I thank the Ceann Comhairle for allowing me the opportunity to address the House on the nursing homes support scheme. I am aware of the anxiety caused to older people and their families by the uncertainty over the scheme. As the House is aware, while the fair deal scheme has been accepting applications in recent weeks, the approval system has been awaiting clarity on the financial situation. I am pleased to announce that the fair deal scheme will begin to process approvals next Monday.
Fair Deal Scheme: Statements
Deputies
Hear, hear.
The HSE will start by giving approval to those applications processed to final stage in recent weeks in the order in which they were received. As of mid-May, 22,277 people were in receipt of State support through the nursing homes support scheme versus 21,421 at the end of 2010. My Department has estimated that the total number of people covered by the scheme by year end should be almost 24,000, a net increase of 1,700 compared with mid-May. This increase will be financed out of a range of identified savings.
Before going into further detail, I will give a little background on the scheme. The nursing homes support scheme is a system of financial support for individuals in public, voluntary and approved private nursing homes. The scheme is available to anyone assessed as needing long-term nursing home care, including dementia-specific nursing home care. The legislation underpinning the scheme enshrines the principles of a resource cap, patient choice and funding that follows the patient. In 2010, the total long-term residential care budget was €979 million. The 2011 budget is €1.011 billion. This budget covers residents who are availing of the fair deal scheme as well as residents covered by various transitional arrangements.
The House will know that, in May, I became aware of a potentially serious shortfall in the 2011 budget for the nursing homes support scheme. There appeared to be a number of issues. First, it is clear that the previous Government grossly under-provided for the scheme from a budgetary perspective. Second, it seems that a series of factors, including greater than expected demand, were creating significant financial difficulties for the scheme. Third, preliminary indications suggested that ancillary services, such as physiotherapy, occupational therapy, speech and language therapy and drugs services, which were not intended to be included under the umbrella of the fair deal scheme, were in fact being funded by its subhead or pot of money. While it is clear that these services were being provided to residents in nursing homes, this practice had nonetheless contributed to the emerging deficit in the fair deal scheme.
In response to this new information, I asked for a full examination of the funding situation by my officials and the HSE. I received the report on this examination last Friday. Before I go into some of the details of the report, I would like to make it clear that the report's conclusions and forecast are not as definitive as I would have wished. A lack of reliable historical data, combined with a multiplicity of different accounting systems, has made it difficult to drill down into the scheme in the way I would want. Nevertheless, the examination provided enough data for the report to reach a number of conclusions.
The report makes it clear that a number of factors are putting pressure on the fair deal budget for 2011. These include an increase in nursing home costs and an unexpected and so far unexplained increase in the average length of stay for nursing home patients, which was two and a half years in 2009 and has now risen to more than four years, resulting in a higher net demand for nursing home places. As a result of these and other factors, the report indicated that the nursing home support scheme, even if there were no net additions to the scheme for the remainder of the year, was likely to face a deficit of €36 million this year. It is also clear that payments from the fair deal subhead have been used to cover ancillary services such as therapies, drugs and medical services. It was initially estimated that the total cost of these ancillary services was approximately €100 million. However, further examination by the HSE has indicated that only €48 million of ancillary costs were billed to the fair deal subhead.
To seek to deliver the 1,700 net increase in residents under the scheme for the remainder of this year, other savings and income will be used to support the scheme. Expected savings of up to €30 million will be made in non-service related spending. Long stay in-patient charges, which have not changed since 2008 and should be increased annually, will also be increased so as to realise additional income of some €12 million in a full year. Despite the current economic climate private nursing homes received price increases over the past nine months. The annual cost of these increases is approximately €20 million. In my view, these increases are not sustainable in the current financial situation. I have instructed the National Treatment Purchase Fund to renegotiate the price increases for private nursing home beds, which were negotiated by the private nursing homes last year. This will be done with a view to producing further savings.
I must emphasise that these savings have been identified as part of a wider review of the financial position of the health system. As Deputies will be aware, there have been significant overruns in the overall health budget so far this year. I hope to shortly announce details of the actions that will be taken to address this wider financial deficit and to support the HSE in its responsibility to operate within this year's financial provision.
