Nursing Homes Support Scheme Bill 2008: Report Stage.

I draw the attention of Members to some printing errors in the amendment list. Amendment No. 2 should have a footnote indicating that it is referring to the subsection being inserted by amendment No. 99. Amendment No. 49 should begin, "Any decision under subsection (4).....,“ not “Any decision under subsection (2).....”. Amendment No. 63 should propose to delete lines 32 to 41 and not 32 to 43. The footnotes to amendments Nos. 101 and 102 should read, “This is the correct reference if amendment No. 99 is accepted” and not “amendment No. 100”.

Amendment No. 1 requires recommital because it does not arise out of Committee proceedings. Amendments Nos. 45, 46 and 83 are related so amendments Nos. 1, 45, 46 and 83 may be discussed together.

Bill recommitted in respect of amendment No. 1

I move amendment No. 1:

In page 6, between lines 49 and 50, to insert the following:

""authorised person" has the same meaning as it has in section 17;”.

The collective purpose of these amendments is to provide for the possibility of electronic registration and discharge of charging orders under the nursing homes support scheme. This is consistent with the current e-conveyancing programme being pursued by the Property Registration Authority. The amendments enable the electronic creation and registration of charging orders by authorised persons within the HSE and the electronic discharge of charging orders by authorised persons within the HSE following repayment of ancillary State support. They also provide for the prescription by regulation of simple forms of charging order and discharge application for the purposes of the nursing homes support scheme.

The benefit of the amendments is significant in terms of ensuring a speedy, standardised and extremely cost-effective approach to processing charging orders. This is important in terms of enhancing public sector efficiency but also in terms of ensuring that families are not unduly delayed in selling or transferring property.

A final important point is that the amendments are enabling rather than restrictive in nature. As such, charging orders and applications for the discharge of charging orders can also continue to be processed under the existing paper based system. I ask Deputies to support these beneficial amendments.

I ask the Minister of State for some clarity. In regard to amendment No. 45, is the board of the executive the board of the HSE?

In regard to amendment No. 46, is it correct that the HSE will notify the Property Registration Authority?

In regard to amendment No. 45, which refers to transmitting orders by electronic means to the Property Registration Authority in accordance with subsection (13), can we include "and other means" in case there is a systems or an electronic failure?

It is not necessary because we have said they can be processed under the existing paper-based system.

Where is that?

I have just given Deputy Reilly that information. It says "may" and not "shall".

Why is this being included in the Bill by way of recommital? Why was it not included in the first place? I have no problem with it. We should use electronic means and find the best way to process and pass on information.

The reason is the Property Registration Authority, which is referred to as "the authority", commenced this electronic discharge of mortgages after 30 March last after Committee Stage. We saw this project as providing a new on-line system enabling the lending institutions to request the cancellation of registered charges by electronic means without the need to submit any paper to the authority. There are benefits to the new system. It only commenced this electronic discharge of mortgages after Committee Stage.

Amendment agreed to.
Bill reported with amendment.

Amendment No. 2 arises out of Committee proceedings. Amendments Nos. 99 to 103, inclusive, are related to amendment No. 2. Amendments Nos. 2 and 99 to 103, inclusive, may be discussed together.

I move amendment No. 2:

In page 8, line 14, to delete "shall specify" and substitute "shall, subject to section 33(2), specify”.

Amendments Nos. 2 and 99 to 102, inclusive, collectively address an issue raised by my colleague, Deputy Reilly, on Committee Stage. The Deputy had proposed that the basis for charges for public nursing home care should be laid before the Houses of Oireachtas. It is my intention that information on the goods and services that make up the public bed price, that is, the cost components, would be openly available to the public. Thus, in the interests of transparency, I am happy to accept the spirit of Deputy Reilly's original proposal.

One will note that the wording differs somewhat from that proposed by Deputy Reilly. The reasons for this alteration are twofold — first, to ensure legal clarity in terms of what exactly the Minister must lay before the Houses and, second, to ensure consistency and correct alignment with the definition of long-term residential care services and other directly related provisions within the Bill. For that reason, I ask my colleagues to support these amendment in place of the amendment No.100 which has been resubmitted by the Deputy.

Amendment No. 103 proposes that the HSE, in determining the cost of care services, shall stipulate the services provided. As explained on Committee Stage, this amendment is unnecessary as the definition of long-term residential care services in section 3 already provides that the HSE must specify the health and personal care services to be provided when designating facilities for the purposes of the scheme. Moreover, this amendment could now conflict with amendment No. 99 which stipulates that the Minister, following consultation with the HSE, shall be ultimately responsible for publishing information on the services provided. For that reason, I do not propose to accept amendment No. 103.

