Dáil Éireann díospóireacht -
Wednesday, 31 Jan 2001

Vol. 529 No. 2

Adjournment Debate. - Nursing Home Subventions.

Mr. Ring

The Ombudsman's report was published yesterday but I did not have an opportunity to read it due to the pressing events of the past two days. There was a great deal of concern last summer following the publication of stories in the media which revealed that health boards were taking money from elderly people and their families for subventions. It now appears that these moneys will have to be returned by the health boards. I hope the Minister and Minister of State will tackle the health boards and ensure that whatever funding should be returned to these families will be returned. I also hope the Minister and his Department will rap the knuckles of the health boards.

The Minister of State, Deputy Moffatt, is also responsible for the special housing aid for the elderly scheme which is operated by the health boards. In my constituency, the health board is frightening old people by demanding money from them for this scheme. I have written to the Ombudsman and asked him to investigate this scheme as well. It is wrong that people of 65 years and more should have to make contributions to the health board. Sometimes when they are asked for the contribution they do not actually know what works will be carried out or how much money in total they will have to pay. This practice does not occur in every health board. I put down parliamentary questions on this subject today and, according to the replies, some health boards have abolished it. I call on the Minister to ensure that the health boards who continue it are stopped.

A constituent called to my clinic to discuss the subvention issue. He was most disturbed about it. He was not well off and his brothers and sisters in America were obliged to make a contribution towards the subventions for his mother when she was in the nursing home. At that time, the health board inquired about every member of the family, no matter how many there were or where in the world they lived. Each member was obliged to send a statement of their income. That was outrageous. Some family members took on the responsibility of looking after their elderly relatives but other members had their own families to support and mortgages to pay.

I wish to ensure that moneys are returned to the people who were obliged to pay subventions at the request of the health boards. I also ask the Minister, with regard to the housing aid for the elderly scheme, to stop the practice of health boards taking money from the elderly. I have raised this issue on many occasions.

I did not get an opportunity to read the Ombudsman's report. There is terrible abuse of the elderly in this country. Up to 12,000 elderly people suffer abuse at the hands of their carers and other people, according to a report drawn up by the national council on ageing and older people. Every day there are court cases which show how elderly people are treated. I have previously called on the Minister to establish a help line for the elderly. Since I raised this matter and the media gave it coverage, I have received phone calls from people throughout the country describing their problems and the abuse they suffer. Abuse can take many forms.

I will return to this topic on another occasion. I now have to return to other pressing business. I hope the Minister of State will give the health boards a slap. I do not often agree with comments made by the Minister and the Taoiseach but on this occasion I do. The Civil Service, the health boards and councils have gone too far. They seem to think that because they work for the State their word is law. Thank God for the Ombudsman. I hope when legislation relating to the Ombudsman comes before the House again he will be given further powers and more resources. He will then be able to take on the health boards and the councils. The only time one can put manners on health boards or councils is when one threatens to refer a case to the Ombudsman. However, his powers are restricted. I hope he will be given more power and resources.

I compliment the Ombudsman on this report. The Minister must take on the health boards and the officials.

Minister of State at the Department of Health and Children (Dr. Moffatt)

I presume the Deputy is referring to the issues raised in the report into the nursing home subventions published yesterday by the office of the Ombudsman. This is a detailed report, representing a considered analysis of significant issues of public policy, public management and the practice of good government.

While the report analyses in detail the operation of one scheme, the nursing home subvention scheme, its conclusions dwell on the more fundamental reforms considered desirable by the Ombudsman in how Government operates in the Irish context, particularly in relation to the balance between the roles of the Executive and the Legislature. The far reaching conclusions outlined in chapter eight of the report will justify careful consideration in all relevant quarters and particularly at political and senior public service levels.

The Department of Health and Children and the health boards are criticised in the report for their handling of the nursing home subvention scheme. A number of significant shortcomings in the operation of the scheme have been highlighted and the findings in the Ombudsman's final report will be fully considered by the Department.

An expenditure review of the scheme is currently being undertaken by the Department in association with the Department of Finance and is expected to be completed shortly. It is my intention to bring proposals to Government in relation to whatever additional measures may be necessary arising from the findings of the review, the report of the Ombudsman and experience gained from the operation of the scheme since its inception in 1993. I outlined in my replies to parliamentary questions yesterday a number of immediate steps being taken to remedy shortcomings in the scheme. It might be helpful if I highlighted these again this evening.

The immediate priority is to ensure that the two aspects of the regulations that have the most direct impact on nursing home patients and their families are fully addressed without delay. The first of these relates to the payment of refunds to subvention recipients or their families arising from the application of Article 8.2 of the Nursing Home (Subvention) Regulations, 1993. This allows health boards to disregard a sum equivalent to one fifth of the old age non-contributory pension when assessing means and calculating the amount of subvention to be paid.

In relation to the operation of Article 8.2, an additional allocation of £4 million was made available in 1998 in letters of determination to six of the eight health boards where the regulations had been applied incorrectly to meet the cost of arrears payments under Article 8.2 in addition to other expenditure under the scheme.

Following a meeting with the Office of the Ombudsman in December 1999, the Department became aware of continuing delays in paying arrears. The Department took up this issue with the boards concerned and is continuing to pursue the matter. The current position is that where arrears were due to be paid, health boards have made retrospective payments in respect of persons currently resident in nursing homes. Some boards have also paid arrears in respect of former subvention recipients now deceased and former recipients who are no longer resident in nursing homes.

To date, approximately £900,000 has been paid in respect of Article 8.2 arrears. I assure Deputies that every effort will be made to pay all outstanding arrears as soon as possible and I have instructed my Department to pursue this with the health boards concerned.

I will now deal with the manner in which the £4 million allocation in 1998 was used by the health boards. As I indicated earlier, this allocation was not intended to be used solely for the payment of Article 8.2 arrears. The Department has been informed by the health boards concerned that the funding provided was used to cover arrears payments under the article; additional expenditure arising as a result of the easing of family circumstances regulations in 1996; the payment of enhanced subventions; expenditure shortfalls arising from the increased demands under the scheme and legal and other costs associated with the administration of the scheme. A proportion of the allocation was used by three of the health boards to fund other services for older people, namely, the provision of aids and appliances – primarily incontinence wear, improved home help services and the opening of a unit for the elderly mentally infirm. While this money was not expended on the subvention scheme, it was used for the benefit of older people.

Arrangements are being made to make appropriate payments in respect of nursing home patients and their families who may have been affected by the family circumstances regulations prior to their amendment in 1999. This amendment removed the provision which allowed health boards to assess the capacity of adult sons and daughters over 21 years of age to contribute towards the cost of nursing home care for their parents. A group representing the Department and the health boards-ERHA has been established to ensure that this process is carried out on a uniform basis. This will be a complex exercise involving difficult issues of traceability and it may take some time to complete. Nevertheless, every effort will be made to make payments as quickly as possible. I should add that the legal advice available to me is that there is no legal liability on the State to make retrospective payments in relation to family circumstances. However, in the interests of fairness to the people concerned, the Minister and I decided on this course of action. It is expected that these payments will cost in the region of £6 million.

My immediate priority is to remedy shortcomings identified in the report which impact on people in nursing homes and their families. The steps which I have outlined to the House in regard to the calculation and making of payments by the health boards will, I hope, reassure Deputies that this matter is being given the highest priority.