Dáil Éireann debate -
Tuesday, 16 May 2006

Vol. 619 No. 4

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

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

Mr. S. Ryan

I welcome the opportunity to speak on the Health (Repayment Scheme) Bill 2006. This is the second occasion in two weeks that I have spoken on legislation relating to older people, which represents progress. For too long, the needs of the elderly have been neglected and have been dealt with on a piecemeal basis, usually through secondary legislation, some of which has been found to be faulty and illegal. The best way to deal with the needs of the elderly is through primary legislation.

While I welcome this Bill, it is disgraceful that it has taken so long to introduce the legislation necessary to refund the illegal charges paid by people in nursing homes. No other group would be left waiting for almost a year and a half to have their money refunded to them.

The bottom line in respect of the nursing home payments is that the State broke the law over a long period. During that time various Ministers and Ministers of State at the Department of Health and Children knew there was a problem and either kept quiet or simply forgot about it. Deputy Perry should be complimented on his initiative in raising this issue. How long would the unlawful action of the State have continued were it not for Deputy Perry's intervention? That is a valid question.

When the unlawful payments were eventually highlighted, the Tánaiste and Minister for Health and Children, Deputy Harney, with the full support of the Government, introduced legislation with the specific purpose of denying the most frail and vulnerable people in our society the money due to them in retrospective payments. During the debate on that Bill, I and my Labour Party colleagues, as well as other Opposition Deputies, warned the Minister that she was taking a grave risk in introducing that type of legislation and that, in all probability, the Bill would be found to be unconstitutional. In effect, that is what happened — the Supreme Court found that the Bill was unconstitutional. The rights of the elderly were vindicated by the courts, not by this House. The Government failed to vindicate the rights and entitlements of the elderly in our society.

Another fundamental question which must be addressed in legislation and which could have been dealt with in this Bill is what happens to older people who need care and cannot get it in their own home setting, and for whom a public nursing home bed is not available? In theory, our laws provide that everyone is entitled to long-stay care but we all know that in reality, the situation is very different. We do not have sufficient long-stay places for the people who need them. The majority of older people want to stay in their own home environment but approximately 4% or 5% of them will require long-term care in nursing homes. In that context, the age profile of the country means additional long-term nursing home beds in the public sector will be required.

At present, an abundance of money is available to the Government. However, as far as I can see, it is used for the pet projects of Ministers whose sole objective is to identify projects in their constituencies to promote get themselves re-elected. They were elected to this House to look after everyone.

A commitment was given that this Government would provide 2,000 extra long-term public nursing home beds. Regrettably, that was reneged upon. That the Government has failed to build on its commitment and provide long-term care needs in public nursing homes will be a major scandal in the future.

I received representations, as have Members of all parties, from medical card holders whose spouses need long-term care. Unfortunately, that care was not available within the community. Those older people could no longer look after their spouses at home and public nursing home beds were not available. To provide the care for their spouses, these people, elderly themselves, were obliged to secure a loan from a credit union to augment a social welfare payment and a subvention to meet the weekly repayments of approximately €800 in a private nursing home.

I asked the Tánaiste whether medical card holders are also entitled to a refund under this scheme. She has turned her back on this group of people. Notwithstanding this, will the Minister of State address this issue when he responds at the end of this debate? Are medical card holders who are unable to gain access to a public nursing home and who must enter a private nursing home and pay for it themselves through loans entitled to a refund? If not, why not? As I stated, the Tánaiste has turned her back on this category of people. However, given that people are entitled to long-term care, the courts once again may intervene on behalf of older people.

Last night's RTE "Prime Time Investigates" programme on accident and emergency departments highlights the lack of commitment by the State to older people. Most of the people in accident and emergency departments are elderly. I have given much consideration to the fact that the Government will only respond when a scandal or potential scandal is highlighted by the media, especially on television. The same approach was taken after the Leas Cross scandal. When issues are raised in this House by Members of the Opposition or questions are asked why legislation has not been enacted or certain steps have not been taken, we are pawned off by the same standard reply that legislation is proceeding. Years afterwards, particularly in the context of the elderly, promises made have still not been enacted.

Last week we dealt with the Health (Nursing Homes)(Amendment) Bill 2006 and the need for the Legislature to regulate. Care within public long-stay settings is not subject to regulation. The private and voluntary nursing home sectors are subject to certain regulations. However, they are completely inadequate. They emanate from 1993 regulations and the Health (Nursing Homes) Act 1990.