Amendment agreed to.

Amendment No. 3 in the name of Deputy Reilly cannot be moved as it is a charge on the Revenue and is, therefore, out of order. Amendment No. 4 in the name of Deputy Jan O'Sullivan arises out of Committee proceedings. It is related to amendment No. 5 and both may be discussed together.

Amendment No. 3 not moved.

I move amendment No. 4:

In page 11, between lines 25 and 26, to insert the following:

"5.—The scheme provided by this Act shall be subject to the principle that the applicant and where relevant his or her family can choose the nursing home that most suits their needs, and any applicant who is entitled to benefit from the scheme shall be informed of the details of all nursing homes from which to choose care.".

I thank the Minister for taking my point on board. Her amendment No. 5 accepts the idea that there should be choice. What I was trying to achieve in amendment No. 4 was that the applicant and his or her family should have the choice of nursing home that most suits their needs. On Committee Stage, the Minister said she would look at it to see if she would come back with an amendment on Report Stage. While her amendment is not exactly the same as mine, it states that the applicant may select the relevant facility or approved nursing home from a list given. That is a reasonable acceptance of the point I made.

Amendment, by leave, withdrawn.

I move amendment No. 5:

In page 11, after line 45, to insert the following:

"(5) The Scheme established by this Act shall be operated subject to the principles that—

(a) applicants who are determined by the Executive to need care services in accordance with section 7(8) shall be informed of the names and addresses of all relevant facilities and approved nursing homes, and

(b) subject to section 12(3) and subject to the availability of a long-term residential care bed, the applicant may select the relevant facility or approved nursing home in which to receive care services.”.

Amendment agreed to.

Amendment No. 6 in the name of Deputy O'Sullivan arises out of Committee proceedings.

I move amendment No. 6:

In page 11, after line 45, to insert the following:

"(5) It is a function of the Executive to assess the adequacy of resources provided under subsection (4) and to report thereon to the Houses of the Oireachtas.”.

This is an important amendment which I intend to press if the Minister of State is unable to accept it. It states: "It is a function of the Executive to assess the adequacy of resources provided under subsection (4) and to report thereon to the Houses of the Oireachtas.” Basically, a limited amount of money is being set aside for the purposes of this legislation. We have already been told how much is being set aside this year and the scheme is being introduced in September, or at least the autumn. It may be adequate for the remainder of this year but we have no idea how much money will be set aside next year, or in future years.

While I am not allowed to table an amendment that would be a charge on the Exchequer, this amendment is as strong as I can make it. It seeks to impose an obligation on the HSE to inform the Houses of the Oireachtas if there is not adequate funding to pay for people in nursing homes who qualify under the scheme. If there is not enough money, we shall end up at some stage in the year with the money gone and people having an entitlement under the scheme, which is a frightening prospect for elderly people and their families. I alluded on Committee Stage to the types of schemes being implemented by local authorities where a house can be adapted to meet the needs of an elderly or disabled person. We all know from dealing with our respective local authorities that the money runs out. No matter how much a grab rail for a shower or a ramp for a wheelchair is needed or whatever, these services will not be available if the money is gone.

I do not want enshrined in this legislation the principle that somebody in an acute bed qualifies under the provisions of the Bill but there is no place to go because of a lack of funding with the result that the family cannot afford to pay for the nursing home. In all parts of the country long-stay public beds are being closed. Beds for old people in publicly run hospitals are being closed. In my constituency, the Abbey ward in St. Camillus's hospital would have been closed were it not for nurses refusing to co-operate. There are many other cases such as this around the country.

My fear is that we shall see far fewer public beds available and more and more dependence on the private sector, which has been the trend in recent years. If the money runs out there is no way the private sector will care for people if there is not means of payment. Many families have been struggling already with the gap between the subventions as they currently exist — even with the top-up subvention, plus the pension and any moneys families can scrape together — and the actual cost of the nursing homes. The intention in this legislation is to bridge that gap, but it will be resource capped and there is not even a mechanism for the HSE to inform the Oireachtas, which has the power to introduce a supplementary Estimate to provide more money, as required. This is not provided for in the legislation and it is what my amendment is seeking to do. At least then the House could be told if there was a shortage of money and the Government of the day could then introduce some mechanism for providing it.

