Private Members' Business. - Services for the Elderly and People with Disabilities.

I move:

That Dáil Éireann:

– aware of the growing public concern and hardship caused by inadequate provision of health, housing and support services for the elderly and people with disabilities;

– noting the lack of sufficient subvention in respect of nursing home care and the inadequacy of respite and residential care;

– deplores the lengthy waiting lists for disabled person's housing grants, the changes made to the eligibility criteria for such grants and the failure of the current level of disabled person's housing grants to meet demand and modern construction costs;

– believes that this situation will result in further pressure on the overstretched health and housing services;

– condemns the Government for its failure to address these and other issues affecting the rights and quality of lives of people with disabilities, the elderly, their families and carers;

and calls on the Minister for the Environment and Local Government and the Minister for Health and Children to immediately bring forward a comprehensive package of measures, including additional finance, to address these crises and to provide for the eradication of such waiting lists.

I wish to share time with Deputies Allen, Pat Breen and O'Dowd.

Is that agreed? Agreed.

The genesis of this motion was the need to highlight the difficulties which are causing beds to be unused in our acute hospitals. Despite widespread publicity and concern about this issue, it is extraordinary there has been no serious attempt to identify or review the obstacles to finding appropriate and timely placements for patients. The immediate priority is to resolve the problem of unused beds which causes queues and waiting lists and results in patients being placed on trolleys. However, the broader, more difficult and more important issue, which has not been addressed, is our ageing population. The critical question is how we will fund the provision of care for old people.

Ideally, the transfer from an acute hospital to an alternative care setting should be seamless. If this is our objective, it would be difficult to devise a more tortuous or user unfriendly system than the one we are currently trying to operate.

On a point of order, is the Minister for Finance taking the debate?

I am talking to myself. The transfer system needs to be seamless not only because the delays in discharging patients are a significant waste of resources, but also because it is important for patients and their families that the transfer from hospital to an alternative care setting is as stress free as possible.

On a point of order, is there any point continuing the debate when neither the Minister for Health and Children nor the Minister for the Environment and Local Government is present.

That is not a point of order.

It is outrageous that the Ministers are not here when an important issue, which affects the sick and people with disabilities and impairments, is being debated. The reason the Minister for Finance is still in the Chamber is he was present for Report Stage of the Finance Bill.

The Deputy will appreciate he is taking up the time of his colleague, Deputy Olivia Mitchell, who intends to share time with him.

It is an insult to us all that the Ministers are not in the House.

The Deputy will have an opportunity to speak, during which he can make whatever points he likes. I ask him to allow his colleague to continue without interruption.

It is unprecedented, in my experience in the House, that a Minister shows the discourtesy of not attending or sending a message to explain his absence from a debate on an issue of such importance.

I propose we suspend proceedings until the relevant Ministers arrive.

I ask the Deputy to allow his colleague to continue.

I will proceed under protest at the grave discourtesy shown to the House. Discharge from hospital is a fraught time for a patient's entire family. Moreover, a successful, stress free and easy transition to an alternative setting is critical to clinical outcome in terms of preventing readmission. Despite the importance of a smooth transition to both the hospital and the patient, almost no aspect of the discharge system appears to be working well. Coping with the challenges created by discharge policy requires one to be fighting fit rather than recovering from a serious illness.

My colleagues will address the various aspects of transfer while I will focus on the problems associated with long-term nursing home care. I will do so for a variety of reasons, principal of which is the imminent and significant increase in our elderly population. This is our time bomb. I have lost my place due to the failure of the Minister to turn up for the debate.

The Deputy was distracted by the changing of the guard.

Despite the changing of the guard, the relevant Minister is still not here. I thank the Minister of State at the Department of the Taoiseach, Deputy Hanafin, for turning up.

On a point of order, it is outrageous that we are having an important debate without a Minister in sight.

That is not a point of order.

First we had the Minister for Finance, now we have the Chief Whip.

It shows a lack of interest on the part of the Government.

I remind Deputy Allen that his colleague, Deputy Olivia Mitchell, has a limited time to speak.

The Minister is so disinterested in the issue, he refuses to debate it in the House.

That is a matter for the Deputy and his colleague.

We are talking to ourselves.

As Chief Whip, I am delighted to represent the Government.

I will attempt to read my contribution into the record so that the Minister for Health and Children can read our comments later, if he can be bothered. There are currently slightly more than 100,000 people aged 65 years and over living in Dublin. Within 30 years, that figure will have risen to 250,000. Even more frightening is that the number of people aged 80 years and over is set to double in the next ten years. We also face a series of simultaneous developments, namely, the rising cost of nursing homes, a huge increase in demand for nursing homes, a static subvention system and a fall in the value of private pensions. Combined, these factors effectively boil down to an ever-growing gap between the cost of a nursing home bed and what the average family can afford to pay for one.

Ten years ago the nursing home subvention covered 60% of the cost of a private nursing home bed. Nowadays, it covers approximately one third of the cost, while in Dublin it covers barely one quarter. If one adds to the subvention the value of the State pension, one must still make up about 50% of the cost of a bed. Bridging this gap is the critical, almost impossible task facing families today and it places a major strain on the majority of them, for whom the cost is unsustainable for any length of time.

The tragedy is that suppressing the value of the subvention does not generate savings as families find it impossible to make up the difference and this, in turn, forces them into dependence on the State for a fully funded bed. The State must then offer them either contract beds or fully funded public beds. The more money directed into total provision, the less funds are available in health board budgets to provide partial subventions. This vicious circle means fewer and fewer people are being accommodated and the system fails to give good value for money.

More significantly, the inadequate subvention is eroding the long-standing practice by which people provide for their nursing care in old age. Precisely because people wanted to be in a position to provide for their own care, they bought homes, saved throughout their lives and joined pension schemes. At times when they probably needed money for more immediate and pressing purposes, they set it aside to have the dignity of choosing the care they deserve in their old age. People want to retain the independence to choose the kind of care they receive in their old age and do not want to be totally dependent on the State.

If this debate sends out one message, it is that subvention levels must be increased to ensure that, combined with the average pension, they come at least within spitting distance of the total weekly cost of care in the average nursing home. The potential tragedy is that middle Ireland, by which I mean the vast majority of ordinary people, not the very rich who will always be able to look after themselves, will quickly realise there is no point in buying a home, saving or investing in a pension. Irrespective of the efforts people make, they will never be able to accumulate sufficient funds to keep themselves in a nursing home bed in the future. Their sacrifices will be pointless.

The average annual cost of a typical nursing home bed is €35,000. Pensions are nowhere near that value. Prudent provision for the future is the attribute of a good citizen. The Government should encourage such provision and recognise the genuine efforts people are making to look after and provide for themselves. It should not throw this gesture back in their faces.

If the Minister was here, the second message I would like to communicate to him would be the total absence of clarity and consistency in the way in which the current scheme is administered. Families encountering the system are mesmerised by categories such as dependency, eligibility, entitlement, ordinary subventions, enhanced subventions, public beds and contract beds. Even if all that were understandable, there is no consistency among health boards which operate different agendas. This week, for instance, one health board told nursing homes that under no circumstances were they to accept patients from hospitals unless their subventions were sanctioned by them. This week also another health board encouraged hospitals not to wait for subvention sanction before discharging their patients from hospitals into nursing homes. That is the kind of system that currently operates.

