In view of the time I think the Deputy should commence. Last week we adjourned the House.
Adjournment Debate. - Nursing Home Subventions.
The Minister is not here yet.
The Deputy leaves me with no option but to adjourn the House.
I will give the reply.
This is ridiculous.
The Chair has no responsibility for the Minister.
Can the Chair reprimand the Minister?
Yes indeed, and has reprimanded Ministers in the past. The Chair has drawn attention to the fact that it is disrespectful to the House for either Deputies or Ministers not to be present when their item on the Adjournment is called.
I have been here for ten minutes.
The Chair has made this ruling on a regular basis and it is unfair to the staff of the House, particularly when we are sitting late, to keep the House sitting later than is necessary.
I thank the Minister of State for coming in to reply to my Adjournment debate. I am raising the issue of enhanced nursing home subvention for people in the Southern Health Board area. There are currently 344 elderly people on the waiting list in the Cork and Kerry area for enhanced nursing home subvention. This in itself is a very long list but I have learned from the health board that they are only dealing with applications now for this payment that were made in March 2001. The applications are almost a year behind.
Many of the applicants for advanced subvention are very elderly people whose expenses far exceed their pension or any other income. Many of them are struggling to scrape together the necessary funds to pay their accommodation fees in the nursing homes. Many of these people have been in nursing homes for many years and would have no place to go but for the goodwill of the staff and management of the nursing homes. One of the key features of a booming economy is its ability to care for its most vulnerable members. The issue I am raising tonight is evidence that the Government is failing to grasp the principle and act on it.
In many of the cases I referred to, the people have no next of kin to support them or speak on their behalf. These are the voiceless people who are often not well enough informed about their right to apply for enhanced subvention where their income fails to meet the cost of their care. In some of the cases of which I am aware the management and staff of the nursing homes are deeply concerned about the plight of their patients who they care for with the greatest dedication and kindness. I pay tribute to the many hard-working and committed staff that I know in nursing homes in my constituency.
I implore the Minister for Health and Children to speed up the processing of applications for enhanced subvention in the Southern Health Board area. It is completely unacceptable that there are almost 350 people on the waiting list for enhanced subvention in Cork and Kerry. It is totally unsatisfactory that these applications that were made a year ago are only being dealt with now. Where does this leave people that have only recently applied? Will they be kept waiting for another year and be forced to spend that time scraping together the necessary money to pay for their care? In many cases they just do not have the money.
It has come to my attention that discussions are currently ongoing with the Department in regard to the overall arrangements that apply to the enhanced subvention scheme. I hope the Minister will be able to outline to the House the nature and content of these discussions. The Minister needs to tackle the waiting list for enhanced subvention in the Southern Health Board area by speeding up the processing of applications and he must also provide the necessary resources to do this. The voiceless and the vulnerable are again suffering as a result of this Government's failure to tackle the crisis in the health services. Many people are lying awake at night worrying that their application will not be processed before their money runs out. This situation cannot be allowed to continue.
I thank the Deputy for raising this issue on the Adjournment. As the Deputy will be aware from previous discussion on this issue, under the Health (Nursing Homes) Act, 1990, health boards provide subventions to assist persons in meeting the costs of nursing home care. However, it was never intended that subventions would meet the full costs involved. Apart from contracts entered into under Article 22.3 of the Nursing Home (Subvention) Regulations, 1993, which allows a health board enter into an arrangement with a private nursing home, the placement of a person in a private nursing home and the fees charged are private arrangements between the nursing home and the individual resident.
The Nursing Homes (Subvention) Regulations, 1993, are administered by the health boards and the Eastern Regional Health Authority. A health board may pay more than the maximum rate of subvention relative to an individual's level of dependency, for example in cases where personal funds are exhausted. Articles 22.3 and 22.4 of the Nursing Home (Subvention) Regulations, 1993, permit health boards to contract beds in private nursing homes and to pay more than the maximum rates of subvention in such cases. However, the application of these provisions is a matter for the individual health board concerned in the context of meeting increasing demands for subventions within the board's revenue allocation as notified annually in the letters of determination. This is in keeping with the provisions of the Health (Amendment)(No. 3) Act, 1996.
Significant additional funding has been provided by Governments since its introduction in 1993. In 1994, in the first full year of operation of the nursing home subvention scheme, £12 million was made available. This year, the additional funding provided by the Department has brought the amount available for the scheme to £72 million or €92 million.
Deputy Moynihan-Cronin will be aware that the Southern Health Board received a significantly increased number of claims from patients for enhanced payments in accordance with Articles 22.3 and 22.4. It is a matter for each board to determine the extent to which it can meet such claims consistent with its requirement to live within its overall revenue allocation and taking account of the fact that such enhanced payments are discretionary. However, in the interest of avoiding hardship to individual patients, my Department has been in regular contact with the board in an effort to find a solution which would take cognisance of the considerations outlined above. A solution has been found to meet the most immediate individual problems and discussions are continuing in an effort to reach agreement on a more long-term approach to the issue.
However, it should be noted that the nursing home subvention regulations do not specify a maximum amount to be paid in respect of enhanced subvention. A decision relating to the amount to be paid is a matter for each health board, following assessment on a case by case basis and bearing in mind their obligation to comply with Article 20 of Nursing Home (Subvention) Regulations, 1993, as well as the Health (Amendment) (No. 3) Act, 1996. Article 20 of the regulations provides that, if under section 31 of the Health Act, 1970, the Minister specifies a limit on the expenditure to be incurred in providing services under the Act, a board may pay such amounts as would enable it to contain its expenditure within the specified limit.
As the Deputy will be aware, in line with a Government decision, an expenditure review of the nursing home subvention scheme has been undertaken by the Department in association with the Department of Finance. It is the intention to bring forward proposals in due course in relation to whatever additional measures may be necessary arising from the expenditure review and the Ombudsman's report, together with experience gained from the operation of the scheme since its inception in 1993. As announced in the health strategy, which was published recently, it is also the intention of the Department to amend the nursing home subvention scheme to take account of the expenditure review of the scheme and to introduce a pilot home subvention scheme in consultation with the Department of Social, Community and Family Affairs. This will be carried out in the context of an integrated approach to meeting the needs of ageing and older people.