I have already indicated that the examination to date has not been as definitive or comprehensive as I, and I am sure Members of this House, would wish. In the short term, I have asked the HSE to put in place additional and more rigorous governance and reporting measures. My officials will closely monitor developments over the remainder of the year. I will also consider whether external auditors should be used to help bring greater clarity to the situation in the future. I am anxious to identify the reason for the unforeseen increase in applications, the increase in the average length of stay in nursing homes and some of the unexpected monthly variations in approvals under the scheme. I am requesting the HSE to undertake a clinical audit on the appropriateness of care and admission.
Over the longer term, I am determined that there should be a full review of the fair deal scheme, as outlined in the programme for Government. This review will look at the ongoing sustainability of the scheme, the relative costs of public versus private provision and the balance of funding between residential and community care. We must assist as many older people as possible to remain in their homes and communities for as long as possible. More than 95% of older people do stay at home and remain there, which is only right and proper. Regardless of how kind and effective an institution is, people almost always prefer the familiarity and independence of their home. However, it is also vital that the small minority who do end up in long term residential care are able to live in a surrounding that is as comfortable and free from worry as possible. I am acutely aware of the need to plan for an aging population. This is more than a financial challenge. It is a challenge to us as a society to treat our older people with the care and dignity that they so richly deserve. Our goal must be nothing less than to deliver a comprehensive, person-centred service that promotes health, well-being and quality of life.
I welcome the Minister's statement which sets out the actions he has taken to date with regard to the shortfall of funding in the nursing home support scheme. During Question Time last week I used the word "misappropriation" of funds and was berated by the Minister for so doing. The Minister said it was an extreme word, one that should not be used outside the House. However, the Minister stated in an article in The Irish Times that it was quite possible that other pots of money might have been “pilfered”, which is an equally strong word. Are there concerns in regard to the allocation of money in the context of corporate governance and who made the decisions to transfer money from one subhead to another? That is a serious issue.
This matter has caused much anxiety for people who made applications under the fair deal scheme and people who were considering whether they needed long term care. I assume, from the Minister's statement today, that everyone who makes an application and qualifies under the fair deal scheme will be approved in the months ahead regardless of the number of people who apply. Perhaps the Minister will clarify if that is the case. This is the most important issue for people who are planning for their long term needs in terms of nursing home care.
The Minister set out the statistics in relation to the scheme, which highlight the longer duration of stay in nursing homes. This either means people are making a conscious decision to apply for the fair deal scheme because it makes long term care financially viable or that we do not have in place enough supports in the community or by way of home care packages to allow people remain in their homes. As the Minister said, as a Parliament and society we must debate how we are going to address the challenges facing this country in the context of an aging population. This issue also feeds into the debate on pensions.
The review due to be published last Friday has not been published. The Minister said the reason for this is that the review was not a full review and as such did not show up the necessary detail in regard to where the money went, on what it was spent and, more important, how he will get this money back in order to fund the fair deal nursing home scheme. When can we expect the final review to be published?
Another issue of concern, which I have previously highlighted in the House, is the overlapping of corporate governance in the HSE. Currently the HSE board consists of HSE employees who are basically reporting to themselves. Is there a breakdown of communications or even trust between the Minister, Department of Health and Health Service Executive in the context of trying to ascertain the facts of what happened to the funding for the fair deal scheme?
Fianna Fáil was supportive of the putting in place of a long term scheme that would remove the pressures being put on families for many years in relation to subventions, applications and whether they would be able to afford long term nursing home care. The fair deal scheme has been a good scheme in that it has removed the uncertainty and has guaranteed people who qualify access to nursing home care, be it public, private or voluntary. As borne out by the statistics, the scheme has benefited many thousands of people.
As regards Rostrevor nursing home and the issues raised in that regard, the Health Information and Quality Authority was set up to inspect health and social care facilities. It is important as many inspections as possible are carried out and that the resources in that regard are made available. This includes public, private and voluntary facilities. HIQA should not distinguish between nursing homes be they public, private or voluntary. We must ensure enforcement of the inspection service and that HIQA goes about its business in a thorough manner, as it did in the context of Rostrevor nursing home. Overall, when one considers how this was handled, including the uncertainty created in recent weeks and which still remains, the Minister must give us a cast-iron guarantee today that everybody who applies and qualifies will get approval. When the scheme was suspended, there was no statement from the Minister, the Department or the HSE and the information was extracted by stealth over that weekend and the following week until it was raised in the House and we eventually got a statement from the Minister in that context.
