should be pointed out that a number of people covered by the funding arrangements which preceded the scheme are also covered by this.

The HSE operates a national placement list to enable it to operate within the budget allocated for the nursing homes support scheme. All applicants who are approved for funding are put on the placement list in chronological order by the date of determination of their application. Funding issues to applicants in this chronological order to ensure equity nationally. The current waiting time on the placement list is 15 weeks, with 2,007 people on the list awaiting release of funding. The HSE makes every effort to match available funding to demand by releasing funding on a weekly basis. In the first seven months of 2014, 3,553 new clients were funded under the scheme. The length of time an applicant remains on the placement list depends on the number of new applicants awaiting approval for the scheme at any given time and the number of applicants currently receiving payment under the scheme. Therefore, the duration of time on the placement list can fluctuate.

The provision of services must be managed within available resources. The scheme is continuing to take on new clients within the limits of the resources available, in accordance with the legislation. The resources that are available will be applied to provide the best possible mix of supports and services in a way that most effectively matches the needs and preferences of older people themselves. There is a particular focus on enabling people to live as independently as possible. For this reason, €23 million was transferred from the nursing homes support scheme to provide additional community services, with a view to allowing more older people to be supported in their own homes and communities for longer, which is in line with the expressed wishes of older people.

The Senator will be aware that the nursing homes support scheme is currently the subject of a review. The review will consider the long-term sustainability of the scheme as well as looking at the current operation and management of the scheme. Work on the review is advanced and is expected to be completed in the coming months. The report will then be made publicly available.

Paul Bradford (Independent)
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I thank the Minister for his comprehensive reply. He mentioned that the HSE makes every effort to match available funding to demand by releasing funding on a weekly basis. That is fair enough, but I am advised that up to seven weeks ago, on a Monday or a Tuesday, the funding released each week from the central office would cover a five-day period and, obviously, a set number of applicants, whereas now that funding covers applicants only for two and a half days. That is the reason the delays have more than doubled. I am advised that sanctions for funding have decreased by 60%. It is fair to say that money is being released weekly, but a significantly reduced number of applicants are sanctioned each week. I ask the Minister to bring this to attention of the Minister of State, Deputy Kathleen Lynch. I look forward to the review and I appreciate the funding crisis. I appeal to the Minister to try to make progress but also to ensure that the broader spectrum of care for the elderly, services and future methods of dealing with the elderly are considered also.

Leo Varadkar (Dublin West, Fine Gael)
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I cannot confirm the detail of what the Senator has said, but the basic point he makes is correct. The scheme's funding is constrained, as it was cut this year. As a result, the waiting time has slipped from about four weeks, which most people found to be reasonably acceptable, to 15 or 16 weeks, which people find unacceptable. They are right to find it unacceptable. As things stand, that will get worse as the year goes on. The effect is that older people cannot be transferred from hospital to nursing homes, where they would be much safer and less likely to acquire infections. Thus, there is a problem of delayed discharges in hospitals. There are almost 700 delayed discharges today. If those beds were freed up, we would be able to deal much better with accident and emergency overcrowding and elective waiting lists. That is the present situation and there is no point in denying it.

The Senator's second point is a valid one. I have some experience of the health service in England, where home care and community care are much more advanced. It is easier, therefore, to keep people in their homes for longer and to get people out of hospital because they know that the public health nurse and the home care services will click in on a Saturday or Sunday, or a Friday evening if the need arises.

Ireland has underdeveloped social care services. As a consequence, we have people going into nursing homes sooner in their lives than they might want to. That is the major structural thing that needs to be changed over the next couple of years in Ireland. The more immediate problem is one of funding.