Added to that is the inconsistency created by the Ombudsman's ruling that all patients have entitlements to nursing home care. In this ruling he is at variance with the Government. In its strategy the Government promised legislation to clarify that issue but the legislation has not been brought forward.

To add to all the confusion we also have the extension of the medical card scheme to those over the age of 70. Traditionally, a medical card was the criterion for eligibility for a publicly funded bed. If we are to follow that argument to its logical conclusion, everybody over 70 is now entitled to a publicly funded bed but, unfortunately, that provision was not included in any budget and those over 70 are not getting a publicly funded bed. That is another aspect of the extension of the medical card scheme to those over 70 which was not thought through. It is causing major problems for families who, at a very difficult time, are thrown into utter confusion by the complexity of the system. Increasingly it appears that many of them are falling into a category where they have no options.

While the Celtic tiger was roaring enhanced subvention to contract beds was fairly readily available, although not with any degree of consistency or fairness. In many cases, people with assets and income got contract beds while people with very modest means could not even get a partial subvention.

We come then to the most controversial issue, namely, the role the family home should play in the funding of the nursing home place. There is an absence of clarity, consistency and fairness in this area. Some families sell the family home without any question and even when the proceeds from the sale are spent, they put themselves to the pin of their collar to continue to fund the bed for their parent. Others dig in while the parent is still in hospital, refuse to part with what they see as their inheritance and often end up being rewarded with a fully funded bed.

Only legislation will give absolute clarity as to who is responsible or the way this issue should be resolved, but the Minister cannot continue to ignore it. All of these issues are now critical. Even today, the system is crumbling and in disarray but with an ageing population the whole system will collapse unless it is rationalised and clarified.

In the Mater hospital today, 100 beds are occupied by people who are ready for discharge. In Beaumont Hospital the figure is 86 and in Louth hospital it is 24; I could go on. Approximately three-quarters of those beds are blocked by people awaiting transfer to long-stay nursing home places. The Minister might say that problem is due to lack of capacity but that is not the case. Currently there are 216 empty beds in private nursing homes in Dublin. Those beds, provided as a result of encouragement from the Minister for Finance, who has just left the Chamber, with tax incentives to provide them, are now lying empty. That does not make any sense.

Worse than that, however, are the empty public beds in nursing homes. Some of the new community beds provided at great expense to the taxpayer are now lying empty because those institutions cannot afford to hire an extra nurse. There is a beautiful 90 bed unit in Laoighis-Offaly which is not open because there is no money to fund it. This is not exclusively a matter of capacity. Increasingly, it is a matter of lack of funding and, more important, a lack of political decision making. I ask the Minister not to ignore this problem because if he does, he will do so at his peril as the system is ready to crash around him.

I support Deputy Mitchell's motion. I am aware of cases throughout the country where elderly people are being threatened with eviction from nursing homes because of the failure of health boards to make decisions regarding enhanced subventions. Families have to come up with €300 to €400 per week to make up the difference between the nursing home charge and a combination of the person's pension and subvention. The health board in my constituency, the Southern Health Board, has 560 people waiting for decisions on enhanced subventions. That board is dealing with the crisis cases in that where a threat of eviction exists, a decision is made. The subvention is rationed in that awful manner. It is unpardonable that following many years of prosperity and economic expansion, the elderly and those who are impaired are bearing the brunt of cutbacks and inefficiencies in these services, and the lack of political courage on the part of the Minister to make a decision.

Last week we saw examples of power in the health services. When the consultants bear their teeth, the Minister does his U-turn. We saw that in the indemnity insurance case when he decided to succumb to the powerful blocs in the health services. However, Deputy Olivia Mitchell dealt with that aspect of the motion more than adequately.

This year, 2003, is supposed to be the European Year of People with Disabilities. The Irish people pride themselves on being great Europeans. This is also the year we host the Special Olympics, which are organised for people with intellectual disabilities. Before, during and after the Special Olympics, Ministers and the leaders of society will be anxious to be seen to support and attend this great event. Having attended the event in the United States some years ago, as Minister for Sport, I can say it was a memorable occasion. This should be a milestone year for disabled persons but, shamefully, official Ireland is treating disabled persons in a different way.

The provisions of the 2003 budget were devastating for people with disabilities, their families and advocates. There is no money this year for additional services. Services planned in anticipation of funding have been scrapped, as have the hopes of many for day care, personal assistance, home help, respite care and adaptable housing.

One aspect of the motion before the House tonight concerns the disabled person's grant. Ongoing funding shortfalls in the grant scheme have left people with disabilities and their families in an intolerable position. By June 2002, there were 11,200 applications for DPG, more than 6,700 of which were still to be processed at that time. I am aware that figure has since increased.

Despite the fact that demand is increasing and construction inflation is high, the 2003 Estimates show that more than €0.25 million has been cut from the budget. Over recent years, many local authorities have run into funding constraints which meant they were unable to meet commitments to the DPG scheme. Local authorities must fund one-third of the total cost of the scheme from their own resources but because of funding cutbacks, DPG applicants have had their grant applications deferred by their local councils to the following year's budget. This practice has resulted in building delays, increased costs to disabled persons and their families and major disruption in people's lives.

During the closing months of 2002, many local authorities had begun to further erode the social and financial value of the DPG scheme by agreeing to the introduction of a review process of the administration of the scheme. We are all aware there is a crisis in local authority funding and that many local authorities are being forced to increase local taxation to make up for the shortfall in funding from the Government. However, what is now of serious concern to disabled people and their representative organisations is that some local authorities are beginning to review their administration of the scheme. These reviews are resulting in the introduction of measures which effectively erode the value of a housing adaptation grant scheme that was hard won by disabled campaigners and disability representative organisations. These measures include establishing priority systems, introducing means testing and reducing the amount of the grant available to individual applicants and others.

I thank the Irish Wheelchair Association which, through its chief executive, has briefed Deputies, Senators and councillors on the threat facing people with disabilities. The association has confirmed that the Irish housing stock is largely inaccessible to people with a mobility impairment. The disabled person's grant scheme was introduced 35 years ago to part fund house alterations as required by people with mobility impairment. At that time, many disabled people were living in intolerable circumstances, often without access to running water and toilet facilities. During the early years of the scheme the Irish Wheelchair Association and other voluntary groups and service providers invested considerable resources both in terms of professional advisory staff and financially in terms of personal loans and grants to support its members in making best use of the scheme.

As the disabled person's grant scheme became established, health boards took over the advisory role and the Irish Wheelchair Association continued to lobby the Department of the Environment and Local Government regarding desired changes to the administration of the scheme. The terms and conditions of the scheme have for several years been a campaign item for the Irish Wheelchair Association and other disability organisations.