The Deputy's party has all the answers. Who under-funded the scheme?
They should have sorted it out.
It is very worrying that there was not a clear and concise statement. It shows there was no need to suspend the scheme. If the Minister is now stating in the House that those who had applied and for whom approval was not granted because of the shortfall——
Give the Minister some credit for sorting out the mess Fianna Fáil created.
This is important. The Minister is now stating that those who applied for the fair deal nursing home scheme and did not get approval because of the suspension will now seek approval. Therefore, by extension, there was no need to suspend the scheme in the first place.
That is Fianna Fáil logic all right.
It is clear the Minister will now provide the funding for——
The problem is the amount of money Fianna Fáil left us.
Order, please. Allow the Deputy to continue.
The Minister stated in the House that the trauma and uncertainty all of those people were put through in recent weeks was unnecessary because they will now seek and get approval.
Who created the uncertainty?
Who created the trauma?
It was handled in a ham-fisted way and did not take into account the concerns and anxiety it created for many thousands of people throughout the country. Every Deputy in the House has at this stage received numerous representations——
Has the Deputy heard of Mary Harney?
Order, please.
——from people who were very concerned because an application was made but approval was not granted. That was clearly unnecessary in the context of what the Minister said in the House today, namely, that they will now be approved in chronological order of application. In my view and that of many others, the way it was handled and the stealthy way it was cancelled for a period prior to any statement coming through was wrong.
On the broader issue of the fair deal scheme, it is obvious that if the numbers are as projected, there will be an increase of approximately 1,700 from last year and funding will have to be provided for this, which everybody acknowledges. At the same time, the programme for Government, to which both parties opposite have signed up, states there will be an increase in funding year on year for care for the elderly. This is one of those years but we are seeing no major increase——
There has not been a budget.
There were to be year on year increases. The Government was able to introduce an initiative some weeks ago that was originally a jobs budget but which has now fallen to being a simple jobs initiative.
The Deputy has a short memory.
I put down a Dáil question to the Minister for Finance, who stated clearly that the incoming Government was aware of all the challenges facing every Department in the context of putting together the programme for Government, and that it was given full and open disclosure of the books and of the difficulties and challenges facing it. To come to the House and suggest the parties opposite may not have known, did not know or were unsure there were challenges in the various Departments is simply unacceptable. The Minister for Finance told me quite clearly in this Chamber in the context of a Dáil question——
There were certainly challenges after Fianna Fáil left.
A Deputy
It was because of their dishonesty.
We are talking about savings Fianna Fáil did not make, savings they subscribed to but——
Excuse me. The Minister has five minutes to reply. Members should allow Deputy Kelleher to make his statement and the Minister can reply to any inaccuracies made by any Deputy.
He is spinning.
There is accuracy and there is fantasy.
Obviously, he will not be referring to any of the inaccuracies I make because I am not making any; I am just making statements of fact.
He never once mentioned the under-funding.
I ask Deputy Buttimer to refrain from interrupting.
It was clearly stated in a Dáil reply by the Minister for Finance that they were given full and open disclosure of the books in the context of forming the Government. Everybody was aware there were challenges in every Department in the context of funding in the year ahead. Yet, the programme for Government states clearly that, year on year, there will be an increase in provision for care for the elderly. That is simply not truthful because no extra funding is being made available for 2011 — none whatsoever.
When will the Minister's review of the overall fair deal scheme take place? Who will carry out this review given there does not seem to be much trust from the Minister in the HSE given what he stated regarding the review of funding of the nursing home support scheme itself?
I begin by deploring the fact the Minister for Health, Deputy James Reilly, has yet to present himself to answer questions from Deputies in this Chamber on what has been a real crisis in nursing home care.
I answered oral questions last week.
He has not at any time presented to answer questions on this matter specifically in the House. These are statements which are taking place today and, despite our appeal on the Order of Business this morning, the Minister is not making himself available for questions, of which there are many. Last week and the week before, he did the same, putting the Minister of State, Deputy Kathleen Lynch, in the front position for the Adjournment debate and for oral questions on this matter. The Minister did not take the questions on the fair deal. With all due respect to the Minister of State, Deputy Lynch, the buck does not stop at her desk; it stops at the Minister's.
