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Dáil Éireann debate -
Thursday, 27 Apr 2006

Vol. 618 No. 3

Health (Repayment Scheme) Bill 2006: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

I do not know whether I welcome the former Minister for Health and Children, Deputy Martin, back into the hot seat for a health related Bill. With all respect to him, I am a little unnerved at the prospect.

I hope he is apologising. We all are a bit upset at the idea. In any event, we note the presence of the Minister of State at the Department of Health and Children, Deputy Seán Power, and the absence of the current holder of the position of Minister.

The Minister, Deputy Martin, is leaving.

He is leaving again. Good, at least that is a promise kept, not like the one on the Monaghan Hospital issue on the last day before he left office as Minister for Health and Children.

The Health (Repayment Scheme) Bill 2006 at last provides a legal framework for a scheme to repay charges to fully eligible people who were wrongly charged for publicly funded long-term residential care. Progress has been far too slow on the part of Government in repaying people on whom these long-term care charges were illegally imposed. It contrasts greatly with the expeditious way in which the Minister moved forward to regularise the exacting of payment from people resident in long-term nursing care.

It is well over a year since the courts confirmed that people had been wrongly charged and therefore were entitled to refunds. Legislation and the scheme to repay the money wrongly taken were promised for this time last year. This is the legislation.

The Bill confirms that repayments will be made to those who were wrongly charged and are still living, and payments will be made to the estates, usually the nearest surviving next of kin, of those who were wrongly charged and who have died since 9 December 1998. I understand that is the intent.

The Government has stated this Bill will become law before the end of May and I want the Minister of State, Deputy Seán Power, or the Minister, whoever is delivering the summation of Second Stage, to clarify with certainty the intent to ensure the passage of the legislation and, hopefully, the early initiation of the process of repayment.

I note the Government has already promised that repayments will start shortly after the passage of this Bill but this, of course, is dependent on the Health Service Executive appointing a private company to administer the scheme. At this juncture, I seek clarification on the need to contract out this work. Does the Health Service Executive lack the resources to administer the scheme? The HSE has already invited people to submit details to it if they think they will qualify for repayment. There is obviously a great number of these as they include the next of kin of those who have died in the period to which I have already referred.

In reply to a parliamentary question from myself in October last, the Tánaiste and Minister for Health and Children, Deputy Harney, stated that a national helpline had been set up by the Health Service Executive to allow people to register if they believed they or a family member were due a repayment. Up to the date she answered, in October last, she indicated that some 18,000 applications had been registered with the HSE. She stated the helpline would continue to operate and further stated there was no need for anyone who had already been in contact to make further contact, that ultimately the system which would be put in place would initiate the follow through to the initial contact by the applicant parties.

I understand the helpline is continuing to operate. In the summation contribution from the Government side, perhaps the Minister of State, Deputy Seán Power, or his colleagues would indicate the updated numbers of people who have contacted the helpline in the period since October last so we will know exactly the figures we are now considering.

If a private company is contracted for the work of making the repayments, are we to presume the data built up to which I have already referred by the Health Service Executive will be transferred to this company? Surely the private contractors would not need to start from scratch. Perhaps the Minister of State, Deputy Seán Power, would give us an indication of the transition involved if a private company is to anchor the process of repayment entitlement, assessment and the initiation of the repayments.

We are told that repayments are due to approximately 20,000 people who are still alive and that approximately a further 40,000, perhaps even up to 50,000, estates will benefit.

The bottom line in all of this is that elderly people were illegally charged and must now be reimbursed with the minimum of further delay and bureaucracy. It is no exaggeration to state that it is clear to everyone, and must be an embarrassment to those on the Government side, that there has been such a delay in bringing this legislation forward and initiating the repayment schedules. The tragedy is that the State's shabby treatment of older people under a succession of Governments has caused a great deal of distress. I doubt there is a Deputy who has not become aware of that within his or her constituency.

The Government's handling of this particular repayment scheme has caused enormous confusion and worry. People, especially older people in residential care and their families, have been and are worried about it. Proper adequate information must be made available to the public to ensure any confusion remaining is ended quickly. There must be clarity before the scheme gets up and running and everyone, including elected representatives, must secure all the detail of the methodology of application, processing et al. It is extremely important that such matters are addressed speedily. We need to know the steps beyond the helpline and I hope all that information will be shared quickly.

The issue has also raised many questions about the way the State supports or fails to support older people in long-term residential care. The National Economic and Social Forum published a report in November last entitled Care for Older People, with which the Minister of State, Deputy Seán Power, will be familiar and which did not get the attention it deserved. It describes the barriers to the development of community services for older people and it refers to perverse investment incentives. It states:

The present official funding of services is not consistent with the policy objective of encouraging community-based responses. Considerable resources are invested in nursing home care responses, some of which are unnecessary and inappropriate.

That is relevant to the debate. Bungling by the State resulted in people in nursing homes being wrongly charged and a huge bill was incurred by the Exchequer, which this legislation is designed to meet. The National Economic and Social Forum exposes the fact that in failing to support community-based care fully, the Government is denying older people the most appropriate care and, at the same time, spending large sums on inappropriate nursing homes places. In addition, the private nursing home sector is being subsidised through large tax breaks.

I urge the Minister to produce accessible, clear and legible material to explain the repayment scheme fully. It must be presented in a clear and understandable way, without the forbidding and complex constructions of the census form, which will have caused a great deal of concern, particularly for older people. As public representatives, we are a buffer in this instance between the State and the wider community, for which the legislation is intended. We need to assist people at every step and to explain to them in clear terms what are their entitlements and what they need to do to claim them. Perhaps, when the Minister of State replies, he will elaborate on this detail. It is important that the debate should ensure a complete understanding and awareness of the process from start to finish and that nobody is left out of the frame.

Will the Minister of State indicate whether it is intended to set a timeframe on the application process for repayment? That is an important issue because people may present later for a variety of reasons such as confusion or disagreement with next of kin and so on. The scheme should be open ended or, at least, the expiry date for applications should be well down the road so that nobody is left out and feels disadvantaged as a result. Given the many years of illegal charging, a long period should be provided to allow people to explore and pursue their entitlements properly.

I welcome the opportunity to contribute to the debate on the repayment of charges which were found to have been levied illegally on elderly people, but the debate should go beyond that issue. The primary objective should be to discuss the type and level of care an elderly person can expect to receive when he or she needs it and the debate should also include the question of whether there is agreement on the principle of people paying towards the cost of care and how much they should pay. Previous speakers have dodged that issue and we will not have such a debate. We have mainly witnessed attempts at political points scoring and I will fall into the same trap during my contribution as I comment on the issue raised by Opposition Members.

I have been involved with health boards for more than 20 years and I have always been concerned about catch-all phrases such as "care of the elderly" which are used to categorise people. Care of the elderly is a handy category for anybody aged over 65 and it is easy for administrators to use such a description. The equivalent description of those aged under 65 who need high level care is the "chronic young sick". These are two examples of how the State tries to depersonalise the services needed by such people. I would not like my contribution to be totally negative because great work is being done throughout the State on behalf of the elderly and younger people in need of long-term care. We are afraid to get too personal about the people needing such services and I am concerned about the tendency to lump people into a suitable category.

Field workers such as those implementing the southern region's Ageing with Confidence project know their client's names, needs and personal requirements but legislators, departmental officials and other decision makers prefer to categorise them in easily identifiable groups because that is handier. It is only when we, as public representatives, deal with the problems facing people at the coalface that we gain an appreciation of what we have legislated for in this rarefied atmosphere. We must never forget that we legislate for individuals, no matter how we categorise them. I fall into that trap when I refer to people aged over 65 and so on. Every elderly person has needs, which are changing, many for the better. Activity programmes promoted by health boards and other interest groups such as the Irish Heart Foundation have had hugely positive benefits. On the other hand, unfortunately, the incidence of Alzheimer's disease is increasing and it has not been properly addressed. The State must be prepared to respond more quickly to changing needs.

I do not blame the Department because Ministers can make their own decisions, but there is a reluctance to address issues when they are highlighted. When private nursing home subvention was introduced in the late 1970s, a condition was laid down that if the elderly person owned his or her own property, it had to be sold if the need arose to fund the service. A threshold of £75,000 was set and if the value of the person's property exceeded that, it had to be sold. Despite fighting and arguing for between ten and 15 years about the need to recognise increased property prices, the Department was reluctant to adjust the threshold. That is an indication of how reluctant the State is to respond to changing circumstances.

If it is agreed the underlying principle is to work to cater for all the medical needs of an individual, we will have made a good start. If we decide that such care should come free of charge or that some level of payments should be made after a certain stage, that is also okay. However, we need to be consistent. Those in this House who state they are opposed to the principle of means testing for services for old people should not also be critical of the decision of the former Minister for Health and Children, Deputy Martin, to give medical cards to the over 70s. I argued for that initiative for many years. People at a certain age should be entitled automatically to free medical cards. However, we have got complaints about this from the same people who now urge no means testing.

When I started my career in local government, the most humiliating aspect in the care of the elderly was the pensions board. That board was made up of the honourable members of a local council who could delve into the personal details of any elderly person applying for a pension. I am glad that I personally boycotted that board, but there is still an element of that old-fashioned thinking. After the medical cards initiative, we received complaints that millionaires would avail of it. It is ridiculous to think that a millionaire would queue among 20 or 30 others so that he could avail of his medical card, yet people still made political points out of it.

Such convoluted thinking also arose during another welcome initiative for the elderly for which I lobbied successive Ministers. Concern has been expressed in this House on many occasions about our unfortunate people who had to leave this island. We often say that we owe them a debt. The best example of repaying that debt came with the courageous decision made by the former Minister for Finance, Charlie McCreevy, to give those people credit for pre-1953 stamps. Contributions at that time did not contain a pension element and successive Ministers of Finance had opted to follow the Department's guidance on this issue, which was not to give credit. Elderly Irish emigrants in many countries are now enjoying a reasonable pension thanks to that initiative. I believe that the payment from this country is their entitlement. Did those who raise concerns about our elderly emigrants applaud and support this initiative? No. They and their parties questioned and criticised the cost. So much for the concept of caring for the elderly and doing away with means testing. We need to establish standards and levels of care, but we also need some degree of consistency in supporting that concept.

These issues have been raised at the Committee of Public Accounts and criticism has been levelled at those who took such courageous decisions. They were easy targets and the cheap criticism was that it cost too much. We can be a caring community or we can be a firm of accountants, trying to get the balance sheet right all the time. Our population is growing older and while we once had the distinction of having the youngest population in Europe, the obvious outcome is that at some point we will have one of the oldest. This legislation has one eye on the past, but also has one eye on the future and the implications of this Bill will be far reaching. We must make some decisions such as whether we provide services that are required by the elderly, whether we respond to their needs in a humanitarian way or whether we take the side of the accountants. We should not criticise decisions that affect the balance sheet if we do not make an allowance for the good of a particular initiative. It has distressed me, as a member of the Committee of Public Accounts, to hear critical comments when the figures do not turn out as projected. I would prefer to take the initiative when we see the justifiable need for it.

There is a conflict between those who want rushed legislation and those who say that such legislation is seldom successful. The same people again seem to be on both sides of that argument. We need to be consistent. The Minister spoke about the possible exploitation and manipulation of the repayments scheme. The majority of the people to receive money are elderly, but in some cases it will be their estate and a proportion will also go to the mentally impaired. When the potential abuse of a patient's private property is considered, it is crystal clear that safeguards must be put in place as part of this Bill. Not everyone is happy with the current position regarding patients' accounts in the general medical services, despite several recent changes. Due to the existence of eight health boards in the past, there has been much inconsistency throughout the country in how these accounts were handled, especially the charges that could be levied for staff wages. There have been many debates on the issue, such as the use of patients' funds to provide a better environment for them. However, proper legislation is not in place to cater for patients' accounts, especially for those who are mentally incapable of making their own decisions. We need a standard formula for patients' accounts generally. I have no objection to a reasonable charge to deal with the millions of accounts throughout the country, but the system should be transparent with no opportunity provided for anyone to delve into the funds. These people have been wronged once and we must ensure they are not wronged again.

In its last budget, the Government put new measures in place to fund child care and this Bill is a means of helping those at the other end of the spectrum. It will assist in providing for older people in their community, but we need much more transparent rules on what will be provided to whom. For the past 30 years, there has been much confusion about what is involved. We have had three or four different Acts in this area, including an Act dealing with subventions for private nursing homes. That was very welcome at the time because families were going destitute trying to cater for an elderly relative or friend. That Act was amended to allow for extra subsidies and there were three or four Acts that covered care and related issues. It was so complicated that even Members of this House had no idea from where it came. On the original issue, Deputy McManus, now a member of the Labour Party, stated that the kernel of the problem was that the State broke the law and mugged the elderly and frail. I remind Deputy McManus that it was a former leader and Minister from the Labour Party who brought in the original legislation. I may be wrong in crediting her as a junior Minister in the early 1990s but she has certainly been around for a long time and, given that she holds a brief on health care, I would have expected her to familiarise herself with the genesis of this problem. She could at least have found out who was in the wrong.

Every Government of the past 30 years has failed on this issue. I have raised it on a number of occasions but instead of being given satisfactory replies, I was quoted articles, financial subventions and bed contracts. The problem became so convoluted that nobody knew what was happening. However, Members of this House should be familiar with the basic fact that the former Minister for Health, Mr. Corish, introduced a Bill without also bringing primary legislation to allow for charges. The various people who have tried to tamper with it since then are equally guilty and we have all failed in many areas of care for the elderly.

We need to change our ways and to stop patronising people. A great deal of good work is being done. The active age concept is being fostered by the Minister of State, Deputy Seán Power. We do not need to patronise people because for the most part they are capable of looking after themselves. If they need hospital care, they should get it, regardless of whether that involves beds in Bantry, which I costed against nursing home care in 2001, or elsewhere.

The reason we have so many nursing homes, which are most welcome, is that the State failed to provide beds for elderly people in need of care over the past 30 years. Having failed to cater for these people, the final insult is then to tell them that they are holding up beds or to degrade by calling them bed blockers.

As a long serving Government Member, I felt guilty when I was informed of the result of a survey carried out in 2002 which indicated that 200 extra beds were needed in Cork alone to care for the elderly. Despite the shouting I have done with regard to care for the elderly, I believe I let my people down and we need to redress that failure. This Bill will deal with historical aspects but I appeal to the Minister of State to build a new regime for the future. We have the money to do so and should be frank in deciding whether a charge should apply or if the full pension, which is topped up for the over 80s and others who need extra help, and the cost of a bed will be paid. People cannot be Tadhgín an dá thaobh on every issue and sooner or later they will have to admit they are concerned for the elderly and that free medical cards and beds should be provided. They cannot have it one way here and another way in the Committee of Public Accounts. I appeal to them to put the elderly first because, although many elderly people will never require any services, thanks be to God, the population is aging and people will need help. For example, I have concerns about our inability to cope with Alzheimer's disease.

This Bill is a sort of a fait accompli in that nobody will vote against it but we should use it as a fulcrum to improve services. A great deal of money will be available. There are patriotic people who will refuse the refunds because they want the money to be used for care. Any such money should be ring-fenced for the care of older people. I hate categorising people but, being in the older age group myself, I must be careful when describing us. I foresee a positive outcome and wish the Minister of State well in the job he has been given of sorting out 30 years of political incompetence.

