Dáil Éireann debate -
Tuesday, 31 Jan 2006

Vol. 613 No. 3

Private Members’ Business.

Social Services Inspectorate: Motion.

Dr. Twomey

I move:

That Dáil Éireann,

concerned at:

—the failure of the Government to fulfil promises made in this House by the Taoiseach and the Tánaiste and Minister for Health and Children to introduce legislation to provide for an independent statutorily-based inspection regime for all nursing homes;

—the lack of information and transparency about standards applying to nursing homes; and

—the failure to make current inspectors' reports easily accessible and available to the public, nursing home residents and their families;

calls on the Government to:

—prioritise the drafting of the promised legislation so that it is introduced in this session of the Dáil;

—make all inspection reports directly available to residents of nursing homes and their families and accessible to the public, free of charge; and

—ensure that the nursing homes inspectorate is resourced with relevant professionals.

This motion addresses the social services inspectorate that is supposed to look after people in public, private and other forms of residential institution within this State. It was promised but not delivered by the Government during 2005. We are calling on not only the Government but particularly the Taoiseach to move on this issue. If he is happy to look after the child care needs of children in Latvia and Poland, the least he could do is look after issues surrounding the care of the elderly in his own country. He has paid lip service in the past 12 months to this as a priority for his Government.

The charge against the Government tonight is that there is no commitment to the care of the elderly in the community or residential sector. The Government has dragged it heels on this issue and kicks and screams against every proposal made by the Opposition. It only moved on issues related to the care of the elderly in the last budget because there will be an election next year. Prior to that, nothing was done for the care of the elderly in the lifetime of this Government.

Mr. Cassidy

We never gave anyone £1.83 in a budget.

Mr. O’Dowd

Deputy Cassidy is a disgrace and so is his party.

Mr. Cassidy

I am not a disgrace.

Mr. O’Dowd

The Deputy could not care less about the elderly.

Mr. Cassidy

Fair is fair and I respect the speaker who is addressing the House.

Mr. O’Dowd

Such rubbish. I take my hat off to the Deputy.

Mr. Cassidy

I salute Deputy O'Dowd too.

Dr. Twomey

All vulnerable adults, such as those with a disability, in this society deserve the protection of the State but they are not getting it. Children do not get the protection of the State, as we have seen time and again in regard to vetting, which is not coming through. The proposals I have for the social services inspectorate will protect elderly people in every setting in society. The Government has only paid lip service to this idea in the past 12 months. Words are not enough, it is time for the Government to stand up for what it believes or it will have zero credibility with the people at the next election.

The Taoiseach, the Tánaiste and the Minister of State at the Department of Health and Children, Deputy Seán Power, promised legislation before the end of 2005, but not even the heads of a Bill have been delivered as we start this new Dáil session in 2006. It is worth remembering what was said. The Tánaiste stated in April that there are commitments in the health strategy, Quality and Fairness — a Health System for You, in Sustaining Progress, the social partnership agreement for 2003-04 and An Agreed Programme for Government of June 2001 on the establishment of a social services inspectorate on a statutory basis and the extension of its remit to other social services, including residential services for older people. In the nine months since those words were spoken, nothing indicates any more commitment on the Government's behalf to the establishing of a social services inspectorate than there was in April 2005. It is a shocking indictment of the Government.

The former Minister of State at the Department of Health and Children, the self-styled champion of the elderly, Deputy Callely, in July 2003 told the Dáil that health boards were involved in the preparation of draft standards of care for residential institutions for older people. These draft standards were to build on the standards required of private nursing homes under the Nursing Home (Care and Welfare) Regulations 1993 and to have regard to international good practice in this area. It is obvious neither Deputy Callely nor the Government chose to follow up and ensure these standards were finalised or implemented. If they were finalised, where are they now and why were they not implemented in the past two years by the Government?

In 2005, we tabled a parliamentary question to find out what services for older people, promised by the Government in the health strategy, which was Fianna Fáil's manifesto on health prior to the last general election, were being provided. We were promised 600 day hospital beds but none was delivered, at least to the best of our knowledge because the HSE could not tell Fine Gael how many day hospital beds for the elderly were provided since 2001. We were promised 1,370 assessment and rehabilitation beds but how many have been delivered since 2001? There was a total of 95, a 7% success rate. We were promised 7,000 extra day care places in 2001. How many have been delivered? Only 2,250 were delivered, 32% of the figure promised. We were promised 5,600 beds in community nursing home, community care, community support and extended care beds — the Government pledged to provide 800 beds every year for seven years. How many have been delivered? A total of 537, a 9.5% success rate in delivery of Government promises on services for older people.

Should it come as a surprise, therefore, that the Government has totally failed to implement legislation that would protect the elderly or establish an inspectorate that would protect elderly people from abuse in public and private residential nursing homes? I will not go into detail on what has happened in many of those nursing homes. I will leave that to Deputy O'Dowd, who has done trojan work on this issue in recent years.

Other promises were included in the health strategy, specifically in the care of the elderly area, that have become stuck in the 2001 time-warp, promises made before the last election. Legislation was enacted to clarify entitlements because many elderly people still do not know their entitlements, but under the HSE, which was supposed to equalise services across the State, there are still differing rates of subvention in different health board areas and different interpretations of entitlements. This basic legislation has not been implemented.

Every time a Minister discusses care of the elderly, it is pointed out that our population is aging and the percentage of people over 70 is increasing year on year, but where is the framework policy to address this? After five years, the Government has failed miserably to even publish a policy document on care of the elderly. Many ideas have been bandied about, with report after report, such as the O'Shea report, the Mercer report and another Cabinet working group that is to report back to the Ministers for Health and Children and Social and Family Affairs. As we move further into the century, the Government has no idea how it will fund care of the elderly in future.

This lack of commitment was demonstrated in the last budget, where the Government trumpeted the broadening of subvention criteria as a great step forward. Broadening the criteria for the subvention is not much use if the rates of subvention patients can get are still stuck in the 2001 time-warp. How much help would it be for patients to receive between €131 and €160 per week to pay nursing home charges? Has the Minister any idea of the changes in the cost of nursing homes since 2001? If he thinks they have not changed, he is also stuck in a time-warp. There has been a dramatic change in the cost of nursing home care.

