Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 22 Apr 2010

Vol. 707 No. 2

Adjournment Debate.

Nursing Home Subventions.

I thank the Acting Chairman who always brings a breath of fresh air to the Chair and is very efficient.

I welcome the opportunity to raise this important issue on the Adjournment debate and I thank the Ceann Comhairle for it.

The fair deal nursing home scheme which came into effect on 27 October 2009 was described by the Minister for Health and Children, Deputy Harney, at the time as a groundbreaking change within the nursing home sector. It was to give peace of mind to people who required nursing home care for the future by providing a single comprehensive scheme covering private, public and voluntary nursing homes. Its aim is to give patients equal access to care and end the two-tier system that had applied.

My constituency office has been inundated with queries from anxious patients and their families about the scheme. I organised a public meeting on the issue in Kilrush recently at which there were more than 150 people. They are concerned and do not know what is happening. My intention was to try to provide some clarity to people as to how the scheme operates and who qualifies for it. I thank the HSE for giving me information and supplying personnel to the meeting.

I draw the Minister's attention to some of the difficulties which have been experienced by families following the introduction of the fair deal, especially the fact that no provision was made for patients who would require short-term stay in nursing homes. Furthermore, since the scheme was introduced last October the HSE received more than 5,200 applications by the end of December. As a result it is taking a considerable number of weeks for these applications to be processed. Some applications take up to five months. Although there is a provision for financial support to be backdated to the date of admission of the person into a nursing home the reality is that in the meantime patients and their families are coming under enormous pressure and suffering anxiety regarding paying for the care of their loved ones in a nursing home.

The nursing homes, too, reported to me that like any other business they cannot afford to wait five months for payments. They have operating costs, wages, electricity, etc. Applications for the fair deal scheme for County Clare are being dealt with by the HSE nursing home support section in Limerick. I have heard very positive stories from both families and nursing homes following their interactions with this office. The staff there are doing their best but are overloaded with cases.

I appeal to the Minister of State present, Deputy Seán Haughey, to put extra resources into the office to help it clear the backlog of applications. It is traumatic for any family when an elderly person has to go into a nursing home. If people are to have confidence in the scheme it is essential that applications are dealt with quickly.

I understand the Department of Health and Children has begun work on analysing future funding requirements for long-term care which would include the role of short-term care such as step-down or respite care within nursing homes. I urge the Minister not to allow this backlog situation to continue and I hope the Minister of State will convey this information to Deputy Harney. She must introduce measures to bridge the gap for those people who need short-term stays.

Only this week I met a constituent who was in tears as she told me of her experience. She lives in Dublin; her uncle, who broke his hip some weeks ago, lives in County Clare. He is an old age pensioner living alone so after his hip surgery he had to go into a nursing home where he might have to stay for up to two months. His niece is out of her mind with worry and the bill for his care is already over €5,000. She is out of work but people from the nursing home are on to her every week looking for money. There are similar cases all over County Clare and we can all give such examples.

I met with other families with similar experiences, whose members require nursing home care for convalescence after hospital treatment or short-term nursing home care in emergency cases. The Minister claims the availability of the respite care grant can be used to cover the cost of short-term care in a nursing home. However, the winter initiative now only allows for a person to have one week of free respite care in a nursing home to convalesce. Once the winter passes, there is nothing in any event. One week is completely inadequate.

The scheme should be extended and the number of qualifying weeks increased to bridge the gap that currently exists. This would help to alleviate the worry and stress families are currently enduring. I appeal to the Minister of State this evening to introduce interim measures to handle the anomalies which have arisen since the introduction of the fair deal scheme. A nursing home scheme to address the requirement for short-term stays in nursing homes should be implemented; otherwise, nursing home care for some people and their families will be anything other than a fair deal.

I will reply to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Breen for raising the issue, which provides me with an opportunity to update the House on recent and proposed policy developments in services for older people.