I welcome the opportunity to speak on this Bill and want to respond to some of the issues raised by Deputy Dennehy. It is important to note that the State has failed our elderly in many ways. The shortage of State run nursing homes is not in the best interests of elderly people because these homes could solve the problem of step-down beds and ease the pressure on accident and emergency units.

St. Mary's nursing home in Castleblaney, County Monaghan, is an example of best practice. In former times it was regarded as a poorhouse but people are now queuing to stay there because of the excellent service it provides, not only as a nursing home but as an Alzheimer's disease unit. When Fine Gael entered Government in 1994, two vacant wards in the home were turned into a treatment unit for Alzheimer's disease which, with its accompanying day care service, has become a great success. We should try to expand these services, so that people who have given service to the country over many years are given proper care in familiar environments.

Home care, which Deputy Dennehy discussed, cannot be over-emphasised as a means of keeping people out of nursing homes and getting them out of hospitals at an early stage. Despite the promises made by the Minister of State on this issue, I do not see any change on the ground.

I can supply plenty of evidence to the Deputy if he so wishes.

The Minister of State might explain why a County Monaghan resident with an amputated limb and other serious problems receives two hours of home help per week. She previously lived in County Donegal, where she was given 12 hours of help. These issues must be addressed on a regional basis. Every person, wherever he or she lives, is entitled to equal treatment. Further home care subventions are needed because, while the carers allowance is all right, it is means tested. The allowance could help to keep people out of hospitals and nursing homes and would relieve accident and emergency problems.

This Bill was not drafted by accident but as a result of the extremely hard work done by Deputy Perry in bringing this issue to the attention of our party leader and others, having it discussed in this House and, eventually, forcing the Government to admit that it was operating an illegal system. The former Minister for Health and Children, Deputy Martin, was fully informed of this issue in 2001 but it is only today that action is being taken. How many elderly people have suffered because of this practice and passed on to eternity without knowing that the money would be refunded? The media are quick to condemn this House and to allege we do not have a role to play, although there are few from the media listening to this debate. This issue came to light through the activity of this House and an astute Opposition. Many Deputies will issue press releases in the next few weeks and months about how many millions of euro they got back for their constituents. Not one penny would have been reclaimed for constituents but for the work of Deputies Perry and Kenny and the indepth efforts of Deputy O'Dowd to expose the nursing home scandal.

The Bill only puts in place the legal basis to make repayments to those who were illegally charged in public nursing homes. People who are still alive, or their representatives, will have the right to claim back what was illegally taken from them. What scares me most is that a private company will be employed at a cost of some €40 million or €50 million to send out these payments. I know more about agriculture than about health, and I make no apology for that. The Department of Agriculture and Food can press a few buttons and pay the cheques that are needed for all aspects of farm payments without a private company being involved. Who will dig out information on each patient? I suggest it will be the HSE at local level, which will hand on that information to this private company. It does not make sense to employ a private company to collate this information and issue the cheques. It would be better to give €40 million or €50 million to the HSE and employ extra people if necessary, although with the number of administrators maybe some people could be moved from other areas to do the job. Last week I was trying to have a medical card replaced for a person who was clearly having personal difficulties. The community welfare officer has known the family for years and is convinced the person should have a medical card. However, unlike a few years ago the community welfare officer must go through four or five layers of bureaucracy before that card can be issued. Each layer has to raise some queries to justify its existence. If that process were costed I wonder if it would show that it is better to spend the money on people in need than on administration. Personnel could be taken from this process and used to administer the refunds. I ask the Minister of State and his senior Minister to reconsider giving so much money to a private company to deal with the issue.

When the Bill goes through and the structure to pay the money is set up the forms should be made as simple as possible. We do not want a situation where the elderly or their families cannot understand the forms. Former Minister for Agriculture and Food, Deputy Walsh, once told us the EU insisted on certain forms for farm building grants, and they were approximately 50 pages long. When I was in Cavan for a publicity stunt and got my first look at the forms, I could not believe I was getting a book rather than a form. Some years later somebody who understands farming better, the Minister, Deputy Coughlan, and I give her credit for that, provided a short, readable and usable form that satisfies the EU. All things are possible if the will exists. I urge that the form be readable and as simple as possible. I acknowledge that millions of euro are involved and applications must be scrutinised, but let us not go over the top. If it has to be done by legal people, that service must be paid for but we should not allow costs to escalate on a large scale.

This Bill deals only with patients in public beds, such as St. Mary's Hospital in Castleblayney or the beds owned by the HSE in nursing homes such as the Sacred Heart Nursing Home in Clones, where my mother was well looked after, along with many others. Many were forced into private nursing homes because public beds were not available and they are as entitled to a refund. Their pension was taken from them although the subvention covered the balance. The same amount was taken from people in private nursing homes and I suggest it would be better to deal with this than to let it go into a long legal battle that will cost everybody more money and delay the right of people to be repaid. I do not suggest that everybody who went to a private nursing home is entitled to a refund; some people decided to go there and did not try to get into a public nursing home. However those who requested a place in a public nursing home, who filled in subvention forms and who had no means other than their pensions are as entitled to get their pensions back as anybody else. I urge that this element be examined and treated seriously. As I said earlier, the delay has meant that many people have died before this issue was dealt with.

As one who was involved in the debate on the over-70s medical cards, it also worries me that there is no definite figure on how many are entitled to a refund. I apologise that I was not here to listen to the Minister's speech. I question that situation. Although we have been discussing this situation for a number of years and it is over a year since this Bill was promised, we still cannot put an accurate figure on it. The over-70s cards were originally estimated to cost €19 million but finally cost over €52 million and I wonder how long any business that was run like that would survive. Although I want people to be paid as quickly as possible, and in that context we will not object to this Bill, I want to return to people who were forced into private nursing homes. I know one father who had Alzheimer's disease and whose family desperately wanted to get him into St. Mary's Home in Castleblaney, but there was no room. This was nobody's fault. He had to be moved to a nursing home in Cavan and family members had to pay a significant amount of money towards that through no fault of their own. It would be very unfair if somebody who was lucky enough to get a bed in the special unit in Castleblayney got their money refunded, to which such a person will be legally entitled under the Bill, and that simply because there was no bed, this other family was not repaid. The man's widow must now provide for herself but because the €20,000 or more in their savings was utilised, she has little or no income to live on.

I will move to another part of the Bill which has major implications, in particular for the people of my part of the country, where nursing home subvention has been very difficult to access in recent years. From memory — I apologise if I am not exact — there were approximately 270 subvention cases in Monaghan at the time of the previous election. Immediately after, a catastrophe occurred when it was found that there was insufficient funding to justify that number of cases and an attempt was made to reduce the figure to 150. It was then increased to 170 and, eventually, following much pressure from me and others, it was increased to approximately 210 or 220. People of 90-odd years of age were on a waiting list to get subvention. It is in that context that I suggest subvention is very important to my area.

In one case, a lady was put into a nursing home in the west. She was dealing with a home that had never had dealings in the north east before. The executive was amazed at the difference between the areas, in particular due to the lengthy and tight scrutiny of a person with no means and because there was such debate whether the person would be covered from the day she entered the nursing home. Eventually, a compromise was reached and the family paid for a month or so. No other case made it clearer to me the differences in practice in different areas.

There is an urgent need to reconsider the funding in the north eastern health area, whether it is called a health board area, HSE area or otherwise. The area has experienced an enormous increase in population, in particular in the Louth-Meath area, and a similar increase in the need for care of the elderly. However, it has not received anything but the national increase in funding. There have been cutbacks in subvention, home help and similar issues. These are facts I stand over. The situation in that area is not comparable with other areas.

The Deputy should consider the budget of last December.

The 109,000 people of Cavan and Monaghan have had 10,000 medical cards removed, although some have since been replaced. In the city and county of Cork, which have a population of 500,000, only 8,000 cards were removed. There must be a major problem with funding and a major discrepancy.

To return to the need for speedy and proper subvention, Cavan General Hospital constantly has 20 to 30 patients on trolleys. There is no doubt this mostly results because people do not vacate beds quickly because there is no alternative accommodation for them, either at home or in nursing homes. The speedy and increased availability of subvention places would obviously relieve this problem and would be more cost effective for the HSE than keeping beds filled with patients who could be elsewhere. It is a scandal that 25 beds of the psychiatric wing in Cavan General Hospital are empty constantly when those beds could be put to other use. I accept that nobody would want a parent or other relative in a psychiatric ward but the ward could be changed and renamed to rectify that situation. There are also long-term beds at Lisdaran which could be changed to short-term use to ease the situation and relieve delays.

I welcome that this money will be paid and I hope this happens quickly. However, comments from the Government side suggest that the Government believes a significant amount of that money will not be claimed or requested. I want an assurance that money which is donated will be put into a proper public fund and utilised for the elderly, not for political or other skullduggery.

I am delighted to see the Minister of State, Deputy Seán Power, in the House. He is a very caring man who has faced up to his responsibilities and is doing a good job.

Is that a reference to his predecessors?

I refer to the man who is present, Deputy Seán Power, the current Minister of State.

He is a good man, we would all agree.

We will stick to the present and look to the future, which is how we will make progress.

We will not mention the Minister, Deputy Martin.

If Members wish to address our record, I can list all we have done in the years since coming into office on behalf of the elderly and everybody else for whom we are concerned. We have done a lot of work but I wish to focus my contribution on the Bill.

There is a lot more to do.

I fully agree with the Deputy. I am glad he agrees with our sentiments. I hope he will work with us to help us. I am glad he approves of the Bill and will support it because it is positive legislation in the interests of the people. I thank the Deputy for his support.

We instigated the Bill.

I thank the Deputy. The Bill provides for a clear legal framework for a scheme to repay recoverable health charges which were wrongly imposed on fully eligible persons for publicly funded long-term residential care. A significant and long-standing feature of our health system of publicly funded long-term care has been the principle that it is fair and reasonable that people should make some contribution to the cost of their long-term care.

Most families in my constituency were happy with the long-term care their relatives received in County Longford in both private and public nursing homes. They had no problem making a contribution towards that long-term care because the care in Longford, in public and private nursing homes, is second to none. I am sure the standard is good throughout the country but the standard in my constituency is probably the best in Ireland, with a good quality and delivery of service, good accommodation, good food, good care and good medical attention. That said, I fully accept the Supreme Court decision which found the charges unlawful. We will make that right. Almost all involved told me they were happy with the care and service and did not mind having to make some contribution towards the cost of the service.

The Bill will enable full repayments of public long-stay charges to be made to all those who were wrongly charged and are alive today and the estates of all those who were wrongly charged and died since 9 December 1998. It will also allow anyone wishing to put money into various health services to do so from their estates if they do not wish to take up the money. The repayments will include both the actual charge paid and an amount to take account of inflation with reference to the consumer price index. All repayments to living persons and their spouses will be exempt from income tax. I welcome the important provision that repayments will not be taken into account in assessing means for health and social welfare benefits.

The normal tax and means assessment arrangements will apply to those who benefit from repayments to estates, as is only right. As I said, the scheme includes a provision to allow those eligible for a repayment to waive their right and have the money assigned to fund one-off service improvements for older persons and those with disabilities. The application process will be as simple and, importantly, user-friendly as possible, while also providing appropriate safeguards against fraud and the exploitation of those who cannot manage the repayments they will receive.

My experience of health care in my constituency is that those administering it, from management through to nurses, doctors and other staff, provide a user-friendly service. That is also the experience of patients availing themselves of the various services. We recognise both that there is a great deal of pressure on staff in the Health Service Executive and that one has a very trying and tough time when one is ill. It is hard enough to be on top of one's form when one is in the best of health, but being sick makes one vulnerable.

The patients are very considerate and understanding people and accept a great deal. Sometimes relatives may be a little impatient or hard, and we must recognise that those who work in the health services are due some consideration too. We must advance care for the elderly, with everyone working as a team. Everyone must understand everyone else and work together for a health service of which we can be proud. We can certainly be proud of all those involved in it.

The background to the long-stay charge was that on 16 February 2005 the Supreme Court found the Health (Amendment) Act 2004, which contained provisions to introduce legislation to provide a legal basis on which to charge medical card-holders for the maintenance element of inpatient services in long-stay care, to be unconstitutional. Like everyone else, I believe we must observe, obey and respect the courts of the land.

The main elements of the Bill address the application process for repayment, how an application is determined, the payment of settlements, the donation of repayments to fund improvements in specific health services, and the operation of patient private property accounts. I hope we do not encounter too many difficulties with that and that common sense will prevail, with relatives, management and the HSE reaching a suitable arrangement to avoid more disagreement.

As in everything else, I welcome the inclusion of an appeals process. A special account will be established to facilitate repayments. I also welcome the Government's audit of the scheme. It is estimated that up to 20,000 people still alive, and a further 40,000 to 50,000 estates will benefit. The cost will be approximately €1 billion. Some €400 million has been earmarked for 2006, and the balance will be required in 2007-08.

I am glad that the care and service that people receive in public and private nursing homes have improved, although they were always good and very well run in our constituency. People may seek more public beds for the elderly, and perhaps we should try to create more, or work with the private sector so that it designates a certain percentage of such beds in all new private operations.

Regarding the elderly, it is important to highlight the many positive developments in their care recently. In case anyone gets the wrong idea from having listened to a previous speaker, we must state that older people are a core priority for the Fianna Fáil-led Government. We are committed to developing a comprehensive range of services for them and will ensure that they can live in dignity. Where necessary, we will provide for them to receive care at home too.

I am sure all Members attended on budget day. The Minister referred to the €150 million package in the 2006 budget for new care services for older people, which is the largest ever and will mean a major improvement in home — and community — based support. Thousands in need of care will receive new services and support in 2006.

When I tour my constituency or visit the elderly, either at home or in nursing homes, I find they are the happiest people in the country. They are an example to us all, being patient, friendly and courteous, displaying great faith, hope and charity. They are very understanding and undemanding, in most cases content with their lot, and have great peace of mind. They have lived their lives and have seen everything, gaining vast experience. They are quite content and not avaricious or greedy. Once they enjoy a certain standard of living, they are very happy. Most will remind us of expectations in their youth and middle age. They never thought they would see the day when they would be so content, happy and satisfied with the way the Government is treating them, particularly in respect of pensions. As promised, the €200 per week target will be reached and will be paid to these people who deserve it. They worked hard all their lives and made many sacrifices to educate their families. Without their sacrifice, commitment and dedication, we certainly would not enjoy the benefits we enjoy today. Everything comes at a price. Some must make sacrifices for the benefit of others. The elderly of today made major sacrifices so that we could enjoy the benefits.

I welcome the fact we owned up, said we were wrong and tried to rectify the situation as quickly as possible. As a goodwill gesture, the Government agreed to make ex gratia payments of up to €2,000 to those wrongly charged and who were alive on 9 December 2004. So far, the Health Service Executive has made payments in excess of €21 million to approximately 10,800 people. People in my constituency did not expect to get €2,000 as they were happy with the way they had been treated. When the announcement was made that the Government was prepared to make an ex gratia payment of €2,000, many people could not believe it because they felt they had received great care and attention and were looked after. Some 99.9% of people were happy with the system the way it operated. The only aspect about which they may not have been happy was the fact there were not enough beds and there were waiting lists.