The Minister has not been shy about speaking to the media in a selective manner about the fair deal crisis but he refuses to make himself fully accountable to the Dáil on the matter. That, I regret to say, is a bad start for a new Minister and a far cry from the openness and accountability he vehemently demanded when he was a particularly effective Opposition voice marking the previous Minister for Health and Children. We had hoped that last week's ministerial questions would clarify matters but they did not do so. We then had the statement from Minister yesterday that his inquiries into HSE spending on the fair deal scheme are not yet completed. His review that was reported last Friday has not provided the full clarity needed, as he repeated in his contribution today. There should be an elaboration on this aspect in the closing remarks.
Meanwhile, hundreds of older people who should be in nursing homes are languishing in acute hospital beds. The Minister of State, Deputy Kathleen Lynch, could not give us an accurate figure last week but it is estimated that approximately 500 older people are inappropriately holding acute beds in a public hospital system that is already stretched to the absolute limit. As of January this year, over 1,600 acute and continuing care public hospital beds are closed, mainly due to cutbacks and staff shortages. Therefore, the knock-on effect of this crisis in the care of older people is very far-reaching, and not just for those people and their families. The longer this situation drags on, the worse the bed shortage in our already over-stretched hospitals will become. Let us hope we are now looking at the prospect of an end to the current crisis.
On top of all this, we have the deplorable revelations about the ill-treatment of people in the Rostrevor nursing home in Rathgar. The approval of applications under the fair deal scheme should have resumed by now. It is not justifiable that they were suspended. Instead, we have older people and their families in great distress and gravely concerned about the future. It is the Minister's job to clear up the confusion and tell us and, more importantly, to tell older people and their families, the full facts and that this is being resolved and will not re-present over the remainder of this year. Can he give us those guarantees?
On Wednesday, 18 May, it emerged in the media that the HSE had informed hospitals that funding allocated for the fair deal scheme in 2011 was running out, even though we were only in the fifth month of the year. These reports naturally spread huge concern among older people and their families, including people already availing of the fair deal scheme and those who had applied or would be applying for it. We acknowledge that the positions of those already catered for under the fair deal were not at risk, as the assurances stated. Age Action reported it was inundated with telephone calls from concerned older people as, I am sure, were Deputies across the Chamber. I experienced some such calls, from callers in tears. It was a very difficult time and has not ceased.
On 20 May the Minister for Health issued a statement in which he claimed that €100 million in funding for the fair deal scheme had been used for other purposes, specifically ancillary services, including therapies and drugs. The Minister stated there was "tremendous confusion"between the HSE and his Department. Has that confusion been addressed and sorted to his satisfaction? He spoke of "some very strange figures coming through from various parts of the HSE". Amazingly, he spoke of "confused messaging" and stated that money which belonged to one subhead had been spent on others. We are speaking here about tens of millions of euro of public money.
There was a sigh of relief when the Minister stated the fair deal scheme would recommence approving applications but that relief was short-lived. I, too, contacted the HSE, specifically those involved in the processing of the applications, only to be told that they were not being processed or progressed. I welcome the Minister's announcement today although some examination of it is required. I hope the announcement will hold up and that from Monday next all new approvals will secure access to nursing home places.
I refer to the sequence of events. The HSE was reported as stating it had not yet recommenced approving applications for the fair deal scheme as it was still seeking clarity on the funding issue from the Department of Health. The HSE also stated it was not the case that money was diverted from where it should have been spent, as had been claimed by the Minister. The Minister and the HSE were contradicting one another, feeding into the confusion across the wider public. This is about the vital matter of the care of older people and such confusion is simply not acceptable. There is no question that everything was heading towards a crisis and that is what we have experienced.
The pressure on the fair deal scheme in the past year has already led to the situation I described, with increasing numbers of delayed discharges of older people from hospitals. These are older people kept in hospital beds longer than is medically necessary because there are no nursing home places for them to go. Will the Minister take and respond to questions in his summary contribution today? Will applications from some 500 people in acute hospital beds be fast-tracked under a resumed fair deal scheme as of Monday? Will they quickly secure nursing home placements?