I hold strong views on this aspect. It is one of the areas of concern to the various representative organisations we have met. There is a weakness in the legislation that has not, perhaps, been as publicly aired as some other aspects. At a time when there is a shortage of public funds — I realise resources are limited — we must have a mechanism whereby if it is found there are not sufficient resources for this scheme in any given year, there must be a mechanism for bringing this to the attention of the Legislature so that something may be done about it.

I support my colleague's amendment. The real danger concerns the assessment of people. What will meet requirements today will not do so tomorrow as the money runs out and the threshold for high dependency will rise, unless it is strictly laid down — which is something we shall address later — and there is independent assessment.

I, too, support Deputy Jan O'Sullivan's amendment. It focuses on one of the real deficiencies in relation to the whole approach behind this Bill. There is no commitment to ensure adequate provision for people who will need nursing home care at some stage in their lives. God forbid, it could be for any of us in this Chamber this evening.

I am deeply alarmed by one of the major purposes of the legislation, namely, to remove the entitlement to a public bed in a public nursing home free of charge. That has been a right heretofore but the Bill seeks to remove that entitlement. There has been a universal right, albeit against a shortage of bed provision has, to that entitlement. To put it in simple terms, if any of us was to have a cardiac arrest we are entitled under current legislation to have access to a free public bed in a public hospital to get the care required. However, if one of us was to have a stroke and required longer term nursing care support the person concerned would no longer have the same entitlement and right as a citizen as had been enjoyed up to now.

This will have very serious consequences for people in the future. Given the bent of this Government and this Minister — and I do not divorce one from the other although the Government would like to hid behind the current Minister — this is the position that has been repeatedly endorsed by the Taoiseach. Their whole bent is towards the privatisation of health care need and provision, something I strongly oppose. In a time of ever straitening economic circumstances it is another of those areas along with the litany of others involving people in greatest need, who will suffer first and most from the Government's approach.

It is very important to have the necessary assessment regarding provision of resources and accountability should be made directly to the Houses of the Oireachtas. This is something that needs to be affirmed and I hope the Minister of State will accept the amendment on behalf of the Minister and the Government. Given the make-up of this Government and the Department's stewardship there is little hope otherwise for people having their real concerns and needs aired honestly in the future.

I agree with the sentiments expressed regarding Deputy O'Sullivan's amendment. This question arose on Committee Stage. I should like the Minister of State to reflect carefully on this because it is very important. As has been pointed out, we all know we are in very tight financial circumstances, which are likely to prevail in Ireland for a number of years. The problem arises in terms of the time it takes legislation to be interpreted once it is passed. There are several classifications of people outside the assessment eligibility for this scheme, and I want to put this on the record, as I did on Committee Stage.

In rural areas, there are a number of people who live on their own, who suffer from great loneliness and who have a certain type of mental health problem. The latter is not too severe and these individuals are just about able to care for themselves. However, they do not have anyone to look after them. I am of the view that by the time the legislation is enacted, they will not meet the assessment criteria. In such circumstances, what will they do? According to the Government, the playing field is supposed to be level but there is no place to which these people can go.

I made the case in respect of this matter quite strongly on Committee Stage and I am very disappointed that the Minister for Health and Children and the Government have not seen fit to ensure that the people to whom I refer will be catered for in the legislation. Will the Minister of State indicate who these individuals will be assisted in their old age when they will have no one else to care for them?

The allocation and adequacy of resources is ultimately a matter for the Minister for Health and Children, Deputy Harney, and the Government. Notwithstanding that, the Minister is satisfied that sufficient provision has been made to ensure that the resources allocated under the scheme, and their adequacy, are constantly monitored.

Under section 31 of the Health Act 2004, the HSE must prepare and submit a service plan and the Minister will stipulate that this plan must indicate the numbers of people provided with support under the scheme. In addition, the HSE must also include in its annual report any information which may be specified by the Minister for Health and Children under section 37 of the 2004 Act. For the purposes of the scheme, a dedicated subhead, B16, has been established within Vote 40. This subhead will be subject to careful monitoring and my Department has already agreed a set of reporting requirements in this regard.

On the care needs, we do not accept that the benchmark for dependency will be moved upwards, particularly because it will be subject to a multidisciplinary panel of professionals and their codes of ethics. This will equalise access for both public and private patients because, as must be acknowledged, the majority of provision in nursing homes is in the private sector. By law, the care needs assessment, which is holistic in nature, must take family, social and community circumstances into account.