The Government is also failing miserably to provide services for people in the community. We will need to keep a close eye on events because there appears to be a drift towards privatising much of this service. I wonder whether a large number of home help hours are being repackaged into small parcels to be delivered by the private sector, without an overall increase in the delivery of care in the community.

Not only is the Fine Gael Party calling for the immediate establishment of the social services inspectorate — we have had enough dilly-dallying from the Government on this important issue — but all the issues which arise as a result of its establishment must be acted on immediately. Legislation on entitlements must be introduced and applied equally throughout the country. The purpose of establishing the Health Service Executive in what the Government describes as a reform process — it is far removed from reform — was to have a uniform approach.

With regard to subvention payments, only 5% of the elderly population reside in a nursing home or avail of any other form of residential care. Those who end up in such care should be given the utmost protection and comfort. Families should not have to go broke looking after elderly relatives. The Government must have the courage of its convictions and deliver a policy on funding care for the elderly, rather than continuing to tinker at the edges. The funding package of €150 million for care of the elderly the Government announced for 2006 suddenly dropped to €110 million when the details emerged. This figure must be scrutinised more closely in future to ascertain what precisely is being delivered in the area of care for elderly people.

In terms of expenditure, the only advance the Government made in this area since 2001 was to introduce medical cards for those aged over 70 years. The delivery of this measure was considered stroke politics at the time. While giving medical cards to all those aged over 70 years is not a bad idea, giving them to multimillionaires and paying general practitioners three times the rate paid for less well-off medical card holders demonstrates the major shortcomings in the system. Unless this measure is followed up with all the other Government promises and the Government demonstrates a commitment to the care of the elderly, its credibility will be completely undermined. The reason the Fine Gael Party is putting pressure on the Government in this area and making primary care and care of the elderly in the community our political priority is to embarrass the Government into looking after elderly people properly in their communities.

During questions earlier, I was shocked by Ministers' lack of knowledge about services they claim to be providing in the community. The current position must change and the Government must take as its starting point the need to provide care for the elderly. The messing around must stop. The Government must quickly provide proper care of the elderly in the community and residential institutions and ensure that those living in such institutions are protected.

Mr. O’Dowd

While this is an important debate, it is unfortunate that it takes place in the full and certain knowledge that the Minister of State at the Department of Health and Children, Deputy Seán Power, has laid before the House no evidence of changes he has made in the Department and the Health Service Executive since the Leas Cross story broke about a year ago. It is shameful that he has sat on his hands and that the Government has done no productive work on this issue in the intervening period.

As a letter the Minister of State received from the Health Service Executive demonstrates, he was informed in May last year that up to ten nursing homes could have to close in north County Dublin if changes were not made. The level of care in Leas Cross and many other nursing homes around the country was appalling. The Minister of State has been charged with the responsibility of changing this but has failed miserably to do so. It is a disgrace that the Government has not produced the legislation it promised, as my colleague, Deputy Twomey, stated.

I received a letter on 31 May 2001 under the Freedom of Information Act before the legislation was amended. It states:

I refer to your request under the Freedom of Information Act in relation to copies of nursing home inspections where significant breaches of the regulations were noted. I apologise for my delay in replying. I have now identified 12 nursing homes of interest.

I will discuss three of the institutions referred to in the letter.

Mr. S. Power

On what date did the Deputy receive the letter?

Mr. O’Dowd

It was sent on 31 May 2001, long before the Minister of State was appointed to office.

The fourth, eighth and ninth nursing homes on the list are Bedford House in Balbriggan, Rostrevor nursing home and Rathfarnham nursing home, respectively. In the 12 months since the Minister of State was appointed, the case against Rostrevor nursing home has concluded successfully with the courts imposing a fine of €8,000 on the home's operator. In the second case today's issue of The Irish Times features a report on the Rathfarnham nursing home. A letter dated 30 June 2005 from a doctor who was on an inspection team which visited the home states:

As a member of the inspection team of this nursing home in the past 12 months, the only possible outcome is the non registration of the above nursing home. My conscience would not allow me to consider any other alternative. As a medical doctor I stand over the reports I have already signed regarding this home's non registration. My medical integrity would be at issue were I to decide otherwise. I have no difficulty making myself available giving evidence as to the breaches I noted on my inspection visits in the district court should the proprietor appeal.

These remarks, made in June 2005 and after the Minister of State's appointment, relate to a nursing home which was regarded as a problem home in 2001. The Government's lack of interest and failure to take action on foot of promises it made in 2002 to change the nursing home regime have resulted in people suffering unduly in nursing homes. Many hundreds of such homes are excellent and have the highest possible standards but those to which I referred are not the only ones with appalling standards. The job of the Government is to protect the weak and elderly and it has singularly failed to do so. For example, it has failed to amend legislation to address the nursing homes which were mentioned in 2001, were still causing problems in 2005 and, to the best of my knowledge, continue to be a problem in 2006. The Government has shown a complete failure of intent and commitment.

How do we know some nursing homes are so bad? We find out through the Freedom of Information Act. Unfortunately the Health Service Executive is treating the Act as a barrier to getting information on nursing homes. Time and again one must submit an application and €15 to secure information. I asked the Health Service Executive, through a parliamentary question, to provide me with the number of successful convictions secured against nursing homes in the past ten years. The reply I received stated that I should seek the information under the Freedom of Information Act. The Health Service Executive is rapidly becoming the "Health Secrets Executive". There is no transparency or openness about the manner and means in which nursing home procedures are dealt with.

I was told by the Health Service Executive when I rang today that, despite the written promises I received from the Minister of the day last year following events at Leas Cross, which indicated that nursing home inspection reports would be placed on the HSE website as soon as they were available, one can search its site as much as one likes but one will not find transparency or information on any nursing home inspections that have taken place in the State since the Leas Cross case. This is another case of the Government failing to deliver its commitment to change and the Health Service Executive failing to provide true, honest and open information to Deputies who seek it. Members of the Oireachtas are the least of those who count. The people who count in this regard are patients in the nursing homes and their families who are being denied access to this information. The Minister of State, as I have shown, has failed in his job. Over the last few days I have met people who work in different nursing homes in my constituency in north County Dublin. The most significant legislative problem people face is that the Minister has failed to protect the whistle blower. I know nursing home carers and nurses who feel if they took their requests to the Health Service Executive they would not be protected and would lose their jobs. They have told me there are still appalling situations in nursing homes. One of them, which would concern us all, is that when people die in a nursing home they are not properly laid out and no respect is shown to the bodies before they are placed in a coffin. Another is where if residents are able to go to the toilet their bodies are not washed by the staff afterwards. In other cases clothes are recycled. People may have just one outfit and clothes in the nursing home are given to everybody. There is no compassion, concern or commitment to look after those people by the people who operate those nursing homes.

