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Dáil Éireann debate -
Thursday, 13 Oct 2005

Vol. 607 No. 4

Adjournment Debate.

Nursing Home Subventions.

I am grateful for the opportunity to raise this important issue. The HSE western area has decided to abolish the payment of enhanced subvention for nursing home residents due to funding shortfalls. This is an unacceptable cutback. Although 117 people in Mayo in receipt of enhanced subvention will continue to receive it, anyone else without independent means requiring a nursing home place will no longer be able to afford it. In the case of a rock bottom nursing home tab of €450 per week a funding shortfall of €100 per week will exist.

Cutbacks of some 100 beds have been made in Mayo in recent years. As the State is unable to provide sufficient public residential beds, older people will occupy even more acute hospital beds for longer periods because there is nowhere else for them to go. This will worsen the trolley chaos that already exists. The entire subvention scheme is unacceptable and is in disarray.

Nationally there is disparity between amounts payable for a nursing home place. For enhanced subvention the maximum amounts payable, after subvention and pension payments, range from €680 or more in the east of Ireland to €30 in the mid-west. This range across the country is unacceptable, especially in respect of the new HSE set-up where so much uniformity had been promised. Older people need some certainty on the funding available so that plans can be made. If nursing home places are needed there must be certainty on availability of places.

I urge the Minister for Health and Children, Deputy Mary Harney, to address the chaos that exists by providing the necessary funding to the HSE to restore enhanced subvention payments. The HSE does not receive a designated budget to make these payments. In recent years services had to be cut back in order to make these payments. Our older people deserve better than to be subjected to this additional trauma.

Enhanced subvention exists for people who have nothing else. Means testing has proved that these people have nothing, no money except the pension, no land, no property and no relatives with money. If relatives exist they do not have money and the old people are totally impoverished. These people are at the mercy of the State and it is letting them down and I regard this as another cutback. In the HSE western area the maximum subvention is €220 per week and once a pension is added to this there remains a funding shortfall of €100. Enhanced subvention is a necessary top-up for those people. Otherwise, where can they go? They will end up occupying a hospital bed. If the State does not pay this top-up for them, they will be unable to afford a nursing home place and will continue to occupy that hospital bed, thereby unwittingly depriving someone with an acute condition of that bed. A person will be on a trolley downstairs in a hospital because the bed upstairs is occupied by an older person who would prefer to be in a nursing home.

I thank Deputy Cowley for raising this matter on the Adjournment. On behalf of the Tánaiste and Minister for Health and Children, Deputy Harney, I wish to outline to the House the current position regarding enhanced subvention in the western area.

Deputy Cowley and all Members of the House will be aware that the nursing home subvention may be paid towards the cost of private nursing home care where a person is unable to meet the cost or where he or she has been assessed as needing nursing home care by the Health Service Executive and where the person has satisfied a means test. The amount of subvention will depend on the degree of nursing home care required, that is, medium, high, maximum, and the amount of the person's assets including property, stocks and shares, savings etc. The rates of subvention payable are as follows: for medium dependency there is a payment of €114.30 per week; for high dependency the payment is €152.40 per week; and the amount for maximum dependency is €190.50.

The nursing home subvention scheme was introduced to assist with the cost of private nursing home charges and was not intended to cover the entire cost of nursing home care. However, I am very aware that the gap between the rates of subvention being paid and nursing home costs has widened considerably in recent years.

The Health Service Executive may, in accordance with article 22.4 of the Nursing Home (Subvention)(Amendment) Regulations 1996, 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 application of these provisions, however, is a matter for the HSE in the context of meeting increasing demands for subventions.

The average rate of subvention paid by the HSE generally exceeds the current approved basic rates mentioned above. Spending on the nursing home subvention scheme has increased from €5 million in 1993, when it was introduced, to a figure in the region of €140 million this year.

When a person applies for a subvention it is subject to a means test and a person's assets are taken into account, but the test currently being used is very much in need of a change. If person's house is valued at more than €95,000, it would rule him or her out but one would have to travel a good distance before one would find a house worth less than that. When one considers that the average price of a second-hand house in Dublin is close to €400,000, it gives some indication of the necessity to change the guidelines. We will be announcing changes in that regard in the near future.

The Department has been informed by the HSE that the position in the western area is that every person in receipt of nursing home subvention and enhanced nursing home subvention is being paid and will continue to be paid. There is a heavy demand for enhanced nursing home subvention. Each individual application for enhanced nursing home subvention will be reviewed by the local health office manager in each county in the HSE western area and each case will be considered individually. Also, as part of the 2006 Estimates process, proposals have been put forward by the HSE for additional funding for the western area.