When the Supreme Court decision was made, it was agreed the money received by the HSE as a result of the imposition of unlawful charges would be repaid. The legislation will allow repayments to be placed in patient private property accounts. These accounts need to be regulated given the significant amount of money which might be in them as a result of repayments of long-stay charges. Patients' private property refers to money and personal possessions patients have with them on admission to care. In the case of long-stay patients, the property also includes regular pension payments. Patient property accounts are operated by the HSE and formerly were operated by the health boards and support clients in managing their financial affairs and assist them in dealing with various aspects of daily living. The patient private property account system manages the private money of long-stay patients which may include pension income, maintenance charges, spending money or comfort payments to patients or clients and lodgments to accounts. This scheme will be operated in the most equitable and effective way possible.

The HSE said that in the circumstances it was necessary to put a new procurement process in place and subsequently placed an advertisement in the Official Journal of the European Union on 2 February 2006. We expect the appointment of a successful company at the end of April with repayments likely to commence in June 2006. The people can look forward to this happening.

I do not believe there are any dissenting voices. This Bill has the unequivocal support of all Members of the House. I do not believe anybody could disagree with this legislation since all those wrongly charged for inpatient services will be repaid in full. It is unfortunate people were wrongly charged. We cannot, under any circumstances, condone anybody not obeying the law.

I compliment the Minister of State, Deputy Power, and will continue to do so as long as he continues to do the great job he is doing. I fully support the Bill.

I wish to deal with this measure under a number of headings, namely, the history of the saga which goes back to the early 1970s, the hand-over between the former Minister, Deputy Martin, and the Tánaiste, the first Bill which was deemed unconstitutional and the one we are now discussing and the prospects for administration. It is important to state at the outset that if anybody wanted to do a PhD on public administration in the Irish governmental system over the past two decades which span the administration of different political combinations, this would be a wonderful test case to examine. I have some experience of it from my time in Government.

The complexity of the issue and the structure which presides in health as distinct from local government is a major contributing factor to all of this. It is also important to state that nothing wrong was done. What was done was illegal but it was not wrong. I do not believe anybody has challenged the fact that somebody with a non-contributory pension getting full-time care should make a contribution from that pension to his or her upkeep since he or she is in care 24 hours per day, seven days per week. What was wrong about it was that it did not have statutory underpinning.

A former leader of my party was the first Minister to introduce the system or to give it his accord. On numerous occasions, things have been done in good faith, were deemed to be correct and were politically sanctioned but did not have the necessary legal statutory authority for them to be implemented. This is one example. I understand from the contribution of my colleague, Deputy McManus, that the only person who really spotted the problem was the late John Boland who had an eagle eye and a sharp tongue. In the short two month interregnum after the Labour Party left Government in 1987 when the election was inevitably coming, he clearly saw this legal lacuna and that the gap would have to be properly underpinned by some type of statutory measure. It was on the table for the incoming Fianna Fáil Minister for Health, the Ceann Comhairle, Deputy O'Hanlon, but for reasons we do not know and probably never will, unless the freedom of information legislation or the 30-year rule reveal otherwise, it was not high on the agenda of that slash-and-burn Government. I do not believe the Minister of State, Deputy Power, supported the head of it at the time but those were different days.

We fast forward then to the view of the chief executive of the former Southern Health Board who raised a possible problem. He got the legal opinion which brings us up to the eventful day — 16 December — in the Gresham Hotel. That takes us to the modern history and the hand-over.

I wish to focus on a test case of how bad this Administration is and how utterly incompetent it is as a collective entity. Although the Minister of State, Deputy Power, has been sent into the House, as Deputy Kenny said, his hands are clean. He was a million miles away from the scene of the so-called cock-up. The Labour Party and Fianna Fáil introduced the system of programme managers and special advisers to ensure the political corpus of a Minister could be in three places at the one time. It was also to ensure civil servants could have political direction that knocked heads between different Departments, safe in the knowledge their loyalty to their own Department was in no way compromised by their need to accept a political compromise authorised by a programme manager with the clear authority that would come in due course from the Minister. It was a very good system, it worked extremely well during my experience with Fianna Fáil and it was about governance rather than publicity. It was about fast-tracking decisions and avoiding cock-ups and mistakes. Frequently Ciaran O'Meara or Greg Sparks would have addressed me, Ministers from Fine Gael, the rainbow coalition or Fianna Fáil as follows, using language that no civil servant could ever employ: "For Christ sake, Minister, if you don't get your act together on this matter, the party will be in serious trouble". Self-evidently, civil servants cannot adopt that language, nor should they. They can draw attention diplomatically to what, in the words of Sir Humphrey, might be a very brave decision to make. However, they cannot be as brutally frank as a programme manager needs to be and should be. It is hard to be such.

I say advisedly, from my vantage point of limited knowledge, that programme managers and special advisers were more concerned with the image of the former Minister for Health and Children than the content of his head. If he did not have time to read the documentation discussed in and around the meeting of 16 December, he could have consulted the two advisers who were paid to read it to look out for landmines and problems. One of them, the Minister of State, Deputy Tim O'Malley, did so. However, he is not of the same party and he is very inexperienced in political terms, although he may be a wise man in many other respects. He did not deal with the issue. The former Minister of State, Deputy Callely, says he spoke to the Taoiseach and was to talk to the then Minister about the issue, but there is no record of this. Ultimately, at a meeting of the committee that subsequently inquired into this matter, the former Minister denied all knowledge of it. However, the former Secretary General of the Department said he did brief him. We know what happened thereafter. The current Minister, Deputy Harney, took over the job. She knew everything about everything, and still does, and introduced a Bill that was struck down because it was not unconstitutional.

To return to my suggested theme for a PhD, let me put in context the difficulty the Department of Health and Children faced at the time and which it faces now. Given that the current Minister of State, Deputy Seán Power, was previously a member of a county council, he may accept the analogy I will draw. There is never a problem like the one in question in the Department of the Environment, Heritage and Local Government over what is being spent in Kildare County Council in light of what the Custom House knows. The legal and administrative structures and the political traditions, dating from the commencement of the County Management Acts, ensured that the Custom House had, at all times, a very good handle on what was happening. It had a local accounts auditor supervising and finding out relevant information. More important, at the local level the administrative staff from the county manager down, under the scrutiny of the councillors — I am primarily talking about management rather than politics — had a dominant but not a domineering relationship to the technical staff, be they engineers or architects. The same cannot be said for the structure in the health system. The Department of Health and Children, which was not housed in an elegant Gandon building like the Custom House but in what is probably the worst building in the city, and certainly one of the most unhealthy, had a semi-detached relationship with the local health boards and various health agencies. This relationship was not of its making because of the historical way in which the health services increasingly came within the public domain.

From calculating Estimates while in the Department of Finance, I know that, of all Departments, the Department of Health fared worst because it could not get a hard handle on figures. It did not receive the figures and there were so-called demand-led schemes. I produced three budgets in the Department of Finance and at all times got the impression that the Department of Health was dealing with estimates of figures based on estimates coming from estimates. It was always difficult. Additionally, the management history of the Department of Health and Children is probably one of the worst, with the exception of the management histories of the Departments of Justice, Equality and Law Reform and Agriculture and Food. Can one think of any other Department in which a senior civil servant took the Secretary General to court on the grounds that a promise of promotion had been reneged upon after a serious performance by that person in respect of a health scandal? The Department of Health and Children, through no choice or fault of its own, went from crisis to crisis owing to agencies for which it was ultimately responsible.

It is against this background that we should examine this Administration and, in considering this Bill, determine whether lessons can be learned and applied. I am not in the business of attributing blame and asking people to take responsibility — the electorate will ultimately make this choice. However, if one is trying to manage what is perhaps the most complex and expensive Department in terms of its budgetary allocation, and perhaps the most difficult because of the dominance of health professionals in the system, as opposed to the position of environmentalist professionals in the local government system, who represent the technical side rather than the administrative side, and who come into the Department from a smoothly run Department such as the Department of Enterprise, Trade and Employment, the smartest thing is not to fire the general who is in charge.

Consider the circumstances that would obtain if any one of us elected politicians worked in an organisation that was constantly in the front line, dealing with agencies that were not telling the truth and in some cases telling lies, and had a Secretary General with a reputation among his peers for commitment and professionalism, which I certainly noted. The former Minister for Health and Children, who had responsibility, paid advisers to read the briefs and two Ministers of State who knew there was a landmine ready to blow up, claimed he knew nothing about the matter in question, yet, to protect the security of this coalition Government, the current Minister, Deputy Harney, instead of demanding the head of the former Minister, fired Michael Kelly. When she could not fire him properly he was promoted to a higher-paid job.

Some day somebody will write this story in its entirety. The political group in this Chamber, charged with a very professional Civil Service, will not come out of it well. If collective responsibility means anything, it must be noted that the current occupants of these benches have reneged on the mandate and responsibility the citizens of this Republic give to us. This is why there is a lesson to be learned from this saga.

The issue does not just extend this far. The Minister of State, Deputy Seán Power, had no direct responsibility in the matter. Where do we stand now? We, on this side of the House, are supposed to scrutinise legislation and it is our task to hold it to account. Nobody has a monopoly on truth and no drafter of legislation can see around all the corners all the time. When the first Bill to address the overpayment issue was introduced by the current Minister for Health and Children, my colleague Deputy McManus said it was probably unfounded and unconstitutional. However, the Minister, who knows everything and who was to transform the health service with a magic wand, refused to accept this criticism. On foot of the culture she engendered by effectively politically sacking the Secretary General of the Department of Health and Children within a week of entering office, what other senior civil servant will have the nerve to try to tell her something? Would the Minister of State or anybody else do so? What kind of climate of terror and intimidation was created among a group of individuals who did not know the hell what was going on in most of the hospitals because they were told lies, but who were politically accountable therefor nevertheless? I do not refer to high-speed senior management expertise but to common decency and respect for citizens who, because of the political vow of neutrality they make to ensure a non-corrupt Civil Service, for which we are eternally indebted, are defenceless when treated in the manner I have described.

The first Bill was found unconstitutional and contrary to the advice of this House. It was introduced because the current Administration knows everything. If the Minister for Health and Children does not, the Minister for Justice, Equality and Law Reform certainly does. They have an obsession with private sector magic wands that will cure every ill in the country. I know Fianna Fáil does not believe in these because they are patent nonsense, but it must go along with the Progressive Democrats because it needs their votes.

If one passes through Dublin Airport this summer, one will recall the insistence of the Progressive Democrats that Aer Rianta be broken up and that the new terminals should compete against each other. Nowhere else in the world is there such a nonsense in terms of infrastructure provision but, because of that ideological stand-off and since the tail is wagging a very big populist dog, millions of passengers will be put through hell in the airport as a consequence.

We have the same nonsense in the method of administration by hiring a private company to do something for which no private company has the expertise in this country. There is no expertise in the private sector to administer payments of this kind retrospectively, yet in the public sector three such organisations exist. The Revenue Commissioners do this kind of work all the time and have fantastic expertise. They run the public service payroll. If we did not want to use them to do it, we could use the Department of Social and Family Affairs, which is also on the payroll. It has a body of expertise and entrepreneurial skill, and has the wisdom of experience having learnt from mistakes made in the past. Why was it not possible to get a task force of the best administrators from the Revenue Commissioners, the Department of Social and Family Affairs and perhaps the National Treasury Management Agency to deal with the problem and when the problem was dealt with, the group could have been stood down and the individuals could have returned to their sections?

This in effect is what a Department is: a semi-permanent task force set up to address a particular problem, staffed by professional full-time civil servants with the assistance of external consultants where needs be. The Department of Supplies during the Second World War, the Department of the Gaeltacht, the Department of Labour and the Department of Equality and Law Reform were all established for specific tasks and when that set of tasks was completed, the Department was stood down and the civil servants moved to other Departments.

There is no need to waste citizens' money of the order of €50 million for administration. If that figure is not accurate, perhaps the Minister of State could correct me. The company that gets the contract will interview people from the Department of Health and Children, the Department of Social and Family Affairs and the Revenue Commissioners. Nobody will get a fee for this. The company will pick the brains of officials and will write a report based on the knowledge taken from staff employed by the State. It will then charge the Government a fortune to tell it what these people are paid to tell it professionally if it had the courage to listen to them in the first instance.

There is a lesson in this sad saga. It is about arrogance and incompetence combined with a sense that the Government knows it all and that nobody can tell it anything. When that point of incompetent arrogance is reached, the emergency panic button that is the key to a successful democracy kicks in. The real value of a democracy, as the people of Nepal are struggling to discover, is not the right to elect a government but the right to fire one. It is not the right to choose the government of people's liking, but the right to get rid of the government that has become incompetent, incapable, blind and deaf. While I know, admire and like many Government Deputies individually, sadly, collectively, like a team, their performance is worse than that of Leinster last Sunday.

I wish to share time with Deputy Devins.

Is that agreed? Agreed.

Much has been said and much more will be said on this issue. I do not disagree with much of what Deputy Quinn said. The last thing we want to do is use vulnerable people in nursing homes as a political football. I do not suggest that anybody is deliberately trying to do so. There is no point in apportioning blame at this stage. I am sure this will be investigated at some other time. We need to try to achieve excellence in public administration in our health service. If we do so we will be working in the interest of patients, the public and staff.

It is important that people in long-term care and their families should have clarity about how care will be provided and paid for. It is important too that where mistakes are made, they are recognised, responsibility is taken and the lessons are learned and applied. Many mistakes have been made and many changes of direction have occurred, some of which have been poorly thought out. Let us not apportion blame. The issue of charges for those in long-term care has been ongoing for some time and has continued under various Governments of all political parties. The issue of the charges is being addressed in as good a way possible in the circumstances.

Notwithstanding that the policy had consistent support and that people received a benefit for their payment, the Government believes that repayments should be made because a mistake was made. We should all be sufficiently honest to hold up our hands and say the money belongs to those people and they need to have it returned. I heard other contributors make valid points. The issue that triggered the matter in the public mind was the debate about Leas Cross nursing home, many of whose 116 residents regarded it as their home, which became the pilot for the investigation into how this debacle took place.

The Bill will ensure that all those fully eligible persons who were wrongly charged and are alive, and the estates of those eligible persons who were wrongly charged and died since 9 December 1998, will have the charges repaid in full. The issue of the Statute of Limitations and related issues may need further clarification. As 20,000 people who are still alive and a further 40,000 to 50,000 estates will benefit from repayments under the scheme, it indicates the scale of the problem. Even if €1 billion needs to be repaid, so be it. However, let us try to learn from what happened.

Essentially we are discussing the care of the elderly. It is a moot point whether this has been a priority for Governments of all parties up to now. However, from now on we must put the needs of the elderly at the forefront. While the Bill concentrates on repayments of money illegally charged to people in nursing homes, let us try to get to the stage where fewer people need to end up in nursing homes.

I heard another speaker refer to the county homes. In their time they did a fantastic job. The Acting Chairman, Deputy Costello, will know that St. Mary's Hospital in the Phoenix Park provides the very highest possible quality of care for the elderly. While it is a fairly austere building, the quality of provision is second to none. We need to ensure that level of care is replicated elsewhere. While they have been much criticised, I pay tribute to the health boards and now the Health Service Executive for the way they have developed homes in the public sector. I would much prefer to see more provision delivered through the public sector than through the private sector. However, we are where we are.