I repeat that the vast majority of nursing homes are excellent but those that are not are appalling hell-holes in which people are treated like animals. The Minister has taken no action to change that situation. The case of the Rosstrevor nursing home shows that unless the legislation is changed all the inspectors in the world will change nothing. The High Court found that the legislation the Minister promised to change almost a year ago, and which the Government promised to change four years ago, is not strong enough to close an appalling nursing home such as Rosstrevor. The Minister has the legislation to change the nearest chipper were mouse droppings found in it. What about the elderly who are being abused in some of these nursing homes? The Minister offers them no protection. This Government has failed to protect those people, a shameful situation which must change.

The law requires that within two months of a person's admission to a nursing home a contract of care be signed by the nursing home and the patient. Thus the needs of the person and the provisions of the nursing home are written down and signed off by everybody concerned. However, the Health Service Executive has no contracts of care with patients in private nursing homes. In many cases it is hard to escape the view that people are dumped there and that nobody cares about them, least of all the health board that placed them there. That is a shameful situation and one about which the Minister could command knowledge. The least he could have done when he got his job was to call in the nursing home inspector and ask to see what is happening in his constituency. I have facts on bad nursing homes in the Minister's constituency and would be glad to give them to him. They are not good, but he has done nothing about it.

I challenge the medical profession to come clean with the knowledge it has. I refer to members of the medical profession who are registered owners of nursing homes. I ask that Bedford House and its operation over the past few years be examined by the media. There is an important issue there. If somebody who has a special oath and commitment to the medical profession runs a nursing home, it should be the best place.

The fundamental issue is transparency and openness. I do not know who wrote the Minister's script. The work I have done tells me that throughout the country, in each former health board region there have been thousands of breaches of the regulations — many minor, some not so minor and many of them major. This has been the position over the last few years it continues. There has been no change in the law and that is where the Minister has failed. Time and again the nursing home inspectorate suggests things should change and then says it is seeking legal advice. Year after year the legal action fails to happen and the problems continue.

I have done much work on this and all my spare time goes into it. The Minister's job is to spend all his time at this work and if I were marking his card I would give him zero because while there are many changes he could have made he has done nothing. I challenge the Minister to bring in the legislation he promised, to protect the elderly, the weak, the sick, the infirm, the sufferers of dementia and the psychiatric patients put into nursing homes. The Minister has a duty of care to them. If they were children people would be screaming outside the House demanding change and the Minister would have acted. Perhaps because they are old people they may not be as valued or as emotive an issue. Old people are valued and important in our community and we must show them great respect and honour. What happens to people in the worst of our nursing homes, and what we do to address it, will be a judgment on all of us and on the integrity of our health service. The Minister has failed in his statutory duty and should resign.

Mr. Connaughton

This motion is extremely important. Its main aim is to ensure our elderly will be well cared for in both private and public nursing homes. Leaving politics aside, many people, including myself, never thought the actions reported by "Prime Time" could happen to the elderly in a Christian, caring Ireland. Crimes against the elderly were perpetrated. My colleague, Deputy O'Dowd, has put great effort into this and has behaved in a professional way over years of research into this. I do not single out the Minister but speak of the Government's inactivity. I hope the Minister in his reply will indicate why the legislation on the inspectorate is not being introduced. I cannot understand it. Is he saying it cannot be done or that it should not be done? My colleagues have pointed out that it has been promised so many times and I cannot understand why any Government could leave itself open to the charge that it failed to care for the elderly by bringing in that legislation. Legislation comes through this House every day, which is the purpose of the Dáil. The "Prime Time" investigation taught us all a lesson. In east Galway I know 20 or 30 private nursing homes and I am aware of no complaints. I know several people who spend valued time in them. One must stand back from this and examine carefully the findings of the "Prime Time" investigation team. It happened in one place already and due to human nature, if it is let go unchecked, what is contemplated today could be an accepted practice in the system in ten years' time. That is why the inspectorate is so vitally important.

As far as I know, there is never any trouble in a nursing home with people that are active and whose mental capabilities are such that they are able to look after themselves as far as is practicable. These people are not only inside the nursing home as they are also able to walk out during the day and meet their neighbours. An inspectorate is important for these people, but it is not necessary. However, some people lose their senses and are unable to look after themselves. Such people may have to be spoon-fed and looked after like children. It is only then that this inspectorate should be there on behalf of those people because such people have dignity, they have served this country well over the years and they should not be stripped of their dignity in the last years of their lives. This should not be allowed in any civilisation, Christian or otherwise. It should not be allowed to happen, whether it is due to profit, uncaring attitudes or whatever.

If Deputy O'Dowd put down a question in this Parliament about the HSE, why would he be told that he could not get the answer here, but through the Freedom of Information Act? Why should that be the case? In schools and colleges, the done thing is to ensure that parents know what exactly is happening in those establishments. That is as it should be. However, nursing homes are treated like an enclosed order. When will that change? When my parents were alive, nursing homes did not exist, but if I thought that I had unwittingly committed my parents to a nursing home that did not meet the expected specifications because I could not get the information, I would stand outside the gates of this House with a placard, and so would the Minister of State. We would not take "no" for an answer.

When I am told that the only way I can acquire such information is to make a freedom of information request, I wonder what I am elected for. What is a democracy? What is a national parliament? What are we doing here? If I know the Minister of State well enough, I believe he would want to change that, but I cannot understand why the Government will do nothing.

In the last budget, we were delighted that €110 million was made available for public nursing homes. Why, therefore, are more and more people approaching me in my constituency because they are forced to apply to the HSE western area for access to State-run nursing homes such as St. Brendan's in Loughrea? The figures show that there are more people lining up for access to these homes. Any old person in receipt of only the old age non-contributory pension, with no relative to help them and with the subvention that currently exists, is not able to make up the €500 to €700 per week that is now charged by the vast majority of nursing homes.