A working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established. The objective of this group is to identify the policy options for a financially sustainable system of long-term care, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea. This group is expected to report to the Tánaiste and to the Minister for Social and Family Affairs in the very near future.

Child Care Services.

The next item is in the names of Deputies O'Connor and Crowe. The Deputies have five minutes each.

I acknowledge sincerely the co-operation of the Ceann Comhairle's office in allowing Deputy Crowe and I to raise an issue of serious concern to our community in Tallaght, where we live in the same estate. My son Robert made the point to me today that it is interesting to listen to Dáil proceedings when, as was the case this afternoon, we speak about issues such as the children of Pakistan, about whom much concern was expressed. The issue I want to raise is important for my constituency, and I acknowledge the presence of the Minister of State, Deputy Seán Power. It is also nice to see one of the Fianna Fáil vice-presidents, Michael Stokes, in the Visitors Gallery.

Tallaght west is an amazingly positive place which has been the subject of occasional bad publicity and a bad reputation over the years. Those of us who are honoured to represent the Tallaght west estates are anxious to paint a positive picture of the great communities of Jobstown, Fettercairn, Brookfield and Killinarden. My party leader, the Taoiseach, Deputy Bertie Ahern, made the point when he visited Jobstown on Monday last that he has visited Tallaght west on a number of occasions.

There is no doubt that much progress has been made recently in the community, which is only right. We now have in place a number of projects that we were waiting on for a long time. They include the building of the swimming pool in Jobstown, which is exciting everybody in the community, a new community centre in Brookfield and the need for a youth centre in Jobstown. Also, during the summer the Taoiseach opened the Citywise education project in Jobstown.

There is no question that the progress made on resources, facilities and infrastructure for the Tallaght west estates is only what the people deserve. I have always supported and been committed to a strong social inclusion policy for those Tallaght estates, which clearly need that assistance. In doing so I am following the example of my colleague, the former Minister of State, Chris Flood, who is also a long time colleague of the Leas-Cheann Comhairle and who strongly represented the Tallaght west area.

The initiative Deputy Crowe and I raise concerns a report, A Place for Children: Tallaght West, a living document, which is the result of a ten-year approach by the Childhood Development Initiative whose consortium includes An Cosán, Barnardos, Brookfield Headstart pre-school and crèche, the Health Service Executive, Integration of African Children in Ireland, the Jobstown child care centre, Killinarden school completion programme, Little Scholar's pre-school in Jobstown, the Rainbow House early education and child care centre, Scoil Chaitlín Maude and Naíonra Chaitlín Maude, Scoil Cnoc Mhuire in Knockmore, South Dublin County Council, the south Dublin child care committee, St. Aidan's and St. Bridget's national schools in Brookfield, St. Aidan's Traveller centre in Brookfield, St. Anne's primary school in Fettercairn, St. Louise's playgroup in Knockmore, St. Thomas's senior school in Jobstown, Tallaght Partnership, West Tallaght RAPID, the YMCA and Youth Horizons. That list is an indication of the importance of this child care initiative. We were all delighted to join the Taoiseach on Monday in a tent in the grounds of Kiltalown House near Jobstown. The event was attended by more than 900 children and some 400 adults. It was an amazing experience.

I said in an earlier debate that when I visited a local school last week, a youngster told me that road safety is not just for one day or one week but forever. It is important that we get the message across that it is not just about a launch or making a point on a day but asking Government to examine this serious report, which not only would be good for the Tallaght west estates but could be used as a model for the rest of the country.

I appeal to the Minister of State to get the message across to the Tánaiste and Minister for Health and Children and her colleagues, the Minister for Justice, Equality and Law Reform, the Minister for Community, Rural and Gaeltacht Affairs, the Minister for Education and Science and the Minister for Social and Family Affairs that it would be worth their while examining this report and taking action on it. As a Tallaght-based Fianna Fáil Deputy, I make a special appeal to the Minister of State to do what he can to help us ensure this report is resourced, which would give a tremendous boost to the Tallaght west estates. It would give the children of Tallaght west a great future. I make a special appeal to the Minister of State to help us in that regard.

Like my colleague I welcome the opportunity to speak on the question I have put to the Minister for Health and Children. It is clear from the statistics for Tallaght west that it is a unique area with special needs. The area was officially designated decades ago as a County Dublin Areas of Need, CODAN, area in recognition of the difficulties there, and is now a RAPID area. It has not received the investment and support mechanisms the people in this area deserve and to which they are entitled.

