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Dáil Éireann debate -
Wednesday, 4 Apr 2001

Vol. 534 No. 1

Written Answers. - Nursing Home Subventions.

John V. Farrelly


86 Mr. Farrelly asked the Minister for Health and Children if he has approved a scheme to claw-back moneys from the estates of elderly people for whom the State paid subvention for nursing home care; his views on whether the majority of people who receive subvention should be looked after by the State; his further views on whether the State has fulfilled its commitments in caring for the elderly; and if he will make a statement on the matter. [9846/01]

In line with a Government decision, an expenditure review of the nursing home subvention scheme is currently being undertaken by my Department in association with the Department of Finance and is expected to be completed shortly. The aims of the review process are: to provide a systematic analysis of what is actually being achieved by expenditure in each programme; and to provide a basis on which more informed decisions can be made on priorities within and between programmes.

The purpose of this review is to address the following issues: the operation of the nursing home subvention scheme and the extent to which current objectives are being; met the efficiency, effectiveness and equity implications of the current subvention scheme; the need and the likely future demand for private nursing home care; the supply of nursing home care in the future; the role of the nursing home sector in an integrated public-private care system, the role of the social economy in an integrated, community-based, long-stay care system; optimal funding arrangements for long-stay care; the major policy questions for the future.
Documents recently released by my Department under the Freedom of Information Act, 1997, include correspondence between my Department and the Department of Finance. These documents show that a draft of the expenditure review includes a suggestion that consideration should be given to a provision which would enable the State to claw-back some of the cost of subvention from the estate of deceased beneficiaries of the scheme. This suggestion is one of a number of proposals made by the author of the review. As the review is still in draft form, it would be inappropriate for further comment to be made without the full findings and recommendations of the review being available for consideration.
It is the intention of my colleague, the Minister for Health and Children, to bring proposals to Government in relation to whatever additional measures may be necessary arising from the forthcoming expenditure review of the subvention scheme, the Ombudsman's report, together with experience gained from the operation of the scheme since its inception in 1993. The whole eligibility framework for health services generally is also one of the key issues to be addressed in the new health strategy currently being prepared by my Department. It is expected that this strategy will be published in the summer.
It is, however, worth noting that when this Government came into office in 1997, the budget made available for the nursing home subvention scheme was £27.8 million. In 2001, the level of funding made available for the scheme has almost doubled with £52 million being made available, including the resources necessary to facilitate the recent increases in the rates, bringing them to £90, £120, and £150 per week in respect of medium, high or maximum levels of dependency.
I would also like to remind the Deputy that this Government has allocated significant resources to services for older people, particularly health services, in an attempt to deal with the change in demographics, and the resulting issues, which will emerge. Additional funding for the development of health services for older people has increased significantly from £10 million in 1997 to an additional £36 million in 2000, while in 2001 an additional £57.427 million has been provided. This has resulted in approximately 880 posts approved to services for older people between 1997 and 2000. Between 1998 and 2000 over 400 additional beds have been provided in ten new community nursing units and over 1000 day places per week have been provided in ten new day care centres.
A total of £2.0 billion has been made available by this Government for investment in the health services under the national development plan. This represents a trebling of investment compared to the previous seven year period. The purpose of the plan will be to create an infrastructure that will bring significant and tangible advances in delivering a more patient-centred and accessible service. In the case of services for older people it is proposed to provide a greatly improved physical environment to ensure a high quality and client-centred service. Approximately £200 million will be available for the capital development of services for older people over the period of the plan. A broad range of facilities will either be provided, replaced or upgraded as a result including assessment and rehabilitation facilities, ambulatory care facilities, community hospitals, community nursing units, convalescent and respite beds, daycare centres and services for the elderly mentally infirm.