The availability of suitable housing for a disabled person is an absolute basic requirement that directly contributes to a person's ability to lead an active and fulfilled life. House alteration for a disabled person is not a lifestyle choice but a basic necessity. Until now the grant available under the scheme for housing alteration, since the 2000 budget, has been 90% of the approved cost of the work up to a maximum payment of €20,000. Each local authority recoups 60% of this money from central Government.

The ceiling of €20,000 under the scheme has meant that a disabled person undertaking any major house alterations experiences a considerable shortfall, often as much as €20,000, especially if a bathroom-bedroom extension or another major renovation is the advised option. Many disabled people are without personal financial resources and are therefore unable to make up this shortfall. The adaptation work is often undertaken at a crisis point in people's lives, when future work and personal income options are uncertain. Many such applicants are among the 120,000 people with disabilities who are dependent on social welfare payments or unemployed. Unemployment among disabled people is at 70%.

In recognising both the disadvantaged situation of so many people with disabilities and that accessible accommodation is a basic necessity, many disability representative organisations and the Commission on the Status of People with Disability have repeatedly called on the Government to increase the disabled person's grant to cover 100% of the cost of the approved building work. The review measures being introduced are a cover for cutbacks because the end result of these measures will translate into people being stuck in hospital, people going on to housing lists and people being unable to live independent and fulfilling lives. It will cause immeasurable strain for the individuals concerned and for their family members and friends.

Tonight I support the Irish Wheelchair Association's demands that these so-called review measures be terminated by local authorities and I support the demand to introduce 100% recoupable funding rather than 60%, as is the current situation. The reality is that the scheme is now supporting a far wider range of people than previously, for example, people with varying medical conditions certified by occupational therapists, elderly people, people with intellectual impairment and people with mobility impairment.

The important thing is that it permits these people to continue living in the community, either independently or with their family. It must also be noted that a major proportion of these people are existing on social welfare payments or are working in low paid jobs. It is absolutely certain that if the existing level of support provided by the scheme is not increased and broadened, rather than being eroded, many who qualify for it will be forced into residential care and social housing that will require community supports, resulting in astronomical costs to the Exchequer. As we all know, the cost of residential care is now approximately €2,500 per person per month, as Deputy Mitchell said.

The disabled person's grant scheme is being slowly but surely dismantled and the fact that local authorities are reviewing the procedures will mean that the scheme will descend into a shambles and will no longer be a uniform national scheme. Health boards are no longer supporting the scheme by the provision of professional advice from their occupational therapy staff. The disintegration and the dismantling of the scheme cannot be allowed to continue. The Government must direct local authorities to ensure uniformity in the application of the scheme. There must be no cutbacks or erosion of it.

To show how useless the scheme is in its present form I will cite a case study. A young man in his mid-30s, a self-employed mechanic, crashes his sister's car in which he is uninsured. He sustains head injuries and is in a coma for several weeks and he is in hospital for over a year. He comes home, a wheelchair user and with impaired intellectual function, to a small two storey family house, where his elderly parents live. There are no ground floor facilities, he sleeps in the sitting room and he uses a commode for a toilet in the sitting room. A bedroom-bathroom extension is advised. His parents are old age pensioners and the young man is on disability allowance, with no insurance or employment prospects. The cost of the extension is €38,500 and he gets the maximum grant, €20,000, but there is a balance of €18,565. A loan is out of the question and he has no funds available. What is he to do? I could cite other tragic cases.

The availability of suitably adapted and designed housing for disabled people is an absolutely basic requirement which directly contributes to a person's ability to lead an active and fulfilled life. An individual's requirement for suitable housing is so basic that the entitlement to and the level of payment of the disabled person's grant scheme, which for over 30 years has supported and facilitated the adaptation of an inaccessible Irish housing stock, should not be negotiable. Any supposed review of this scheme, which would result in an eradication of the value of the scheme or in any way impact on the prompt availability of the scheme to people who require housing adaptation, should be repudiated in the strongest terms. Any so-called review measures which result in devaluing the scheme would be short-sighted and would eventually translate into people being stuck in hospital, people going on to housing lists and people being unable to live independent and fulfilling lives, and will cause immeasurable strain for the individuals concerned and their families.

I call on the Government to terminate the dismantling and downgrading of the scheme which will make home alteration more difficult, more costly and more prolonged for people with mobility impairment. In addition, I call on the Government to come clean about its real intentions towards people with disabilities. Away from the cameras and the photocalls, the reality is that they have abandoned people with disabilities. They have broken their promises and there will be no newly adapted homes for many in the foreseeable future. People will continue to live in inaccessible and unacceptable surroundings because the Government has denied personal assistance, day care, respite care and training facilities. In the European year of people with disabilities, the Government continues to leave people with disabilities literally locked out. While the Government is locking people out, the Minister for Health and Children is taking care of himself. He is refurbishing his offices and looking after his own personal comforts and to hell with those who need help and support in the community.

Some time ago I received a call to accompany a constituent to see his wife in a nursing home. I went with him and we found his wife fully clothed in bed, with the bed clothes on top of her. She was freezing. There was no adequate system of inspections to insist that the temperature in the bedroom be over 18 degrees – it was nearer 12 degrees. That may be a rare exception among some of the excellent nursing homes but it is true nonetheless.

The health board was on site within 30 minutes and investigated and pursued the nursing home but it took three or four visits from the inspectorate in the North-Eastern Health Board to get total compliance with temperature guidelines. I charge the Government with neglect of care of the elderly, particularly through the lack of transparency, uniformity and organisation in the inspection of nursing homes.

Each nursing home is supposed to be inspected twice a year. That does not happen in every case because the health boards do not have a dedicated inspectorate. A medical officer, a nurse and others occasionally go in as a team to visit homes. It is not good enough. Nursing homes are an important part of our society that will become more vital as people live longer and will need to be cared for in their declining years.

The Government must put in place a transparent system for every nursing home and every patient. It must establish a national inspectorate for nursing homes, separate from health boards and the Department of Health and Children, that will inspect on a full-time basis, with fully qualified teams that look at every aspect of such homes. The teams should arrive unannounced at night and during the weekends. If nursing homes are fully in compliance with regulations there will not be a problem but for the minority where there are problems, they will be exposed for what they are.

No one knows what is happening in nursing homes. Where can we find the information? It is not on the Department of Health and Children's website. The health board cannot help either. We should look at the example of New Jersey, where every nursing home is on the state Government website. Anyone interested can find out how many patients are in each home, the percentage with certain illnesses, the number who are mobile and the frequency and results of inspections.

The Government has been in power so long it has forgotten about care of the elderly. For 16 out of 20 years, it has had an opportunity to address the problem but has failed miserably to do so. It is those unfortunate people who cannot speak for themselves who are suffering. What about the percentage of people in nursing homes suffering from Alzheimer's or where there is high dependency on care? How many nurses are on duty at night in nursing homes? Where is the career path for nursing home carers or those who would like to work with senior citizens? There is no structure or national training resulting in disparate levels of care.

There are some excellent nursing homes and carers and some very poor ones. I challenge the Minister to address this issue in his response, not to be as complacent as the Government and ponder who will empower the Department to spend €500,000 on a nice seat for his office. What does he care about old people? It is a rhetorical question. The Minister does not care and the people are suffering as a result.