There is a shortfall of about €200 per week. Where does that come from? It is all right if the old person's sons and daughters are around and are able to pay. I see nothing wrong with family members having to do things like that, but some people do not have anybody belonging to them, or the people belonging to them are so stressed out with high mortgages that they cannot pay. I do not know where the €110 million is going, but it is certainly not going to those people.

In the assessment of eligibility, 5% of the market value of the house owned by the patient is taken into account. That would be fine if the house was modern enough to be rented while the person was in the nursing home and was making money, but most of those houses by their nature are small and conventional as elderly people have lived in them for the previous 20 years. They make no money as they are lying idle, yet the 5% of market value makes the world of difference in the amount of subvention they receive. It is time such a policy is taken out of the equation because it is very unfair. Where the house is not being used and is not making money, it should definitely be taken out of the equation. It is of no use to the patient in that nursing home.

The Government and the HSE claimed that there would be much investment in State-run nursing homes. I can only speak about what I have seen in my constituency. There has been a very fine establishment in St. Brendan's Loughrea for generations. It used to be able to take about 160 patients. A badly-needed new refurbishment is now under way, but when it is finished the hospital will only be able to take 80 patients. We were told many years ago by the former Western Health Board that an equal number of places would be created in Ballinasloe. Now we find that the entire campus in the old St. Brigid's psychiatric hospital is about to be put up for sale. It will make millions of euro. I feel that the money raised from the sale will go into the coffers of the HSE at national level and we will be left holding the last straw.

The Minister of State's party colleagues are well represented in east Galway. I want to put a marker down tonight on behalf of all old people in my constituency that we will not tolerate what is going on. If ever there was an election issue, this will be one of them. We know that there is a lot of money in the sale of that hospital and we do not want it redistributed elsewhere. With all due respect, to put nursing homes in Dublin, Louth or Cork will not wash with us. We want them in east Galway because that is where the assets are coming from. The Minister of State might tell the House why the legislation regarding inspectors is not being introduced. We see no valid reason it should not be introduced immediately.

Minister of State at the Department of Health and Children (Mr. S. Power)

I move amendment No. 1:

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

‘—notes the Government's commitment to introducing legislation which, inter alia, will establish the social services inspectorate function on a statutory basis;

—welcomes its commitment to extend the work of the social services inspectorate to public and private nursing homes and to resource it accordingly;

—notes the Government's commitment to ensuring that high quality care is made available to all patients in public, private and voluntary nursing homes, and in that context welcomes the preparation of standards for residential care settings for older people;

—welcomes the HSE's provision of information to the general public on nursing homes and its policy decision that all completed inspections of nursing homes should be made available to members of the public on request subject to freedom of information and data protection legislation;

—welcomes the proposed implementation by the HSE of a common national approach to the inspection of nursing homes; and

—commends its policy of supporting older people in their homes an communities in keeping with their stated wishes, and providing support to those who need residential care, and in that context acknowledges the significant investment made by the Government for the care of older people by the provision of €110 million additional revenue funding in the budget announcement for 2006 — €150 million full year cost.

I wish to share time with the Minister of State at the Department of Health and Children, Deputy Tim O'Malley.

I welcome this opportunity to address the House on these important issues. I acknowledge the significant investment made by the Government in the care of older people by providing €110 million in additional revenue funding in the budget announcement for 2006. The full year cost is €150 million. The Government is committed to maintaining older people in dignity and independence in their homes and, in accordance with their wishes, for as long as possible. It is also committed to providing high-quality, long-term residential care for older people when living at home is no longer possible.

The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations 1993 set out the standards to which the private nursing home sector must adhere for the purpose of registration under the Health (Nursing Homes) Act 1990. The regulations only apply to the private nursing home sector and do not cover public long-stay facilities for older people. However, there was a commitment in the health strategy, Quality and Fairness — A Health System for You, to extend the remit of the social services inspectorate to other social services, including residential services for older people.

Legislation is being prepared in the Department to provide for the establishment on a statutory basis of the health information and quality authority, HIQA, with the social services inspectorate, SSI, function as part of the HIQA. The SSI function will be vested in a new statutory office to be known as the Office of the Chief Inspector of Social Services. The legislation will also provide for the establishment of a registration system in respect of residential services for children, older people and people with disabilities to replace existing registration procedures in the Health (Nursing Homes) Act and the Child Care Acts. It is intended that the functions of the office of the chief inspector will include, inter alia, monitoring of standards in respect of residential services for people with disabilities, older people and children in accordance with the Child Care Act 1991 and Part 2 of the Children Act 2001 — family welfare conferences, and registering and carrying out inspections in respect of those services.

The preparation of the draft heads of this legislation is at an advanced stage and it is expected that these will be submitted to Government shortly. It is intended to publish the draft heads to allow for a period of consultation on their contents prior to commencing the drafting of the Bill, and it is anticipated that it will be published later in the year.

The SSI has operated on an administrative basis since 1999 and has been focused since then on child welfare and protection services, specifically on residential and foster care services. It is proposed that the HIQA will be the new authority for setting standards for all health and personal social services. As I have already said, the extension of the SSI remit results from commitments in the health strategy that its remit would be extended to cover other social services, including residential services for older people.

It is of the utmost importance that the public has access to information on health services. We are all agreed that in this day and age it is unsatisfactory for people not to have comprehensive and easily available information on services being provided in nursing homes. The HSE national care group manager for older persons' services established a national nursing homes steering committee in July 2005. One of the priority tasks outlined for this committee was the standardisation of inspection documentation to make the information on inspections more transparent and easily understood by both nursing home proprietors and the public. At the time, a number of different reporting templates were in use.

The HSE nursing home inspection and registration teams are using a standardised reporting template on an interim basis. The inspection report is based on the standards and criteria laid down in the Health (Nursing Homes) Act 1990 and the Nursing Homes (Care and Welfare) Regulations 1993. A final reporting template will be agreed later this year. The information contained in the nursing home inspection reports can be accessed by the public, either by requesting a copy from the nursing home proprietors or from the HSE under the Freedom of Information Act. When the final reporting template is established, it is proposed to implement web-based access to these reports.

Nursing homes are required to be registered by the HSE. Registration certificates must be placed in a prominent position in nursing homes. If a registration has certain conditions attached to it, these will be displayed on the registration certificate. When it is necessary for older people to move into long-term residential care, it is important that they have a choice of top quality nursing home care. For this reason it is important that a robust inspection process be in place to ensure that the quality of these homes remains at a high standard. To this end, the HSE will continue to inspect nursing homes in accordance with the Nursing Homes (Care and Welfare) Regulations 1993.