I am not reassured by the Minister of State's remarks. She indicated that the HSE will monitor whether adequate funding will be available. At present, however, the HSE is presiding over the closure of wards in Our Lady's Hospital for Sick Children in Crumlin and other hospitals throughout the country and cutbacks that are affecting patients everywhere. I do not have any confidence that the HSE is suddenly going to provide adequate funding for the scheme under discussion.

On Committee Stage, the Minister for Health and Children, Deputy Harney, stated that the scheme is based on eligibility rather than entitlement. In other words, one can be eligible but not entitled. While one might be eligible, if there is no money one will not be catered for. As a result, one could be stuck in an acute bed with nowhere else to go.

As Deputy Ó Caoláin pointed out — this matter was also referred to by Deputy Bruton at an earlier stage — the Ombudsman differed with the Minister of the day in respect of the entitlement of elderly people to be provided with long-stay care as a matter of right under the Health Act 1970. The Bill removes that right. We fundamentally object to this development. In the absence of their having a right, we must ensure that adequate funding is provided in respect of people who require care. I feel strongly about the amendment and I intend to press it to a vote.

If I heard her correctly, the Minister of State indicated that adequate resources would be available to the HSE in order to allow it to monitor the position. That would not surprise me. Like Deputy Jan O'Sullivan, I have no faith in the HSE ensuring that adequate services are provided. In addition, I have no faith in the Minister for Health and Children who, as was the case with cervical vaccinations, cystic fibrosis facilities, etc., gives and takes away at the same time.

I do not accept the Minister of State's contention that a multidisciplinary team will act as a guard against standards changing. There has been much experience of this in the UK. In that jurisdiction, if a health authority has facilities relating to, for example, autism, there will be a much higher diagnostic incidence of autism. Among health authorities which lack such facilities, the incidence drops considerably. This is due to the fact that if a child is diagnosed with autism, he or she must be facilitated by a neighbouring health authority. In addition, his or her care must be paid for by his or her local health authority.

Unless, as the amendment suggests, an assessment process that will be independent of the HSE is put in place, there will not be a safeguard in place in respect of patients. As a result, I oppose the relevant provision in the Bill.

Will the Minister of State indicate the extent of the consultation that has taken place with the various representative bodies which work, campaign and lobby on behalf of senior citizens since the Second Stage debate took place? We noted on Second Stage and Committee Stage that consultation involving groups such as Age Action did not take place during the drafting process relating to the legislation. These groups strongly protested about the fact that they were left outside the door with regard to the compilation of the proposals contained in the Bill. Will the Minister of State indicate the extent of any engagement that has taken place since Second Stage? Was the extent of the concern that exists among the current cadre of senior citizens impressed upon the Minister or Ministers of State at the Department of Health and Children? In the future, and if God spares us, those of us present in the Chamber will be members of that cadre.

This is an extremely important matter. The Government is pressing ahead with legislation which is not favoured by those who have the first and direct responsibility of voicing the concerns of the aged. As stated earlier, a serious precedent is being set in the context of a section of society, the members of which will not have access, by right or entitlement, to an essential element of public health care provision, being carved off. The Government is saying that people of senior years who, for a variety of reasons, may have need of nursing home care will no longer have an entitlement to universal access to free public health care provision.

What will happen when this legislation is enacted? Will the Government carve off a further section of society, the members of which have specific problems relating to their age or the ailment or disease from which they suffer? Who is next?

The longer this debate goes on, the more worried I become with regard to what will happen to the elderly in the future. In light of the Minister of State's remarks, I am of the view that huge waiting lists will be created and that there will be a competition among the elderly to qualify for the scheme. The Minister of State provided a guarantee that the HSE will have adequate funding. It is only two or three weeks ago the winter initiative respite service for the western region was discontinued. The official line from HSE West is that only people who do not have relatives to take care of them can avail of a two-week stay at a nursing home or step-down facility when they leave hospital. If the HSE is given the same power to cut budgets under this legislation, what will be the impact on the elderly? That aspect of the matter has not been highlighted to any great degree prior to now. The gloss is going off this scheme as every minute passes in the Chamber.

Regarding the monitoring of resources, the allocation and adequacy of resources is a matter for the Minister and will be monitored by the Department. The HSE must prepare and submit the service plan and give all relevant information to the Department. Monitoring is done by the Minister and the Department on a dedicated subhead against a monthly profile and return.