That is not true.

Since being elected to Dáil Éireann I have had to make representations to Clare County Council every day on behalf of constituents experiencing difficulties with the disabled person's grant. This is totally unacceptable because it leaves many families in an intolerable situation brought about by an uncaring Government.

Since the introduction of the disabled person's grant 35 years ago, many people have availed of it to part fund house adaptation for those with mobility impairment. It worked well but the situation has changed radically in recent years, with huge cost increases in building materials and construction costs and a shortage of labour while the number of applications has also increased considerably. In County Clare there are 286 applicants. While application numbers have increased, funding has not and local authorities only get back two thirds of the cost of the grants. Clare County Council allocated €584,200 in its Estimates last year for almost 300 applicants. That money will not go far because the maximum grant drawn is 90% subject to a maximum cost of €20,320.

The disabled person's grant should be divided into two categories – extensions and house adaptations and new houses. The present system where all applications are treated the same does not work and is unfair. Six months ago a disabled woman telephoned my office. She lives alone and was told she was on a long waiting list but if she could get her own occupational therapist, it would bring her case forward. It cost her €300 but when I heard from her yesterday she was still waiting. I presume that wait will continue. It is degrading when an applicant receives a notice of qualification but the letter says the grant is only payable subject to funding being made available because the local authority is cash starved.

The system as it stands is too loose. There is no national policy on disabled person's grants so each local authority makes its own rules. As the Government acquires new jets to carry Ministers around the globe and spends hundreds of thousands of euro to decorate ministerial offices, it ignores the situation on the ground. No wonder two thirds of the electorate is dissatisfied with it. The Government is completely out of touch.

A serious situation exists. The Government must provide the essential funding for local authorities and increase it from the present 60% to 100%. According to the Combat Poverty Agency, seven out of ten people with disabilities are unemployed. It is utterly unacceptable, as the ESRI found, that 54.4% of households headed by a person with a disability live below the poverty line. The extra cost of having a disability is met by those with a disability.

The Government has no care policy. The administration of the disabled person's grant is a shambles. Even multi-millionaires can qualify for the grant. The current policy in many local authorities is that a person who has the money should do the job and the local authority will pay later. Those who do not have money have to wait but then the limited budget is spent repaying those who had the money in the first place. This must change and priority must be given to the areas of greatest need.

Medical conditions must also be graded. A person with one leg in a wheelchair must have far greater priority than someone with a mild disability. Those on the lowest incomes must be given priority.

Local authorities must introduce measures. We cannot wait until the Government comes back down to earth to redress this urgent funding shortage. Local authorities are starved of cash by central Government and the Minister for Finance, Deputy McCreevy, missed a golden opportunity to redress the problem in the budget. He did not even mention disabled persons' grants in the Budget Statement despite the fact that 2003 has been designated as the year of the disabled. I deplore the long waiting lists for disabled persons housing grants and the failure of this cold, uncaring Government.

I propose amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"– recognises the importance of addressing the needs of older persons and people with disabilities;

– acknowledges the significant measures being taken by the Government and the further development of services supporting the needs of older persons and those with disabilities;

– in particular, approves the Government's commitment to put in place an increased level of service provision in line with the programme for Government;

– commends the actions taken by this Government and the previous Government since 1997 in meeting this commitment which include the allocation of substantial additional funding;

– notes the commitment by the Minister for Health and Children to review the nursing home subvention scheme; and

– acknowledges the significant improvements to the terms, conditions and financing of the disabled person's grant and essential repairs grant chemes in recent years."

I wish to share time with the Minister of State, Deputy Noel Ahern.

Is that agreed? Agreed.

I welcome the opportunity to speak on issues related to the provision of services for older people and people with disabilities and to outline what the Government is doing to meet the needs which have been identified for these groups.

In passing, I wish to comment on references which have been made to decoration of offices and so on. Since 1997, there has been no expenditure on refurbishment or refurnishing of my offices in Hawkins House or, indeed, those of my predecessor. I repeat, there has been no expenditure since 1997 on my office. As the House is aware, an additional position of Minister of State has been created in my Department and we decided—

An expensive Minister of State.

—to make the necessary provision, including staffing arrangements, as has been normal practice when any Government appointed a new Minister of State with specific responsibility. The suggestion that my office is being decorated is untrue and I ask Deputies to accept that. Any Deputy is welcome to see my office at any time. It has all the signs of an office which has not been refurbished for ten years.

It is important in a debate of this nature to reflect on the growth in funding available in recent years for services for older people and people with disabilities. The substantial increase in funding is indicative of the Government's ongoing commitment to a comprehensive range of services for older people. Revenue funding for the development of services has increased significantly, from €12.7 million in 1997 to an additional €87 million in 2002, including nursing home subvention funding. In excess of €270 million additional funding has been provided for services for older people from 1997 to date.

Never mind the past.


The Deputies opposite are hardly in a position to criticise. When they were last in Government, they provided a pittance for services for older people.

The Minister should tell us what he did this year.


Deputies should allow the Minister to speak without interruption.

This expenditure has resulted in more than 800 additional staff being recruited for services for older people between 1997 and 2000. Between 1998 and 2001, over 550 additional beds have been provided in new community nursing units and over 1,250 day places per week have been provided in new day care centres. The additional funding of €87 million made available in 2002 provided home help service, community support structures, carers support, funding for the Alzheimer's Society of Ireland and a range of voluntary groups, improvement in staff ratios in many of our elderly care units and substantial additional funding for the nursing home subvention scheme, to which Deputy Mitchell referred. A further €34 million was provided to commence implementation of the provisions in the new health strategy for older people and €10.5 million was used for the improvement and enhancement of existing services in 2002, such as additional funding provided to community nursing units, day care centres and community services, as well as a contribution towards improvements in home help pay and innovative approaches to the delivery of services for older people at local level.

In 2003, a total of €23.6 million in additional revenue funding was allocated to services for older people. This funding will be used for a variety of services, including home help service, the nursing home subvention scheme, support to carers, commencement of the elderly abuse programme, support to voluntary organisations, opening of new community nursing units, aids and appliances, development of dementia services, funding of day care centres and development of consultant-led services.

Since 1993, there has been an unprecedented level of investment in the nursing home subvention scheme. A sum of €5 million was allocated for the scheme when it was introduced in 1993. Due to a range of factors, including demographics, increasing levels of dependency, economic circumstances and so on, the costs have risen significantly. In 1994, the first full year of the scheme, the cost was approximately €15 million. Total expenditure on the scheme in 2003 will be almost €110 million. That is an important figure. Deputy Mitchell said the Government is not providing enough nursing home beds and funding.

The issue is about managing, not money.

People need to be informed that only a few years ago expenditure on nursing home subventions was about €30 million whereas we are now spending €102 million.

The Minister is not managing the situation properly.

The Minister, without interruption, please.

You were a member of a health board for much longer than I was. You were the man who had responsibility in terms of management and you should not deliver lectures in this House.

No doubt we will hear of more review groups being set up by the Minister.

Deputy Allen should allow the Minister to speak without interruption. If the Minister would address his remarks through the Chair, we might have fewer interruptions.