In general, where problems occur, the inspection team which inspects the private nursing home will discuss its findings in detail with the owners or operators and this will generally ensure that the matters raised are addressed. The HSE may remove a nursing home from its register or refuse to register a nursing home if it is of the opinion that, inter alia, the premises to which the application or registration relates do not comply with the regulations or the continuance of services in the home will not be or is not in compliance with the regulations.

A working group——

Mr. S. Ryan

Another one.

Mr. S. Power

——has been established by the Department to develop the standards for residential care settings for older people. Membership of the group comprises officials from the Department, the HSE, the SSI and the Irish Health Service Accreditation Board. The group will commence the development of standards for the inspection of both public and private residential care for older people and, in doing so, will consult with appropriate and interested parties. In addition, the Irish Health Services Accreditation Board has examined the development of accreditation standards for both public and private residential care for older people.

The Government's commitment to the development of a comprehensive range of services for older people can be demonstrated clearly by outlining the resources made available in recent years for service developments. From 1997 to 2005, inclusive, additional spending on health care services has been in excess of €300 million. This funding is being used for a variety of services, including the nursing home subvention scheme, home care grants, the home help service, the elder abuse programme and support to voluntary organisations.

In addition, the Tánaiste and Minister for Health and Children, Deputy Harney, announced a €150 million package to expand and improve services for older people and palliative care in 2006 and beyond. This will mean a major improvement in home and community-based support for older people. A comprehensive health and social care service will be developed in a way that is reliable and that respects and values older people. This is the largest ever increase in funding for services for older people. These initiatives set out the Government's continued commitment to older people and putting older people at the centre of health policy now and in the future. The investment package is focused on caring for people at home, in accordance with their expressed wishes. It is a major step in focusing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and reflects the growing independence of older people who want to stay living in their communities.

It is entirely right that we should devote substantial additional resources to services for older people. They have made a great contribution to our society and to our current economic and social success. In this way, we are saying that the next generations value their contribution and will respect their needs and their continuing role in our society. This new investment involves additional resources of €150 million in a full year, that is, €110 million in 2006 and €40 million more the following year. Reflecting the new emphasis on home and day care, almost three quarters or €109 million of the full year costs are being committed to community care supports.

This investment is a response by the Government to older people's preference to be cared for at home rather than going into residential care. Very often that may require some additional home help or more developed home support, including various therapy services. All the evidence shows that families caring for elderly relatives continue to provide care in partnership with the support services put in place for those who require it. It is estimated that 28% of nursing home residents have a low to moderate dependency level and many of these residents might very well have continued to live at home if the right supports had been made available to them at the appropriate time.

The budget package provides for a number of initiatives, including home care support packages. These home care packages deliver a wide range of services and have been piloted successfully in several regions in recent years. They include the services of nurses, home care attendants, home helps and the various therapists, including physiotherapists and occupational therapists. A home care package will vary according to the care needs of the person so that, for example, there might be a greater emphasis in some packages on home care assistants while other packages may require a greater level of therapy and nursing.

The priority will be older people living in the community or who are inpatients in an acute hospital and who without this support would have to be admitted to long-term care. The home care packages will also be available to those older people who have been admitted to long-term care and who now wish to return to the community. In addition, the packages will be offered to people who are already using existing core services, such as home helps, but need more assistance to continue to live in their community.

The packages are delivered through the HSE, by a range of providers, including the Health Service Executive, voluntary groups and the private sector. The scheme will be as flexible as possible and highly responsive to the real needs of the individual so that where a family or friends of an older person wish to provide these services, they will be encouraged to do so, with support, and linking in with the HSE, voluntary or private sectors. Approximately 1,100 home care packages are provided to people at present. By the end of this year a total of 2,000 additional home care packages will have been provided. This will amount to a trebling of the current service provision.

The 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a care package on a temporary basis. The major thrust of this initiative is to be directed at older people. However, there will be some flexibility in the scheme so that a person who is under 65 years and may need home care may receive it as appropriate.

Home helps are an essential part of supporting older people at home, thereby delaying or preventing admission to long-stay residential care. They also help to keep people out of acute hospitals or help their early discharge from hospital. There is a continuing demand for home helps because of the increased number of older people. An additional €33 million full year cost is being allocated for this programme, €30 million of which will be for 2006. This represents a significant increase over the Estimates provision of €112 million for 2005.

The additional funding of €30 million will provide 1.75 million more home help hours. As with home care packages, it is expected that these additional resources will be implemented in a flexible way by the HSE so that particularly vulnerable individuals who need a home help but who are under 65 years of age can access the service.

Day care and respite care are an integral part of delivering a comprehensive community service for older people. The service provided may include a mid-day meal and a bath, physiotherapy, occupational therapy, chiropody, laundry and hairdressing; social contact among older people; respite for family members and-or carers; and social stimulation in a safe environment for older people with mild forms of dementia. The provision of €9 million in a full year will allow for an additional 1,325 places per week in such centres. The number of older people who will benefit from these new places will be substantially more than 1,325 since over the whole year one place can provide a service for more than one person.

The investment of €9 million will allow for additional programmes for specific needs, such as activity therapy. It will also mean that many day care centres can open for five or seven days a week rather than the two or three days that is often the case at present. There will be an investment of €7 million in 2006 with the balance of €2 million being provided the following year.

There will be a significant increase in the resources available to the "meals on wheels" service. An additional €2.5 million will be provided in 2006 together with a further €2.5 million in 2007. Again, this is part of the range of services which help support older people to continue living in their own homes. In the provision of meals on wheels we depend on the voluntary support of individuals and organisations to bring the meals to people. Often this is the only outside contact these people have. While the meal is necessary and appreciated, the social contact is also most important. It is a service that brings great comfort to those who receive it and it is one we are happy to support by providing additional funding this year and in the years ahead.

The Government strongly supports the development of sheltered housing accommodation for older people as it provides a real alternative to residential care and reflects the desire of older people to live with as much independence as possible. To support the development of sheltered housing, a full year commitment of €1 million will be allocated, split evenly between 2006 and 2007, to provide front-line health service support for sheltered housing, such as therapists and public health nurses.