The Government is committed to supporting people in living in dignity and independence in their own homes and communities for as long as possible. Where this is not possible, the health service supports access to quality long-term residential care and we continue to develop and improve health services in all regions of the country and ensure quality and patient safety.

The year 2009 was a time of fundamental change and reform within the nursing home sector. In addition to the new quality standards, care and welfare regulations and a system of independent inspection for all nursing homes, the Minister for Health and Children also introduced a new scheme of financial support for long-term nursing home care, a fair deal. The fair deal scheme was introduced to address the fundamental inequity in the treatment of public and private long-term nursing home residents and to alleviate the financial hardship being experienced by long-term residents in private nursing homes.

Prior to the introduction of the scheme, many people in long-term nursing home care experienced unaffordable care costs over many years. The result was that many people had to sell or remortgage their houses or turn to family and friends in order to find the money to meet their care costs. A fundamental purpose of the new scheme was to offer assurance to one of the most vulnerable groups in society, those in need of long-term nursing home care. Such care was to be affordable and remain affordable for as long as required.

The Government also recognises that many people need short-term care in nursing homes from time to time. The HSE provides significant short-term care, including over 750 designated respite care beds benefiting an estimated 19,000 people. It also provides in excess of 1,000 dedicated rehabilitative, convalescence and assessment beds within its own facilities. In addition, the HSE is currently working to reconfigure services within its facilities to ensure that the best possible use is made of public resources in the provision of both long-term and short-term residential care services.

The Department of Social and Family Affairs provides a respite care grant which may be used to purchase short-term care in private nursing homes. With regard to the extension of the fair deal scheme to short-term care patients, it must be noted that the scheme involves long-term co-payment arrangements between applicants and the HSE, including the possibility of entering into a loan agreement secured by a mortgage. The feasibility of extending these arrangements to short-term patients would have to be carefully considered.

The Government is committed to developing a financially sustainable funding model to support all long-term care services, both in community and residential care services. It is envisaged that this work would also encompass short-term residential care such as respite and convalescence care. This commitment by Government was made in the social partnership agreement, Towards 2016, and preliminary work has commenced within the Department of Health and Children on the analysis of funding models.

Nursing Home Subventions.

I thank the Ceann Comhairle for affording me the opportunity of raising this very important issue. It is somewhat related to the issue raised by Deputy Breen but concerns payments. This scheme was hailed as being great and in theory it could be. However, the reality is that it is not working. Regardless of whether we like it, there are significant issues, and I am only speaking for south Tipperary, where many constituents have come to me about the delay in payment.

These people, some of whom are on very low incomes, are frustrated and may have to borrow money from credit unions or seek supplementary welfare sources in order to keep going. They have to pay for services that should be provided by the HSE. There is a second issue concerning people in hospitals and accident and emergency departments who are being held up as a result of payments not going through. Down the line such people cannot get into nursing homes.

There are significant delays causing desperate concern to those in the system. I spoke to a medic recently who said the fair deal scheme is causing chaos in the health service. The Government must deal with the issues arising from that. Deputies trying to help their constituents have the difficulty of officials in the HSE who are not even prepared to answer our questions. The matter should be examined.

A small portion of the population, some 4%, requires nursing home care and we should look after these people, who made a commitment to society through the years. Some of them are at the end of their days and others are very ill as a result of sickness which may have struck them down. The current position is unfair and having such a non-functioning scheme is a poor response from any government or Minister. We were promised the sun, moon and stars when the scheme was first announced. It was spoken about for many years but although we are assessing people, no payment is being made in many cases. I hope the Minister of State will have something relevant in his response. It is a desperate issue for many people.

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Deputy Hayes for raising the issue.

As they Deputy is aware, the nursing homes support scheme commenced on 27 October and the HSE is now processing applications under the scheme. The scheme is administered, and applications are processed, in accordance with the Nursing Homes Support Scheme Act 2009 and the HSE's guidelines on the standardised implementation of the nursing homes support scheme, which were approved by the Minister for Health and Children. This framework ensures a consistent approach across the HSE in the processing of applications.