Unemployment in the area is two to three times the national average. The population aged under 15 is 39%, whereas the national average is 24%. Almost one third of all families in the area are headed by a lone parent, twice the national average. A total of 54% of the adult population in Tallaght west left education at or before the age of 15.

Only 6.8% of the population is in full-time education after the age of 20, which is less than half the national average. The area has suffered unacceptable levels of anti-social behaviour, criminality and its negative spin-offs. Over 600 people from the area are in treatment for substance abuse — this is only the tip of the iceberg because studies suggest the real level of substance abuse is three times higher.

This Government and previous Governments should have pursued a strategy for the area in light of the statistics I have outlined. The childhood development initiative has done that with the strategy it launched earlier this week, A Place for Children: Tallaght West, a living document This is described as a living document and hopefully will get the response it deserves. It proposes intervention at the earliest possible stage with a view to preventing a child falling by the wayside.

The initiative has six targets, namely, to improve early childhood care and education radically; to co-ordinate the integration of services in schools and child and family centres with a view to increasing efficiency; to develop new services where needed; to liaise with current services; to reduce stresses on parents and children; and to evaluate and apply what is learned on a national level.

This is designed to have a major impact on this Government's targets for reducing child poverty, increasing child care places, reducing educational disadvantage and drop-out rates, and reducing anti-social behaviour. It also includes the aspiration to build an inclusive and more equal society where no child goes to bed cold, hungry or frightened and children in this area receive the same opportunities as the well-off children from middle Ireland.

What practical steps do the Minister of State and his Government intend to take in support of this initiative? Will he and his Department invest the extra €634 per child for three years as called for by this strategy? The strategy involves expenditure of €15 million over a ten year period. That is small change in the context of the amount of money taken into the economy this year, including the unexpected extra €1 billion.

If the Minister of State takes into account the problems I outlined at the start of this debate and the difficulties facing people in the area, he will see there is need for a proper response from Government. Not only this Government but successive Governments have failed the people in this area. We are trying to create a new place for children that will offer them new opportunities to break out of the cycle of poverty and structured inequality. This requires investment and joined-up Government.

I applaud the people who came together in this initiative which should have come from the Government but instead came from the community. I appeal to the Minister of State to support this positive initiative from the people of Tallaght west.

On behalf of my colleague, the Minister for Health and Children, Deputy Harney, I wish to respond to the issue raised by Deputies O'Connor and Crowe. It is nice to see constituency colleagues working together. This provides me with an opportunity to outline to this House our response to the launch of this ten year child care strategy for Tallaght west. The objective of the strategy, as the Deputies have outlined, is to improve children's health, safety, learning and achieving, and to increase their sense of community belonging. I welcome its goals and its aims.

At the research stage of this project, my colleague, Minister of State at the Department of Health and Children, Deputy Brian Lenihan, made some funding available to ensure that the valuable research continued. Given the research, planning and consultation, including consultation with children, that has gone into this project, it is clear that the strategy is based on a realistic picture of life for children in Tallaght west. It emphasises the need for co-operation across Departments and agencies, together with similar assistance and understanding from the local community and the local authority, South Dublin County Council.

The Taoiseach, in launching the ten year strategy, entitled A Place for Children: Tallaght West, a living document, on Monday last indicated that it points in the right directions. Despite the real progress that has been made in Ireland in recent years with increased investment, spending and planning, many children continue to experience poverty and disadvantage in their daily lives. The problems which lie behind this poverty and disadvantage are often complex and do not lend themselves to simple solutions. To address these problems, social policy must be based on a strategic approach and must target those in need. The Government has put a number of initiatives in place with the aim of improving children's lives, some of which I will outline.

As a Government designated geographic area of disadvantage, or RAPID area, it has been estimated that approximately €27 million was spent in 2004-05 by statutory bodies on children's services in the part of Tallaght covered by the strategy. The project recognises this, which is a substantial sum in the area concerned. The National Children's Office is in place to co-ordinate the implementation of the children's strategy, including consultation with children, and hearing their voices. The Ombudsman for Children provides an independent voice on their behalf.

Ireland is one of the first countries in the world to have a national policy on play, Ready, Steady, Play, which was launched by my colleague, Deputy Brian Lenihan. The Government wants to build more playgrounds and parks with spaces to play and to make playgrounds and play areas safer for children. Part of this can be done through direct provision from the Exchequer and part by good forward planning on the part of local authorities. The Government has put funding in place. In Tallaght west, grants of €72,000 each have been provided to Jobstown, Fettercairn and Killinarden for playgrounds under the RAPID scheme.