In addition, the HSE will be asked to develop proposals in the primary and community care areas which are new ways of delivering service and-or reflect best practice elsewhere. The proposals should reflect significant emphasis on home care and involve non-statutory agencies working in partnership with the HSE. A total of €4 million, €2 million in each of the next two years, is being provided for such initiatives to improve and increase services delivered to older people. We are seeking initiatives that will make a difference.

A total of €2 million is being allocated to address the issue of elder abuse, again split evenly between 2006 and 2007. This level of funding will facilitate the implementation of the full range of recommendations contained in the report, Protecting Our Future, and will provide for the development of a research function in this area. Approximately €2.5 million has been made available in recent years towards implementing the report.

With regard to the development of the nursing home subvention scheme and additional long-stay bed capacity, a total of €20 million is being allocated to the nursing home subvention scheme for residents of private nursing homes. This represents an increase of 14% over 2005, which has an estimated spend of €140 million. The €20 million is a 2006 full year cost and will go towards supporting increasing numbers entitled to basic nursing home subvention, reducing waiting lists for enhanced subventions and bringing greater consistency to the different levels of enhanced subvention support throughout the country.

Mr. S. Ryan

When will we get a report on that?

Mr. S. Power

I listened closely to what Deputy Connaughton had to say and I know that in setting up the HSE the intention was to have uniformity in the delivery of services throughout the country. He made a case with regard to subvention and how it works in his area. I will take on board what he said and report back to the Deputy in the near future on it.

Some €8 million is being provided to cover the cost of 250 extra nursing home beds which the HSE is in the process of sourcing from private nursing homes.

Regulations have been made recently to ensure the assessment criteria for subventions, which have not been updated since 1993, reflect the major changes in property values. The property ceiling that was set at £75,000, approximately €95,000, in the 1993 nursing home subvention regulations is being increased, having regard to the Department of the Environment, Heritage and Local Government house price indices, to €500,000 for Dublin and €300,000 for the rest of the country. The assets ceiling is also being increased to €36,000 from the previous £20,000. Previously, the first £6,000 or €7,618 of an applicant's assets would be disregarded when applying for a subvention. This is now being increased to €11,000.

Specialist palliative care is another area we dealt with in the budget. In addition to services for older people, €9 million was provided in the budget day package for specialist palliative care, including home care and community initiatives in 2006. This allocation includes funding for 24 additional extended care beds in Our Lady's Hospice in Harold's Cross. A further €4 million is being allocated in 2007 to develop palliative care services, giving a full year cost of €13 million.

It is clear from the budget day package that the Government is firmly committed to developing services for our older people. The emphasis on developing home care packages and the increases in the home help and meals on wheels schemes and other community based supports will aid older people to remain in their own homes and communities for longer, in accordance with their wishes. Additional funding has been provided to the nursing home subvention scheme to go towards supporting the increasing numbers entitled to subvention and to reduce waiting lists for enhanced subvention.

Following on the publication of the Mercer report on the future financing of long-term care in Ireland, 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, was established. The objective of this group was 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. The report of the group has been completed and was recently submitted to Government.

In terms of staffing resources for a statutory inspectorate, this would have to be explored by the stakeholders in the overall context of ensuring that standards are met and that health service staff are utilised in the most effective way.

It is clear to the House from what I have outlined that the Government's commitment to older people cannot be denied. The focus is on supporting older people in their homes and communities for as long as possible and at the same time supporting those who require residential care if the time comes that such is the most appropriate care required. The Government is committed to ensuring high quality care to all older people in public, private and voluntary nursing homes and is working towards having the best standards and inspection processes in place to achieve this. We acknowledge that we must continue to develop policy in this area to meet the growing demand for services and that we cannot be complacent in this regard.

We gave commitments in the House about bringing forward legislation and I have outlined the stage at which we are with regard to that legislation. We intend to bring it forward. It has not happened as quickly as we would want, but we are committed to bringing it ——

Mr. O’Dowd

Nothing has changed. Nothing has been done in a year.

Mr. S. Power

We do not have to listen to lectures from the Deputy about how we deal with older people——

Mr. O’Dowd

The Minister of State has done nothing. He has changed nothing. He is an absolute waste of space and resources.

Mr. S. Power

To listen to the Deputy one would think he was the only one who understood the needs of older people. We are all supposed to bow to his judgment on this. We do not have to listen to him to bring forward change.

Mr. O’Dowd

The Minister of State is a disgrace and should resign. He could not care less about the elderly.

Mr. S. Power

I will be happy enough to go before the people of Kildare and let them decide whether I should resign.

Mr. O’Dowd

I have information on nursing homes in Kildare if the Minister of State wants to read it.

Mr. S. Power

I would be happy to do so.

Mr. O’Dowd

The Minister of State knows nothing about them. He has not even seen the reports. Has he asked to see them?

Mr. S. Power

Speaking of nursing homes in Kildare, lest people think I have a hidden agenda, I should declare an interest at this stage. An aunt of mine and her son have been running a nursing home in Kildare for a number of years.

Mr. O’Dowd

Nursing homes in this report on Kildare are recognised by number only, not by name.

Mr. S. Power

Following an RTE programme last year which shocked us with its portrayal of the treatment of a number of people in a particular nursing home, we gave commitments in the House that we would remedy the situation. That commitment stands and we will honour it in the near future.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I welcome the opportunity to address the House on this important issue which affects some of the most vulnerable people in our society.

As my colleague the Minister of State, Deputy Seán Power, mentioned, the policy of the Department of Health and Children is to maintain older people in dignity and independence in their own homes, and in accordance with their wishes, for as long as possible. Indeed, the majority of our older people are fit and well and leading full, independent lives. However, where this is no longer the case, the Department is committed to providing high quality long-term residential care. This is the minimum we can afford our older citizens who have played a major part in helping our country to achieve the success that it enjoys today.

The majority of long-term residential care is of a high standard and affords a good quality of life to those older people who live there. However, even with the best will in the world, there are always exceptions to the rule, and there will always be situations where older people feel vulnerable or, worse, exploited. That is why the Department is committed to developing quality standards and putting in place a robust inspection process for all nursing homes, both public and private. My colleague has outlined the steps that are being taken in this regard. These include the establishment of the Health Information and Quality Authority and the establishment of the social services inspectorate function on a statutory basis, with the office of the chief inspector having the function of registering and carrying out inspections, including services for older people. They also include the establishment of a working group by the Department to develop the standards for residential care settings for older people. Of course, the HSE will continue to register and inspect private nursing homes under the Nursing Homes (Care and Welfare) Regulations 1993.

