Regarding the 1990 Act, does the Minister have a broad idea of how many inspections of nursing homes have taken place which have resulted in prosecutions against the proprietors of the homes?
SECTION 20.
Question proposed: "That section 20 stand part of the Bill."
The section amends section 3 of the Health (Nursing Homes) Act, 1990, and makes it an offence to carry on a nursing home which is not registered under the Act. The section arises from a loophole which became apparent in the Health (Nursing Homes) Act. While the Act makes provision for penalties to be levied on a person who has committed an offence, it does not state what constitutes an offence. The amending section rectifies that point. It is patch work on the Health (Nursing Homes) Act.
I do not have with me the information sought by the Deputy in respect of the number of prosecutions. However, if it is not available in the Department, it can be easily obtained through the health boards. I will provide it to the Deputy in a letter, if that is acceptable.
I do not expect the Minister to have the information today. However, there is much concern that money towards the subvention is not being paid to health boards based on the percentage of elderly as opposed to the percentage of population in each health board area. For example, the health board area in which I and Deputy Moffatt live has a high percentage of elderly people living in remote rural places, a large number of whom live alone. There is probably a greater call on places for these elderly people in the Western Health Board area than in many other health board areas. The board cannot cope with the level of application for spaces in properties it owns.
The number of private nursing homes has mushroomed in the board's area and this must be encouraged because nursing homes are run in a worthwhile manner and within the law. The tremendous service they provide should be recognised but patients are being placed at risk. They are in a nursing home but they are not getting the subvention because the health board says it does not have enough money. However, the same health board approved their eligibility for the subvention. It is a much broader picture and the western association of nursing homes wants to meet the Minister to discuss the matter. During the discussion of the section, it is no harm to signal that there is a growing problem in this area which could become contentious if it is not handled now.
The subvention scheme is relatively new. When it was originally introduced, the Minister of the day, the officials and the health board personnel gave it their best shot. However, in common with any new scheme, one was not sure how it would run. For example, £16 million will be provided this year. This is a significant sum of money by way of subvention to people in nursing homes. In effect, £16 million of relief is being provided to the relatives of persons in nursing homes and the homes' proprietors.
I will not move to make it a demand led scheme because I do not know where it would end. In terms of budgets, experience does not yet show where the demand will lead. If it were run as a demand led scheme, subventions would be given all over the country and would be funded by way of supplementary payments. It would not necessarily address the greatest need. Initially it is done by way of allocation. Sometimes if the number of people sanctioned exceeds the amount of money available there is a problem. So far what has happened is that the health boards discuss their overrun problems with the Department of Health.
As regards the second area, when the subventions first came in, the policy and political intent was that it would ease the situation of those in nursing homes as well as their relatives, but nursing home proprietors have jacked up their prices. They are running private businesses and there is no way of imposing price controls on them. Quite a lot of money expended in early subventions did not benefit families of the elderly in nursing homes; it went to the proprietors of those homes. There were up to 50 per cent increases in the fees charged although I am not saying they were not justified. The nursing home proprietors say they were carrying people for years because they could not throw them out on the road. In effect, they say, they were always carrying a handful of patients for whom they did not receive anything. There was a difficulty there which I hope has now been regularised fairly. As we gain more experience in this area we will get a clearer picture of it. Like all budgetary matters I hope the funds will match needs. There are discrepancies in certain health board areas at the moment.
People may not be aware that before the summer recess, on 31 July, I changed the regulations following recommendations from the committee of chief executive officers which looked at this matter. I have been lobbied continuously by parliamentary colleagues over the manner in which the means test applies to sons, daughters and other relatives. In the original regulations there was an allowance at a low level. We have now significantly increased the allowances so that there is a major easing.
Members will be interested because constituents they represented in the past, who were either refused or received a low subvention level because of the means test on sons and daughters, will now be eligible for a higher subvention or will come in under the section. I do not have the precise figures but the personal allowance of £5,000 has been increased to approximately £8,000.
Regulations have also been changed so that health boards can contract beds above the subvention rate and that is particularly important in the Eastern Health Board's area. In Dublin, you could get people out of the acute hospital beds which are badly needed if you had step down facilities. There is a shortage of step down facilities in Dublin but by contracting spare capacity in nursing homes the health board can improve the situation. We needed a statutory change to enable them to do it at the market rate.
There is an appreciation that things have improved considerably. Can the Minister give a figure for the cost of maintaining a person in a geriatric hospital compared to the amount paid to a nursing home in respect of subventions for maintaining a patient?
While the Minister is considering this question, I should say that we are straying a little from the Bill. I wish to discourage other Members who may be thinking of posing similar, albeit interesting, questions.