Last week a senior official in a hospital in the Dublin area told me that it had been given permission to purchase additional public beds in private nursing homes. He also told me that those beds would be acquired in places as far away as Wexford, Drogheda and Dundalk. Most of the patients in my constituency go to a northside hospital where they are being accused of being bed blocking. Transferring them to somewhere in Drogheda or Wexford would be a great imposition on their families. It is unfair and the issue of distance needs to be borne in mind. We should drive our policy to ensure families can expect that their mostly elderly parents can be looked after in their own homes. I have heard other people referring to the home help service, which was an amateur Cinderella service for many years. The Government has been much criticised, but it should be credited with putting the home help service on a much more secure footing. It is not that long since the providers of that service were paid not much more than pocket money. I accept they are still not being paid much more than the minimum wage, but they are now working towards the provision of a paramedical service. That is an area we could develop much more.

The issue of nursing home packages trips off the tongue very easily. I have learned, from the inquiries I have made, that it may be more difficult than people think to put together a nursing home package. Not only will nurses have to come in to look after patients in their homes, but services like occupational therapy, doctor on-call services and physiotherapy will also have to be provided. We need to ensure, before we raise people's expectations by deciding to provide thousands of nursing home packages, that we are able to put such packages together.

I raised the issue of appropriate housing for elderly people during a debate on another Bill. Local authorities should step up to the plate in that regard, but they are not all doing so. I am most aware of the experience at Dublin City Council level. I credit that council for pioneering good quality housing for elderly people. I have noticed recently that the council is working in partnership with organisations like Respond and co-operating with the HSE to provide centres in which a model of care that works and could be replicated is offered. Respond, Dublin City Council and the HSE are working together in Finglas, which is in my constituency of Dublin North-West, to provide and manage a centre in which elderly people can live in a manner that is quite independent. Although they have their own homes, they are dependent on the provision of services like those offered by nursing homes, such as meals and medical services. That is an example of an approach that works.

The Minister of State, Deputy Seán Power, is familiar with the Odenswood day care centre in Finglas, which is another example of an intervention facility provided by the HSE. The centre provides care, in the form of medical and personal services, for up to 80 patients each day. Those who want to spend half a day in the centre have to stay on a waiting list for six months or a year. There is a need for many more centres of that nature.

I cannot understand why much more use is not made of the disabled person's grant scheme, which is probably administered reasonably well in Dublin, as a means of keeping people at home. I have heard of sorry cases, like the case of a woman whose leg had been amputated. Her family wanted to provide hand rails so that she could get into her House. She had to be kept in hospital for an additional 12 weeks while an occupational therapist was found to write a report, to supplement a report which had already been written, to recommend that hand rails and a walk-in shower, etc., should be provided. There is no reason such issues cannot be more speedily resolved, with a little more inter-agency co-operation.

I am sure the Acting Chairman, Deputy Costello, is aware of the imminent transfer of some long-stay patients from certain units in James Connolly Memorial Hospital in Blanchardstown. Their families have not been given sufficient notice of the transfer of their relatives to public beds in private hospitals throughout the Dublin area while units 3 and 5 are being refurbished which, in my experience, will take two years or more. Although the families will be able to cope with the disturbance that will be caused, the patients will experience great difficulty. I know of patients who have been in the units in question for up to eight years — the hospital is their home. We know about the trauma that can be associated with the onset of Alzheimer's disease, for example. We need to streamline such issues and learn from such cases.

This Bill represents an effort to address the injustice that was perpetrated on elderly people and their families by all parties. There is no point in saying that one party was more responsible than another. It should not have happened, but it did. I hope the repayment scheme will be administered with minimum fuss. It should be done speedily, efficiently and in a most transparent fashion. The Money Advice and Budgeting Service has a role in this regard. It worked quite well when awards were being made by the Residential Institutions Redress Board. The Department of Health and Children should encourage those who operate this repayment scheme to engage with the budgeting service to ensure that people to whom a fairly substantial amount of money is suddenly paid look after that money properly and wisely. The budgeting service has a good record in that regard. With that caveat, I welcome the Bill.

I am pleased to take this opportunity to speak about the Health (Repayment Scheme) Bill 2006, which is quite important. The announcement by the Minister for Health and Children that people in long-term care institutions in the State had been wrongfully charged for their stays is still a vivid memory for me, as it is, I am sure, for all the Members of the House. That issue has been fully debated in the House. The Bill under discussion is the result of the Minister's commitment to repay the moneys which were wrongly taken from patients.

The Government has no choice in the matter.

The huge amount of money that was taken from patients under defective legislation — the cost has recently been estimated at more than €1 billion — must be repaid. I understand that more than 20,000 people who are still alive will be eligible to recover money, on foot of this legislation, and refunds of moneys will be paid into the estates of almost 50,000 people who have died. The recent Supreme Court judgment highlighted the fact that the Statute of Limitations means that the estates of people who died before December 1998 will not be eligible for repayments, unfortunately. I welcome the fact that the repayments will comprise not only the actual charges which were imposed on patients, but an amount that takes account of inflation, calculated by reference to the consumer price index since the time when the person was wrongfully charged. The payment of the extra amount is just and correct because patients have been denied the use of the money in question since the illegal charge was first imposed. It is obvious that any interest they may have gained from such moneys should be included in the repayment scheme.

On an unrelated but similar issue, I have frequently wondered why the Revenue Commissioners do not adopt a similar approach when they are dealing with tax refunds in the cases of people who have overpaid their tax liabilities. I recently heard about the case of an individual who received a tax refund in February 2006 in respect of tax that was overpaid in 2004. She did not receive an additional amount that was calculated to take account of inflation in the intervening period. I suggest that the Revenue Commissioners should follow the example being given by the Minister for Health and Children in this Bill. It is interesting that all repayments to living persons will be exempt from income tax. Such repayments will not be taken into account when the means of individuals are being assessed for health or social welfare benefits.

I congratulate the Minister on this progressive and innovative legislation, which recognises that patients were wrongfully charged in the first place. Therefore, what these people are getting, in effect, is the return of their own money. While they will be getting it all in one sum, this should not and will not deprive them of any benefits to which they might normally be entitled. It is not the fault of the individual patient that money was wrongly taken from him or her. Therefore such patients should not be penalised in any way because those moneys are being returned to them now.

Since this issue first came to light I have been approached by a number of constituents representing patients who are still alive, thankfully, but also others who are involved on behalf of relatives who have died. The words of one particular lady resonate with me. She said, "The care that my late father received while he was in St. John's Hospital in Sligo, was of the highest order and I do not wish to avail of the repayment". I welcome the provision in the Bill that allows any eligible person to waive his or her right to a repayment. The fact that any money so waived will be assigned to fund one-off service improvements for older people and those with disability, is also very welcome. It is important that such money is ring-fenced for those improvements to which it is assigned.

I will even go further and ask that if possible, the money should be used for improvements in the institution in which the patient resided. In that way the institution that provided the care to the patient will benefit directly. This idea might not be administratively possible, but I ask the Minister of State to examine it. After all, if any institution provided care that was of such a high standard that the patient or his or her relations felt positive about, it is surely only right and proper that it should be first in line to benefit from the generous waiving of the repayment money.

As I said at the start, the amount of money involved in this process is very large — close to €1 billion. When one considers that the total health budget for 2006 is €12 billion, then the enormity of the repayment cost can be appreciated. The potential for fraud or wrongful repayment is recognised and I welcome section 17(2) which makes legal provision for the recovery of any moneys obtained through fraud or overpayment. Every euro must be repaid correctly, but because of the enormity of the sums involved, due care must be taken that the moneys are repaid to the correct persons. It is also important that there is a clear appeals mechanism in place for those who believe they might not have been treated correctly in the repayment process. Section 16 of the Bill deals with the appeals process in some detail. Hopefully, it will not have to be used. However, if a situation should develop where there is a dispute between an applicant and the repayments scheme, then the appeals process, as proposed, is transparent and fair.

I am glad that the Bill deals with the unfortunate situation of patients who have a degree of mental or intellectual impairment. It will ensure that where there has been a deterioration in the intellectual capacity of a patient, his or her rights are protected by the use of a patient private property account. This will mean that any funds accruing to patients in this category will be used for the benefit of the individual and that the money can be invested on behalf of the said patient. This Bill will correct what was a serious wrong to patients in long-term care institutions. It is right and proper that the Government is taking this line of action. It will be successful, with sufficient safeguards in place to ensure there is no misuse of the enormous amount of money involved. I commend the Bill to the House.

I welcome the opportunity to speak on the Bill and to deal specifically with some aspects. Like other contributors I am concerned about the need to ensure there is proper care for the elderly.

The delay in bringing the legislation before the House has been remarked on by many speakers. It is unfortunate that the elderly have had to wait such a length of time since this matter was first raised by Deputy Perry. They have had to wait until now to see some movement on the moneys illegally deducted from them which the State has a duty to repay. If the boot were on the other foot and the patients or their families were obliged to pay the State moneys for services, a time interval of this duration would not be tolerated under any circumstances. Many people have asked me whether the repayment had been made, why they did not get it and so forth. People do not understand why there has been such an extensive delay in bringing this legislation before the Dáil.

No doubt there is a need for proper funding of care for the elderly. The elderly population is growing. One in 20 old people will need long-term care at some time in their lives. Much of this will be for a relatively short period — three to five years on average. It is important that the State identifies, plans and finances proper care for the elderly.

We see a growing difficulty with nursing homes. The subvention system has not been reviewed for six years and a great deal has changed in the interval. Most of all, the cost of nursing home care has grown substantially and the level of subvention has not increased proportionately. Will the Minister of State comment on the need for a full re-examination of nursing home subventions?

People have great difficulty in understanding the approach being taken by the Health Service Executive and the Department towards the public-private use of long-term care for the elderly. There should be clear criteria on who is eligible for long-term public care, with clearly outlined reasons for any refusal of an application. The present situation seems very vague and it is difficult to understand how decisions are arrived at. Such matters should be very transparent. This would assist public representatives who can only tell constituents at present that HSE policy is to steer people towards private nursing homes. While the HSE considers admitting people to public nursing homes, neither the criteria involved nor the examination of applications is transparent. There is need for much greater transparency to remove much of the suspicion, including many of the incorrect reports we get as well. There is no way to examine the systems for determining whether a person qualifies for a private or public facility.

I have long been concerned about the mechanisms for consulting elderly people in hospital on their treatment and discharge. In most situations discussions take place between the family and the consultant or the hospital authorities. Often the patient is ignored or not informed about what is happening. This is wrong and very disrespectful to the individual patient. Just because people are elderly does not mean they do not have views, stresses or concerns about their conditions. While some families keep their elderly relatives informed, in many cases families are not in a position to reassure elderly patients who are admitted to hospital for strokes, heart attacks or other serious problems in regard to their future. In many cases it is obvious that patients are not in a position to return home and their future is often discussed at one remove from them. That is an area we should examine to ensure that the approach taken to patients aged 85 is as inclusive as it would be in terms of patients aged 25 or 35.

The maintenance of people in their homes for as long as possible should be seen by the Minister and the HSE as an investment rather than a cost because it is preferable to paying nursing home subventions and the cost of public nursing homes. Home helps could be used much more effectively and more extensively to assist people to stay in their homes. I heard of a case recently where the home help of somebody in receipt of five hours of home help was unable to continue and another person was obtained who lived six miles away. The person in receipt of home help was informed that their home help hours would be reduced to three hours and they would have to pay for the travel expenses of the new home help.

Despite numerous assurances following discussions in this House we have not moved towards integrating and rationalising the area of special housing aid for the elderly, essential repairs grants and disabled person's grants for people aged over 65 years. The present system is confusing and leads to a waste of resources. Work should be completed by local authorities according to clearly set criteria and a proper budget should be supplied which would considerably reduce the administration of the system.

Essential repairs grants can be quite effective in improving the housing conditions for the period of an elderly person's life. The special housing aid for the elderly scheme has a similar function but is much more cumbersome in terms of completing the work and although the cost to the person concerned is less, delays are more likely. The disabled person's grant is similar to the essential repairs grant but the need for an occupational therapist's report and other requirements before a decision is made can result in considerable delays and makes the system cumbersome. We need an overall policy on the level of care to which elderly people are entitled. The denial of moneys to people that is outlined in the Bill does not augur well for the State's approach to the elderly. This must change.

I wish to address the issue of people with medical cards in private nursing homes, to which some of my colleagues have also referred. Has the Department examined the situation whereby elderly people are in private nursing homes who were refused admission to public nursing homes despite the fact that they had medical cards? Does the Minister of State accept he has some responsibility for this area? Events may proceed in such a fashion in the courts that it is decided there is some responsibility for the State towards those with medical cards who were refused beds in public nursing homes and went into private nursing homes.

I am aware of many people with medical cards who went directly to private nursing homes because they were advised by hospital authorities, doctors and others that it was pointless applying for long-term care beds in public nursing homes. As a result, these people made the decision not to apply for those beds. As a politician I have often advised people that the chances of obtaining a bed in a public nursing home are very small and that in the interests of the patient and because of the delay in the decision making process, it would be advisable to go to a private nursing home. Many people have not applied for long-stay beds in public nursing homes even though they have medical cards.

Those who will benefit from the repayments outlined in the Bill are, for the most part, in the final years of their lives in long-term care and do not have much time to enjoy the refund. It is disappointing that there has been such a delay because many people who would have had some enjoyment from the refund have now passed on without having had the opportunity to do so. In reply to what the Minister of State said about the average length of a person's stay in a nursing home, it is two to three years, which is not a long time.

I understand the Department of Health and Children has made ex gratia payments of €21 million to 10,800 people. As the Minister of State, Deputy Seán Power, pointed out, the HSE, which assists the new organisation responsible for making the payments, will have to pay people who are alive first, which amounts to 10,000 people. The Minister of State may be correct but I understand that repayments are due to up to 5,000 deceased people who have died since the first legislation appeared in November 2002. If the Government continues at this rate, most eligible people will have passed away before the payments begin. The Supreme Court reinforces this in its statement that whatever expectations may exist, it is an indisputable fact that the Bill will affect many people who are old, poor, disabled, mentally and physically ill and in many cases will have all these conditions. Such patients will have little or no capacity to understand their rights under the legislation or to protest against the unlawfulness of the charges nor will they have the pleasure of enjoying the refunds being made by the Government.

The explanatory memorandum provided with the Bill consists of one page. We are accustomed to receiving detailed information in explanatory memoranda to Bills whereby sections of the legislation are explained in more detail. The Government has had more than a year in which to prepare this legislation and I expected the explanatory memorandum to be more detailed. Many of us are not very legally literate when it comes to reading legislation——

At the same time I would not like to be trying to pull one over on the Deputy.

The explanatory memoranda are of great assistance in understanding and reading the legislation.

Section 3 allows the Health Service Executive to enter into an agreement with a person to supply services for the purpose of the Act. During the period when the publication of the legislation was awaited we were informed the delay was due to outside companies quoting prices of up to €50 million to administer the scheme. We questioned on a number of occasions the reason the HSE could not undertake this work. Deputy Quinn referred to other efficient and experienced Departments such as the Revenue Commissioners and the Department of Social and Family Affairs who would be capable of doing this work. The Department of Health and Children has successfully dealt with the surviving 10,000 people in a very short period by making ex gratia payments through the use of departmental records. It is surprising that an outside company is required to deal with the estates of the 40,000 to 50,000 deceased people. Any delay incurred if the HSE undertook this work would not make much difference to their estates and will certainly not make any difference to the patients themselves. I am surprised the HSE, considering its staffing, is not in a position to undertake this job when it was perfectly capable of dealing with matters up to this point. One of the reasons for the establishment of the HSE was to rationalise the system and create efficiencies within the overall system for the delivery of health care. I am confident the HSE has sufficient staff numbers to address this issue. I ask the Minister of State to explain the reason he has not considered the expertise within the HSE rather than going to an outside organisation. Is the Minister of State passing a vote of no confidence in the HSE by outsourcing something which is a matter of public administration?