On 31 May there was the revelation that more than 4,600 people have had their applications for the fair deal scheme processed and are awaiting final approval. Is the Minister in a position to deal with that number of cases? That was the figure only to 31 March. What is the actual number of people waiting for approval of their applications?
The Minister also confirmed that when the scheme recommences approving applicants it will be at a slower pace than up to now. Will he consider this statement and clarify it? I pay tribute to Age Action and the organisation Older and Bolder which have constantly raised these issues. I welcome what the Minister announced in the Chamber today and the fact that he has chosen to use the Chamber——
Hear, hear.
——to make this announcement because it is an appropriate place for him to do so. I hope this will prove to be the pattern in the future. However, it must be asked why it was necessary to suspend approvals. What was achieved by this other than the creation of real distress among many older people and their supporting families?
I note that charges for acute beds in public hospitals are to be increased. That is bad news for patients. However, I welcome the announcement that recently increased fees paid to private nursing homes by the HSE are to be renegotiated. I commend that action.
When the legislation providing for the fair deal scheme was on Second Stage I contributed to the debate. I reiterate my party did not support the Bill at that time because we believed it was a move away from universal entitlement, of which the Minister has been an advocate. I do not see now, and did not then, that it is a rights-based scheme. It is not comprehensive in terms of providing the wide range of care older people require and is no substitute for comprehensive, State-provided care for older people, including fully resourced and supported care for people in their homes in the community and, where necessary, in nursing homes.
I wish to share time with Deputies Mick Wallace and Richard Boyd Barrett.
We heard positive news today that the scheme is back on track. However, I have many questions. I would have preferred to have had a question and answer session rather than one in which Members make statements after the Minister's speech.
I gave conditional support to the fair deal scheme when it was introduced because of the absence of sufficient numbers of publicly funded nursing home places and because there were two levels to the subvention scheme. The first of these was inadequate as to cost. The second was rationed where it was focused on higher dependency and very often that posed its own difficulties. That scheme was available during the good years; we all know the economic straitjacket that exists today.
Prior to the introduction of the fair deal scheme many people were in acute hospital beds rather than in nursing homes. "Blocked" beds was a derogatory term that was very hurtful to people who had paid taxes all their lives. We were at risk of repeating that situation for people who had lost their independence but who had paid their taxes throughout the years, hoping services would be there to meet their needs when they became older. When a person is a long-stay patient in an acute bed his or her quality of life is very much reduced. The Minister will understand that point.
I have some questions and hope the Minister will be able to answer some of them. He stated he was unhappy with the information and historical data provided. If one designs an information system one does so against the system already in place. That tells me the system now in place is sick. All of us know that a computer system can only sit on the physical system provided. One must re-engineer the processes if one is to have a proper system that can deliver the kind of information which is needed. That must be addressed.
I am very concerned by some of the points the Minister made. Will physiotherapy, occupational therapy and other kinds of services be available to people who will now enter nursing homes? Where else might they be provided if not in nursing homes? I may have picked the Minister up wrongly but I believe he stated patients would stay for four years in nursing homes rather than two and a half years. My understanding of the fair deal scheme is that one pays for the first three years but not after that period. To me, this comes across as offering a "free year"; that one should not get in unless one is sick. Perhaps he might return to that point because it comes across badly, at least as I understand how it was articulated. When highly dependent people such as those with dementia go into nursing homes — that is what such homes are for — the quality of life of others in such homes can be badly diminished. The mix is important. I completely support the care of people in their own homes. A radical job of work needs to be done to deliver a fair system. The embargo will have to be dealt with in that context. I would like to hear what the Minister has to say about that.
I am not madly familiar with all of this area. Given that he has not been in the job for very long, it would be a bit premature to shoot the Minister.
We will wait a few months.