The HSE has indicated that the normal timelines for processing applications and making a determination regarding financial support can be expected to vary according to individual circumstances and complexities. It is estimated in cases where the submitted application is fully and correctly completed that a straightforward application for State support should take one to two weeks and a straightforward application for ancillary State support, or the nursing home loan as it is commonly known, should take three to four weeks.

Since the introduction of the scheme, the HSE has had to deal with a large volume of applications from both existing residents and new entrants. However, this should not impact negatively on existing residents due to the safeguards provided within the primary legislation. The legislation provides that applicants to the scheme who were in nursing home care on the date the scheme commenced shall have their State support backdated to that date.

Furthermore, anyone who was in receipt of subvention prior to the commencement of the scheme continues to have his or her subvention paid while his or her application is being processed. Once the application has been determined, the backdated State support will be netted off against the subvention already paid. In practice, this means people will not be paid twice for the same care but will have State support paid from 27 October 2009.

For new entrants to nursing home care, the HSE's guidelines on the standardised implementation of the scheme state that, subject to overall resources, people who enter nursing homes after the commencement of the scheme will have their financial support paid either from the date the application was made or from the date of admission to the nursing home, whichever is the later.

The HSE estimates that it has received more than 9,000 applications and that it has processed approximately half of these to date. In addition, more than 1,000 applications for ancillary State support have been received, of which more than 600 have been completed. I am aware that the processing of a number of applications may have taken longer than the timeframes quoted above. It should be remembered that these estimates of the time taken to process applications apply to straightforward applications that have been completed fully with all the necessary information supplied. It can be expected that more complex applications and those where all the necessary information has not been supplied will take longer to process.

Unfortunately, due to the current industrial action as mentioned by the Deputy, this is the most up-to-date information available to me. I regret that l do not have any more information at present but if the Deputy wishes to raise this matter again once the current industrial action has ceased, I will endeavour to have the matter re-examined at that stage.

Human Rights Issues.

I wish to share time with Deputy Finian McGrath. The Acting Chairman might tell me when I am halfway through the allotted time.

I believe the case of the Miami Five is one of serious injustice and given our experience in Ireland of miscarriages of justice, this case resonates deeply with Irish people. The Miami Five were five Cubans who were sent to try to infiltrate Miami-based terrorist groups to prevent them from carrying out terrorist actions against the people of Cuba. The information they collected built up into a substantial intelligence dossier on the workings of the terrorist groups. The Cuban Government invited the FBI to Havana and presented it with 4,000 pages of documentary evidence on the activities of the groups concerned. While the Cubans felt confident this information would lead to arrests and prosecutions, instead of so doing the FBI arrested the five Cubans. The charges brought against them included travelling on false passports, failing to register as foreign agents, conspiracy to commit espionage and conspiracy to commit crimes against the United States of America.

The trial was deeply flawed and failed to prove these men were guilty of the charges brought against them. The original trial was one of the longest ever held in the United States and the judge acknowledged that members of the jury had been intimidated. Moreover, before the trial, the men were held for 33 months without bail, during 17 of which they were held in solitary confinement. This punishment typically only is used to punish prisoners who are guilty of violent crimes after conviction and prison regulations in the United States generally permit a maximum of 60 days in solitary confinement.

Hundreds of NGOs from all around the world, including international human rights organisations, lawyers' groups, parliamentarians, trade unions and academics have called for an appeal of this case. However, the United States Supreme Court has declined such calls and has refused to provide a reason for its decision. Deputy Finian McGrath will agree with my call on the Government to address this miscarriage of justice at the highest diplomatic level and for the Minister for Foreign Affairs to raise the matter at European Council level.