The mistakes were made by the Government and should be dealt with by the HSE if it is to demonstrate the improvement it has supposedly brought to the health services. The HSE began collecting information on who was entitled to repayment. Employing consultants to administer the scheme seems strange when the HSE has already dealt with ex gratia payments worth €20 million to more than 10,000 people. The Minister of State informs the House that a consultancy firm will be engaged in April. Will the Minister of State confirm that the consultants have been engaged and whether contracts have been signed or will this be announced at a later stage?

I hope the forms which must be completed by patients or their families will be as simple as possible. Patients or their families should not be required to make claims in duplicate. If the HSE has most of the information there should be no need for patients to complete forms. Whatever way it is administered I hope the forms will not be used as a delaying tactic to avoid making the repayments.

I remind the Minister of State, Deputy Seán Power, of what he said to me yesterday evening; that I would love to be over there on the Government backbenches with Fianna Fáil. I assure Deputy Power that I have a very comfortable seat here on this side of the House and I am delighted with it.

One should never get too comfortable in a seat in this House.

I intend to hold on to it.

The delay in bringing this Bill before the House is outrageous. The Bill seeks to address a wrong that was perpetrated on one of the most vulnerable sections of the community and who deserved a quicker response. As other speakers have pointed out, if the Minister for Health and Children's predecessor, Deputy Martin, had read the memos from his staff on the illegality of nursing home charges, we might not have had to wait so long. However, given that Deputy's habit of seeking a report or inquiry on everything that came his way, we might have had to wait even longer. It is more than 14 months since the Supreme Court deemed the Minister, Deputy Harney's Bill to be unconstitutional. It was a shameful attempt to legalise blatant fraud. Since then, the introduction of this Bill has been deferred from one quarter to another. It has been a source of deep embarrassment to all Members of the House since then that any query we received asking when repayments might be made could only be answered with uncertainty due to the foostering and bumbling of the Tánaiste in trying to put a repayments mechanism in place. There is now supposed to be a user-friendly, uncomplicated process which is independent, transparent and through which swift repayment will be made to all those due repayments since 9 December 1998. I hope it will do exactly what it says on the tin.

The need for an independent and overseeing body for the administration of the repayments process and management of the private property accounts should be explained to the House, considering there are Departments such as the Department of Social and Family Affairs which pays millions of euro every week in benefits. Why is there a need to pay an outside agency to take charge of the repayments?

Similarly wasteful has been the tendering process for a body to make these repayments. The Health Service Executive so much enjoyed the process the first time that they did it twice. If ever there was an illustration of the lack of public confidence in the Department of Health and Children, it was that the first tendering process could not attract one suitable company willing to be associated with this shambolic administration.

This repayment process will be audited by the Office of the Comptroller and Auditor General. He should intervene now and insist that the repayments be made by existing Departments which are already audited by his office and so save the taxpayer enormous expense. Although the House has debated the overcharging by nursing homes and the Travers report dealt with the history of the levying of those charges, the simple fact remains that except for Mr. Michael Kelly, a senior civil servant who was far from being solely or totally to blame, no one has been held responsible for not taking action on the overcharging when notified of it. There is anecdotal evidence that when challenged about the legality of the charges in individual cases, some health boards simply stopped charging those individuals. The practice was highlighted in the annual reports of the Office of the Ombudsman in 1989, 1992, 2001 and 2003, yet no action was taken.

Due consideration should be given to those who are not competent to make a claim which is unfortunately the case in a substantial percentage of those entitled to make a claim. The Minister should ensure that workshops staffed by employees of the health service visit the various nursing homes and ensure that all those who are entitled to repayments make a claim.

In my constituency a share of patients live in St. Joseph's in Raheen and in Ennistymon and Kilrush geriatric hospitals. I have visited those hospitals, some of which are of a very high standard. The patients enjoy great care but I can tell the Minister of State, Deputy Seán Power, that the staff work in atrocious conditions.

I strongly urge the Minister to set up visiting workshops. A faceless telephone helpline is useless in these circumstances. It is time for the Government to face up to the health care needs of the elderly. A comprehensive report to tackle the care needs of our elderly is urgently needed. This needs to be addressed positively with elderly care specialists and support teams based in the community, and we need to put an end to the statement that caring for the elderly is increasingly problematic in the health system, which merely promotes ageism in society.

Given the delay in bringing this Bill before the House, the length of time the practice of illegally collecting the charges continued, and that no claims prior to 9 December 1998 can be made, it would have been appropriate that the Tánaiste and Minister for Health and Children, Deputy Harney, would at least have included in the Bill a deadline by which repayment claims received would have been paid, but even this consideration to the elderly in the community was beyond her.

Let me deal with a statement made in this House last night, that patients, before being discharged into the community, are seen by a doctor and then by an occupational therapist, and then when they are discharged they are visited in their homes by an occupational therapist. Is the Minister of State, Deputy Seán Power, aware that one must wait six months to get an occupational therapist in County Clare, unless one is able to pay up front?

Subvention is another matter. A lady whose mother is in a nursing home came into my office the other day. On applying for subvention the health board wanted her to sell the family home in order that her mother could remain in care. Would anyone in this House today like to see their family home sold? Often the family homes and farms such people own are part of family settlements. The health board will demand that those homes be sold to keep a loved one in care. A generous subvention should be given and home help made available on a regular basis, which is not the case.

People looking for home help in my county cannot get it. In west Clare an elderly man who needed home help in January last was told to apply again in April when the money became available.

This is the Government which tells us we have a great health system on which it has spent millions. It has squandered, not spent, millions on it. A root and branch analysis of the health boards was never undertaken. The Government commissioned various reports such as the Hanly report. Currently in the mid-west it is conducting a survey of what we need in our hospitals. This is another survey costing more money. The Government can dish out money for electronic voting machines, to the horse racing industry and to the GAA. Being a true GAA man myself, I welcome the latter spending. However, the people who need the money are the elderly in this society and the Government is not giving it.

I visited a geriatric home in my county last week and met the loved ones of two people in that home who are suffering from the MRSA super bug. One of those patients was in a semi-private ward and the other was in a public ward. When I asked the nurse in charge why those people suffering from this deadly MRSA bug were in public and semi-private wards I was told that they could not put them into a private ward because they did not have one. When I stated that nurses going out for lunch should change out of their uniforms, a nurse came to me and said there was nowhere for them to change unless they did so in the ladies' toilet because there was no staff room. That is the position in St. Joseph's Hospital in Ennis. The Government can proudly state that this is the health service and we are spending money. We are not spending it; we are squandering it.

I want the Minister of State, Deputy Seán Power, to visit Ennis again. I stated yesterday evening that the accident and emergency department in Ennis hospital was so crowded a few weeks ago that patients were put in the reception area and no fire or safety measures were in place for the vulnerable people concerned who were unable to care for themselves. Will the Minister of State undertake to come back to visit and see for himself the institutions in Clare, especially the geriatric homes, and compliment the doctors, nurses and staff who give an excellent service in atrociously poor conditions

Originally I was to have seven minutes to speak but I am delighted that I now have 20. Many of the Deputies on this side of the House do not get much time to speak and we relish any such opportunity. There is certainly much to say on this issue.

The first aspect of this Bill to which I wish to refer is the delay. Other Deputies have spoken about this and I will do so as well. It is 14 months since the Supreme Court rejection. The Minister of State, Deputy Seán Power, introducing the Bill on Second Stage, stated "It is regretted that, due to the detailed and complex nature of the issues involved and the need to consult with a broad range of agencies and interests, the drafting of this Bill has taken longer than anticipated."

At the end of the summer recess my colleague and party leader, Deputy Sargent, in the interests of North-South co-operation and the east-west dimension following the British-Irish Agreement, asked that the House should sit in line with the UK Parliament, the Scottish Parliament, etc. and once again the Government decided to take early holidays. In January, the same occurred. There were two months of legislative time when we could have been working. Unfortunately, we did not get that opportunity. The work could have been done sooner and we could have debated it, but unfortunately time for dealing with such issues is not allocated.

I do not accept that it is a drafting issue. It is an issue of trying to find space within the legislative programme to discuss it. The last time we had a chance to speak on the Bill was on 30 March, almost a month ago. That is because of the logjam of legislation and the preponderance of statements on various issues which the Ministers feel compelled to spend a day debating such as yesterday's motion on accident and emergency services by the Tánaiste and Minister for Health and Children, Deputy Harney. That is not good legislative practice or good Government. If we had more time——

That was a request from the Opposition and it was facilitated.

That is fair enough. I did not request it. I would prefer an opportunity to deal with legislation as well as statements and we do not get that opportunity.

I understand that in the old days this House sat until 2 a.m. or 3 a.m. Perhaps it should return to that practice because, as an Opposition Deputy, I find it difficult to get chances to speak on many of the major issues outside my portfolio. I would welcome such opportunities. I rarely get 20 minutes, as is the case today, to speak on an issue. My point is that, notwithstanding Easter, it is the already the best part of a month since this matter was discussed. If the summer and winter recesses were shortened and brought in line with those of the UK Parliament, we might get business carried out a little more efficiently and would not be seen as a laughing stock by our colleagues across the water.

Although every Deputy, myself included, likes to be out working in the constituency, particularly as an election approaches, if I were out at a public meeting or knocking on doors and was told that I would get an opportunity to speak at 11 o'clock at night, I would gladly take it. As it is, I have my chance to speak now. The last time I contributed on this issue was during the debate on the Health (Amendment) Bill in March 2005. I outlined my disgust at the legislation, which was aimed at legalising the charging of elderly patients for their care through pension deductions. While this robbery has been legalised, the legislation concerns repayments to those against whom the robbery was deemed illegal.

I welcome the specific generalities of the Bill in that context but I have a number of queries, the first of which relates to the appointment of consultants. Is it a "Harneyism" that outside consultants must be appointed? Is it because of their relationship with big business that the Government parties must go the business route and they will not resource their own staff and teams adequately to address issues? A motivated, properly resourced team comprising officials from the HSE, the Department of Health and Children and other Departments would be more appropriate. Significant amounts of taxpayers' money has been wasted in the past on consultant reports. Consultants will be appointed in this instance to set up a scheme to repay the stolen moneys and, in that context, I welcome the move but is it logical to appoint external consultants? It is not enough to state it is such a complicated issue that consultants are needed. Deputy McManus referred to similar schemes such as that which addressed payments to married women. That was dealt with internally and I do not know why this issue cannot be addressed internally, as it would be more accountable.

I am reminded of my efforts to question the Minister for Arts, Sport and Tourism. More than 50% of the questions I tabled are referred to the Irish Sports Council, the Arts Council and Fáilte Ireland and the problem is such outside bodies are not accountable. Increasingly, the Government cannot be held to account by this Parliament because of the crammed legislative programme and its tendency to pass the buck. In this context, the buck has also been passed and it will be difficult to scrutinise the impact of the legislation when it is enacted.

In principle, I agree with the notion of legally reinstating the moneys to families and individuals from whom it was stolen. In March 2005 I stated it was an even greater sin, having known it was illegal and morally unjustifiable, to legalise the robbery. I said half jokingly that the Tánaiste and Minister of Health and Children and the Government were a bunch of robbing hoods and she was the Sheriff of Nottingham robbing from the poor and giving to the rich. The Government needs a few Robin Hoods and perhaps it will introduce fairer distribution in the taxation system rather than allowing high earners to get away scot free following the next election.

The people who were robbed contributed to the State's success over the years. Unfortunately, the Minister is not present because, as a constituency colleague, I would love to rub it in. The Progressive Democrats continually raises, as at its conference last weekend, the need to cut taxes. The economic sensibility of further tax cuts can be debated on another day but the Progressive Democrats, under McCreevy's system, has reduced taxes. Some argue it has worked well while others argue if they had opted for the Berlin model, we might have better public transport, health and education systems because revenue would be distributed more efficiently. The relevance of the Progressive Democrats commentary on the tax system and tax cuts is found in the poignancy of the creation of the Celtic tiger because the people who were robbed, who are very elderly or deceased, paid tax at the highest rates. They lived through the Charlie Haughey hairshirt period and the oil crises of 1973 and 1979. Young people do not know what is like to live through a crisis. Our elderly lived through the tough economic circumstances of the 1950s. They tried to benefit from the boom in the 1960s but there was another recession in the 1970s. Their blood, sweat and tears paid for my third level education and paid for young people to travel before returning to live and work in Ireland and earn high incomes. The elderly are being told, however, that they must pay for their health care. The system could have been organised totally differently but the opportunity was not taken.

While the lucky few will get their money back, which is welcome, as we go forward, countless thousands of others who paid tax at the highest rates but who are no longer working and are in receipt of a pension have been told their health care is in their own hands and their blood, sweat and tears was in vain. Deputy Durkan is nodding in agreement and I welcome his support because he is slightly older. I can only speak on the basis of the experience of my parents and grandparents, which is not quite the same. It is difficult to put oneself in somebody else's shoes. Any right thinking member of society would say that charging elderly people in nursing homes was daylight robbery. I reiterate my protestations about legalising such charges and I propose a number of alternatives.

As education spokesperson, I have pointed out repeatedly that the Government consistently fails to take into account the social and economic costs of its activities. When I raise issues about investment in education, the Minister for Education and Science asks whether I would like investment in special education needs to be cut back to pay for the McIver report or she says she may not roll-out educational welfare officers if class sizes are to be reduced. Investment in education, as highlighted by the High/Scope Perry preschool project, pays for itself. Similarly, preventative health care also pays for itself.

I do not know what it is like to be old and infirm but I have dealt with constituents who are. I was contacted by the relative of an 80 year old woman who had been told she would have to wait three years before she would be assessed by an occupational therapist and then she could apply for a grant for a shower unit. I kicked up and, in fairness to the HSE, it was pointed out that whoever spoke to the relative was incorrect and that a person over the age of 80 must only wait a year. Miraculously, because the issue was raised in the House, an occupational therapist slot was found within a few weeks. Politicians blow their own trumpets a great deal and claim this, that and the other but I do not claim I secured that slot for the woman, although some politicians would. However, if the error had not been brought to the attention of the HSE through this House and the media, which embarrassed the Government, that woman would not have her shower unit. I am approaching middle age and I am in the whole of my health. The health care system could be constructed in such a way so that those who get regular exercise and engage in a programme of preventative health care reap the benefits in later years. I am not just talking about the private system of insurance whereby if one engages in exercise, one gets reductions in health care insurance, but the actual health care system itself. Why is there no official scheme for rewarding people who engage in exercise? We have heard much about the medical card for those over 70, but what about some form of incentive for those who go to the gym? I read in Time magazine that the fastest growing age group for fitness and lifestyle issues is the over 60s. There is no reason a person over 60 cannot sweat through exercise as such a person will be healthier and will cost the taxpayer less in the long run. I keep referring to the costs of the system because the Progressive Democrats Party always looks at the bottom line. If we invest in preventative health care, money will be saved down the line.

An inter-agency approach needs to be taken by various Departments. For example, some of my constituents are involved in active retirement associations and it has been statistically proven that the more someone is involved, the more likely brain activity will continue and there will be lower instances of illnesses such as Alzheimer's and osteoarthritis. Active retirement associations that get involved in physical and intellectual activities should be applauded and encouraged. However, as staff costs in the vocational education committees rose last year, the charges also rose for retired people who wanted to sign up to art classes and fitness classes and so on. The Minister for Education and Science refused to provide any funding to pay for the increased costs. While some pensioners were able to absorb the cost, others on lower incomes were not so lucky. The threshold for the definition of a senior citizen moved from 55 to either 60 or 65.