He should be given the benefit of the doubt until he proves to be unworthy of it. I consulted a voluntary group that has done some research in this area and was very interested in what it had to say. I am aware that the programme for Government promised a review of the fair deal system. According to the group I consulted, there is a need to establish absolute legal clarity on the right to nursing home care of a highly vulnerable group of citizens. Equally, there is a need to consider different models for the financing of long-term care, including nursing home care. It is critical that the costs and benefits of those models be assessed. As we attempt to quantify current and future long-term care needs and costs, the key issue is not to identify the size of the older population, but to identify current and future disability and dependency levels within that population. A clear agreed understanding of what constitutes long-term care should be developed. I agree there is a need to establish absolute legal clarity on the right to nursing home care. The Ombudsman has been involved in a dispute in that regard. The 2009 nursing home support scheme is now deemed to supersede the provisions of the Health Act 1970, which obliged the State to provide for nursing home care.
I have read that 95% of elderly people are cared for at home rather than in nursing homes. I assume that figure is correct. If so, it is brilliant. There is a fear that the 5% figure will increase in the years to come. The role of the extended family is probably decreasing, rather than increasing. The notion that grandparents should live with their children and grandchildren is not as popular as it was. It is probable that fewer people are available to look after our older people. I have been struck by the difference between the attitude to older people in Ireland and Italy, a country with which I am pretty familiar. I have watched older people in places like Turin. I am pretty familiar with a small village of 3,000 people in Piemonte. I have seen older people gathering together in such places. There seems to be more respect for older people in Italy. Rather than being seen as surplus to requirements, they are valued as people who are worthy of respect, having been there and done that. We have a lot to learn from other cultures. I cannot help feeling this country has probably been too Americanised in the past 15 or 20 years. Older people are not getting the respect they are due. Any Government should be well judged on how it looks after the most vulnerable people in society. This Government should be judged in those terms. I am not accusing it of anything, as it is only getting started. It is important that the Government treats older people with more respect than we have seen over the past 20 years.
I call Deputy Boyd Barrett. There are two minutes remaining in this slot.
Deputy Wallace robbed some of my time.
It is about time someone did so.
The Deputy is right. Like him, I think it is too early to lay the blame for the crisis in the provision of nursing home places at the Minister's door. It is a bit rich for members of the previous Government to be giving out about this crisis, frankly, given that it is clearly a legacy of their policy failures.
This is the first time Deputy Boyd Barrett has made sense.
It is obviously welcome that the Minister, Deputy Reilly, has come before the Dáil to try to explain this. I am pleased that the immediate crisis, at least, is over. Can the Minister assure us that the 500 people in acute hospital beds whose applications have been approved will get the places they need and deserve as a matter of urgency? Can he ensure the 4,500 outstanding applications will be processed quickly? Will the needs of those people be met as a matter of urgency?
This issue raises serious questions about the provision of long-stay residential care to the elderly in nursing homes. I am critical of the Minister in the sense that it is unacceptable, frankly, that one of the consequences of the manner in which this crisis has been dealt with is that long-stay inpatient charges will have to be increased. If I understand it correctly, an extra charge will be imposed on patients. It is not clear how much this unacceptable increase will be. The Minister has said it will have to raise €12 million. We need clarity on where the rest of the money to make up the shortfall will come from. Will it affect other areas of service? I refer specifically to the provision of the physiotherapy and occupational therapy services needed by people in nursing homes.
I will conclude by referring to the review of the whole thing. Many of the Minister's statements have emphasised the fact that the private nursing home sector is cheaper than the public nursing home sector. However, this report informs us that part of the problem is that prices in the public sector are increasing. When one considers the horror of the Rostrevor House nursing home in Rathgar and cases like Leas Cross, perhaps one will understand why the private sector is sometimes cheaper. It seems that some nursing homes in the private sector are not providing the level of care they should to the elderly. The Minister should review the idea that the private sector offers a simple answer to this problem. The private sector is cheaper in many cases because it often does not provide the same level of care. In addition, the public sector has to take patients with higher levels of dependency. We need proper and fair funding of proper nursing home care of the elderly.