The problem is that there has been a historical lack—


It is important that Members of this House, from both sides, are allowed to put their contribution on the record. The Chair will insist that each Member is allowed to do that. If there are further interruptions from Deputy Allen, he will be asked to leave the House.

The Minister addressed me directly.

The Minister has already been asked to address his remarks through the Chair.

I will, of course, obey the Chair. Historically, in the 1980s and 1990s, there was a lack of infrastructure for community nursing units for the elderly. That is well known and one of the results has been a huge dependency on the nursing home subvention scheme as a method of plugging the gap. In the Eastern Regional Health Authority area alone—

Which has 70% of the population.

Please, Deputy.

—there have been enormous increases, continuing up to the present day, to supply a substantial number of beds from the private sector to cater for older people. The most recent information available indicates that approximately 455 nursing homes have been registered, with 7,580 people in receipt of subvention and an additional 1,500 people approximately in contract beds. When the subvention scheme was first introduced, Deputies Howlin and Noonan, as Ministers, made it very clear that it was not originally intended to pay for the full cost of private nursing home care. The scheme was originally intended to provide financial assistance to people most in need and that is how it has operated subsequently. 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.

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. My Department has been in discussion with health boards as to whether there are better ways of organising their funding under this heading and making sure they manage the beds under their care or within the private sector to achieve a better throughput of patients. That point has been made to health boards throughout the country and I understand the pressures under which they are operating.

We have undertaken an expenditure review of the nursing home subvention scheme to examine the objectives of the scheme and the extent to which they remain valid, to assess the service delivered and to establish what scope, if any, exists for achieving the programme objectives in a more efficient and effective way. In tandem with that, a review of the nursing home subvention scheme is under way in my Department. This review will look at all aspects of the scheme, including the allowances given for assets, assessment procedures for means and dependency and all other elements of the scheme. My Department is also in the process of consulting all stakeholders with an interest in the scheme to hear their views on how it might be improved to benefit the most important person involved, that is, the patient. It is planned to bring forward proposals on whatever additional measures may be necessary arising from the expenditure review of the nursing home subvention scheme and the Ombudsman's report, together with experience gained from the operation of the scheme since its inception.

There is an acknowledgement that there is insufficient provision of public long-term care beds to cater for our growing elderly population, with a resultant over-reliance on the private nursing home sector. The Eastern Regional Health Authority and the Southern Health Board areas are particularly affected because of a lack of public long-term care beds. This was acknowledged when my Department was preparing the national health strategy and there is a commitment in the strategy to provide 1,370 additional assessment and rehabilitation beds, plus 600 additional day hospital beds with facilities encompassing specialist areas such as falls, osteoporosis treatment, fracture prevention, Parkinson's disease, stroke prevention, heart failure and continence promotion clinics.

The Minister does not like the rehabilitation aspect.

I will ask Deputy Allen to leave the House unless he ceases interrupting.

Public private partnerships are currently being piloted in the health sector. PPP is based on the concept that better value for money for the Exchequer may be achieved through the exploitation of private sector competencies to capture innovation and the allocation of risk to the party best able to manage it. Initially the focus will be mainly in the area of community nursing units for older people. It is anticipated that 17 new CNUs will be created when the initial pilot programmes are complete, providing up to a maximum of 850 beds in Dublin and in the Southern Health Board region. The services offered in these units will include assessment and rehabilitation, respite extended care and convalescence. If the PPP pilot demonstrates success, it is the intention to use it as a means of providing additional CNU in other locations throughout the country. The current position of the project is that the two agencies involved, the ERHA and the Southern Health Board, are in the process of recruiting business advisers who will assist in the development of the project.

May I ask the Minister a question?

If the Minister wishes.

Has he cleared the PPP concept with the Department of Finance—



We have been sanctioned by the Department of Finance to do the pilot project and we are working closely with that Department.

Are these sanctioned?

You have made your point, Deputy.

Additional revenue and capital funding of over €327 million has been provided for intellectual disability and autism services between 1997 and 2002. That funding has been used to provide approximately—

We know that. He should tell us what he will do. This is what he has done.

Deputy Breen—

Do not tell us what you have done.

—I ask you to desist from interrupting or I will ask you to leave the House. Members cannot come into this House and frustrate any other Member of the House from making a contribution. You will have an opportunity to contribute and you can make your point.

The motion condemns the Government for its record. I am entitled to state its record, not only last year but this year and going forward. I am delighted that Deputy Breen, at long last, has acknowledged what we have done. It is the first time I have heard him acknowledge what the Government did in terms of these services.

He will be voting with us then.

To date, there has been no acknowledgement of anything that has been achieved and at times one would wonder about some of the debate in that regard.

On disability, about 1,700 additional residential places have been provided in the community. There are issues going forward. We have made significant progress on inappropriate placements in psychiatric hospital for those with disabilities and I make no apologies for reiterating in the House that we have reduced it from 970 in 1996, to 571 in 2001.

The national intellectual disability database and the physical and sensory disability database are the keys to ascertaining the needs going forward in both sectors. Despite the fact that the first assessment of needs three years ago identified that if we did certain things we would more or less meet the needs which exist, and the Government actually fulfilled its commitment in that regard, of course the review and the updating of the needs assessment is throwing up bigger issues and higher numbers in need of residential, respite, etc. Obviously that is a factor of demographics as well as everything else in terms of the numbers of people who are coming into services and in need of services, and age profiles are increasing also.

However, there has been a significant impact in terms of the people who have now got services who did not have them a number of years ago. There has been about a 10% increase in the number of persons in the intellectual disabilities sector availing of full-time residential places. In the area of respite services, the increase has been over 200%. The numbers in receipt of multi-disciplinary services has increased by 300% and the number of children accessing early intervention services has risen by over 200%.

That is waffle.

It illustrates the very low base from which we were coming over the past number of years and successive Governments, including ones in which the Opposition served, did precious little on this issue. The lack of decent acknowledgement of the progress that has been made does not serve the debate well.

On capital funding for older people, the national development plan showed a sum of just over €36 million to be made available between 2001 and 2002, but I am happy to say that we have spent just under €55 million on constructing or equipping new CNU in places like Killybegs, Dalkey, Leopardstown Park, Birr, Virginia, Lusk, Maynooth and Achill.

They are lying idle.

Substantial money was spent on facilities for older people at the Royal Hospital, Donnybrook, the Mercy Hospital, Cork and the South Infirmary/Victoria Hospital, Cork. The capital funding was also used to construct new day care centres in locations such as Killorglin, Finglas and Mallow. In addition, money was spent on badly needed upgrading and refurbishment of a number of community and district hospitals.

In home help, there have been dramatic improvements, both in the levels of pay for people in home help and in the services.

Because they went on strike.

We all know of the days when home helps worked for a pittance, and particularly in the Southern Health Board area where Deputy Allen served for a long time.

His party controlled it.

Deputy Allen, allow the Minister to speak. He has only a few minutes remaining.

Not at all. In Cork, the rates for home help were a disgrace.

His party controls it.

Deputy Allen, please.