The adage that the Government has been cutting taxes but getting at us by stealth is also true in respect of the elderly.

That is called ambushing.

That is true. They must pay one way or the other and society must pay as a result. If an elderly person is not able to interact with society, that person is more likely to end up in a nursing home. The majority of people over the age of 60 are active and independent. Any financial incentive to encourage people to be active should be followed. Some people will end up in nursing homes and some will need medical assistance, but let us ensure that such assistance is given gratis to people because of the contribution they have made in the past. That is the least they deserve.

Older people also make a contribution through part-time work, community employment schemes, voluntarism and even by getting back to work. I know of one individual who worked for 40 years, retired for four years and is now back in full-time work. He enjoys it and is making a very positive contribution. Older people have a huge contribution to make but they are not being valued sufficiently. I would like the Minister to take that on board and to change the system. If the Government will not allow for the proper subsidised treatment of elderly people in nursing homes, then it should at least invest money to create incentives for older people to get involved in activities such as adult education and physical activity. Many people feel isolated and they sometimes do not know what is available, so more money needs to be spent on advertising and creating incentives. If a small amount of money is put forward in these areas, it will save the taxpayer in the long run. Even in Progressive Democrats speak, that makes sound economic sense.

I am delighted to have the opportunity to speak on the Bill. This problem has existed since the early 1970s and it has been a shambles since then. Almost every political party in this House has been in power and had responsibility for the Department of Health and Children in that time. Since the late 1980s, the political establishment and the Department were aware that the system for charging patients in long-stay institutions was illegal, yet they did nothing about it. Different Ministers from different parties were in charge of the Department, knew this system was illegal and refused to do anything about it. That is a scandal and it will be written about in the years to come because there is adequate information in this story for a bestseller. To add insult to injury, the current Minister brought in a Bill that was deemed unconstitutional. Now we must deal with this Bill.

It is time that politicians, especially those who worked in the Department over those years, admit that they have a political responsibility for what happened. They should not try to pass the buck to someone else, be it a civil servant or a Minister of State. The buck stops with the political head of the Department of Health and Children. Every party had members in that Department, they were aware that these charges were illegal, yet they refused to do anything about it. It will go down as a lesson to be learned in the political history of this country.

I am astonished by the proposal that some outside agency will arrange for the repayment of these charges at a horrendous cost. A huge amount of resources and public money have already been wasted by this Government on PPARS and €1 million per year is spent on securing and storing the voting machines bought by the former Minister for the Environment, Heritage and Local Government, Deputy Cullen, even though they will never be used. It is now proposed to spend somewhere between €20 million and €50 million — nobody knows the correct figure — on making these repayments. There is adequate expertise in the public service. The Departments of Health and Children and Social and Family Affairs, the HSE and the Revenue Commissioners all have experience in repayment schemes and the knowledge required to do a good job. Once a template is put in place for a scheme of repayments, the process becomes routine. It is a scandal to suggest that we should waste further public money. I would have thought that publicity over the waste of public money would have brought some people to their senses but that obviously has not happened.

The people who were effectively robbed by successive Governments and Ministers for Health created today's Celtic tiger. They worked hard and paid their taxes while others ripped off the country. However, they now find themselves being ripped off in their old age. There is no doubt that the 1916 leaders we have been celebrating, such as Pearse and Connolly, who spoke about cherishing all the children of the nation equally, would turn in their graves if they knew of this saga or of the way in which the public has been ripped off. PAYE workers have paid more than their fair share but a golden circle of people in politics and business ripped off the country in the latter half of the 20th century.

If we are to resolve this problem, we should address it in its entirety. The Tánaiste and the junior ministers at the Department of Health and Children and the HSE know full well that this Bill only deals with half of the problem and that thousands more elderly people have been forced into private nursing homes. Medical card holders who have requested beds in public institutions have been denied the medical services to which they are entitled. Some years ago, the Ombudsman clearly indicated that this was also illegal and I believe that the Tánaiste and her Department should address that matter in this legislation.

Nearly 500,000 people over the age of 65 live in this State, the vast majority of whom can look after themselves or be looked after at home. They do not want to stay in nursing homes or public beds but would prefer to see out their days at home in the company of their families and communities. Between the 1970s and 1980s, when I worked in the health service, and today, much attention has focussed on the provision of community care services. However, the substantial initial costs of providing these services are not being met, even though the investment could bring significant returns.

Home help services have, in effect, been reduced in recent years. The maximum home help available to any individual in my area and, I am told, elsewhere in the country, is about one hour per day excluding Saturdays and Sundays, when no help is available. Anyone who believes that people can be looked after at home in their communities on the basis of a diminishing home help service does not live in the real world. Elderly people who come out of hospital and live alone receive one hour per day of help. That level of assistance probably lasts for one month, after which it is further reduced to two or three hours per week at most. Home help services are the key to ensuring that elderly people are able to look after themselves or be looked after at home in their own communities, which in turn would create significant financial savings for the State. However, the will does not exist to provide proper community care services. The laundry and chiropody services which should be provided in the community are non-existent.

If elderly people are to remain at home, the way in which carers are supported is vital. Despite improvements in past years, carers have not been properly resourced. The means testing of the carer's allowance is particularly unhelpful in looking after people at home. The fact the carer's allowance will not be paid in addition to the carer's basic social welfare payment means that, for example, a person who is dependent on a spouse's payments gets a carer's allowance of €180 but loses the €120 adult dependent allowance. This amounts to a small payment for caring 24 hours a day, seven days a week, 365 days a year.

There should be significant changes to the carer's allowance. It should not be means tested and should be payable in addition to social welfare payments. Further publicly funded elderly beds are necessary too. St. Patrick's Hospital in Cashel, which is in my constituency, is a geriatric hospital that provides a fine service. One of its wards, St. Michael's, has the capacity to provide a further 30 elderly beds at a cost of €1 million. The waiting list for that hospital is 176, which means people must wait at least two and a half years for admission. Many on that waiting list will not be alive when they are called. The hospital staff frequently contact relatives of a person on the waiting list only to find the person has died. If we could provide another 30 beds at a minimal cost that situation would be alleviated.

I wish to address funding. People will say my suggestions will cost a fortune. They will cost money, but this country is awash with money. There was a €6.7 billion revenue surplus last year and since this Government came to power in 1997 there was a revenue surplus of €39.6 billion. That surplus should be used to provide human services such as health, education, housing and additional gardaí, particularly for community and drug policing. Most of that money is being used to provide roads, bridges and broadband. This is poor economics as everybody knows that capital projects in most, if not all, European countries are, and should be, funded by borrowing. I can hear somebody saying we almost bankrupted the country before by borrowing. However within EU rules we can borrow up to an additional €4 billion a year. When the country was nearly bankrupted before it was due to borrowing for day-to-day expenditure by a previous Fianna Fáil Government.

I welcome the opportunity to speak on this legislation, which has been much talked about. As the last speaker said it has been ongoing for the last 30 years and has been dealt with by different Ministers, civil servants and health boards. I was a member of a health board in the 1970s, 1980s and part of the 1990s when this was discussed at health board meetings. I recall the views expressed and it is interesting to look back. Some people who had worked hard all their lives, striven to rear their families, fought hard to eke out an existence in this and other countries, survived high interest rates and illness and suffered much adversity over the years, were referred to an institution when they are no longer able to fend for themselves at the end of their days. There are situations due to the absence of family or different work patterns in which that is the only way they can be accommodated. An interesting debate used to take place when interest rates were in the early 20s that it would be unfair to expect the State to look after people in these situations and that there should be a payment. I have no problem with the payment but the underlying logic was that as long as a person had a house it should be sold and the person's assets liquidated to pay for his or her maintenance in an institution. I often thought how callous and thoughtless people can be. Did they not realise that the day may come when they will find themselves in that situation? Oddly, some of the people who expounded that theory were older then than I am now. I could not understand how thoughtless people were to think that those people, who had worked through hard times and survived should pay the ultimate price by having their houses taken. There were circumstances in which the house was sold over people's heads to pay for their maintenance in an institution. That is a sad reflection on our society then and now.

People have spoken on the merits of the Celtic tiger and it is great to know we are among the richest nations. By our deeds we will be judged. When people come to judge us and write about us the way we treat the less well off in our society, our children and our elderly will be the basis on which they will come to their conclusions.

Deputy Healy said the payments were illegal. They were not, but no legislation had been provided to facilitate the making of charges. It was identified in the 1980s but nobody had the guts to introduce reasonable legislation. Everybody saw the opportunity to make more money from the system. Let us examine what is happening. I am dealing with a mother and daughter who jointly own the family home. The mother, by virtue of the nature of her illness, is in a nursing home. The subvention for which she qualifies is the paltry sum of €34 per week whereas the weekly charge is €900. The daughter, who is still at work and is the joint owner of the home, has been told that her mother's half of the home must be liquidated and the payments put towards maintenance before any change will take place. That is a disgrace.

The bureaucrats who work in the system and who come up with such conclusions and make such decisions should think about their own day, because their own day will come and it will be a sad day if they are treated in such a callous fashion. During the 1980s a senior official in the health services fell into serious bad health and was hospitalised over a period of years. He found himself and his family almost destitute as a result of paying health bills. The wise will tell me that he should have had health insurance. He had insurance but after a certain period of serious bad health that insurance was no longer economical. The wife of the unfortunate man wrote to me to explain the family position to the effect that the family home had been sold and the next stage was the decision whether he would be discharged into private rented accommodation for the short time he still had left to live.

Imagine treating a person who had worked in the health services in that fashion. Whatever we might be called — Celtic tigers or otherwise — we have much to answer for in the context of how we have treated some people in this time of wealth and affluence in this so-called caring society, with its aura of how good, giving and caring we are. We have a lot to learn.

I welcome the Bill in so far as it deals with the situation. However, if it does not deal with the type of situation to which I have just referred and if reason does not prevail with those who are given the job of making decisions, we are wasting our time. As Deputy Crawford stated, it would be best if the same time and energy were given to medical examinations and accident and emergency services, and the same emphasis were placed on prescribing and on medical cards, as is placed on the interrogation of those who are deemed to qualify or not for an entitlement. It is crazy that we should be impervious to what is going on. We hear daily of the billions of euro that are being spent in the health services but we do not seem to consider carefully where and how they are spent.

In recent years I dealt with the case of a constituent who had a serious illness which turned out to be terminal. He was living in conditions which were not ideal and did not have any institutional help. Eventually, he managed to get limited home help but he was then forced to look for an institution that would cater for a person in his situation. This patient required 24-hour, heavy, ongoing nursing care. It took me three weeks of a continuous barrage of telephone calls, letters, parliamentary questions, repeat telephone calls and so on before I eventually had to identify a particular ambulance driver and the personnel involved to chaperone the person into an institution where, unfortunately and due in no way to the excellent care he received, he passed away. If all the time and energy spent in attempting to get accommodation and treatment for the unfortunate man had been devoted to providing the treatment, it would have been much easier and cheaper for all.

We are reaching a situation where there are so many preventative barriers to the achievement of the entitlements of various categories of people, especially the ill and elderly, that it is no longer possible to access these entitlements. Many people throw up their hands and decide it is not worth trying and that they will not humiliate themselves by going any further down that route. I know of a family where the father and mother both required care and attention. As no family member was at home or nearby and in a position to provide that care, the parents were lucky enough to get into a nursing home, which cost approximately €1,000 per week. No subvention or other payment was received because the unfortunate people owned their house. That is the sad penalty. They owned their home and it was deemed that it should be liquidated to pay for their upkeep. The husband of the couple passed away and, eventually, the wife was referred to the same institution. It is a repetition of the same old story. I could paper the walls with the letters that went backwards and forwards in that regard.

Decisions were made regularly which we knew had no basis in law. Even with the passage of this Bill, I do not know where we will be in a few years because I cannot be sure the situation will change and cannot foresee how it will change. If we are to have the same interrogation and the same treatment of elderly people whose only option is institutional care, then we will not make progress and the degree to which we pride ourselves on our caring society will not add up.

Deputy Gogarty reminded me that last week one of the Government parties came out with a unique proposal, which it has not yet achieved but which it obviously intends to carry out, to abolish taxation and provide services. I know there are experts, financial and otherwise, in this House, the country and worldwide but I am sorry to have to suggest that in most democracies attempts to achieve this have failed so far. I presume if we re-examined the theory of gravity and the case of the falling apple, we could qualify the theory in various ways and perhaps disprove it. However, I am interested to know how one part of the Government, the lower end, will prove that it will deliver health and other services with virtually no taxation.

If that party is still around at the following general election, it will abolish taxation entirely and pay a premium to the people of the country by and large. Is that not the obvious direction to go? Why not do it?

Because there will be no services.

There will be no services. We live in a time when we cannot provide hospital services, including accident and emergency services, or adequate staffing for medical, surgical or general hospital beds. We cannot provide adequate staffing for schools, the health services generally and local authorities.

I would be interested to know where we will be in another four or five years if we continue in this way. Let us not cod ourselves but ask the salient question. For example, when we reduce revenue to the system, let us by all means take full credit, telling everyone that we will ease their burdens. However, let us also tell them that there is a down side to it and that the so-called coping classes referred to in recent weeks also need care and attention, retirement, hospital services and institutions at various times. Let no one forget that all members of Irish society, from whatever social and economic strata, are human. They will all have to rely on the kinds of services about which we are talking, unless they are superhuman.

I know that it is not easy to say that we will increase subventions, in which case all the private institutions will up their charges, absorbing the entire benefit. Notwithstanding all that, a means other than that now in use must be found to determine an equitable way of dealing with the extremely vexed situation of subventions and the entitlement that I believe everyone should have, since the notion that those with a property should render themselves homeless before receiving any help is crazy.

I know what people will say. For the site of an ordinary house in suburban Dublin, the going rate can now be €1 million to €5 million. However, we are living in cloud-cuckoo land, since that will not continue. No one should be in any doubt about that, and the farther that we go down that road, the nearer we approach the bubble bursting.

The Minister of State will remember the person in County Kildare who told me in 1980 — during a Fianna Fáil Government, which makes it worse — that he had lost IR£1 million within the previous 12 months.

I thought that the Member meant Punchestown.

I meant a very prominent member of the Deputy's organisation in County Kildare who would remember saying that to me. I raise that to explain what happened then, something that very few can remember. The price of all property dived overnight for no reason. There were various worldwide fears of oil shortages connected with Iran, and the gentleman said that the value of his property had gone down by IR£1 million in one year. He counted himself lucky to have survived to tell the tale.

We must consider what will happen if we continue as at present. I mention that in the context of this legislation, not because I wish to have a swipe at someone but simply because we must realise that, in theory, if one wishes to consider institutional care for someone in the greater Dublin area, he or she has no chance at all if one applies the principle that the person must sell his or her house, and that house is worth €1 million to €5 million. Unfortunately, the reality is that they will not get anything and may as well sell now.

The sad part is that many of those people struggled through the 1970s and 1980s, and in the 1990s just about managed to free themselves of debt in the face of very high interest rates. Ultimately, all that we can offer them is an apology that, now that they have lived their lives, struggled, worked hard, and earned their money by the sweat of their brow and paid taxes, we must take from them their houses, which in reality were only lent to them for a short time. I do not believe in that philosophy. The State, particularly when it boasts of less intrusion, should practise that itself.