The provision of early childhood care and education services is identified as central to positive outcomes for children. The Government is reviewing options for future child care policy, taking account of the work of the high level working group on early childhood care and education and other reports on the issue. The National Children's Office was asked to prepare the high level working group report which was presented to the Cabinet Committee on Children last week.

Funding of over €10.6 million under the equal opportunities child care programme has been allocated to the Tallaght-Jobstown area since the beginning of the programme. School age child care is being addressed under the equal opportunities child care programme as well, under an initiative announced by my colleague, the Minister for Justice, Equality and Law Reform, Deputy McDowell, earlier this summer. The Health Service Executive is also involved in developing and supporting a number of child care and family support services in the Tallaght area and is represented on this project's consortium group.

Education is the key to young people reaching their full potential. It can provide them with the confidence to participate actively in society. Tackling educational disadvantage continues to be a key priority for the Government as reflected in the new action plan on educational disadvantage, delivering equality of opportunity in schools, launched by my colleague the Minister for Education and Science, Deputy Hanafin, last May. The new action plan aims to ensure that the educational needs of children and young people from disadvantaged communities are prioritised and effectively addressed in a more targeted, coherent and integrated way.

Another priority for the Government is reform of the youth justice system. Young people are subject to many pressures. Drugs, alcohol and social disadvantage can lead to a cycle of poverty, anti-social behaviour and getting into trouble. The Government is working to identify those at risk as early as possible and build their capacity to become responsible citizens.

The Children Act 2001 provides us with unique and specific opportunities. Major principles enshrined in the Act include the need for early intervention, the provision of community alternatives to detention and the principle that custody must remain a measure of last resort. A review of the structures of our youth justice system is being finalised and the results will be brought to the Government shortly.

Those developments at national level are mirrored in the approach outlined in the childhood development initiative's ten-year strategy. The strategy will support steps already being taken to improve outcomes for children in this area and play an active role in seeking new solutions to emerging issues. As the Taoiseach stated at the launch, the strategy and its proposals will be considered by relevant officials from the Departments drawing on the involvement of many local agencies in its preparation.

Grant Payments.

I wish to raise the issue of the disabled persons' grant, the inequality in how it is provided nationally, and what I believe must happen to resolve that. It must be attached to the initiative that the Tánaiste announced last week, which is very welcome, regarding incentivising people to stay well at home instead of entering a nursing home.

One aspect is the provision of something like the disabled persons grant or the essential repairs grant, the two being interlinked. They are two thirds funded by the Exchequer, with one third coming from the local authority, which is really the Exchequer too. Meeting the demands sought very much depends on whether one's local authority can produce the missing third. I have produced a table per head of the population. The lowest amount paid per head is in Kildare, some €7.35 for every person in the county. That understates the situation since there has been very rapid population growth there and the figures do not include people who have not yet been counted in the census of population. At the other end of the spectrum is Leitrim which receives €100.72 per head for this scheme.

I know that one cannot take one fund in isolation and that one should consider the totality. However, if one telephones the local authorities at the bottom of the list, one typically hears that they have a problem in meeting the demands of people applying. That is certainly the case in Kildare where applications total €5.5 million, with €1.5 million necessary to meet them. That is having a real and definite impact on people. It is certainly having the opposite result to that which the Tánaiste sought in the home care programme that she launched last week. It is not only disproportionate. Some of the disability groups tell us that money is returned from some local authorities where it is not used.

If we can see a problem like that and the money is in a fund, we must consider the structural reason that the problem occurs in the first place, which is that the local authorities at the end of the funding stream find it impossible to produce the one third required of them tomeet the demands of people living in those counties.

I have encountered situations such as that of a couple where the man had retired to care for his wife who suffered from motor neurone disease, which is progressive. He was trying to keep her at home for as long as possible and maintain a high quality of life for her despite the degenerative illness. The disabled persons grant list was closed and even to install a ramp proved impossible for that couple. Such things should not happen in this day and age. People are not able to modify bathrooms to have a safer walk-in shower fitted. Those are typical of applications returned to people in Kildare who are told that they are not disabled enough and that they must be utterly disabled to qualify for funding.

It is really not fair that in one part of the country one can have that funded through a grant while in another one cannot because one's local authority cannot produce the missing third. The sorts of choices that must be made regarding the one third include not introducing traffic calming or augmenting water treatment systems. This scheme is competing with so many other necessary schemes that it should be nationally funded and locally administered. That is the only way to overcome the difficulty. The funding exists but is inappropriately dispersed throughout the country.

I thank the Deputy for raising this matter on the Adjournment. I wish to reply on behalf of my colleague, Deputy Noel Ahern, Minister of State at the Department of the Environment, Heritage and Local Government with responsibility for housing and urban renewal.