Regarding Deputy Ó Caoláin's point, departmental officials met with anyone who requested a meeting after the debate on Second Stage. This included the Senior Citizens Parliament, Age Action Ireland and the IFA. Departmental officials also met with the social partners after the publication of the Bill in October 2008 and on the announcement of the scheme in December 2006.

Will the Minister indicate the extent of heeding of the submissions by the Department?

I am sure the Department listened very carefully to what was said.

There were many things of which it took no heed.

As nothing the Minister of State said has convinced me otherwise, I will press the amendment. To be told that the HSE will propose a service plan and the Minister will monitor funding gives us no security in terms of safeguarding the needs of senior citizens.

It is cold comfort.

We know the history of the HSE and the Minister, particularly in the past year, in terms of providing adequate funding for a variety of areas. I referred to the Our Lady's Hospital for Sick Children in Crumlin and other cuts. The HSE is largely responsible for this although the Department of Health and Children and the Department of Finance, which has a major role in deciding what money will be spent in health, are standing idly by while wards are being closed and waiting lists grow longer. There are more people on trolleys in accident and emergency units now than when the Minister said it was a national emergency.

Regarding the Minister standing over the rights of elderly people, she decided she could not introduce the HPV vaccine for young girls in order to protect them from a deadly disease. I do not have confidence in the Minister or the HSE to ensure that there is adequate funding for this scheme. The entitlement under the 1970 Act, which the Ombudsman referred to as an absolute entitlement although the then Minister, Deputy Micheál Martin, disagreed with the Ombudsman, has been taken away. It is up to legislators to do what we can and, as members of the Opposition, all we can do is press amendments to ensure that this legislation safeguards the needs of our elderly people so that they do not end up being told, halfway through the year, that they are entitled to a long-stay bed under the support scheme but that the HSE has no money to allow them to take up the entitlement. It is intolerable and I cannot stand over this proposal.

Amendment put.
The Dáil divided: Tá, 37; Níl, 75.

  • Bannon, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burke, Ulick.
  • Burton, Joan.
  • Byrne, Catherine.
  • Carey, Joe.
  • Connaughton, Paul.
  • Creed, Michael.
  • D’Arcy, Michael.
  • Enright, Olwyn.
  • Gilmore, Eamon.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Lynch, Ciarán.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McGrath, Finian.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Mahony, John.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Reilly, James.
  • Sherlock, Seán.
  • Stagg, Emmet.
  • Stanton, David.
  • Tuffy, Joanna.
  • Upton, Mary.


  • Ahern, Dermot.
  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Johnny.
  • Browne, John.
  • Calleary, Dara.
  • Carey, Pat.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gogarty, Paul.
  • Gormley, John.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Kitt, Tom.
  • McDaid, James.
  • McEllistrim, Thomas.
  • McGrath, Mattie.
  • McGrath, Michael.
  • Mansergh, Martin.
  • Martin, Micheál.
  • Moloney, John.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Brien, Darragh.
  • O’Connor, Charlie.
  • O’Dea, Willie.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Keeffe, Batt.
  • O’Rourke, Mary.
  • O’Sullivan, Christy.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Ryan, Eamon.
  • Sargent, Trevor.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.
Tellers: Tá, Deputies Emmet Stagg and David Stanton; Níl, Deputies Pat Carey and John Cregan.
Amendment declared lost.

Amendment No. 7 arises from Committee proceedings and amendments Nos. 8 and 26 are related. Therefore, the amendments may be discussed together by agreement.

I move amendment No. 7:

In page 12, line 34, after "possible" to insert "and in any event within two months".

Two of these amendments are in my name, Nos. 7 and 26. The purpose of No. 7 is to have a deadline for the carrying out of care needs assessments. In other words there should not be an expansion of the time allowed for care needs assessment, as it is important that these be done as quickly as possible while giving a reasonable amount of time to them. I have suggested a timeframe of two months. Amendment No. 26 gives a timeframe for the preparation of reports.

My amendment is of a similar ilk but seeks to make the timeframe even shorter at six weeks, which is reasonable. I would be happy if the Minister of State agreed to leave it at two months.

I support the principle of setting a specified period within which the assessment must be carried out. The way the Bill is currently drafted leaves the matter very open-ended. The proposition "at the earliest time possible" or words to that effect is not good enough. The timeframe should be six or eight weeks but I would prefer it to be shorter having had experience of representing many cases over the years. That is what is needed. I ask the Minister of State to accept this principle and insert it into the legislation.