I thought that all the repayments would have been made by now. I am not sure that it was such a great administrative problem. All the records are readily available, and it should not have been necessary to go through so many legal loopholes and wrangles to make the repayments. It should have been possible to work out a simple resolution whereby people were repaid whatever they were entitled to.

It would do no harm to remember that in certain situations some will appear to be better repaid than others. We all know that this will ultimately emerge. In those situations, I hope it will not be necessary to go to court to resolve problems, if anyone fails to receive what is a right or entitlement. We would be far better off if attempts were made to resolve the issue without costing the State any more and hope that lessons that should have been learnt over the past 25 years will stand it in good stead and that we will not repeat the mistakes.

I am very pleased at the opportunity to speak on this Bill. It has been spoken of for a long time and was slow in coming before the House, but it is here now to deal with illegal nursing home charges. It shows that the State is willing to take responsibility for its actions and make amends for what it has done.

As public representatives, we all deal with the needs and concerns of elderly people daily. We are increasingly concerned about their vulnerability as a group in modern society. Care of the elderly is an issue that often seems to come bottom of any list of priorities. That the present Bill has been necessary shows real concern at the potential exploitation of the elderly, internationally and otherwise.

The elderly are very vulnerable for several reasons. One area in which vulnerability manifests itself is older people's capacity to achieve the type of care and accommodation that they want and need to see out their lives. Often the elderly find that they are not listened to nor are their views treated with respect. The dominant factors determining where and how they live become "convenience" and "cost-effectiveness".

The 2004 annual report of the Ombudsman pointed to a range of discriminatory practices that elderly people in Ireland must endure daily. The discrimination identified by the Ombudsman extended beyond goods and services and related to a general attitude that the elderly are a burden. The report of the Ombudsman stated:

Above all they worry about the increasing tendency in society to view them as redundant and wasteful of resources...One of the most distressing aspects of the A and E crisis, as noted by those who witnessed it, was the fact that those who suffered most were often the elderly, frequently robbed of their dignity as hard pressed and otherwise caring staff nonetheless were forced to carry out certain tests and interventions in public areas of the hospital.

Discrimination in the provision of goods and services on grounds of age is illegal under the Equal Status Act 2000, but we must ensure that the law is upheld in this context and that elderly people are aware that they are legally entitled to equality and have avenues to seek redress if their rights are violated.

It is a strange way for a country to treat its citizens given that we all aspire to reaching old age. By 2011, it is estimated that people aged 65 and over will represent 14% of the population compared with 12% now. By 2050, that percentage will have risen to 24%. Discrimination on age grounds is not the only obstacle constantly faced by Ireland's elderly population. As many Oireachtas Members who deal with elderly people regularly will say, elderly people are often fearful of what the future holds.

My colleague, Deputy Healy, referred to south Tipperary. Many constituents have come to us expressing concern about the future of St. Patrick's Hospital in Cashel. I acknowledge the work of the Tánaiste in bringing to fruition a huge hospital plan for the constituency of south Tipperary which involves Our Lady's Hospital and the now South Tipperary General Hospital. However, there is a real fear among staff, workers and the community at large about the future of St. Patrick's Hospital. It is an old hospital with a great history of looking after the elderly. It is hugely respected because of its work down through the years when people were poor and could not afford to be looked after in their own homes or communities. St. Patrick's Hospital took up that challenge. The pride among the workforce of that hospital in the way it looked after the elderly people in our constituency is recognised by anybody associated with the health service.

The downsizing of the hospital would have a detrimental effect on our community. I urge the Minister of State to bring to the attention of the officials of the Department and anybody else concerned with this issue that the people of South Tipperary need not only the continuation of the hospital but its development. There are few hospitals here that have the record of this small hospital in looking after people. It is a flagship and could be held up as an example in any debate on hospitals and looking after the elderly. I urge the departmental officials, the Minister of State and the Tánaiste to take cognisance of what I have said and to highlight the need for this hospital for the people in my constituency.

If an elderly person wishes to remain in his or her home, the State must endeavour to facilitate this. A key plank of such an approach would be giving proper value to the important role carers play in our society. In this context, a more flexible approach to the habitual residency clause is needed. I know of one person in South Tipperary who left her job and family in America, came home to look after her elderly mother and was refused the carer's allowance. I have written to the Department and have fought this case. I am extremely disappointed that this woman who left her family and returned here did not get the carer's allowance. The State is now paying a large amount of money to support her mother simply because we could not change the rules in regard to this individual. It is quite unfair and draconian to do this to do somebody while she cared for her mother. I appeal to the Government to consider these people who are quite willing to look after their folks in their homes but because they have lived and have property in another country, they are not looked after.

The need to promote the highest standard of professionalism in our hospitals is crucial. Care of the elderly is a specialised area and nursing homes need to be staffed by health care professionals with a knowledge of geriatric health. As many nursing staff as possible should possess a diploma in geriatric nursing. The Health Service Executive needs to inform nursing homes of nursing seminars, up-skilling programmes, etc. These events are taking place but nursing homes are not being adequately notified. That is a very important point. Nursing home proprietors should have incentives for nursing staff to be up-skilled. Non-nursing staff of nursing homes need skills also and these opportunities should be made available to them.

Staffing ratios in nursing homes also need attention. Last year the INO repeated its call for a review of staffing levels and conditions of accommodation for older people in public nursing homes and cited some shocking ratios. It is important staffing ratios are determined by the Health Service Executive. Other important areas to be considered in respect of nursing home regulations include the need to give priority to social interaction, nutrition and hygiene, especially dehydration as an older person can become dehydrated in a short period.

There are many wonderful nursing homes here and it is unfair that some horror stories can taint the whole sector. The best way to preserve the integrity of the nursing home sector is to ensure the conditions under which a nursing home receives its licence are rigorously enforced. There is a case to be made for creating a new monitoring body to deal with nursing homes, particularly new ones. The Government bears a crucial responsibility in respect of care of the elderly. I hope it takes its role seriously and that this Parliament does everything it can to uphold and value the rights of the elderly. I hope this Bill will go some way to address the wrong done to the elderly by the State over many years and that we will learn from our mistakes and ensure nothing similar to the illegal nursing home charges scandal happens again.

The housing aid for the elderly scheme has provided great assistance to many elderly people over the years. Costs have risen dramatically, including oil and energy costs. There is a great need for people to have their homes insulated, particularly the older homes. In next year's budget a massive increase should be given to the housing aid for the elderly scheme. It is crucial and has played a vital role in the quality of life for many people. I urge whatever Department is responsible to take that on board because it is a hugely important scheme providing great benefit to many people.

I am glad to be able to speak now because there is a transition year group, which includes my daughter, in the Visitors Gallery. I hope to have the opportunity to meet them when I finish my contribution. The business of legislating should be complex, involved and considered. There is a particular responsibility on Government before presenting any legislation in this House to illustrate that it has undergone such a process. Unfortunately, the convulsive history of nursing home charges shows that not only this Government but successive ones have failed to tackle this issue properly.

I remember being involved in a debate on the Health (Amendment) Act in the final days of the session before the Christmas recess in 2004. All Stages were dealt with on the one day. Despite the many protestations of Members on this side of the House that this was the wrong way to consider the Bill, and that any apparent flaws in it would be shown up quickly, the Government insisted on pursuing this course of action. It was left up to the judicial arm of the State to highlight the exact legislative flaws of the Bill. The lesson that should have been learned is that rushed legislation is never good.

Later amending health legislation was given more consideration. However, the time allowed for this was short by comparison to the average time allowed for considering a Bill in the House. The questions that should have been addressed at all Stages of the debate went unanswered. There was a considerable interval between this and the Government's substantial presentation on how it wants to deal with repayments of what are coyly referred to in the explanatory memorandum as "wrongful" nursing home charges, which affected elderly patients in particular.

It was somewhat ironic that some weeks after the publication of the explanatory memorandum to this Bill, a second explanatory memorandum was produced with a note of information on the original. It states the original contained a number of errors and that it had been reprinted to correct them. It also stated all copies of the original should be disposed of. If anything is illustrative of the utter cock-up the Government has made of the matter, it is that piece of paper. It indicates a lack of consideration and of appropriate political will to deal with the issue properly.

The Government, along with all previous Governments since the mid-1970s, has been indifferent, has prognosticated and has not really wanted to deal with it. However, since court decisions brought it into the open, its response has been hurried and panicky. Ultimately, those who have been affected and who seek proper redress are not being properly served. That said, the issue of repaying nursing home charges is still only a single element of what should be a more comprehensive response as part of the Government's general care policies. The idea that the State sponsors, through the taxpayer, tax reliefs for the creation of private nursing homes and buys bed space in a number of private nursing homes at full market cost to remove those who have been charmingly referred to in the public health system as "bed blockers" indicates the philosophy of the Government and the priority it affords to care. The same emphasis is not placed on care within the home by close relatives, nor is it placed on voluntary care within the community or on supported care through the home-help system.

If the amount of State resources or taxpayers' money forgone by the Exchequer in support of what is a health industry were given, in proportion, to those caring within the home, members of voluntary organisations and those supporting semi-supported care through the home help system, the nature and scale of the problems in private nursing homes would not even begin to become as pronounced as they now are. The Government is not interested in the holistic approach I advocate. It wants a quick reaction to dig itself out of a hole of its own making. This approach will not be of any long-term benefit to the mainly elderly people who have suffered as a consequence of the Government's lack of thinking and foresight and its general lack of policy.

Some years ago, the home help scheme in the then Southern Health Board area was run by individuals who were more or less voluntary in most aspects of their work. The rate paid by the health board was 50p per hour. At the same time, the State was adopting an approach involving private business ventures and the use of taxpayers' money which did not necessarily meet the care needs of many thousands of citizens.

If we are serious about having a proper care environment for all citizens, a Bill of this type should consider these wider issues. It should certainly address the care environment in which many find themselves in private nursing homes, which are often situated miles from anywhere and certainly miles from the communities from which the patients hail. This lack of connection and ongoing community support is such that many are forced to live their final years with a quiet indignity because the State and their communities have somehow given up on them.

Circumstances could be so different. This Saturday, in what is my constituency but which because of redrawing will unfortunately become part of Cork North-West in the next general election, I will have the opportunity to attend an awards night at the Westgate Foundation centre in Ballincollig. It is a centre of excellence for the care of elderly people. It is such because of its integrated approach. It marries all the elements I have described and has a large number of voluntary service providers and paid and specialist staff. It receives some funding from the Health Service Executive and also from other State bodies, it has adopted a community outreach approach and people use its services on a myriad of levels. Some use it as a day service centre for social outreach or for health care needs and others attend for long-term care. A community of elderly people has chosen to live in a retirement village at the centre and it comprises volunteers and support workers as much as anything else, yet Government funding is not such that the centre is being recognised as a benchmark for the provision of other such centres throughout the country.

The Westgate Foundation had an opportunity to locate another centre in Macroom, approximately 20 miles from Ballincollig. Lynch's Lodge Hotel, which was bought by the Department of Justice, Equality and Law Reform through the OPW for a sum of €4.5 million to accommodate asylum seekers and refugees, was subsequently deemed unsuitable for this purpose. The organisation behind Westgate made an attempt to acquire the premises to develop a second centre for a new cohort of people in the mid-Cork area. Unfortunately, the State agencies' approach, involving the Health Service Executive, the OPW and the Department of Justice, Equality and Law Reform, did not make the premises available but put it back on the market and sold it for €3.5 million. During the biggest property boom the country has ever experienced, a building on which the State had already spent €1 million could have been used for productive, care-giving purposes to benefit the community. That this was not done was all too indicative of an inadequate Government response to care provision.

The Minister of State represents the larger party in the coalition. I have given up attaching any care-giving qualities to the junior partner in the coalition. I hope that someone in the background of the Minister of State's party would at least be concerned, troubled, prepared to ask questions about and make changes to the current policy, but unfortunately I do not get that sense. The priority that could and should be given to this area is not given because it is deemed that the people most affected are those least likely to vote, who are least likely to have a political voice and are not likely to change political configurations in this Chamber for future Governments. It is a damning indictment of any representative in this jurisdiction that the generation that helped to develop the State and brought us to the degree of prosperity we now enjoy is being treated so shabbily.

The Bill could have been broadened and given more meaning for the wider population regarding care in the family setting. As people in nursing homes have their capital assets assessed and the income of their sons and daughters is also assessed, it means that out of necessity many people's health needs can only be met in their family homes. The State offers a bandage solution to meeting the needs of many such people through the home help system. Despite the Government's promises of increased funding, the personal experience of Members of the House is that this is being spread ever more thinly as the population grows older and hours are taken from individual elderly people and given to new applicants to the scheme rather than properly resourcing it.

The greatest neglect in State resources and the need for support relate to family care cases. I have spoken in the main about the elderly as this legislation largely addresses them. I could as easily talk about those in long-term health care and those with disabilities. A woman in my constituency has an adult daughter with spina bifida. In the past her accessing the available State resources in terms of direct funding, services or materials needed entailed being exposed to a regime whereby special nappies needed by her daughter were subsequently weighed in their soiled state to determine whether that woman and her adult daughter were entitled to additional funding. That situation has only arisen in recent years. Our health and social welfare systems are still riddled with such anomalies.

People are trying to live ordinary lives with an additional burden thrust upon them. The State chooses to stay out of cases where it is most needed while at the same time uses taxpayers' money to buy beds in private nursing homes and support those who are only involved in the care business in terms of the commercial imperative it offers them. This is most readily seen in the decision of the Tánaiste and Minister for Health and Children to support a private care agency, called "care givers". If anything sums up the Progressive Democrats approach to care giving, the need for people to get care and how that service should be provided, it is the attitude that it can be reduced in every circumstance to euro and cent. As long as we have an attitude that the problem can be solved through finance and not through other forms of support and acknowledgement, the type of legislation circus in which we have been involved since the first Health (Amendment) Bill was presented in the House will continue.

The Government's majority determines that the Bill will be passed. However, the Government cannot have any certainty that it will not be open to subsequent challenge, judicial review and change. Such a scenario is more likely than not because the Government failed to take the opportunity to be considerate and involve itself in addressing all the complexities of the issue. When we go to the doorsteps and meet individual carers the Government will get a very resounding answer about its callous and indifferent approach to the issue.

I wish to share time with Deputy O'Connor.

Is that agreed? Agreed.

This is a very important issue and I joined others in the House in expressing concern when it transpired some time ago that these payments had been taken from elderly people in residential care under illegal circumstances. There is no need to revisit the debate as to who knew what or when. This matter has been not only discussed in this House but was also dealt with extensively in the media. Obviously, the Civil Service was also involved. I am delighted that the repayments will commence in June. The key point is that those who had pension or other payments deducted illegally must be repaid promptly. Many of these people are elderly and some may be mentally infirm and could even be wards of court. All Members agree that there must be no more delay with these repayments. It is a complex issue and I understand that a public procurement process must be followed. On behalf of my constituents who may have been affected I urge the Government to ensure that there is no further delay with the scheme.

I am delighted with the introduction of the private patient accounts, which is well overdue. It was remiss of all of us not to have considered in the past how pension and other social welfare payments would be handled in the case of those who are elderly or infirm. That issue can and will be fully addressed with private patient accounts.