I thank the Acting Chairman for the opportunity to again raise the case of the Miami Five and the huge injustice perpetrated against the Cuban people. I also thank Deputy Chris Andrews for sharing his time on this urgent matter. I today call on the Government and the Minister for Foreign Affairs to support the families of the Miami Five. I also dedicate this speech to the memory of the 3,748 and 2,099 Cubans killed and maimed, respectively, at the hands of US-based terrorists since 1959. This is not a figure one will hear in the so-called free Western world. This is a story of grave injustice against the Cuban people that has been ignored by the international media and our own so-called free press. I now call for action and an end to this injustice.

I visited Cuba, met the families of the Miami Five and told them I would raise their case on my return. In Cuba, there are posters and pictures of the Miami Five everywhere. They have the same respect and support as did our own Birmingham Six and Guildford Four and hence my support today. For the past 12 years, the five Cubans, namely, Gerardo Hernández, Ramón Labañino, Fernando González, Antonio Guerrero and René González, have been serving long and unjust sentences in American prisons for the sole crime of defending Cuba from the actions of terrorist groups based in the United States. Their legal process has been ongoing for ten years without justice having been served, despite the recognition by both the Atlanta 11th Appeals Court and the Miami court that tried them that none of them has harmed the national security of the United States. During these years, they have endured many legal and human rights violations, including solitary confinement on various occasions without justified cause. In addition, they have experienced delays in authorising visas for their families, with the result that in most cases, they have been allowed an average of only one visit per year. I also note the systematic denial of visas by the Government of the United States to Olga Salanueva and Adriana Pérez, the wives of Gerardo Hernández and René González, respectively.

After 12 years in prison, it is time for the Obama Administration to feel the full weight of international demands and puts an end to this injustice and the suffering of these five men and their families. The international relations commission of the Cuban parliament has called on all parliamentarians of the world "to build another space for proposals on concrete actions directed at the United States government and Congress, to demand that their president releases these five Cuban anti-terrorists and grants visas to [their families]", to put an end to what Amnesty International has described as unnecessary punishment that goes beyond the norm for humane treatment of prisoners and the obligation of countries to respect family life. Finally, I call for action and support for the Miami Five to ensure their release as their only crime was to defend their country against evil people.

I thank Deputy Chris Andrews for raising this matter and both Deputies for their contributions. I am taking this Adjournment debate on behalf of the Minister for Foreign Affairs, Deputy Martin.

The case to which the Deputies referred relates to five Cuban citizens, namely, Gerardo Hernández, Antonio Guerrero, Ramón Labañino, Fernando González, and René González, known as the Miami Five. They were arrested in September 1998 following a two-year FBI surveillance operation in the state of Florida. The five did not deny that they were working for the Cuban Government and stated that they had infiltrated and monitored the actions of anti-Cuban Government groups in Miami to prevent those groups from committing crimes of terror.

The five men were convicted in Miami in 2001 on charges ranging from espionage to first degree murder. The appeal against their convictions was heard in March 2004 in the 11th Circuit Court of Appeals in Atlanta, Georgia. The basis of the appeal was that given alleged pressure exerted on jurors from the Cuban-American community in Miami, the trial venue did not allow the accused to enjoy their right to an impartial and fair trial. On 9 August 2005, the court found in their favour and ordered a new trial. Following this ruling, the Miami District Attorney duly filed an appeal. Subsequent to an appellate hearing on 14 February 2006, a ten to two decision to uphold the 2001 convictions was issued on 9 August 2006.

On 4 June 2008, the 11th Circuit Court of Appeals in Atlanta, Georgia, issued its judgment on appeals lodged on behalf of the five. The court concluded that the appellants' arguments, which centred on the suppression of evidence, sovereign immunity, discovery, jury selection and the trial itself, were without merit and that there was sufficient evidence to support each conviction. The sentences of two of the defendants were affirmed, while the remaining three men were sent for re-sentencing and were given slightly reduced sentences.

The defendants' legal counsel lodged a petition with the US Supreme Court on 30 January 2009 requesting that it review their convictions on the basis that the five did not receive a fair trial because of strong anti-Castro sentiment in Miami. On 16 June 2009, the Supreme Court refused this request and upheld the convictions. The Minister for Foreign Affairs has told the House, most recently on 3 December, that the Government has no standing in this matter, which is a bilateral consular question between the US and Cuban authorities.