He mentioned my name. He is the Minister and his party colleagues control it.

Upwards of €30 million has been injected into the system to ensure that home helps receive a decent level of pay. The bottom line is that €30 million was a substantial sum of money that had to go into just increasing the rates of pay.

They deserved it.

Of course they deserved it and we are glad we did it.

Others failed.

Deputy Moynihan-Cronin, you will have an opportunity to contribute. I ask you to refrain from interrupting.

If I could be allowed to develop the argument—

There is no argument.

People often ask, since there is so much money going into health, where is the output in the services? In terms of investment, we did not get additional home helps for that €30 million but we managed to retain home helps in the service and we gave people a decent basic minimum level of pay to which they should have been entitled a long time ago, and that costs money. Often people shout about value for money and people argue about managing resources, as Deputies have in their contributions to this debate, I am merely retorting and making the point that much of the investment was in existing staff and human resources to get that up to the appropriate level.

An additional €7 million has been made available to the health boards to increase the level of the home help service availability through the employment of more home helps, and by increasing the number of hours worked by existing home helps.

Substantial funding has been put in place for physical and sensory disability services over the past number of years. We have also put many of the voluntary organisations in a better state than that in which they would have been previously. I have discussed the issue of the databases and work is ongoing in terms of the physical and sensory disability database.

We realise, and the National Health Strategy pointed out, that services for older people is one of the key areas going forward over the next decade. These will probably eat up a greater amount of our resources over the next decade than any other aspect of the services. From international experience, both in terms of services for older people and disability services, and particularly the experience in the United States, we know that as we expand services and increase them, the demands will actually increase in tandem and there will be always an ongoing need for further services. Despite the unprecedented growth in services for the disability sector, the waiting lists have continued to grow, even though increasing numbers of people are availing of the services. Much of that work relates to better and more refined databases.

We published a Disability Bill in 2001. There is now ongoing work and consultation because when we published the Bill, we were criticised for not having enough consultation. We were told to withdraw the Bill and asked not to proceed with it. Subsequently a consultative process has been engaged in with groups around the country on the Disability Bill and it is in the context of that consultation that the Departments will be progressing it, and my Department will be working with the Department of Justice, Equality and Law Reform and other Departments on the progression of that Bill.

I hope we made it clear that we have demonstrated, and will continue to demonstrate, a strong commitment to older people. No Government, across all Departments, had a record like that of the present Government—

We will hear about it forever.

—whether on old age pensions, medical cards for the over 70s or funding from the Department of the Environment and Local Government. No Government since the foundation of the State has a record equal to that of the present Government.

I am pleased to contribute to the Government's response to this motion. My colleague, the Minister for Health and Children, has given a substantive response to the health issues affecting older people and people with disabilities. We will now turn our attention to their housing needs and how the Government is addressing these.

From my point of view as Minister with responsibility for housing and urban renewal, I emphasise that both this Government and its predecessor have always taken seriously their responsibilities in relation to housing, especially the housing and accommodation needs of people with special requirements. Local authorities have for many years been providing accommodation for the elderly and people with disabilities as part of their social housing programmes, mainly in small, specially designed housing schemes linked to local community services. There is of course room for further progress in this area. My Department has therefore asked local authorities to construct even more senior citizen units in appropriate locations with a view to earmarking them for older people generally.

In drafting the terms of the 2002 assessment of housing needs, we paid particular attention to the needs and circumstances of older people and those with disabilities. The outcome of the assessment provides valuable information to authorities, which will enable them to plan and develop housing schemes more appropriate to people's needs. A scheme with which Deputy Callely will be familiar is operated by Dublin City Council through which elderly home owners may offer their houses for sale to the city council. The vendor is then provided with rented senior citizen accommodation. The scheme allows senior citizens to move to accommodation better suited to their needs and generally with better access to services appropriate to older people. The resulting vacancy provides the city council with access to underoccupied family-type housing for letting to households on their waiting lists. The scheme is working very satisfactorily and I commend the city council on its success in operating this innovative scheme. There is not a lot of building land in the city and this scheme looks after the needs of the elderly and provides lettings for families.

Apart from the local authority housing programme, we have been very successful in encouraging the voluntary housing sector to get involved in the provision of housing for special needs groups such as elderly and disabled persons. There has been a huge increase in activity in the sector in recent years. This activity is supported mainly by my Department through the capital assistance scheme. The Government has provided increased levels of resources and support for the sector through the capital funding schemes, including the capital assistance scheme, and the sector has responded by achieving record levels of activity in the past two years. In 2002, for example, the total value of new projects approved under the scheme was €64 million, of which €47 million was in respect of projects for the elderly and disabled. This expenditure has the potential to deliver about 550 units of accommodation on completion.

So far this year, funding of about €28 million has been approved under the capital assistance scheme for a further 200 units of accommodation for the elderly and disabled. The provision of this accommodation is instrumental in enabling people to remain in their own communities. This has brought huge improvements in quality of life for many of our elderly people. Furthermore, it has ensured that the people concerned have not been forced to enter long-term care at the expense of the State, as tended to happen in the past.

I will now turn to the needs of elderly and disabled persons in their existing accommodation. While the current standards of design and build ensure that new houses provide accommodation that is generally suitable to their needs, we have retained the disabled person's new house grant to provide extra facilities required. I strongly defend the Government's record in helping elderly and disabled persons to improve or adapt their existing dwellings to meet their needs. The disabled person's grant scheme is specifically designed to allow provision of extra accommodation or necessary works of adaptation to meet the needs of a disabled member of a household.

It is a complete disaster.

Since 1997, we have doubled the effective maximum grant from €10,158 to €20,320 and it can now cover 90% of the approved cost of works, compared to two thirds in 1997.

If it existed it would be wonderful.

The recoupment rate by my Department has increased from 50% to two thirds. These improvements have resulted in a substantial increase in the level of activity under the scheme.

No, they have not. It costs more and there is less activity.

The number of grants paid increased from 2,857 in 1999 to 4,883 in 2001, while the cost of funding the scheme increased from €15.8 million in 1999 to €41.7 million in 2001.

Tell that to the Irish Wheelchair Association. The Minister is completely out of touch to come in here and read this rubbish to us.

The essential repairs grant scheme is another extremely useful scheme for addressing the accommodation needs of older people.

Tell that to Clare County Council.

This is irrelevant rubbish.

An Leas-Cheann Comhairle

The Minister, without interruption.

Again, it is administered by local authorities and they are given an appropriate degree of flexibility in its administration. The terms and conditions of this scheme have also been significantly enhanced in recent years. Prior to 1998, local authorities were recouped 50% of each essential repairs grant paid up to a maximum of €1,143 in each case.

Will the Minister give way to a question?

An Leas-Cheann Comhairle

The Minister's time is very limited. We will hear the Minister without interruption.

Two thirds of the amount of grant is now paid up to a maximum of €8,467. The amount recouped to local authorities under the scheme has increased from €764,000 in 1998 to €5.7 million in 2001.

This is supposed to be a debate.

It is all millions here tonight.

There is no service.

Does the Minister know what the waiting lists are like?