This should be the first stage of a debate on care for senior citizens at a time in their lives when they may not be able to care for themselves. We need to do more to support households, not just carers, but also families. Most elderly people would prefer to either stay on their own in their own house or live with their family in, for instance, a granny flat. I have considerable experience in dealing with elderly people in my area. Most of them do not want institutionalisation, which should be regarded as a last step. We all know how expensive it is. I urge the Minister of State to review this area. It is much more expensive to have people in residential care than it is to have them in the community. I also pay tribute to the many voluntary groups which support the elderly, not only in the community but also by offering house visits. Some of the groups have had difficulties with their budgets, although most of them are being looked after. It is not good enough that many of them have to spend weeks or months scraping the barrel, contacting their local public representatives and making sure their finances are in order. I am calling for a guaranteed roll-over payment to be issued to all community groups which assist and support the elderly in their homes, in day care centres or in community groups.

I welcome this Bill, which will undoubtedly place a large strain on the Exchequer. A sum of €1 billion has been mentioned. The Army deafness cases were spread out over several years, but the payments in this instance cannot be spread out over several years. We have to face our responsibilities quickly and without any encumbrance. As many of the people in question are elderly, I would like a clear timeframe to be set out for the payments. If the payments start in June of this year, I respectfully suggest we should aim to complete the disbursement of all the moneys within a year.

I thank my friend, Deputy O'Connor, for giving me some leeway. This matter should be referred for ongoing monitoring to the relevant Oireachtas committee, which should receive monthly progress reports on the disbursement of these moneys, all of which should be disbursed within a year, if possible. I welcome the Bill.

I was delighted to give some leeway to my good friend and colleague, Deputy Mulcahy, who represents the Crumlin area, where I am originally from. I am happy to co-operate with the Deputy. I am delighted to make a brief contribution to the debate on this legislation. I acknowledge the presence of the Minister of State, Deputy Seán Power, whose work I admire, and I wish him well. I was delighted when he was promoted, not least because it meant I got a bigger and nicer office, which I am looking after well. I am delighted with the progress that has been made by the Minister of State since his well-deserved promotion.

The Deputy will be looking for the Minister of State's job next.

There are 66 of us looking for jobs.

Other Deputies have made the point that we should be interested in the care of the elderly because we are all getting older. The constituency of Dublin South-West, which I represent, is generally accepted as having a young population. There are more than 26,000 young people at school in Tallaght, which is the third largest centre of population in the country. Although Tallaght has a young population, it is an aging population. The challenges of the aging population are presented acutely in many areas, including the area that is so ably represented by my colleague, Deputy Mulcahy. I know the Minister of State understands the challenges we face.

I often say that I bring to politics my experiences and those of my constituency. I have been contacted by, and received some correspondence from, my constituents about the issue of repayments to the elderly, which is of concern to many people. Some Members will be aware that Tallaght, despite what I said about the profile of its population, is lagging behind in its provision of nursing home accommodation. It is clear that this matter will have to be examined by the planners in the Department of Health and Children and the HSE. Elderly women in the Tallaght community have been cared for in St. Brigid's home at Crooksling in Brittas, which does a tremendous job, for quite some time. Kiltipper Woods care centre on the Kiltipper Road in Tallaght, which was developed recently, is a tremendous facility that offers a tremendous service to the local area.

I have often mentioned that many constituents contact me to highlight the need for accommodation for the elderly, which is an issue that upsets people. I have encountered similar circumstances in my family, for example when an elderly uncle went to a nursing home when he was no longer able to cope. He was very happy at the nursing home, even though it was in Bray, which is a long way from his local area of Iveagh Buildings in the inner city. He thought he was a long way from home. Many of my constituents continue to speak to me about nursing home needs and facilities.

Members are aware that I live within sight of Tallaght Hospital, which faces many challenges. I spoke about Tallaght in a positive way during the debate on accident and emergency services in the House earlier this week. I referred to the challenges which are faced by Tallaght Hospital, like many other hospitals in the region. The number of beds in Tallaght Hospital relates to the provision of care for the elderly in the area. Families are encountering challenges, as far as people in beds are concerned, in Tallaght Hospital, St. James's Hospital and all the other hospitals in the Dublin region.

I would like to be associated with the comments of Deputies who spoke positively about the home help scheme. I remind the Minister of State that it is important that we understand the merits of the scheme. A very successful home help project in Tallaght is run by the Tallaght Welfare Society, of which I am a board member as a volunteer. The project employs 150 home help workers, who care for more than 450 elderly people. I agree with Deputy Mulcahy that such projects represent the way forward at a time when there is a great deal of pressure on our hospitals and facilities. I strongly believe the way forward is to care for people at home, for example by helping them to be comfortable and safe in their homes and offering a great deal of support and assistance, which is what they want. I hope it is something we will continue to consider as we make progress.

I want to refer briefly to practices in nursing homes, specifically to a practice I recently raised with the Department which is being examined by the HSE. I have to be careful when speaking about it, as I do not know how widespread it is. I have been told that the pension books of elderly people who are in public beds in nursing homes are being retained in some cases. Family members of some elderly people have raised this issue with me because they are wondering about the legality of the practice. They do not know whether the practice is allowed. It is right that an issue of this nature should be raised during this debate. I hope the Department will tease it out.

I heard the Tánaiste speaking about the former health boards. I do not normally disagree with her. I was a member of the former Eastern Health Board from 1994 and the founder chairman of the former South-Western Area Health Board, which was based in Naas. That was my background for over ten years. While the former structures were not quite right in some respects, I felt there was some merit in the system whereby representatives of health boards visited various institutions, particularly nursing homes. The Tánaiste has said she does not want public representatives to check systems etc., and perhaps that is fair enough. This debate raises the question of accountability of public and private nursing homes. If public representatives do not have an opportunity to visit some of these institutions under the HSE structures, as they did under the health board structures, to see what is going on, some other sort of system needs to be put in place. I do not suggest that the system whereby public representatives visited the institutions was perfect, as that was clearly not the case, but it did a job. I have listened to people raising concerns during this debate and I am sure many more concerns will be raised. I am not criticising the industry in so far as that is concerned. However, there is a need for accountability and the Department needs to find out what is going on. There have been a number of well publicised cases in recent times where questions have been raised in that regard. The Minister of State will understand that people have questions to ask. The public would like to see better accountability as regards nursing homes which are earning very good money in caring for the elderly, and perhaps he might look at that.

The public is very anxious that this issue should finally be put to bed. I do not want to be too party political in front of my good colleague, Deputy Perry, but Fianna Fáil has been responding to the needs of the elderly over a very long period. It is only right that successive Governments should do that. I am proud that at the end of this year the next budget will affirm the Government's absolute commitment to looking after the elderly. As regards pensions, our targets from the previous general election will be well met. I hope this is something that will continue.

At this morning's conference on lone parents in Farmleigh I made the point that there are another 400 days or thereabouts before a general election, or so it is said. Many issues will be raised and certainly health will be one of them. Future provision and care for the elderly merits pride of place among all the important issues requiring our attention in the lead-up to the general election. I hope people will not be vying with each other to decide what will be offered in terms of election promises. The elderly deserve the support they receive from the political system, and that is as it should be. As the number of elderly people — including many of us in this Chamber — grows over the next decade or so, it is important that we continue to do that.

Many public representatives have been asked by different organisations and committees about the delay in introducing the legislation. It is important to recall that following the Supreme Court decision in February 2004, the Department understood that a number of implications had to be dealt with. The judgment required detailed consideration to ensure that all the consequences for policy and law arising from it were taken on board in a positive and responsible manner. We now know that a Cabinet sub-committee was formed to consider all the implications of the decision, especially the issue of a repayments scheme to repay the moneys owed.

The Government announced in May the key parameters of the repayments scheme that had been agreed. It was deemed that legislation was required, given the scale of the repayments involved and because some of the recipients were among the most vulnerable people in society. Legislation was also required to put appropriate safeguards in place to prevent fraud and the exploitation of those who receive the repayments and who are not in a position to manage their financial affairs. That is an important point, as has been stressed by many groups and organisations. I hope these repayments will go to the people who deserve them and that the moneys are not spent on administration.

Legislation is also required to ensure that those applying for refunds receive them as soon and as expeditiously as possible. My colleague, Deputy Mulcahy, made a suggestion which I support. While I do not want to tie anyone up in bureaucracy, as the Government convenor on the Joint Committee on Health and Children, I agree that it has a role to play in monitoring the situation and in keeping an eye out for the public interest. I am a strong supporter of the Oireachtas committee system. It is very important that it is used properly. Sometimes we read in the media that the Dáil is on holidays yet again. It is not pointed out, however, that many of our colleagues attend joint committee meetings, as was the case last week and this week again. The Joint Committee on Health and Children is one of the busier forums in that regard.

I am pleased to note that the simplified applications process was an aspect the Government chose to concentrate on to ensure it was as user-friendly as possible. I am also glad that the Tánaiste took account of the need to ensure that adequate provisions were in place for the project. It is clearly significant legislation and this is an important debate. It is not a question of rubber-stamping matters, but I hope the Bill will be passed and implemented as quickly as possible.

I am delighted to speak on this very important issue. It is great to see the legislation before the House, finally, since I broke the story initially on the issue of entitlement and the illegality of the deductions. Uncertainty as regards refunds to elderly people caught up in the nursing home care scandal and their families and how they will be repaid has been put to rest. That is certainly a good thing.

Some €1 billion will be paid to 20,000 people living in nursing homes who are directly in line for a refund and between 40,000 and 50,000 estates of those who died before their losses could be made good. Many of the people concerned were concerned that the refunds would be taken into account in future assessments of their social welfare and pension benefits. However, the Bill clearly states that in the case of living individuals the payments will be exempt from income tax and will not be taken into account when means testing benefits. That is very significant.

Of significance, too, is the fact that the modest State pensions of ladies and gentlemen in public nursing homes will no longer be raided to pay for their keep. No more than €120 a week out of the total pension of €193.30 will be withheld. At least patients occupying public beds will have a sense of independence. That is a major achievement and it is certainly needed.

We need more public beds to be made available for nursing home patients so that fewer people will have to liquidate all their assets to pay for private care, which is a commonplace occurrence. Fantastic facilities are available in Sligo in Ballymote, St. John's Hospital in Sligo town, Nazareth House and quite a number of private nursing homes which have State beds within them. Those are excellent facilities. Given the difficulties in the large public hospitals with people bed-blocking in some regions while space is available in private nursing homes, it is a pity that people cannot be moved into them, perhaps for periods of respite. The State should deploy more public beds in private nursing homes as well.

Unfortunately many people are not in a position to pay for private nursing homes. The subvention system is inequitable. Families in Sligo, for example, may have to pay twice as much as their counterparts in Dublin to keep loved ones in nursing homes. Nursing home fees can amount to €700 or €800 per week and discretion is given regarding subvention rates in the Dublin region. If a person in a nursing home is paying a fee of €800 per week, for example, after the subvention rate and pension the family may only have to pay up to €200 in Dublin but a family in Sligo will have to pay €400 for a facility that costs the same in Sligo, which is twice as much as Dublin. This is yet another case of Government bias towards the Dublin region and blatant discrimination towards the western sea coast. Families in Sligo have to pay hundreds of euro in additional fees. Because of this there are empty beds in many nursing homes in the north west due to the unfair rate of subvention. This matter must be examined.

A case was brought to the High Court in regard to nursing home charges for people with medical cards and the Government was forced into repaying this money. The Minister guillotined the Bill in 2004 which meant she fully intended only giving everybody a once-off payment of €2,000 with no intention of making it retrospective. At least the legislation now proposes to go back six years. The big issue goes back prior to the last general election and the decision to give everybody aged over 70 a medical card, regardless of means. The Health Act 2001 established the entitlement of people and showed the State was clearly wrong in deducting charges from people who had a full medical card.

Equally, another case is pending in regard to elderly medical card holders who have been forced into private nursing homes where they are paying top fees. A case is currently being taken on this issue. The families of those patients who have been forced to resort to private nursing home accommodation intend to challenge the Government in court on this matter. When this case is overturned the €1 billion which has been referred to may appear small in comparison with the possible level of claims.

Likewise, there may be claims from people who sought a contract bed. Age Action Ireland is fighting this case as well. There are cases where people over the age of 70 with full medical card entitlements had sought contract beds but, in spite of their entitlement to them, were forced to go to private nursing homes. They will have a justifiable case to take. There is no ambiguity about the entitlement that goes with having a medical card. I suspect that when this case is being decided before the courts a similar decision could be taken as when the Supreme Court decided in favour of the people who were illegally charged. People are now being paid back retrospectively up to a period of six years.

Having pushed this case is one of the political achievements in which I take great pride. It was fantastic that the Supreme Court upheld this judgment and brought the Government to task on this issue. One must remember that if the Government had its way, it would only have paid a once-off amount of €2,000 with one day's retrospection from the date in December 2004 when the Tánaiste introduced the emergency legislation, which went to the Supreme Court and proved to be unconstitutional. The President, Mrs. McAleese, would not sign into law the Tánaiste's legislation.

If the Tánaiste had her way none of this money would be paid back. It is important to put this on record, in addition to the fact the President would not sign the legislation into law and that it subsequently went to the Supreme Court which upheld that decision and resulted in the State having to make retrospective payments for a period of six years. It is regrettable it has taken so long to pay back this money despite the fact that within a week the Tánaiste could pay it instantly when she thought there would only be a once-off payment.

A total of 10,000 patients were paid a once-off payment of €2,000, which amounted to €20 million. It has been said that the delay to date is due to the fact this is complicated legislation. I have no doubt it is but what is now required is that the process should not be unduly drawn out in light of the fact the recipients of this money are elderly. The matter should be dealt with decisively. I hope the payments will start as quickly as possible.

A number of anomalies arise. Dealing with the estates of deceased patients will give rise to a number of difficulties. This was brought to my attention by a constituent in Sligo. He contacted the Tánaiste with regard to situations where people die intestate. He was concerned about the mechanism for the disposal of repayments due to those who died intestate. He wrote:

I think all will agree that this is a unique situation, requiring unique legislation. Notwithstanding the terms of the Succession Act, I am sure our legislators can draft particular legislation to deal with the disposal of repayments to those who died intestate. In virtually every such case the reason the deceased failed to make a will was that they were unaware they had any assets. [That would be the case.] Therefore, there is an onus on the Government to endeavour to right this wrong in so far as it can.

Perhaps the legislation could include some, or all, of the following with regard to the disposal of such repayments:

1. The onus be on a claimant to register their claim.

2. A time limit within which a claim must be registered.

3. In addition to their relationship to their deceased, the successful claimant(s) be required to prove they had regular personal contact with the deceased in (say) the five years prior to the death of the deceased and/or had financially supported the deceased in some way during their time in the nursing home. (This would disallow claims from relatives — close or distant — who had no contact with the deceased in many years, if ever).

4. Where there are two or more claimants, a body be established to decide the wishes of the deceased based on the grounds of probability, and the decisions of that body to be final.

In this particular case the patient at St. John's died in his 93rd year and clearly the probate could take years. It is disappointing to see all the possible gain lost in legal fees and searching for extended family members. I hope the Minister of State, Deputy Seán Power, will take on board the problems in regard to people who have not made a will and die intestate. The onus is clearly on the Government to draft legislation that will deal effectively with the possibilities of making those payments. This situation will demand careful consideration as up to €20 million will be paid out in Sligo and the north-west region alone.

I ask Deputy Perry to move the adjournment. When the debate resumes he will have seven minutes remaining.

Debate adjourned.
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