Ten years ago report after report demanded the introduction of statutory regulations governing nursing homes. We still await them. I mentioned it last Thursday and I ask again when that will legislation see the light of day. The time constraints between now and the next general election mean it is unlikely that the Minister of State, Deputy Seán Power, will be in a position to bring it through the Dáil. Well before the Leas Cross scandal was raised in this House, the inadequacies of the regulation structures and the fact they were introduced on a piecemeal basis were outlined in various reports since 1999. That is unacceptable.

I compliment the National Council on Ageing and Older People on the publication of its most recent report on improving the quality of life for older people in long-stay care settings. Having read the report, I plead with the Minister of State and his officials to take on board many of the recommendations contained therein. Unfortunately, during recent years, other bodies, at a cost of resources and time to those involved, brought forward similar reports which were overlooked. They were ignored and were left to gather dust on a shelf in the Minister's office. If some of these recommendations had been implemented, many of the scandals of recent years could have been avoided.

I wish to refer to some recommendations contained in this report, but before that we must acknowledge that we have a major problem in considering how to deal with the care of older people in future years. I read a population labour force report which shows that in 2006, the elderly, or those aged 65 and over, number 463,000. It is projected that in 2036 they will number 1.1 million. If a substantial service is to be provided between now and then, we must ensure that the needs of the elderly are deemed a priority and that hard decisions must be taken by everybody, irrespective of who is in government.

A plan to finance the needs of the elderly well into this century must be formulated. On the basis of various reports and what we know with regard to nursing homes and lack of services etc., much care and many services will need to be provided. The matter must be examined.

In the context of a report from the National Council on Ageing and Older People, some basic issues must be outlined very clearly. With regard to the direction we will take in future, some points should also be made clear. For example, there are no national standards of care, with existing regulations confined to nursing homes and voluntary homes. It is difficult to prosecute nursing homes which violate existing regulations. There is no published analysis of the inspection report on private facilities. We have known this and referred to it time and again. There is no common standardised approach to nursing home inspections. Even if people wished to go to the Ombudsman with regard to private nursing homes, its powers only extend to public long-stay care facilities.

This relates to the issue of the physical environment, and I referred to what was a negative and wrong decision taken by the Government not to proceed, notwithstanding promises, with long-term public nursing homes. Currently, even the inadequate inspectorate system we have does not cover public nursing homes.

Mr. S. Power

We will cover them.

Mr. S. Ryan

Many would say that a reason there was no coverage in the past related to what may have been found.

An Leas-Cheann Comhairle

The Deputy has one minute remaining.

Mr. S. Ryan

In that minute I welcome this Bill as at long last it endeavours to deal with outstanding payments to older people. There is much to be done and I ask the Minister of State, in this context, to ensure that we have full consultation with the people and bodies involved. We must ensure the necessary legislation is put in place to guarantee that the most vulnerable people in our society are cared for in the best of conditions.

Many of the conditions in which they must live are out of character with those that would apply in their own home environment. A priority must be that where people must go into long-term care, we should have a caring home-type environment. The services must be provided. I am pleased to have the opportunity to speak and I look forward to further debate on Committee Stage.

Mr. McGuinness

I welcome the Bill and I hope that it receives a speedy passage through this House. Much money, totalling approximately €1 billion, is pending on this Bill and the assessments must be made so that people who are out of pocket, or covered by this Bill, can receive their payments promptly. I am glad to see Deputy Perry here for the Opposition as it was during his chairmanship of the Committee of Public Accounts Committee that some of these questions were first asked. Since then the matter has been debated publicly throughout the country and identified as a serious problem.

It is no harm to reflect on prior events during the course of this debate. The issue was mentioned a number of times at health board meetings. While the procedure was questioned, the questions were never answered. They may not have been pursued strongly enough to obtain an answer and thereby uncover the process which was going on within the health boards. This shows the value of a committee system, where information is received from the public. I received some of that information as a member of the Committee of Public Accounts. This facilitates investigation and teasing out whether complaints are legitimate. In this case the complaints were found to be legitimate.

It is no harm to reflect on the fact that management of the former health boards proved to be wholly inadequate. It lacked the cutting edge which is required to administer a health system. As a result, these charges were administered willy-nilly, depending on the health board. This showed a lack of consistency throughout the country and there was very poor scrutiny or transparency in the system through the health boards.