The disabled persons and essential repairs grant schemes serve a very useful purpose in helping to meet the housing needs of disabled and older persons. The disabled persons grant is available for the provision of additional accommodation or the carrying out of works of adaptation which, in the opinion of the local authority in whose area a house is located, are reasonably necessary to make the house more suitable for a disabled member of the household.

The essential repairs grant enables people in houses that cannot be made habitable in all respects at a reasonable cost to have basic repairs carried out to them. The scheme is directed primarily at older persons living in poor housing conditions.

I wish to make clear the Government's commitment to those schemes. They assist some of the more vulnerable sectors of society in providing themselves with accommodation appropriate to their changing needs. We have not been found lacking regarding the schemes. Demand for assistance under the disabled persons grant scheme, in particular, has increased enormously, and that is due in no small part to the significant improvements the Government has made to the scheme in recent years. In particular, the increase of the maximum effective grant in 2001 to its present level of €20,320, and the increase in the percentage of cost payable to 90%, has led to significantly greater activity under the scheme. The position is similar regarding the essential repairs grant scheme. The effective maximum grant of €9,523 may cover up to 100% of the cost of the works.

To meet that increased demand, the capital provision for the schemes is €70 million this year. The number of disabled persons grants paid increased from 3,646 in 2000 to 5,222 last year. Expenditure in the same period totalled more than €218 million, with more than 25,400 grants paid. That means that 25,400 projects were completed, allowing that number of disabled persons to remain in their home and enjoy improved housing conditions that many of them would otherwise have been unable to afford. Expenditure on the essential repairs grant scheme totalled €53 million in the period from 2000 to 2004, with 11,400 grants paid.

Deputies will be aware that the management of both schemes is delegated to local authorities within the framework laid down in statutory regulations. As far as practicable, that is designed to give an appropriate degree of flexibility at local level. The fact that the current regulations are framed in a manner that allows authorities maximum flexibility is one of the strengths of the scheme, but it may also require more active management at local level. The majority of authorities have reviewed their schemes in recent years to streamline their operations and reduce as far as possible the bureaucracy that might arise where more than one statutory agency is involved. They have also introduced a variety of mechanisms to ensure that the available resources are targeted to those in most need, including prioritisation on medical grounds, financial ability to carry out the work and unit cost control.

It is a matter for the authorities to decide on the level of funding to be provided for the schemes in their areas from within the combined allocations notified to them for that purpose by the Department. As I said, a combined capital allocation of €70 million is being made available to local authorities for the payment of disabled persons and essential repairs grants in 2005. Individual allocations have been notified to local authorities based on their requirements as notified to the Department. It is a matter for authorities to decide on the level of funding to be provided for the two schemes from within that combined capital allocation.

While two thirds of all expenditure on the schemes is recouped by my Department, authorities are required to fund the remaining one third from their own revenue resources, with amounts provided for that purpose in their annual estimates. In an effort to make the scheme more manageable for authorities, the recoupment level was increased from 50% to two thirds with effect from 2001. I am aware that some local authorities appear to give these schemes greater priority than others in the framing of their estimates. In the case of authorities with a high level of demand for the schemes, the provision of a one-third contribution can be a challenge.

When notified of their combined capital allocation for the scheme in 2005, local authorities were advised that in any cases where they had not made provision in their 2005 budget for their net contribution to these grants, they should advise the Department without delay of their proposals for the funding of their contribution. Any such applications are being considered in the Department. While there are no proposals to remove the requirement to provide a contribution from their revenue resources, this aspect of the scheme is also being considered in the context of the review of the scheme which is being finalised in my Department.

The disabled persons and essential repairs grant schemes are intended, like a number of other housing grant schemes operated by my Department, to assist works which provide additional or adapted accommodation in private houses. However, they are not designed to cover the full cost of works for all applicants. Local authorities may provide reconstruction loans to qualified applicants who have difficulty in obtaining finance to meet the balance of the cost. The focussing of the scheme on real needs, both financial and in terms of accommodation, and its operation by local authorities in an efficient manner will be critical in ensuring that it achieves its aim. I hope the outcome of the review of the operation of the scheme which is under way in my Department will significantly contribute to this achievement.

I am aware of Deputy Catherine Murphy's interest in this issue. We have both been critical in the past of how this issue has been dealt with in Kildare. When comparing counties, such as Kildare and Leitrim, as Deputy Catherine Murphy did, in terms of the funding allocated, there are other considerations one must take on board, including the average age of the houses involved and the percentage of the population who seek assistance in this regard.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 18 October 2005.
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