I thank everyone who has spoken during the debate on this issue. I agree with what Deputy Boyd Barrett said about the Fianna Fáil contribution to the debate, which was a bit rich. The stuff we heard today is about the only rich thing Fianna Fáil has left us. I remind Deputy Kelleher that this was not a "review" and was never referred to as such. It was always referred to as an "examination". The proper and full review referred to in the programme for Government will take place in 2012, which is next year. The examination will continue until we have absolute clarity. I repeat that I am not happy that we have absolute clarity. I alluded to that in my opening statement. We have to deal with this exemplar of what is wrong in the HSE. The financial systems make it difficult to find out where decisions are made, where money is spent and how it is spent. We cannot have a scenario where a subhead, or a pot of money dedicated to one issue, can be used for other issues. The whole thing becomes completely confusing if pots are used in that way. Confusion is not the friend of clarity and it is certainly not the friend of good accounting. This matter will continue to be examined until I have absolute clarity.
I have to point out that this mess occurred because the previous Government underfunded the scheme. To suggest that the new executive board of the HSE could be culpable, when all of this predates its first meeting, is utterly ridiculous.
Hear, hear.
I did not suggest they were culpable.
I utterly reject Deputy Kelleher's suggestion that it was not necessary to suspend approvals until there was clarity with regard to the funding.
It would have been utterly irresponsible to do anything else.
Clearly, Deputy Kelleher did not listen when he made his assertion that there is no increased provision for older people. I have already made it clear that there will be 1,700 places additional to the ones that were available at the time in May last.
On Deputy Ó Caoláin's assertion that I did would not answer questions, the Minister of State, Deputy Kathleen Lynch has responsibility for this area and is entitled to take questions on it. However, there were non-priority oral questions and I answered some of them. I am not afraid to answer questions. Indeed, I spent a full "Prime Time" programme answering questions on this and carers.
As the Minister will be aware, the House is where he must answer them.
That is why I am making this statement here. I can inform the Deputy that anybody who has been on "Prime Time" on a one-on-one interview knows that one will be asked the difficult questions and one must be able to answer them. In so far as I can with the information available, I answered the questions. I do not run away from that responsibility.
As I stated, I am not satisfied that we have total clarity. I stated that approvals would recommence, and they will. Delayed discharge is of considerable concern to me and to many people. Apart from the discomfort it causes families and the worry and concern about the whereabouts in which their loved one might find themselves, it is equally unkind to patients who must lie in those bed, often not getting ancillary services that would make their quality of life better.
To answer Deputy Ó Caoláin's question and the one raised by Deputy Boyd Barrett——
The Minister has one minute.
——those 500 patients who are currently described as delayed discharges will receive approval and will be prioritised.
Universal health insurance is a goal of the Government. Free general practitioner care for all will be delivered in this term of Government and much of what needs to be done to deliver universal health insurance at the end of five years will have taken place, but it will take a second term to be fully established.
Deputy Catherine Murphy and others mentioned the issue of physiotherapy. Those who have medical cards still get their physiotherapy but these ancillary services should not be paid for out of a fair deal subhead or pot of money that was designated for accommodation only. The Deputy had a concern about the two and a half years now becoming over four years. No matter how excellent nursing home care has been, it could not cause an increase in longevity of that nature in one and a half years. There is something else afoot. What I am suggesting here, and will examine, as I stated in my opening statement, is a further evaluation of the assessment tool. If there is variation, both in terms of geography and in terms of the sort of patients that are being recommended for nursing home care, I want to check that it is appropriate to their need and that they are not ending up in long-term institutional care before they need to be there. As I stated earlier, people are quite entitled to stay, and should be supported, in their homes, which is where most people want to be.
Deputy Wallace raised the issue of eligibility. It must be worked on and clarified by my Department. There is a host of issues in that regard, not only in this regard but in regards to medical cards etc. I agree that society should be judged on how we look after the most vulnerable and I believe that the Government will not be found wanting in that regard.
There was an assertion that we see private nursing homes as the solution to our problem. We do not. We acknowledge the good work they do in the main, and that 11,600 people are cared for in private nursing homes in this country at a cost of €300 million versus 11,000 — 600 fewer — at a cost of €700 million in the public sector. There are ancillary costs included therein but when one strips all of them out, it is still 50% more expensive to care for the elderly in the public sector. Part of our valuation and examination will also include assessing the degree of disability among patients to see if there is a difference in the dependency level between the public and private sectors, or what other factors might be involved.
I thank everybody who took part in the debate. I reassure older people and their families that the scheme will recommence approvals on Monday and we will keep the matter under constant review.
That concludes statements on the fair deal scheme.