It was for this reason and other associated issues within the old health board system that I fully supported the change from that health board structure to the current system, the Health Service Executive. Given the commitment expressed last night by Professor Brendan Drumm, supported by the Tánaiste and Minister for Health and Children, Deputy Harney, on "Questions and Answers", I commend both of them on the manner in which they proactively dealt with issues relating to accident and emergency departments, among others in health services.

I hope that in the context of their work within the HSE, the necessary reform, not only in accident and emergency departments but with many other issues relating to the delivery of services to those who need it within the health system, is delivered speedily, accurately and in a focused way for the benefit of the patient. That is what I saw from the debate last night and from exchanges with people like Professor Drumm at meetings of the Committee of Public Accounts.

My only difficulty is with the speed of that system. It is still very bureaucratic and it needs to be trimmed so that an appropriate management system is put in place and there are appropriately qualified people to manage the system. This takes time, which I acknowledge, but we need to see continued funding and commitment until a proper management structure is delivered within the Health Service Executive. We can then accurately point to where system failures continue to occur, from management level to the various hospitals in the country. Until that happens, we will not have the efficiency of service that is demanded by the public.

The proper approach is being taken with regard to this Bill and the patients covered by it. The Health Service Executive has established that up to 10,000 people must be repaid. I welcome the fact that a second company will oversee those repayments and that there has been some involvement on the part of Health Service Executive staff. The decision to outsource the process is correct because it enables the health service, as it undergoes restructuring, to focus exclusively on staff management and redeployment rather than be burdened with such a complex issue as these repayments. A system failure in the old health boards caused this problem.

I also welcome the fact that the Tánaiste is considering how patients' private property accounts are managed. I have had the opportunity to raise this issue at the Committee of Public Accounts and I do not believe there is adequate transparency in the system. In the old health boards there was little or no transparency and a number of whistleblowers employed by health boards have highlighted the inadequacies of the system. They have made complaints but in some cases have been identified and are being bullied and harassed in the workplace. That is not a position that can be tolerated by the HSE.

A national oversight committee has been appointed. It is representative of service users, including Age Action Ireland and the Irish Senior Citizen's Parliament, and provides an independent input into the design of the repayment scheme. I encourage that group to study not only what led to this scheme but also the patients' private property accounts, how they were administered by the health boards and whether money might need to be repaid to patients in that context. It might also examine the whereabouts of funds, property and other possessions of patients while they were under the care of the old health boards, as well as how they were transferred from the health boards to the HSE. A national audit should take place, overseen by the national oversight committee, so that we can create new books of accounts in which the balance of the affected patients' accounts, audited by an independent group or committee, is brought forward.

It is necessary to protect not only patients' rights but the integrity of employees. A protocol should be drawn up in every HSE area stating how the affected patients' accounts should be handled and accounted for and how the patients or their representatives should be informed of the balances and the activities on their accounts. There was a very poor accountancy system in the old health boards.

I have in my hand a patients' money book given to me by a psychiatric nurse who has made a complaint to the Department of Health and Children, a complaint which has not been responded to adequately. It raises serious questions. It dates back to 2003 and earlier and relates to the management of several patients' money. While that complaint awaits a response, it does no justice to the men and women who manage such accounts in the health system. It raises questions that have yet to be answered. It is a poor system that does not take such a complaint seriously and fails to respond. On more than one occasion the person to whom I refer was questioned by the Garda Síochána. I know of another complaint that has been under investigation by the Garda in Waterford for quite some time. The HSE and the Department owe it to staff and patients to investigate complaints vigorously and respond to them effectively to protect the system and those who work in it as well as those who are cared by it.

I urge the Minister of State to pursue those aspects of the Bill that seek to ensure that complaints awaiting response in the Department are dealt with and to ensure that those being investigated by gardaí are also made the subject of internal investigations. The protocol to which I referred should then be put in place to be followed by everyone concerned. It should be transparent and acceptable to all. Until that happens there will continue to be doubts over the system. We have the opportunity in this Bill to ensure that an audit takes place under the scrutiny of the oversight committee. A balance needs to be brought forward and the amount calculated as owed repaid.

I defend any whistleblower who raised a complaint and call on the HSE to offer appropriate protection to people in their employment who express their view on what is happening in the interests of better service. Any complaint should be investigated and both patient and employee be protected.