Coupled with these developments, the Department is fully committed to developing the services needed to tackle elder abuse, and in recent years there have been great strides in developing supports for older people who feel defenceless. The report of the working group on elder abuse, Protecting Our Future, was launched on 11 November 2002.

Elder abuse is a complex issue and difficult to define precisely. It may involve financial abuse, physical abuse or sexual abuse, or it may arise due to inadequacy of care. It is defined in the report as "A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights." In defining elder abuse, this report has, hopefully, given older people, who feel they are the subject of abuse in any shape or form, the confidence to report their anxieties, as appropriate, to a social worker, a public health nurse, a member of the Garda Síochána or any professional or care worker.

The Health Service Executive has recently set up a helpline number, lo-call 1850241850, that is dedicated to dealing with allegations of elder abuse, and this should encourage those who feel they are being abused in any way, and those who witness such abuse, to make the necessary contact and have their voices heard. The importance that the Government affords to the issue of elder abuse is reflected in the fact that a total of €2 million was allocated in this year's budget to address the issue, split evenly between 2006 and 2007. Some €2.5 million has been made available in recent years towards implementing the recommendations of the report, and the level of funding put in place for the next two years will facilitate the implementation of the full range of recommendations. This funding will go towards putting in place dedicated elder abuse officers and clerical support in each local health office area. It will also provide for the development of a research function in this area.

The report also recommends that a senior case worker be appointed to each former community care area and it is anticipated that the Health Service Executive will shortly recruit a senior case worker for each local health office area. Among the responsibilities of the senior case worker, in conjunction with the appropriate health service providers, will be the assessment of suspected cases of elder abuse referred to the local health office area.

I agree with my colleague the Minister of State at the Department of Health and Children, Deputy Seán Power, that the Government has looked after and will continue to look after the elderly, the most vulnerable people in society.

Mr. O’Dowd

The lo-call number does not do that.

Mr. S. Ryan

I wish to share time with Deputy Moynihan-Cronin.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Mr. S. Ryan

I am pleased to have the opportunity to make a contribution to this important issue and to compliment Fine Gael on tabling the motion. The Government's record in bringing forward promised legislation is abysmal and it is particularly bad in the health area. It is quite disgraceful that we do not yet have the necessary legislation to refund the illegal charges paid by people in nursing homes. No other group would be left waiting for over a year to have its money returned to it.

We do not yet have the promised legislation on the health information and quality authority. The heads of the Bill have not even been drafted although this authority is considered an essential element of the reorganisation of health services. The delay in bringing forward the legislation on an independent inspectorate for nursing homes is even greater. The health strategy 2001, which was launched with such aplomb, now lies in shreds with virtually none of its promises fulfilled. This failure is greatest in the case of older people. We do not have any new public nursing home places, we have no new strategy for the care of older people and we have no independent inspectorate.

The fact that the legislation on an independent inspectorate has not been afforded priority reflects the Government's lack of concern for one of the most vulnerable groups in society, that is, those who are no longer able to continue living in their own homes because of age and infirmity. The failures in the nursing home sector are well known. What else needs to come to light for the Government to take action? That it knows there is a problem and is failing to do anything about it is evidence, if it is ever required, of the lack of priority it affords to the inspectorate.

On a number of occasions I have had reason to raise in this Chamber the scandal that elderly people in need of long-term care in public nursing homes in areas of Dublin are now facing a waiting period of up to 12.5 years. That is a fact. In the first instance, priority is being given to the removal of residents who are taking up acute beds in one of our hospitals. Consequently, many elderly people are forced to remain at home relying on family support. Community care and the home help service are being cut back, irrespective of what the Minister of State says to the contrary. Commitments towards extra funding do not even match the cuts made over the past two years. This is happening at a time when beds are unoccupied in the public sector and when there are also beds available in private nursing homes.

I wish to raise the issues of inspections and uniformity of standards in nursing homes. There are no inspections of the State's 500 nursing homes, which care for 12,500 people. I have been informed that there are not enough staff to ensure that, in all areas of the country, the requirement of two inspections of private nursing homes per year, as required by the Health (Nursing Homes) Act 1990, is met. I firmly believe there is a need for the establishment of an independent inspectorate. It is shameful that the Government has not acted on the main recommendations of a series of published reports that call for independent inspection of nursing homes. There is no specific legislation dealing with the quality of HSE long-stay care places for older people and the places are not subject to an external assessment of quality.

Existing legislation governing standards of care is extremely vague, to say the least. The providers or funders of public care homes, the HSE areas, are themselves the regulators of the private sector. One of the points that must be faced up to is that behind the State's reluctance to see an independent inspectorate is a belief that its establishment could result in damning reports of the standards, comfort and staffing ratios in many of the State's public nursing homes. Major questions regarding the age and physical structure of homes, as well as allegations of abuse and neglect, need to be addressed as a matter of urgency.

The Human Rights Commission's report on older people in long-stay care, dated 2002, states there is a need for systematic study of the inspections carried out by the HSE to determine, for example, whether the statutory requirement to have two inspections per year is being met. The study would indicate the sorts of problems being identified and the action taken to address problems. It would determine whether there are structured interviews with residents' relatives, whether health boards have consistent standards, whether inspections are sufficiently broad to provide information about the quality of life of residents and whether the HSE is being sufficiently rigorous in following up when problems are identified. The latter point is vital. It is difficult enough to get a reply to a question from the Department without it referring the question to the HSE. It is important that there be a follow-up.

A systematic study would determine whether the HSE is reluctant to close homes because of a shortage of places, whether the powers available to the inspectorate are adequate, whether the reporting arrangements are adequate, whether all reports should automatically be made public — this is very important as it has not been the case to date — and whether there should be a facility for the inspectorate to report directly to the Houses of the Oireachtas or committees. This must be intrinsic to any legislation brought before the House. I ask the Minister of State to take this on board.

Other fundamental issues that must be addressed in legislation involve older people who need care or older people for whom care is not provided in the community, who cannot get a HSE area place and who cannot afford private nursing homes. Such people are left in limbo and this must be addressed. What are the implications of all these issues?