With regard to the question of family visits, visas have been issued to a number of family members in past years but have not been granted to the wives of two of the convicted men on the stated grounds of US national security. I am not in a position to assess the justification for this decision.

The Minister for Foreign Affairs discussed this matter with the then Foreign Minister Perez Roque during his visit to Cuba in February of last year, during which the latter stressed to our Minister, Deputy Martin, the importance the Cuban Government attaches to the release of the five.

These events must be seen against the backdrop of the bilateral relationship between Cuba and the US. While the US embargo on Cuba, first introduced in 1962 and repeatedly condemned by Ireland and the EU, continues to have a considerable impact on the social and economic development of Cuba, there are signs that the US is beginning to respond to calls from the international community for the normalisation of relations between the two countries, as evidenced by a number of steps taken by the US since the inauguration of the Obama Administration. These include the lifting of travel and remittance restrictions and the resumption of migration talks. I hope that these are but the first steps towards the ultimate resumption of friendly relations and a broader normalisation of contacts between the two neighbouring countries.

Ireland, together with its EU partners, is engaged in developing dialogue and co-operation with Cuba on a broad range of areas, these being political, including human rights, economic, social and cultural. Following the visit of the Minister, Deputy Martin, to Cuba last February, the first by an Irish Minister for Foreign Affairs, we are now examining how we might strengthen our bilateral relationship with Cuba. Work is being taken forward with the Cuban authorities on that basis. Moreover, at the most recent EU foreign affairs Council discussion on Cuba in June 2009, foreign Ministers reaffirmed the Council's determination to pursue a result-oriented comprehensive dialogue with the Cuban authorities as well as with representatives of civil society and the peaceful pro-democracy opposition.

School Staffing.

I thank the Minister of State for attending this debate. I am disappointed that the Tánaiste is not present, but I hope the Minister of State will convey to her my views on this important issue. If the Government is serious about tackling educational disadvantage, it will re-examine its recent decision.

At issue is the supply of substitute teachers who provide cover in the event of classroom teachers being absent for one reason or another. On any one day in the primary school system, there is a demand for up to 800 qualified substitute teachers. Often, there is considerable difficulty in getting them, especially at short notice or in disadvantaged areas. This has been a live issue for some time and it is incredible that we are the only OECD country that does not have a proper national supply teacher system. In the absence of a system we have had a pilot scheme for a number of years that mainly covers disadvantaged areas. This supply teacher panel comprises some 60 teachers. The scheme has been working satisfactorily until now, but the Government inexplicably and indefensible took a decision recently to abolish the panel with effect from next September. This will have a significant negative impact on many schoolchildren, particularly in disadvantaged areas. I ask the Minister of State to reconsider the decision and to discuss the matter with the senior Minister in his Department.

No money can be saved by scrapping the panel unless the Government is planning to use untrained substitutes on an unqualified rate of pay, but even that would only be in the short term. The scheme was reviewed a number of years ago, a report of which came out in July 2006 and to which I will refer in one minute. Overall, the review of the operation of the pilot scheme was favourable.

Most of the panels are in disadvantaged communities where it has proven difficult to find trained substitute teachers. The advantage of a panel is the provision of a consistent service in a prompt manner so as that the children in those classes do not lose a half day, a day or even a few days in the event of difficulty finding a substitute. Someone is available to come in at 9 a.m. to take over from the absent teacher.

There is no doubt that this system has provided fully qualified and vetted teachers. The situation in certain schools is indefensible, namely, that many of the untrained people brought in are not vetted. There are associated risks. A strong advantage of an existing panel is the vetting of the teachers involved, which means there are no worries in that regard. Where a panel operates, a regular number of teachers are known to the schools and pupils, which helps the situation. If the panels are cut, principals' workloads will increase significantly.