Deputy Seán Ryan dealt with subventions and issues arising from the television programme last night. I was impressed by the contribution of Dr. Gary Courtney on the subject of St. Luke's Hospital in Kilkenny. That hospital represents an example of best practice. It showed how a patient could be brought into a medical assessment unit and looked after properly. The patient could then be sent to the appropriate section of the hospital and thereafter cared for in the appropriate bed. If necessary, he or she would be discharged to the pre-discharge unit. I know from my work with that unit that a home liaison officer then ensures the appropriate care and support is made available in a patient's home within the community so that he or she receives the best quality care according to his or her needs.

St. Luke's Hospital is a model that can easily be replicated. There may be different emphases in terms of the type of beds needed. They may be needed in a medical assessment unit, in the hospital itself or in the pre-discharge unit, but that is the job of a bed manager. The Minister of State visited St. Luke's and will know that everybody, from the consultants to the person who sweeps the floor, participates in the management and delivery of the service in that hospital. The hospital also maintains strong links with general practitioners in Carlow and Kilkenny to ensure the best possible delivery of health care to the patient.

I encourage the Tánaiste to adopt a suggestion on "Questions and Answers". Hospitals such as St. Luke's which have recently been funded to the tune of €6.2 million for one particular service and €1.5 million for another but which set an example to others by innovating should be rewarded by the Department of Health and Children, through the HSE. As best practice replicated and rolled out in other hospitals, the hospital in which an initiative originated should be financially rewarded for its achievement. Such awards should be directed towards delivering frontline patient care, improving the image of the hospital, developing innovative approaches in other areas or providing care for the elderly.

Elderly people assessed in pre-discharge units are directed towards the appropriate care facility, either in the community or at home. There is no reason, therefore, that subvention payments made to private nursing homes should not be relabelled and paid directly to those caring for patients in their homes. The Department, with the support of the Health Service Executive, should introduce this innovation which would support families who wish to care for elderly family members at home.

On the issue of subvention payments, with so few public beds available in Kilkenny city, I encourage the Tánaiste to expedite plans to provide a 30-bed unit on the campus of St. Luke's Hospital in order that public beds become available for the care of the elderly and some balance is introduced in a market in which the cost of private beds is spiralling. When the nursing home subvention scheme commenced, a private nursing home bed cost approximately €300 per week but the figure has since increased to €700 to €800 per week, with additional payment required for every extra service needed by those in care. Given the gap between charges and the value of the subvention and the person in care's pension, families must make a substantial contribution towards the costs of care. The State has an obligation to bridge this gap.

The provision of public beds for care of the elderly would also create competition with the private sector. Allowing this market to be run exclusively by the private sector will result in the State being scourged in terms of price. As the population grows older, this issue will become more urgent and will need to be addressed through a mix of public and private beds.

Home care packages, a welcome, new initiative providing for an assessment and costing of people's care needs in the home, need to be promoted much more. The Health Service Executive should identify families which would benefit from home care packages and encourage them to support family members at home. The lack of public beds for providing care for the elderly is the reason for current problems with subventions and charges. Active retired groups in every constituency are campaigning to ensure that appropriate funding is made available for nursing home care in order that the accumulated assets of families, especially family homes, are not placed in jeopardy. Efforts should also be made to have people who normally live alone but are currently accommodated in public hospital beds cared for at home.

I note the company responsible for making the repayments under the new scheme was to have been appointed at the end of April with payments likely to commence in June. Clearly a decision is close on which entity will oversee the process. I hope the work the Health Service Executive has done in identifying patients who were wrongly charged and are still alive — I understand from the Tánaiste's note that almost 10,000 payments have been calculated — will be verified by the company and made immediately thereafter.

Where the person in care has passed away, I encourage the potential beneficiaries to consider donating the reimbursed moneys for use in frontline services. This is a wealthy country and some potential beneficiaries could be encouraged to donate repayments owing to them. They should, therefore, be informed of this provision and the areas on which their moneys would be spent. For example, people could be encouraged to donate money if it is earmarked for use in the region in which they live. While many people are decent enough to consider such an appeal, it is essential that they are informed about the provision. I commend the Bill to the House.

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

I thank Deputies for their contributions to the debate and welcome the broad support from all parties for the introduction of this legislation. I propose to respond to some of the issues raised during the debate.

The enactment of the Bill will be a key milestone in ensuring that repayments will be made as promptly as possible to all those who were wrongly charged for publicly funded long-stay care. As previously noted, the legislation will provide a framework to enable repayments to be made to all those affected who are alive and the estates of those who died since 9 December 1998. Those affected will have all charges levied up to 9 December 2004, the date on which charging ceased, repaid in full.