We must tackle the lack of equity in health services and the apparent lack of a concerted approach on the part of the relevant bodies, especially the Government and the HSE, to addressing these issues. Included in this is the obvious lack of relevant community care and support for older people. The need to formulate policy and, above all, implement that policy is not just a matter of the rights of older people who have contributed to the development of our Celtic tiger but it also concerns recognition of the fact that all of us are entitled to a future of dignity and equality, which I regret do not exist at present. It has been clear for some time that the situation facing many older people has reached crisis point. There has been a lack of emphasis on older person's issues. If it had not been for the efforts of the Opposition — myself, the Labour Party and Fine Gael — in this House for the past ten years to raise these issues consistently, there would have been no movement, which should be acknowledged.

We all know that the Government does not like freedom of information legislation and it has already made it more difficult and more expensive for people to use it. The health boards did not provide adequate information about the services they provided but the HSE seems to be even less forthcoming. It seems that the Department of Health and Children and the HSE are in breach of their obligations under the freedom of information legislation to make available information to the public on matters which affect them. Neither body has the manual of its procedures, known as the section 16 manual — the Minister of State should look it up — readily available as is required by the legislation, which is a scandal. The HSE seems to have no clear view of its obligations under the legislation, which I regret.

Prior to the highlighting of the Leas Cross scandal on "Prime Time", successive Ministers for Health and Children and Ministers of State at that Department were aware of the problems that existed with the operation of private nursing homes. The Minister of State, Deputy Brian Lenihan, speaking on a Private Members' motion on nursing homes in June 2005 stated that there was no doubt about the shock that resounded throughout the country following the transmission of the "Prime Time Investigates" programme. He also said that the Government had a commitment to older people. It has a peculiar way of showing it. Action is required, not meaningless scripts. I hope Deputy Sean Power, as a relatively new Minister of State, will take on his officials on this issue if they are not prepared to come forward with the required legislation. He has made commitments in the past. He should stand up and be counted on this important issue.

Well before the Leas Cross controversy, in response to questions in the House, I was told by the Tánaiste and Minister for Health and Children and her Department that on the basis of the existing inadequate inspectorate, they had found that staffing levels and nursing policy issues were relevant and needed to be addressed, maintenance of accommodation standards was deficient, hygiene problems existed in nursing homes and there was lack of activity for residents. We should try to imagine getting up at 7 a.m. and remaining sitting in the same chair until 10 p.m. before going to bed. The Minister and her Department also found evidence of insufficient record keeping, lack of active involvement with local authorities on fire safety issues, lack of equipment appropriate to clinical practice, such as pressure mattresses, and a discrepancy in the contract of care.

Basic information on the care of residents in nursing homes was withheld. It is time we opened the halls and windows of the Department of Health and Children. We should stand, once and for all, for the older people who have done so much for this country. Let us stand up to the bureaucrats and bring forward the legislation. Nothing less is required.

Ms B. Moynihan-Cronin

I am grateful for the opportunity to contribute to this important debate. I support the Fine Gael motion. We need to revisit the legislation whereby the Minister no longer has responsibility to answer to the Deputies of this House. With the abolition of the health boards, public representatives have no way of getting answers. The Minister of State's colleagues will tell him that their parliamentary questions to the Minister for Health and Children are sent to the HSE, which can take up to six months to reply. Members from all sides are elected with the expectation that we can get answers on behalf of our constituents, but we are not getting answers.

I wish to deal with two specific issues in my contribution. The first concerns the enhanced nursing home subvention, which is available to the elderly in nursing homes or those waiting to go into nursing homes who have no income other than the social welfare pension. An elderly person in my constituency applied for enhanced nursing home subvention in November 2005. I will provide her name to the Minister of State following my contribution. She received correspondence from the HSE stating that she had been put on a waiting list. The letter stated:

Dear . . . your letter dated the 14th of November 2005. In reference to the payment of enhanced nursing home subvention in respect of the above named, I am to confirm that [the woman] has been placed on a waiting list for consideration for the payment of enhanced subvention as and from the 15th of November 2005. This section will contact you in writing when payment of enhanced subvention can be considered in this case.

The family of this unfortunate woman contacted me after Christmas to ascertain whether I could discover where she was placed on the waiting list. I contacted the HSE southern area and to my amazement was told that she was 452nd on the waiting list for enhanced subvention.

Mr. S. Ryan

She will be dead before she gets it.

Ms B. Moynihan-Cronin

What kind of system are we operating? We are literally throwing our elderly people aside and letting them die before we provide care.

We listen to members of the Government on radio and read their quotes in the newspapers about our wonderful economy and the strides we have made. We have made no strides in this regard. This system was introduced when my father was a Member of the House 25 years ago but there was never a waiting list like the one that exists today. The Minister of State or whoever replies during this debate should tell me whether funding will be provided to the HSE to reduce the waiting lists. Some 452 people were on the list last November but how many are on it now? How much funding will be provided and will that funding clear the waiting list?

No elderly person deserves to be in this situation. We know how difficult it is for a parent or anyone else to go into a nursing home. It is bad enough for those who can afford it but it is more horrific for those who must wait to get a few bob together to try to get care for their parents. I know that the Members on the Government benches have hearts. They would not agree to have 452 people on the waiting list for enhanced nursing home subvention in the HSE southern area. It is not good enough.

The second issue I wish to raise is that of the home care or Cúram grant. A pilot scheme was established in the Southern Health Board area in 2004. Approximately 44 people who are looking after elderly and ill relatives at home received letters stating that they were awarded grants but they never received a penny. No money was provided last year to facilitate the commitment made by the health board to these people. I want an answer tonight or tomorrow as to when the money will be paid to the 44 or more people who received letters of commitment from the health board telling them how much they were to get before they were told that, while they had been awarded so much, unfortunately, the board had no money to pay them.

Will the Minister provide the money or ignore the plight of these people, who received letters but have no hope of receiving help to look after their elderly relatives? I hope they will not look for enhanced subventions because they will be waiting for much longer. I want to hear answers to two questions tomorrow night. When will the waiting list for the enhanced subvention be dealt with and when will the money be provided in the form of home care grants?

Mr. S. Ryan

That has put the matter up to the Minister.

Debate adjourned.