The improvements to these two schemes and the provision of extra funding to meet the consequent increase in activity are clear evidence of the Government's commitment to meet the housing needs of these people.

The waiting lists are massive.

The Government is very much aware of the importance of these grants in helping to meet the accommodation needs of elderly and disabled persons. These schemes are operated in individual cases at local level by local authorities.

If they have the money.

They determine the level of funding to be allocated to the scheme from within allocations notified by my Department for house purchase and improvement loans and disabled person's and essential repairs grants.

They did not increase it to 90% without funding.

It is a matter for local authorities to fund the one third of the cost of each grant not recouped by my Department—


From what?

They have not got it.

—and to make provision in their annual Estimates for this purpose. It comes to two thirds from the Department and one third locally. It is up to the local authorities to fund that. We cannot expect the Department to send down the cheque for everything.

They cannot do it.

We do, actually.

This contribution by local authorities is absolutely vital for the proper and continued operation of the schemes.

The Department decided to increase the grant to 90%.

Local authorities, with their local knowledge and experience, are in the best position to determine individual eligibility and apply resources to the cases in question. It is essential that authorities manage the schemes to ensure that they can be accommodated within the funding they have allocated for that purpose. These grants must not be seen as a substitute for a general scheme of reconstruction grants and it is essential that the available funding is focused on persons with the greatest need in our community.

These disabled people are terribly inconvenient.

My Department is currently undertaking a review of the disabled person's grant scheme—


Another review.

—and will be talking to local authority housing practitioners and other stakeholders involved before making decisions on the future of the scheme.

He will be as bad as the Minister for Health and Children soon.

We are at present awaiting the submission of expenditure outcome figures for 2002 and estimates for 2003 from local authorities.

The people seeking grants are waiting also.

If local authorities would send in the information about what they spent last year and the list of people they would like to help this year, it would help.

The Minister should come off it.

Is that an offer for funding?

When we have received and considered these we will notify allocations to local authorities for payment of grants in 2003. When we receive the records of what they spent last year, their current position and what they would like to do this year, we can make the allocations for this year.

What about the 2,600 in Cork and other areas?

While we are speaking of support services for older people, I also refer to the special housing aid for the elderly scheme, administered by a task force under the aegis of my Department—


Another task force.

—and operated by health boards. It was established to provide assistance to improve the housing conditions of older people living alone in unfit or unsanitary conditions.

It is not working. There is a two or three year waiting list.

The Deputies are not in the real world.

They cannot even get one plate. Ministers are getting carpets in their offices, but these people cannot get one plate.

An Leas-Cheann Comhairle

Order. The Minister without interruption.

Last year, almost €11 million was provided for the scheme and more than 5,000 jobs were completed. I have notified health boards of the allocations for the scheme in 2003. This amending motion sets out the Government's achievements in all these areas.

The Ministers will change their view once they are on this side.

They would be better off at the back. When Deputy Callely was at the back he was a better Government Deputy.

I call on Dáil Éireann to continue to support our activities, particularly those focusing on the specific needs of older people and people with disabilities. The local authorities must provide part of the funding for these schemes.

The Government changed the schemes.

An Leas-Cheann Comhairle

The Minister of State should conclude now.

There is no shortage of funding from the Department.

This is pathetic.

The reality is that fewer people get the grant.

Local authorities must provide part of the funding and if they are short they should supply the Department with details of what they spent last year.

An Leas-Cheann Comhairle

The Minister of State's time has expired.

I am happy to commend the Government's amendment to the House.

I wish to share my time with Deputies Sherlock and Perry.

I had a speech but I will throw it in the bin because I have come to the conclusion that members of Fianna Fáil and the Progressive Democrats are living in cloud-cuckoo-land.

Hear, hear.

I do not know where members of the Government parties go at the weekend, but they are obviously not meeting their constituents like I am meeting mine. Week after week, the Opposition parties come before the House to raise matters of extreme urgency on behalf of vulnerable and voiceless people and all we get is a spiel and a spin in response. The Opposition is not listened to. I spoke during a Private Members' debate on people with disabilities some weeks ago and afterwards Deputy Mitchell and I agreed that we could stand here week after week debating but it would not make any difference to vulnerable people because they are not the ones in the hospitality tents at the Galway races. The only people the Fianna Fáil and Progressive Democrats parties look after are those with money.

That is rubbish.

It is the truth. Two weeks ago, the Labour Party tabled a Private Members' motion and I raised the matter of home help on the Adjournment last week, yet the situation is still the same. The facts I laid before the House on those two occasions are true and the people in the tents at the Galway races are not concerned because they have plenty of money to pay for themselves.

That is not a fact, it is rubbish. The Deputy can carry on with her rubbish.

That is fact. I can understand new Members of the House becoming frustrated with the answers they get. I raised the matter of nursing home subvention and enhanced nursing home subvention in the House on the Adjournment in February 2002 and the former Minister of State at the Department of Health and Children, Deputy Moffatt, replied giving the same reply as was given by the Minister for Health and Children tonight. No progress has been made in this area. If the Minister of State, Deputy Noel Ahern, wants a copy of the speech I will give it to him. The then Minister of State promised that a solution would be found to the crisis in waiting lists for subvention in the Southern Health Board. I am not a member of the health board although my colleague, Deputy Allen, is.

He has been a member for some time.

The matter was raised at the meeting yesterday and Deputy Allen told me that a solution has not been found. That statement was made before the election.

Deputy Allen is a member of the board.

The board is run by Fianna Fáil cronies. We are members of a minority group. There are 560 people on the waiting list.

The people will not be fooled any longer. Unfortunately, the people I speak for tonight – the vulnerable and voiceless – are not in a position to march to Leinster House. They are not in a position to go to the Minister and have their rich friends look after them. There are people living on an old age pension who have used up all their life savings and are now dependent on the goodwill of the owners of nursing homes to keep them. I raised the matter of enhanced nursing home subvention in the House and was told that in the Southern Health Board area they were one year in arrears regarding applications for it.

Shame on the health board.

Shame on the Minister of State, Deputy Callely. His party made promises before the general election and fooled the people.


An Leas-Cheann Comhairle

The Deputy should be heard without interruption.

In February last year, the then Minister of State, Deputy Moffatt said:

Article 20 of the nursing home subvention regulations provides that, 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.

In other words, there is a cap on the level of subvention that can be claimed by the nursing home resident.

Will the Government consider amending that legislation so as to provide for everybody in need of enhanced nursing home subvention? Without an amendment to the Bill, neither the Minister nor the health boards are in a position to provide the money to the people who need it.

The Minister of State at the Department of the Environment and Local Government, Deputy Ahern, said that 90% of the costs of disabled persons grants are covered. That is misleading information and if the newspapers report it tomorrow, my constituents will ask me why they are not getting 90% of the grant they applied for. The Minister of State should be truthful. I pay tribute to the staff in my local authority who are doing their best. They are trying to spread the money as widely and help as many people as they can. For the Minister of State to say that 90% of costs is covered is completely misleading to the ordinary person on the ground.

Why is that so?

They are not in a position to give 90% of the grant.

The Department give two-thirds.

The Minister of State does not understand.