The scheme incorporates many features designed to make it a more attractive option than litigation. Repayments to those who are alive or their living spouse will not be subject to income tax. Those in receipt of repayments will retain their current social welfare pensions or allowances and their full eligibility entitlement or medical card status. Repayments under the scheme will not be considered when assessing entitlements to subvention.

Ensuring that the Bill contains the significant benefits I have outlined required extensive consultations with many agencies over an extended period, as did the provisions ensuring appropriate safeguards are in place to protect the financial affairs of vulnerable people. A number of Deputies mentioned the delay in bringing the Bill before the Oireachtas. As I noted, it was necessary to contact a number of the individuals concerned to ensure proper safeguards were in place. While all Members would have preferred to have the legislation before the House at an earlier date, the Bill needed to contain the maximum degree of protection for the vulnerable people affected by this issue. While I acknowledge that the process has been longer than expected, this has been due in the main to the complex and sensitive nature of the issues involved and the need to obtain detailed legal opinion.

In recognition of the special needs of those in long-stay residential care, the Bill will introduce appropriate safeguards to protect those who may not have the functional capacity to manage their own financial affairs without having to resort to wardship or the use of widespread psychiatric assessments, which could substantially delay repayments being made. The scheme will apply to fully eligible people, that is, medical card holders and those aged over 70 years, with effect from July 2001. To ensure repayments are made in an equitable manner, those not having a medical card on admission to long-stay care but who fall within the income-means threshold for a medical card will be regarded as having full eligibility for the purpose of this scheme. This will include those in publicly funded long-stay care, patients in public contracted beds in private nursing homes and patients in receipt of inpatient services in community-based facilities.

An outside company with experience in handling mass claims will be appointed by the Health Service Executive to administer the scheme. This company will provide an independent assessment of the amount of repayment due to each applicant and will help to reassure the public that the scheme is being operated in the most equitable and effective way possible.

Following consideration of all the issues, the initial procurement process was terminated in December 2005 as the HSE considered the tenders were unsuitable for a number of reasons, including value for money. The current public tendering process is at an advanced stage and it is expected that a decision on the appointment of a preferred service provider will be made when the board of the HSE meets on 1 June. A number of Deputies referred to the delay in appointing an outside company and some people questioned why it was being appointed. In fairness, however, it is important to have an independent assessment available. While the Department was very much involved in charging those involved, it is important to have an independent body to reassure people that everything is above board. In view of what happened, the HSE has taken the right decision and I am sure we are getting value for money. Hopefully the decision will be taken on 1 June.

Consideration was given by the HSE to the involvement of public sector staff to assist in administering the repayments scheme. However, the time constraints of the procurement process and the potential for significant logistical difficulties and protracted delays, with consequent implications for the commencement of the repayment scheme, did not allow for this option to be progressed. The HSE has also informed the Department of Health and Children that the operation of a repayment scheme of this nature is not one of its core functions and that it would not be in a position to administer a repayment scheme of this magnitude within existing resources without having to divert staff from their normal functions in the delivery of health services.

Shortly after the Supreme Court made its ruling, we announced we would establish this process to refund money. There has been no reason for delaying the process other than to put in place the simplest and most transparent refund system. While it is estimated that in total the scheme will cost close to €1 billion, we have included €400 million in the Estimates for this year.

The application process will be as simple as possible. January 2008 is the deadline for submitting applications, not for making repayments. Some speakers felt the deadline for repayments was 2008 but we are giving people until January 2008 to submit their applications. Valid applications will be paid until all have been dealt with. Fully eligible persons currently in care and those who have left care recently will be readily identifiable by records held by the institution. The HSE will ensure that applications are submitted on behalf of those in the care of the HSE who are unable to make the application themselves due to a physical or mental disability or ill health.

The application process will identify the personal representative in the case of estates and will provide the necessary documentation to help protect the State against fraudulent claims. In her earlier contribution, Deputy McManus referred to legal advice she had received concerning the recovery of money obtained through fraud. The Attorney General has advised that section 17 is not constitutionally questionable because it is, ultimately, the courts which would determine whether the ground exists for the HSE's claim of fraud, and they would never accept a mere assertion by the HSE that it is "satisfied" that the claim exists.

To ensure that those eligible for repayments are aware of their entitlements, an extensive communications process will be developed around the scheme. This will include TV, national and local radio, and newspaper advertisements.