The maximum subvention is £120 per week which is the maximum dependency figure qualifying under means tests also. The cost in a geriatric hospital would be substantially more than that, although I do not have the figure. It would be a multiple but you would not be comparing like with like. As regards people who might want their mother to be kept in the local hospital — whether it be St. Camillus's in the city or St. Ita's in Newcastle West — the way the geriatricians have organised the service means that if you were in what was one of the old county homes, which are now the geriatric hospitals, an assessment is made and you may not be kept there unless in need of hospital services. It is not enough to be old and dependent, one needs to be ill. A person in a nursing home may be old and dependent but not ill, so you are not comparing like with like.
I understand that. It is obvious that you cannot keep a millionaire in a geriatric hospital.
That is not the point. You cannot keep someone who is not ill in such a hospital, regardless of whether they are rich or poor.
With the advent of the subvention, nursing homes are expanding but quite a few have serious problems in getting capital to expand. They are commercial operations and it is not the Government's job to provide such finance. Perhaps the Minister could assist, although I do not know how, in helping people to get the capital needed to expand. Much more could be done by private nursing homes if they had expanded capacity. It would take a lot of pressure off the geriatric hospitals and institutions in general.
In about two years' time the major problem that will face my successors in the Department of Health will be how to provide the resources necessary to provide different levels of intervention required for an ageing population. The range of elderly includes those who are fit and active and those who are totally dependent. In addition there are those who require a dedicated Alzheimer's unit. A range of interventions will be needed, all of which will cost money. We are working on it and many groups are setting up day care services in a campus situation with little houses for the elderly. We are moving on that area both in urban and rural areas.
The change in subvention regulations I made will also be helpful. However, proprietors of nursing homes are in private business and while as a matter of national policy it is in the interest of the State and the elderly population to have a good subvention scheme, at the end of the day the relationship is a private contractual one between the person in the nursing home and that home's proprietors.
Previously, when I was in Opposition I tried to change the Finance Act so that the provisions of the business expansion scheme would apply to nursing homes, but that did not find favour with the Department of Finance.
The Minister is in a position to do it now. The Minister for Finance is a colleague of the Minister's.
He was a colleague of Deputy Geoghegan-Quinn's as well.
Having heard Deputy Deasy on the news at five o'clock the other evening I will not continue this discussion any further.
I would not blame the Minister but perhaps he could pursue the BES issue with the Minister for Finance.
Question put and agreed to.
NEW SECTION.
I move amendment No. 10:
In page 14, before section 21, to insert the following new section:
"21.—(1) Notwithstanding sections 9, 10 and 11 of the Nurses Act, 1985, and rules 1 and 2 of the Second Schedule to that Act, the Minister may by order extend the term of office of the members of the Board holding office on the 3rd day of October, 1996, for such a period, not exceeding 12 months, as may be specified in the order.
(2) The Minister may by order further extend, once only, the term of office of the members referred to in subsection (1), for a further period not exceeding 12 months as may be specified in the order.
(3) An order may be made under subsection (1), notwithstanding that the term of office of the members of the board expired before the passing of this Act.".
This amendment deletes section 21 and substitutes a new text. The amended text addresses some technical deficiencies in the original which emerged since the publication of the Bill. The general effect of the section is to allow me to extend the term of office of the current members of An Bord Altranais for up to two years, so that a new nurses Bill can be prepared. This effect remains unchanged.
There are two main reasons for the change in the text. References to sections 9, 10 and 11 of the Nurses Act, 1985 have been included to allow me to extend the term of office of those members of An Bord Altranais who are elected directly by members of the nursing profession. Of the 29 members of the board, 17 are directly elected by the nursing profession and 12 are appointed by the Minister for Health. Under this provision, I could not extend the term of office of those members appointed by the Minister. A new subsection (3) has been inserted to allow me to make the order with retrospective effect. The term of office of all 29 board members expires on 3 October 1996. It is unlikely this Bill will be enacted by that date.
There is a new nurses Bill being prepared in the Department of Health. I do not want to require the nursing unions and representatives to run a new election for their members. It is much easier, both from the point of view of industrial relations and of the time involved in preparing the nurses Bill to take the power to extend the life of the present An Bord Altranais. We will then have a new Act. Industrial relations negotiations have taken place in relation to the new legislation. I understand this provision is favoured by the nursing unions.
I am in favour of that. It would be inefficient and expensive for the nursing unions to undertake elections to a body which will become defunct in less than two years. I presume in the event of the new nurses Bill becoming law, for example in 18 months time, that a time will be specified within which they must hold elections to a new An Bord Altranais.
Amendment agreed to.
New Section agreed to.