The review to which I referred, the Talbot value for money report published in 2006, was positive about the pilot scheme. It sought to balance the economic issues with educational and policy issues. According to it, simple discontinuance of the panel would not be a satisfactory option, as it would lower substitution costs in the short term without doing anything to address the issues around the quality of casual substitute teaching, the difficulties in disadvantaged areas or the potential risks in casual substitution, such as temporary teachers not being vetted. It is somewhat disingenuous of the Minister in her replies to parliamentary questions to use this review as some kind of justification for the cost cutting measure — seeking to abolish the panels — in which she has engaged.

There is no question but that the pilot has been a success. I have been contacted by teachers in my constituency, specifically the Ballymun area, but it also applies in the Finglas area. There are three parishes in Ballymun where, unfortunately, every school meets the criteria for being classed as seriously disadvantaged. A panel consisting of five teachers has been operating in the area for a number of years. This means that classes in Ballymun are rarely, if ever, without a qualified teacher, which makes a considerable difference to the children's respect for the schools and to reaching their educational potential. It provides consistency and quality of teaching, which is important.

Deputy Shortall has gone well over time.

This is a matter of cutting costs. It is a retrograde step, short-sighted and a false economy. I strongly appeal to the Minister of State to ask the Minister to revisit this decision.

I am replying to this matter on behalf of my colleague, the Tánaiste and Minister for Education and Science, Deputy Mary Coughlan. I thank the Deputy for raising it and I will be glad to outline the general position regarding the supply teacher scheme at primary level.

The scheme was initially set up at primary level over 15 years ago when schools had difficulty obtaining the services of substitute teachers. It operates on the basis of an additional full-time teacher being allocated to a school to cover certified sick leave absences in that school and a cluster of neighbouring schools. If the teacher is not required in a school on a given day to cover sick leave absences, he or she generally assists with other work such as administrative duties. There are 60 posts allocated under the scheme. A value for money review was published in July 2006 and this found that approximately 60% of these teachers' time was used to cover sick leave absences, with the balance used in respect of various other school duties. This reflects the unpredictable nature of sick leave absences.

While there are benefits for schools in having these full-time teachers available to them, it is considered more cost-effective to use the normal substitution arrangements that apply to all other schools to cover sick leave absences instead of having a cohort of full-time teachers on call——

What is the basis of that claim?

——at all times in these schools in order to cover sick leave absences which may or may not arise.

The supply teacher scheme will cease from the start of the 2010-2011 school year. It is expected that this will save €400,000 in 2010 and €1.1 million in a full year. The teachers concerned will be redeployed in accordance with the existing redeployment arrangements to other schools that have vacancies.

It is recognised that the majority of schools in Ireland may include among their pupils children from disadvantaged backgrounds. In general, most schools are equipped to support the individual needs of such children without recourse to supplementary targeted resources. Evidence shows, however, that when disadvantage levels are found in significant concentrations, schools will require additional supports to supplement their efforts to address the educational needs of all their pupils.

Delivering equality of opportunity in schools, DEIS, is the Department of Education and Science's action plan for educational inclusion. It provides for a standardised system in identifying levels of disadvantage and for an integrated school support programme. The process of identifying schools for participation in DEIS was managed by the Educational Research Centre on behalf of the Department and was supported by quality assurance work co-ordinated through the Department's regional offices and the inspectorate. There are currently 881 schools in DEIS. These comprise 679 primary schools, which include 200 urban band 1 schools, 145 urban band 2 schools and 334 rural schools, and 202 second level schools.

The main focus of social inclusion measures continues to be to retain resources in DEIS schools. There is a need to focus targeted resources on the schools in most need and this approach is in line with the broad thrust of the recommendations of the Comptroller and Auditor General, which are set out in his report of 2006 on primary disadvantage. The basis of those recommendations is that the Department should focus its educational disadvantage measures on those schools serving the most disadvantaged communities.

I again thank the Deputy for raising this matter.

Discontinuing the supply teacher scheme will affect the most disadvantaged schools.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 27 April 2010.