Amendments Nos. 7 and 8 propose to impose a timeframe for the commencement of care needs assessments. I appreciate the policy intention of these amendments. It is envisaged that care needs assessments would be undertaken quickly. However, it is considered imperative the legislation should be flexible on this point. This is particularly pertinent having regard for the fact that the legislation will establish a scheme that will have to accommodate the needs of a rapidly growing demographic.

In drafting the Bill, careful consideration was given to the Disability Act 2005 which provides that assessments must be commenced within three months of the date of application. Assessments of need require a considerable level of resources, particularly dedicated input by health care professionals. As such the stipulation of the timeframe for commencing assessments within the Disability Act has necessitated that a phased approach be taken to the roll-out of needs assessments. However, even with a phased approach the HSE service plan 2009 reports that only 79% of assessments commenced within the timeframe.

Given the variable length and potentially time and resource consuming nature of the assessment, the rapidly growing demographic to which it relates and the experience gleaned from the roll-out of assessments under the Disability Act, it would be unwise to immediately implement a statutory timeframe in respect of care needs assessment.

For these reasons, I will not accept these amendments. I will, however, offer the Deputies a commitment that the issue will be addressed by way of published guidelines, approved by the Minister. Furthermore, the issue will be tabled for consideration in the review of the scheme which will take place three years after its introduction.

I am disappointed by the Minister of State's reply. On Committee Stage, the Minister said she was minded to accept the amendment and would like to reflect on it before Report Stage. Today's reply is less positive in providing a timeframe for assessments. I accept the Minister has said there will be guidelines and it will be revisited at a later stage.

While we want this to be done properly, there is a certain urgency to it. For example, a timeframe exists for a person in an acute bed but who after 20 days is deemed not to be an acute patient any longer. However, there is none for carrying out an assessment.

The Minister of State has said the matter will be revisited. I am not minded, therefore, to call Members back into the House for a division on this amendment. There will also be an opportunity for our spokespersons to table amendments when the Bill goes to the Seanad where I hope there will be a more positive response to this matter.

I do not accept the Minister of State's response. This is what is at the core of all that is wrong with our health service. It is a health system that seeks to serve itself, setting limits to protect itself but not patients. Those who will be adjudged to be no longer in an acute bed will attract charges while the HSE is protected by the legislation.

Someone seeking access, or having access sought on their behalf by family or friends, to an assessment is not looking for a holiday break. This is a serious need. The whole process of assessment needs to be done in the quickest time possible. If people are in inappropriate bed accommodation in one of our acute hospital facilities, surely it gives the State all the more reason to progress the assessment in order to accommodate the person in a more appropriate setting such as a nursing home. It is imperative that those entrusted with assessment know exactly the timeframe in which they must report. There can be no drift in such an important matter.

The Minister for Health and Children reflected carefully on the points raised by Deputy Jan O'Sullivan on Committee Stage. She is not in a position, as I outlined in my earlier reply, to accept the amendment. She will, however, provide the Deputy with the guidelines and they will be reviewed after three years of their introduction. An amendment will be introduced later which will clarify that a person in an acute bed cannot be charged for it while waiting for a care needs assessment.

That is a welcome development and I am glad there has been a response. On that basis I will withdraw my amendment.

I will not push my amendment No. 8 on that basis too.

Amendment, by leave, withdrawn.
Amendment No. 8 not moved.

Amendments Nos. 25, 84, 85 and 110 are related to amendment No. 9 and all may be discussed together by agreement.

I move amendment No. 9:

In page 12, lines 38 to 41, to delete all words from and including "person" in line 38 down to and including "assessment." in line 41 and substitute the following:

"representative of the Health Information and Quality Authority.".

Earlier I alluded to the need for independent assessments. There is a precedent for people not being diagnosed appropriately. Sometimes diagnosis can be an art and one doctor may have a slightly different opinion to another, even if there are guidelines in place. While I do not wish to show any disrespect to or disregard for my colleagues, there is a conflict of interest if the assessment team is in the employ of the HSE which is responsible for funding the service. There is a need for an independent body to supply the medical and social work expertise in the assessments. Will the Minister make a concession on this amendment to ensure people will be assessed in a fair fashion without any bias motivated by the lack of funds in the HSE?

The independence of the assessment is important and I support Deputy Reilly's amendment.

I record my support for Deputy Reilly's arguments.

Will there be an independent appeals mechanism for an applicant who feels they may have been wrongly turned down in an assessment?

Debate adjourned.