The Minister of State obviously does not understand because, with the number of applications the local authorities have, they cannot possibly give 90% of the grant. They are trying to help as many people as they can. If the Minister of State is prepared to give a guarantee that 90% of every grant application considered necessary by the local authority will be granted, I will be delighted. I hope that is the case, but I suspect he is giving misleading information. It is about time the Government gave up the spin and spiel and told us the truth – the next election is four years from now.

The local authority has to provide—

They cannot do so to the tune of 90%. I will not get into an argument with the Minister of State. I ask him to give truthful information to the House. He is misleading the people.

Does the Minister of State, Deputy Ahern, know that local authorities are charging €50 for each application for a disabled persons' grant, some of which are made by old age pensioners. I am surprised the Minister of State has left the House because I would like him to hear what I have to say. I will state facts whereas what he said reminded me of a word we use in the country.

Section 51 of the Health Act 1970 provides that every person resident in the State is entitled to be provided with, where necessary, in-patient care by the relevant health board. This may be provided directly by the health board through publicly funded hospitals or by contracting arrangements between health boards and private nursing homes. The Government has failed to ensure the provision of this service to which the public is entitled. The Minister for Health and Children and his Department is presiding over a practice that is legally indefensible – the Government, in denying people subvention, is acting illegally.

The Minister for Health and Children has advised the Southern Health Board that he is not prepared to agree that this is a demand-led scheme and has told the board to live within its allocation. This has led to elderly residents being threatened with removal from nursing homes where they have been residing for years. Last week, the niece of an 87 year-old nursing home resident was told that if the subvention was not paid the resident would have to leave the home. This is what the Government is doing.

Under the Health Act 1970 the person in need of nursing care has a statutory entitlement to be provided with a service by their health board. The Ombudsman confirmed this position in his most recent publication. The Government has acknowledged this entitlement as demonstrated in the published correspondence between the Ministers for Finance and Health and Children. It reveals that Deputy McCreevy was demanding that the law be changed to withdraw this entitlement. The Minister spoke of an expenditure review of the nursing home subvention scheme in his speech to the House. The Government is proposing to change the Health Acts to withdraw subvention from private nursing homes.

That is not true.

That is what it looks like if one reads between the lines.

That is exactly what the Minister from Cork is proposing to do and he came here to tell lies about it.

The judgment of a civilised society is how it treats its most vulnerable citizens. Elderly people who can no longer care for themselves are surely our most vulnerable citizens and, in a civilised society, they should be entitled to adequate care. The way in which they are being treated by the Government and the worry and distress this is causing them is a national scandal. The Minister will admit that he spent €500,000 on the refurbishment of his offices last year.

In the Southern Health Board there are currently 935 persons in receipt of subvention and of this total, 530 receive enhanced subvention. A further 145 persons currently receiving basic subvention are awaiting enhanced subvention while a further 186 persons who have already been provided with enhanced subvention have made applications for further increases. The reason they apply for subvention is they are being directed from public hospitals to private nursing homes. They are, in some cases, given application forms by nurses in the hospitals and their accommodation is booked in the private nursing home. This is what is happening to the elderly people in this country today. It is an absolute disgrace and the Government should be ashamed of itself.

I wish to share time. This evening's motion has allowed the Government yet another opportunity for self-congratulation. That is a pity, because what this motion calls for, and what I had hoped we would have heard from the Government benches, is a dose of reality. It is time the Government got real about the chaos and the crisis that is an everyday reality for the elderly, their families and carers and most especially for people with disabilities, who rely on what passes for services in the community.

In my health board area – the North-Western Health Board – by June of last year there were 893 elderly people seeking funding from the special housing aid for the elderly scheme. The figure has more than doubled by now. The fund for special housing aid for the elderly is an important part of the effort to allow elderly people to live at home in comfort and security in a house which is suitable to their needs. There is currently no money in that fund and people are being sent to the county councils to secure alternative funding.

A total of €11,537,000 has been allocated to this fund this year. While this would appear to be good news, it may surprise some and disappoint others to learn this is a 3% cut in the amount allowed for in 2002. When costs are rising, the fund is falling – that is reality. Of that €11.5 million, only €1 million is provided by the Exchequer, the remainder comes from lottery funding, which may or may not be available in the future.

The same kind of hit and miss funding applies to the disabled persons housing grant and to a whole range of service provision for people with disabilities. The funding from the Department of the Environment and Local Government for the disabled persons' housing grant this year has been cut by 8%. That is a real cut, not an adjustment or a figment of the imagination.

The demand for the disabled persons grant so far outstrips the funds available in Sligo County Council that we have had to look at funding only 75% of the cost of approved works. This is neither acceptable nor just. It is not practical for most people with disabilities, many of whom may not be able to fund 1%, let alone 25%, of the cost of conversion.

This is the reality of Ireland in 2003 – the European Year of People with Disabilities. We have to spread the resources so thinly that we are in danger of doing more harm than good. By trying to be inclusive, we may, through under funding, be excluding those most in need of support. Several years ago the report "Towards an Independent Future" identified problems within the physical disability sector. It showed a lack of comprehensive data on the numbers and service needs; inadequate access to information on service provision; disparities in eligibility criteria in between and within health board areas; inadequate statutory financial funding for individuals; uncertain funding of voluntary organisations; shortfalls in service relating to therapy, day care, counseling and home support; uneven geographic distribution of services; inadequate transport services; inadequate co-ordination of services; and poor consumer choice. It is an indictment of this Government, in power now for almost six years, that the circumstances for people with disabilities have not changed at all. The 1996 report is, to this Government's shame, still relevant. It is a disaster for people with disabilities. They are the people who are facing the harsh reality of life in Ireland in the European Year of People with Disabilities.

This Government is newly born with the fresh gloss of the value for money party, the Progressive Democrats, and the newly accountable Minister for Finance who demands bang for his buck. This Government will demand value for money from every citizen and every service provider. Yet this is the Government that underestimated the number of people over 70 in the country and almost quadrupled the cost of the free medical card scheme. The Government has increased the costs of medicines to people with chronic illnesses without a legal leg to stand on and now has to pay back €20 million. This is the Government that spends millions on spin and photographs, smoke and mirrors. The Minister spent millions on launching the health strategy before the election.

There was plenty of smoke.

Yet this is the Government that has decreased funding for services to people with disabilities in the North Western Health Board area every year for the past three years. The Government has, in this important year for people with disabilities, brought to a full stop to services and their legitimate aspirations.

From my dealings with the North Western Health Board and Sligo County Council I know there are no funds available. I met a female patient from St. John's Hospital in Sligo who wants to go home. While she needs full-time care, the health board will only give her a subvention of €150. That she is receiving subvention makes her ineligible for home care help. This is what the State is giving this family to bring their mother home. I made an application for the modification of her house. The application was with the health board for two months but was returned with a note saying there was no funding and suggesting I contact the local authority. It is outrageous that there is not one scheme to co-ordinate this. It is being passed from the health board—

Return to sender.

That is the situation. It is sad that in a time of prosperity such as this there is nothing in this country for people with disabilities.

Debate adjourned.