Applicants will be repaid the moneys that are due to them in full, adjusted using the consumer price index to reflect the current value in today's monetary terms. The consumer price index is a widely accepted tool for monetary calculation over an extended period of time. It is used, for example, by the Department of Social and Family Affairs in dealing with underpayments of social welfare entitlements. A precedent also exists whereby in social welfare payments made as a result of the European Court of Justice's equal treatment ruling, amounts were adjusted by reference to the CPI to maintain their value.

The scheme contains a provision to enable those due repayments under the scheme to donate all or part of the repayment, specifically for one-off improvements in public health services for elderly persons and persons with disabilities. It is the intention that the wishes of those donating money will be considered when making allocations from the fund, subject to legal and practical constraints. The HSE is considering how best this can be achieved.

The scheme includes an independent, transparent and user-friendly appeals process. The Tánaiste will appoint suitably qualified independent appeals officers to consider appeals. Regular reports on the operation of the appeals process will be laid before the Oireachtas. All applicants will be advised of their right to appeal and how to make an appeal. Applicants will also be informed of their right to bring a complaint to the Office of the Ombudsman.

The overall costs arising from the long-stay charges repayment scheme have been estimated at approximately €1 billion. An appropriate allocation of €400 million for 2006 will be made when the legislation is passed by the Houses of the Oireachtas and the balance will be required in 2007 and 2008.

While debating this Bill a number of Deputies have referred to the preference of older people in need of care to remain in their own homes. In this regard, an additional €150 million was allocated in last December's budget towards improving services for older people and palliative care. This is the largest ever annual increase in funding for services for older people. Reflecting the new emphasis on home and day care, almost three quarters of that figure — €109 million of the full year costs — are being committed to services in the community.

The investment package is focused on caring for people at home in accordance with their expressed wishes, with additional funding for a number of new and existing community and home-based initiatives, including home care packages, the home help service, day and respite centres, meals on wheels and sheltered housing. Additional funding of €20 million was made available in the 2006 budget for the subvention scheme.

The Department is preparing legislation to update and clarify the present overall system of eligibility for health and personal social services to establish a fair and transparent framework in keeping with a modern health service. The aim is to publish a Bill by the end of this year.

Deputies Twomey and Seán Ryan referred to the proposed establishment of the health information and quality authority, HIQA. Preparation of legislation to provide for the establishment of the health information and quality authority and the office of the chief inspector of social services within the HIQA is well under way. The office will inspect residential services for older people as well as those for people with disability and children at risk. The office will register these homes and will inspect them against standards set by the authority. This process will cover both public and private facilities for the first time. The office will be independent of the HSE. Public consultation on the legislative proposals in the draft heads of the Bill has begun. The closing date for receipt of submissions is Friday, 26 May.

Deputy McGuinness raised the matter of patient private property accounts and he specifically mentioned a complaint that was made to the Department. As is the normal procedure, that complaint was referred to the HSE and will be dealt with by that executive. In view of what Deputy McGuinness said, however, we will make contact with the HSE and ask it to make direct contact with the Deputy and with those who made the complaint. Complaints should be dealt with as quickly as possible through any complaints procedure. If further details are required, we will get them from the Deputy.

Deputy McGuinness also referred to St. Luke's, an establishment I have had the pleasure of visiting on a few occasions. It is an example of how a team should work together.

Mr. S. Ryan

Which St. Luke's is that?

Mr. S. Power

I am referring to St. Luke's Hospital in Kilkenny. The hospital staff accept their role and play very much as a team in performing their duties in an exemplary fashion. As they would say, it is not all about resources, it is more to do with attitude than resources. They have achieved much within the available resources. We can often be critical of things when they go wrong, and it is only when things go wrong that they attract publicity. St. Luke's is one hospital that has risen to the challenge. It is a great example to other hospitals of how to make the most of the resources they are given.

Mr. S. Ryan

The Leas-Cheann Comhairle is aware of that.

Mr. S. Power

The statutory scheme being established by the enactment of the Bill will ensure that the repayment process will be as simple and user-friendly as possible given the age and vulnerability of many of those living persons to whom repayments are due. It is intended that it will operate in a non-adversarial, flexible, open and transparent manner and will cause the minimum of inconvenience or legal costs to the people concerned, their families, representatives or estates.

I thank Deputies for their contributions. I look forward to the further Stages of the Bill, at which time the views put forward will be considered in detail. I commend the Bill to the House.

Question put and agreed to.